Objective To investigate the expression of HOXB4 gene in patients with myelodysplastic syn-dromes(MDS)and its clinical significance in disease progression.Methods mRNA expression of HOXB4 gene in bone marrow mononuclear cells was detected by real-time fluorescence quantitative PCR(RT-qPCR),and the difference in HOXB4 expression was compared between 49 patients with MDS(MDS group)and 35 patients without MDS(group C).The relationship of mRNA expression of HOXB4 with disease characteristics and clinical prognosis was explored in MDS patients.Results mRNA expression level of HOXB4 gene was higher in MDS group than that in group C(P＜0.05).The patients were divided into a high-and a low-expression group according to the median expression level of HOXB4.Leukocyte count was lower in the high-expression group in the low-expression group at the time of initial diagnosis.The proportion of patients with subtypes of primitive cellular hyperplasia,poor prognostic staging and leukemic transformation was higher in the high-expression group than in the low-expression group.Conclusions mRNA expression level of HOXB4 gene has certain relation with AML transformation in MDS patients.

Pelvic floor dysfunction(PFD)is a common clinical problem that can lead to bladder and bowel dysfunction such as urinary incontinence,urinary retention,fecal incontinence,pelvic organ prolapse,and sexual dysfunction.Pelvic floor rehabilitation aids are essential tools in the treatment of PFD.However,there is limited understanding of the efficacy and mechanisms of these aids,and there is a lack of standardized guidelines for selecting appropriate aids for different types of PFD.To assist patients in choosing suitable pelvic floor rehabilitation aids to their needs,it is necessary to summarize the existing types,mechanisms,and applications of these aids.Based on their mechanisms and target functions,pelvic floor rehabilitation aids can be mainly categorized into 3 main types.The first type includes aids that improve pelvic floor function,such as vaginal dumbbells,vaginal tampons,and vaginal dilators,which aim to strengthen pelvic floor muscles and enhance the contractility of the urethral,vaginal,and anal sphincters,thereby improving incontinence symptoms.The second type consists of aids that mechanically block the outlet,such as pessaries,urethral plugs,incontinence pads,incontinence pants,anal plugs,and vaginal bowel control systems,which directly or indirectly prevent incontinence leakage.The third type includes aids that assist in outlet drainage,such as catheters and anal excreta collection devices,which help patients effectively expel urine,feces,and other waste materials,preventing incontinence leakage.By summarizing the existing pelvic floor rehabilitation aids,personalized guidance can be provided to patients with PFD,helping them select the appropriate aids for their rehabilitation needs.

Objective:To retrieve, screen, and summarize the best evidence for non-pharmacological management of Parkinson's disease patients with depression, so as to provide evidence-based basis for medical and nursing staff to standardize the non-pharmacological management.Methods:Following the "6S" evidence model, relevant literature was systematically searched from top to bottom in UpToDate, British Medical Journal, Joanna Briggs Institute Evidence-Based Health Care Center Database, National Institute for Health and Clinical Excellence, Guidelines International Network, Agency for Healthcare Research and Quality, Scottish Intercollegiate Guidelines Network, Medlive, Parkinson's Society of Canada, Cochrane Library, CINAHL, PubMed, Web of Science, Embase, China Biology Medicine, China National Knowledge Infrastructure, and WanFang Data. The search period was from database establishment to March 31, 2023. After conducting methodological quality evaluation based on literature standards, evidence was extracted and summarized from literature that met the standards, and the level of each evidence was determined.Results:A total of 22 articles were included, including one clinical decision-making, three guidelines, 14 systematic reviews, and four expert consensuses. A total of 30 best evidence were formed from six aspects, namely screening and evaluation, psychological intervention, physical therapy, traditional Chinese medicine therapy, exercise, and health education.Conclusions:The best evidence for non-pharmacological management of Parkinson's disease patients with depression summarized provides evidence-based basis for the development of non-pharmacological management plans for Parkinson's disease patients with depression.

OBJECTIVES: Restoration of blood circulation within "time window" is the principal treating goal for treating acute ischemic stroke. Previous studies revealed that delayed recanalization might cause serious ischemia/reperfusion injury. However, plenty of evidences showed delayed recanalization improved neurological outcomes in acute ischemic stroke. This study aims to explore the role of delayed recanalization on blood-brain barrier (BBB) in the penumbra (surrounding ischemic core) and neurological outcomes after middle cerebral artery occlusion (MCAO). METHODS: Recanalization was performed on the 3rd day after MCAO. BBB disruption was tested by Western blotting, Evans blue dye, and immunofluorescence staining. Infarct volume and neurological outcomes were evaluated on the 7th day after MCAO. The expression of fibroblast growth factor 21 (FGF21), fibroblast growth factor receptor 1 (FGFR1), phosphatidylinositol-3-kinase (PI3K), and serine/threonine kinase (Akt) in the penumbra were observed by immunofluorescence staining and/or Western blotting. RESULTS: The extraversion of Evans blue, IgG, and albumin increased surrounding ischemic core after MCAO, but significantly decreased after recanalization. The expression of Claudin-5, Occludin, and zona occludens 1 (ZO-1) decreased surrounding ischemic core after MCAO, but significantly increased after recanalization. Infarct volume reduced and neurological outcomes improved following recanalization (on the 7th day after MCAO). The expressions of Claudin-5, Occludin, and ZO-1 decreased surrounding ischemic core following MCAO, which were up-regulated corresponding to the increases of FGF21, p-FGFR1, PI3K, and p-Akt after recanalization. Intra-cerebroventricular injection of FGFR1 inhibitor SU5402 down-regulated the expression of PI3K, p-Akt, Occludin, Claudin-5, and ZO-1 in the penumbra, which weakened the beneficial effects of recanalization on neurological outcomes after MCAO. CONCLUSIONS Delayed recanalization on the 3rd day after MCAO increases endogenous FGF21 in the penumbra and activates FGFR1/PI3K/Akt pathway, which attenuates BBB disruption in the penumbra and improves neurobehavior in MCAO rats.
Animals ; Rats ; Blood-Brain Barrier/metabolism* ; Brain Ischemia ; Claudin-5/metabolism* ; Infarction, Middle Cerebral Artery/metabolism* ; Ischemic Stroke/metabolism* ; Occludin/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; Rats, Sprague-Dawley ; Receptor, Fibroblast Growth Factor, Type 1/metabolism* ; Reperfusion Injury/metabolism*

Total knee arthroplasty， as a common treatment option for advanced knee osteoarthritis， can alleviate the clinical symptoms of patients. Deep vein thrombosis of the lower extremity is the most common complication of total knee arthroplasty. Previous studies have shown that the occurrence of deep vein thrombosis after total knee arthroplasty is mostly related to the overexpression of inflammatory factors in vivo. Nuclear transcription factor-κB， Toll-like receptor 4， phosphatidylinositol 3-kinase/protein kinase B， tumor necrosis factor， and nuclear transcription factor E₂-related factor 2 are typical signaling pathways related to inflammation. Regulating the expression of the signaling pathways can intervene the formation of inflammatory factors. Inhibiting the formation of inflammatory factors can help suppress the activation of platelets， thereby blocking thrombosis. According to previous research， Chinese medicine monomers， Chinese medicine extract， and compound Chinese medicine prescriptions all directly or indirectly inhibit the expression of inflammatory factors by regulating the above signaling pathways， thereby suppressing the occurrence of deep vein thrombosis after total knee arthroplasty. Therefore， Chinese medicine can reduce postoperative complications and promote postoperative recovery of patients at low cost with small side effects. This article summarizes the research on Chinese medicine intervention on deep vein thrombosis-related signaling pathways after total knee arthroplasty， which is expected to lay a basis for the in-depth study and clinical application of Chinese medicine in deep vein thrombosis.

Objective:The efficacy of using a single electrical or magnetic stimulation for treating pelvic floor dysfunction is limited.This study aims to investigate the efficacy of radiofrequency combined with magnetic stimulation treatment for mild to moderate pelvic organ prolapse. Methods:Patients who completed the treatment in the Third Xiangya Hospital,Central South University were screened,and were divided into 2 groups based on different treatment plans.There were 28 patients who completed magnetic stimulation therapy(the magnetic stimulation therapy group)and 21 patients who completed radiofrequency combined with magnetic stimulation therapy(the combined treatment group).The pelvic organ prolapse quantitation(POP-Q),pelvic floor muscle strength,and pelvic floor ultrasound results were analyzed to assess the efficacy before and after the treatment in both groups,and the POP-Q results of 3 months after the treatment were used to evaluate the maintenance effect of the treatment mode. Results:The POP-Q evaluation results of Aa,Ap,and C points after the treatment in both groups were better than those before the treatment,with statistical significance(all P＜0.05).The Aa point POP-Q result of the combined treatment group was better than that of the magnetic stimulation therapy group,with statistical significance(P＜0.05).Pelvic floor ultrasound evaluation showed that the bladder neck position during the valsalva maneuver in the combined treatment group was higher than that in the magnetic stimulation treatment group,with statistical significance(P＜0.05).The persistence effect of the combined treatment group was long better than that of the magnetic stimulation treatment group,with significant statistical significance(P＜0.01). Conclusion:The combined treatment is more effective and has a longer lasting effect than single magnetic stimulation treatment.

Objective:To evaluate the efficacy and safety of a novel domestic pulmonary thromoboectomy system Tendvia TM in the treatment for high-risk patients complicated with acute pulmonary embolization (APE). Methods:The study was designed as a prospective single-center clinical trial. Twenty-four high-risk patients with APE were recruited and underwent percutaneous mechanical thromoectomy (PMT) with the Tendvia TM pulmonary thromoboectomy system. The primary efficacy endpoint was the reduction of RV/LV ratio at the post-operative 48 h. The secondary efficacy endpoints included technical success rate, mean pulmonary arterial pressure (mPAP), arterial PaO 2 and the instant post-operative thrombus clearance rate. The evaluation of the safety included the intraoperative complications and related complications during the follow-up period associated with the PMT operation and the major adverse event (MAE) rate within the post-operative 48 h. The pre-and post-operative data were compared with paired sample t-test or Wilcoxon rank sum test to evaluate the efficacy and safety of Tendvia TM pulmonary thromoboectomy system. Results:The technical success rate of PMT with Tendvia TM pulmonary thromoboectomy system was 100% (24/24). The 48 h pre-operative RV/LV ratio was 1.19±0.25 and the post-operative RV/LV ratio was 0.82±0.16. The mean RV/LV ratio of the patients was decreased by 0.37±0.25 at post-operative 48 h with significant statistical difference ( t=7.03, P<0.001). The 48 h pre-operative mPAP was (31.09±6.09) mmHg and the post-operative mPAP was (25.91±4.36) mmHg. The mPAP of the patients was reduced by 5.18 mmHg at post-operative 48 h with significant statistical difference ( t=6.73, P<0.001). The pre-operative PaO 2 was (74.66±11.28) mmHg and the post-operative PaO 2 was (88.01±10.57) mmHg. The pressure of oxygen in artery was increased by 13.36 mmHg. The differences were statistically significant( t=-4.08, P<0.001). The rate of thrombus removal was 68.17%±22.66%. 87.5% (21 cases) of patients achieved a thrombus removal greater than grade Ⅱ. One patient underwent catheter directed thrombolysis (CDT) after PMT based on the evaluation of operator. The patient′s thrombus removal achieved grade Ⅲ after 48 h and the CDT was ceased. Hemoptysis occurred intra-operatively in one case underwent PMT and the symptom of the patient was alleviated with conservative medication. The MAE incidence within the post-operative 48 h was 4.17% (1/24). No device-related mortality or all-cause mortality occurred in the trial. Conclusions:The Tendvia TM pulmonary thromoboectomy system is a safe and effective device to remove the pulmonary arterial thrombus for the treatment of patients with APE. The Tendvia TM pulmonary thromoboectomy system can be a new choice in the treatment for the patients with APE.

Cranial defects may result from clinical brain tumor surgery or accidental trauma. The defect skulls require hand-designed skull implants to repair. The edge of the skull implant needs to be accurately matched to the boundary of the skull wound with various defects. For the manual design of cranial implants, it is time-consuming and technically demanding, and the accuracy is low. Therefore, an informer residual attention U-Net (IRA-Unet) for the automatic design of three-dimensional (3D) skull implants was proposed in this paper. Informer was applied from the field of natural language processing to the field of computer vision for attention extraction. Informer attention can extract attention and make the model focus more on the location of the skull defect. Informer attention can also reduce the computation and parameter count from N ² to log( N). Furthermore,the informer residual attention is constructed. The informer attention and the residual are combined and placed in the position of the model close to the output layer. Thus, the model can select and synthesize the global receptive field and local information to improve the model accuracy and speed up the model convergence. In this paper, the open data set of the AutoImplant 2020 was used for training and testing, and the effects of direct and indirect acquisition of skull implants on the results were compared and analyzed in the experimental part. The experimental results show that the performance of the model is robust on the test set of 110 cases fromAutoImplant 2020. The Dice coefficient and Hausdorff distance are 0.940 4 and 3.686 6, respectively. The proposed model reduces the resources required to run the model while maintaining the accuracy of the cranial implant shape, and effectively assists the surgeon in automating the design of efficient cranial repair, thereby improving the quality of the patient's postoperative recovery.
Humans ; Computer-Aided Design ; Skull/surgery* ; Prostheses and Implants ; Head

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.