The correlation between hearing loss (HL) and physical performance in patients receiving maintenance hemodialysis (MHD) remains poorly investigated. This study explored the association between HL and physical performance in patients on MHD. Methods: This multicenter cross-sectional study was conducted between July 2020 and April 2021 in seven hemodialysis centers in Shanghai and Suzhou, China. The hearing assessment was performed using pure-tone average (PTA). Physical performance was assessed using the Timed Up and Go Test (TUGT), handgrip strength, and gait speed. Results: Finally, 838 adult patients (male, 516 [61.6%]; 61.2 ± 2.6 years) were enrolled. Among them, 423 (50.5%) had mild to profound HL (male, 48.6% and female, 53.4%). Patients with HL had poorer physical performance than patients without HL (p < 0.001). TUGT was positively correlated with PTA (r = 0.265, p < 0.001), while handgrip strength and gait speed were negatively correlated with PTA (r = –0.356, p < 0.001 and r = –0.342, p < 0.001, respectively). Physical performance in patients aged <60 years showed significant dose-response relationships with HL. After adjusting for confounders, the odds ratios (95% confidence intervals) for HL across the TUGT quartiles (lowest to highest) were 1.00 (reference), 1.15 (0.73–1.81), 1.69 (1.07–2.70), and 2.87 (1.69–4.88) (p for trend = 0.005). Conclusion: Lower prevalence of HL was associated with a faster TUGT and a stronger handgrip strength in patients on MHD.

Objective To observe the effect of muscone in regulating fatty acid synthase(Fas)/fatty acid synthase ligand(FasL)signaling pathway on cardiomyocyte apoptosis in rats with diabetic car-diomyopathy(DCM),and explore the mechanism of Chen Shuquan's theory of"warming and clear-ing collaterals"in treating DCM.Methods SD rats were divided into blank group,DCM group,low-dose muscone group(0.68 mg/kg muscone),high-dose muscone group(2.72 mg/kg muscone),met-formin group(140 mg/kg metformin),and high-dose muscone+recombinant human FasL protein(rh-FasL)group(2.72 mg/kg muscone+0.017 mg/kg rh-FasL),with 12 rats in each group.Except for the blank group,rats in all other groups were fed with high-fat feed combined with intraperitoneal injection of streptozotocin to construct a DCM rat model.After successful modeling,the rats were administered once a day for 6 weeks.After the last treatment,the changes in fasting blood glucose,left ventricular ejection fraction(LVEF),and left ventricular short axis shortening rate(LVFS)in rats were detected;Hematoxylin-eosin(HE)staining and Masson staining were applied to detect pathological damage and fibrosis degree of myocardial tissue,respectively.Spectrophotometry was applied to detect the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)in myocardial tissue;TUNEL staining was applied to observe myocardial cell apoptosis;and Western blot was applied to detect the expression of cleaved aspartate specific cysteine protease-3(cleaved-caspase-3),Bcl-2 associated X protein(Bax),Fas,and FasL proteins in myocardial tis-sue.Results Compared with the blank group,the pathological damage to the myocardial tissue of rats in the DCM group was severe,the fasting blood glucose,MDA content,myocardial collagen ar-ea fraction and apoptosis rate of myocardial cell,and expression of cleaved-caspase-3,Bax,Fas,and FasL proteins increased,while the LVEF,LVFS,and activity of SOD decreased(P＜0.05);compared with DCM group,pathological damage of myocardial tissue was reduced in the low-dose muscone group,the high-dose muscone group and the metformin group,and fasting blood glucose,MDA content,myocardial collagen area fraction,myocardial apoptosis rate and cleaved-caspase-3,Bax,Fas and FasL protein expression were decreased,and the activities of LVEF,LVFS and SOD were increased(P＜0.05).Compared with low-dose muscone group,pathological damage of myocar-dial tissue was relieved in the high-dose muscone group and the metformin group,fasting blood glu-cose,MDA content,myocardial collagen area fraction,myocardial apoptosis rate,cleaved-caspase-3,Bax,Fas and FasL protein expression were decreased,and LVEF,LVFS and SOD activities were in-creased(P＜0.05).Compared with the high-dose muscone group,the pathological damage to the myocardial tissue of rats in the high-dose muscone+rh-FasL group was intensified,the fasting blood glucose,MDA content,and expression of cleaved-caspase-3,Bax,Fas,and FasL proteins increased,the LVEF,LVFS,and activity of SOD decreased(P＜0.05).Conclusion Muscone may inhibit oxidative stress and cardiomyocyte apoptosis in DCM rats by inhibiting the Fas/FasL pathway.

Objective To observe the effect of muscone in regulating fatty acid synthase(Fas)/fatty acid synthase ligand(FasL)signaling pathway on cardiomyocyte apoptosis in rats with diabetic car-diomyopathy(DCM),and explore the mechanism of Chen Shuquan's theory of"warming and clear-ing collaterals"in treating DCM.Methods SD rats were divided into blank group,DCM group,low-dose muscone group(0.68 mg/kg muscone),high-dose muscone group(2.72 mg/kg muscone),met-formin group(140 mg/kg metformin),and high-dose muscone+recombinant human FasL protein(rh-FasL)group(2.72 mg/kg muscone+0.017 mg/kg rh-FasL),with 12 rats in each group.Except for the blank group,rats in all other groups were fed with high-fat feed combined with intraperitoneal injection of streptozotocin to construct a DCM rat model.After successful modeling,the rats were administered once a day for 6 weeks.After the last treatment,the changes in fasting blood glucose,left ventricular ejection fraction(LVEF),and left ventricular short axis shortening rate(LVFS)in rats were detected;Hematoxylin-eosin(HE)staining and Masson staining were applied to detect pathological damage and fibrosis degree of myocardial tissue,respectively.Spectrophotometry was applied to detect the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)in myocardial tissue;TUNEL staining was applied to observe myocardial cell apoptosis;and Western blot was applied to detect the expression of cleaved aspartate specific cysteine protease-3(cleaved-caspase-3),Bcl-2 associated X protein(Bax),Fas,and FasL proteins in myocardial tis-sue.Results Compared with the blank group,the pathological damage to the myocardial tissue of rats in the DCM group was severe,the fasting blood glucose,MDA content,myocardial collagen ar-ea fraction and apoptosis rate of myocardial cell,and expression of cleaved-caspase-3,Bax,Fas,and FasL proteins increased,while the LVEF,LVFS,and activity of SOD decreased(P＜0.05);compared with DCM group,pathological damage of myocardial tissue was reduced in the low-dose muscone group,the high-dose muscone group and the metformin group,and fasting blood glucose,MDA content,myocardial collagen area fraction,myocardial apoptosis rate and cleaved-caspase-3,Bax,Fas and FasL protein expression were decreased,and the activities of LVEF,LVFS and SOD were increased(P＜0.05).Compared with low-dose muscone group,pathological damage of myocar-dial tissue was relieved in the high-dose muscone group and the metformin group,fasting blood glu-cose,MDA content,myocardial collagen area fraction,myocardial apoptosis rate,cleaved-caspase-3,Bax,Fas and FasL protein expression were decreased,and LVEF,LVFS and SOD activities were in-creased(P＜0.05).Compared with the high-dose muscone group,the pathological damage to the myocardial tissue of rats in the high-dose muscone+rh-FasL group was intensified,the fasting blood glucose,MDA content,and expression of cleaved-caspase-3,Bax,Fas,and FasL proteins increased,the LVEF,LVFS,and activity of SOD decreased(P＜0.05).Conclusion Muscone may inhibit oxidative stress and cardiomyocyte apoptosis in DCM rats by inhibiting the Fas/FasL pathway.

Objective To investigate the expression and clinical significance of TM9SF3 in lung adenocarcinoma (LUAD). Methods TCGA and GEPIA databases were used to screen the differentially-expressed TM9SF family molecules and analyze their effects on patient prognosis with LUAD. The expression and localization of TM9SF3 in LUAD patients were verified by a human proteomic mapping database, Western blot assay, and polymerase chain reaction assay. Herein, the GSEA was used for the signal pathway enrichment analysis of TM9SF3-related genes. Meanwhile, the TIMER database and CIBERSORT algorithm were used to analyze the correlation between differentially-expressed TM9SF3 and the degree of immune cell infiltration. Results The expression of TM9SF3 in LUAD was significantly increased and had a significant adverse effect on the prognosis of LUAD patients. In addition, immunoblotting and polymerase chain reaction confirmed that TM9SF3 was highly expressed in LUAD. Meanwhile, the genes related to TM9SF3 expression were mainly enriched in cell signaling pathways regulating immune cell activity. The expression of TM9SF3 was significantly correlated with the expression changes of six immune cells. Conclusion TM9SF3 is differentially expressed in LUAD and may be used as a potential prognostic marker for LUAD patients. TM9SF3 can also change the level of immune cell infiltration in LUAD patients and is expected to be a new potential target for LUAD immunotherapy.

ObjectiveThis study aimed to understand the epidemiological characteristics of hand-foot-mouth disease （HFMD） in Minhang District， Shanghai from 2009 to 2020， and provide a scientific basis for the prevention and control of HFMD. MethodsThe case information of HFMD was collected from the National Notifiable Infectious Diseases Reporting System of Chinese Center for Disease Control and Prevention. We used descriptive epidemiological methods to analyze the population characteristics， temporal and spatial distribution of HFMD， the pathogen composition of the case and its changing trend. ResultsFrom 2009 to 2020， a total of 66，198 cases of HFMD were reported in Minhang District， Shanghai， including 377 severe cases （severe case rate 0.57%） and 3 deaths （severs case fatality rate 0.80%）. There were more cases of HFMD in boys than in girls （1.5∶1）. HFMD patients aged under 5 years predominated， accounting for 88.91% of all cases. Majority of the cases （91.42%） were in scattered children （55.80%） and children in kindergartens （35.62%）. The incidence showed a cyclical trend， with low incidence years and high incidence years appearing alternately. The peak period was from April to July， and sometimes there were small peaks during October to December. A total of 12 years time-space scanning analysis revealed 3 clusters. The cluster centers were located in Wujing Town， Huacao Town and Xinzhuang Town， respectively. The proportion of EV71 in common cases was generally decreasing， and reduced to zero in 2019. The proportion of CoxA6 had increased year by year， and reached 75.00% in 2020. CoxA6 became the dominant pathogen in recent years. The number of severe cases had decreased year by year since 2010， and the dominant pathogen was EV71 （90.03% on average） in severe cases. ConclusionThe incidence of HFMD in Minhang District of Shanghai has a downward trend from 2014. The dominant pathogen changes from EV71 to CoxA6， and the dominant pathogen in severe cases is EV71. The discovered temporal and spatial clustering pattern is helpful for in-depth understanding of the distribution and epidemic trend of HFMD in Minhang District， and provides a scientific basis for epidemic prevention and control.

Objective:To explore the association between weight status and early changes in blood pressure, cardiac structure and function in children at 4 years of age.Methods:A cross-sectional study of the relationship between weight status and cardiovascular parameters was performed on the platform of "Shanghai Birth Cohort" in Shanghai Xinhua Hospital between 2017 and 2020. Height, weight, blood pressure and echocardiography were measured in 1 477 children at 4 years of age. According to body mass index (BMI), participants were classified into five groups: underweight, lean, normal weight, overweight and obese. Blood pressure, cardiac structure and function indexes were compared among different groups using one-way ANOVA. The associations between blood pressure, cardiac structure and function and weight status in children were analyzed by linear regression models. Multivariate logistic regression models were used to analyze whether weight status was an independent risk factor for elevated blood pressure or left ventricular hypertrophy (LVH) in children.Results:A total of 1 477 children including 772 boys and 705 girls were included in this study. There were 115 overweight and obese boys (14.9%) and 68 overweight and obese girls (9.6%). The majority of children had normal weight (916 cases, 62.0%), followed by underweight (303 cases, 20.5%), overweight (130 cases, 8.8%), lean (75 cases, 5.1%), and obese (53 cases, 3.6%). With the increase of BMI, systolic blood pressure, diastolic blood pressure, left ventricular mass index (LVMI), left ventricular posterior wall thickness in systole, left ventricular posterior wall thickness in diastole, left ventricular diameter in end-systole, left ventricular diameter in end-diastole, interventricular septum thickness in systole and left ventricular ejection fraction showed significantly positive trend, and the differences among the groups were significant (F=31.73, 6.59, 14.22, 4.96, 3.01, 31.50, 39.79, 5.91, 3.09, all P<0.05). Multiple linear regression showed that overweight and obese were all positively associated with systolic blood pressure (β=5.2, 95% CI 3.6-6.8), LVMI (β=1.9, 95% CI 0.8-3.1), left ventricular diameter in end-systole (β=1.3, 95% CI 0.9-1.8), and left ventricular diameter in end-diastole (β=1.6, 95% CI 1.0-2.2). In the Logistic regression model, compared with normal weight children, overweight ( OR=2.37, 95% CI 1.37-4.41) and obese children ( OR=10.90, 95% CI 4.47-26.60) both had significantly increased risk of elevated blood pressure. However, the risk of LVH did not significantly increased. Conclusions:Overweight and obesity in 4-year-old children are associated with increased blood pressure, increased left ventricle diameter and LVMI. Overweight and obesity are independent risk factors for elevated blood pressure in children at 4 years of age.

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.

Objective To summarize the experience of patient positing,port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operations.Methods From March 2017 to December 2017,140 robot-assisted laparoscopic upper urinary tract procedures were performed in our institution,including 110 cases of pyeloplasty,15 upper pole heminephroureterectomy,12 simple nephrectomy and 3 adrenalectomy.There were 103 males and 37 females with a range age from 1 month to 18 years.The assistant surgeon was adjacent to the instrument nurse,and patients were placed in a supine position with 60°-80° inclination and keep the legs low to the body.Room setup and patient positioning were similar to the traditional laparoscopic surgery.Semi-hidden incision technique was used in 140 patients:the camera port was placed umbilicus,two additional arm ports (one 5 mm and one 8 mm) were placed under direct vision,the 8 mm arm port was placed on the line of a Pfannenstiel incision and the 5 mm arm port was placed below the Xiphoid along the midline.Finally,a 3 or 5 mm assistant port was placed approximately 3 cm lateral to the inferior arm port,the line of a Pfannenstiel incision.Results The average time was (11.5 ± 3.2) min (10.5-16.5 min) from skin incision to robot cart docking completed.All surgeries were successfully completed without open conversion.One patient required an additional assist port for severe adhesion after the previously open surgery,there was no injury to other viscera.Average operative time was (146.9 ± 48.7)min (78-259 min) and average post-operative hospitalization time was (5.7 ± 1.4) d(4-10 d),respectively.There was no visual scar on abdominal 6 weeks postoperatively,and all parents made comments about their satisfaction with the cosmetic appearance.All operations got complete success at a mean follow up of 6 (1-9) months.Conclusions A good room setup,patient positioning and the semi-hidden incision technique port placements are maintaining the safety of the patient,avoiding compression injuries,allowing maximum mobility of the robotic arms,and facilitating a smooth and efficient surgery,and improving post-operative recovery.

Objective To analyze the endoscopic observation of gastroduodenal ulcer radioactive injury induced by pancreatic cancer radiotherapy, and to preliminary investigate the risk factors of radiation-induced ulcer after radiotherapy in patients with pancreatic cancer. Methods A total of 112 patients with pancreatic cancer who accepted gastroscopy before and after radiotherapy at Air Force General Hospital were collected. Self-comparative study of gastroscopic findings was performed on these patients. Single factor analysis and the logistic regression analysis model were used to analyze whether the clinical factors were likely to affect the radiation-induced ulcer or not. Results The total incidence of radiation-induced ulcer was 42.0 % (47/112) in 112 patients. The history of ulcer and grade 2 or more acute gastrointestinal symptoms (P= 0.036, P= 0.030) were the independent risk factors of radiation-induced ulcer. The rest clinical factors had no influence on the radiation-induced ulcer (all P>0.05). Conclusion In the radiotherapy of pancreatic cancer, patients who has the history of ulcer or grade 2 or more acute gastrointestinal symptoms should be alert to the occurrence of radiation-induced ulcer.