Objective:To establish a nomogram model for predicting the risk of sepsis in diabetic foot patients, and to provide reference for clinical prevention and treatment.Methods:The clinical data of 430 patients with diabetic foot who were hospitalized in Chu Hsien-I Memorial Hospital of Tianjin Medical University from January 2022 to March 2023 were reviewed and collected, including age, gender, past medical history, smoking and drinking history, family history, diabetes course, Texas grade of diabetic foot and laboratory indicators within 24 hours after admission. Patients were divided into sepsis group and non-sepsis group according to the presence or absence of sepsis during hospitalization. The differences in clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to screen the influencing factors of sepsis in patients with diabetic foot during hospitalization, and a nomogram predictive model was established. The performance of the prediction model was evaluated by receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA). Internal validation was performed by using Bootstrap method.Results:A total of 430 patients were enrolled, among which 90 patients developed sepsis during hospitalization and 340 patients did not. There were statistically significant differences in diabetes course, Texas grade of diabetic foot, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), neutrophil to lymphocyte ratio (NLR), hemoglobin (Hb), albumin (Alb), glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and blood urea nitrogen (BUN) between the two groups. Multivariate Logistic regression analysis showed that diabetes course [odds ratio ( OR) = 2.774, 95% confidence interval (95% CI) was 1.053-7.308, P = 0.039], Texas grade of diabetic foot ( OR = 2.312, 95% CI was 1.014-5.273, P = 0.046), WBC ( OR = 1.160, 95% CI was 1.042-1.291, P = 0.007), HbA1c ( OR = 1.510, 95% CI was 1.278-1.784, P < 0.001), CRP ( OR = 1.007, 95% CI was 1.000-1.014, P = 0.036) were independent risk factors for sepsis in patients with diabetic foot during hospitalization, while Alb was a protective factor ( OR = 0.885, 95% CI was 0.805-0.972, P = 0.011). A nomogram predictive model was constructed based on the above 6 indicators. The ROC curve showed that the area under ROC curve (AUC) of the nomogram predictive model for identifying the sepsis patients was 0.919 (95% CI was 0.889-0.948). The AUC of the nomogram predictive model after internal verification was 0.918 (95% CI was 0.887-0.946). Hosmer-Lemeshow test showed χ2 = 2.978, P = 0.936, indicating that the calibration degree of the predictive model was good. Calibration curve showed that the predicted probability of sepsis was in good agreement with the actual probability. DCA curve showed that the nomogram predictive model had good clinical usefulness. Conclusion:The nomogram predictive model based on the risk factors of diabetes course, Texas grade of diabetic foot, WBC, HbA1c, CRP and Alb has good predictive value for the occurrence of sepsis in patients with diabetic foot during hospitalization, which is helpful for clinical screening of the possibility of diabetic foot patients progressing to sepsis, and timely personalized intervention for different patients.

Sphincter of Oddi dysfunction (SOD) refers to the abnormal physiological function of sphincter of Oddi, which causes a series of syndromes in biliary tract, pancreas and liver. At present, the related research of SOD is becoming a hot spot, but its pathogenesis is not clear. This article will review the domestic and international literatures on SOD, review the advantages and disadvantages of experimental animals such as rabbits, dogs and guinea pigs, and analyze the characteristics of drugs and surgical modeling, so as to provide references for future related model establishment.

N6-methyladenosine(m6A)denotes the addition of a methyl group to the sixth nitrogen atom of ade-nosine,a common occurrence in eukaryotic RNA.The m6A modifications govern RNA splicing,translocation,stability,and translation into proteins.The RNA methyltransferases,like methyltransferase-like protein 3(METTL3),METTL14,and Wilms'tumor 1-associated protein(WTAP),are responsible for these modifications,while the removal process in-volves demethylases,specifically fat mass and obesity-associated protein(FTO)and ALKB homolog 5(ALKBH5).Recog-nition of these modifications is facilitated by m6A-binding proteins,such as YTH family proteins and insulin-like growth factor 2 mRNA-binding proteins(IGF2BPs).The m6A modification regulators are involved in the onset and progression of non-small-cell lung cancer through multiple mechanisms.This review concentrates on the biological functions and molecu-lar mechanisms of m6A modification-related regulatory factors in the malignant progression of non-small-cell lung cancer.

Objective:To study the changes in the sphincter of Oddi pressure in rabbits after bilateral vagus nerve trunk severance and the therapeutic effect of Qingre Lidan Decoction, to provide a new way for the treatment of sphincter of Oddi dysfunction.Methods:Twenty-four 1.5~2.0 kg New Zealand Large White rabbits of either gender were randomly selected and divided into the control group, the model group, and the treatment group. In the control group, only pyloroplasty was performed; in the model group and the treatment group, pyloroplasty plus bilateral vagus nerve trunk dissection at the level of the diaphragm were performed, and in the treatment group, one month of gavage treatment with Qingre Lidan Decoction was carried out 7 days after the operation. Multi-channel bio-signal acquisition system was used to record the pressure changes of the sphincter of Oddi in rabbits of each group; ELISA was used to detect the changes of inflammatory factors IL-6 and tumor necrosis factor TNF-α in the serum of rabbits.Results:The pressure of the sphincter of Oddi in the model group was significantly higher than those in the control group [low-pressure area: (51.95±0.35) mmHg (1 mmHg=0.133 kPa) vs (21.60±1.13) mmHg ( P<0.05) ; High pressure area: (60.75±0.49) mmHg vs (20.70±0.85) mmHg ( P<0.05)], the pressure of sphincter of Oddi in the treatment group of Qingre Lidan Decoction was lower than that of the model group [low-pressure area: (22.70±1.13) mmHg vs (51.95±0.35) mmHg ( P<0.05); high-pressure area: (32.15±0.49) mmHg vs (60.75±0.49) mmHg ( P<0.05)]. Serum IL-6 and TNF-αwere significantly elevated in the model group compared to the control group; IL-6 and TNF-α levels were decreased in the treatment group compared to the model group, and the differences were statistically significant ( P<0.05). Conclusion:Bilateral vagus nerve trunk severance leads to Oddi sphincter dysfunction, and treatment with Qingre Lidan Decoction could improve Oddi sphincter dysfunction.

Objective:To construct an evaluation index system for continuous nursing outcomes of patients undergoing knee arthroplasty.Methods:From January to May 2022, a preliminary draft of the index system was developed based on literature research, semi-structured interviews, and group discussions. We developed a questionnaire and conducted two rounds of consultation with 15 experts using the Delphi expert consultation method to construct the final index system. The positivity of experts was expressed by the effective recovery rate of the questionnaire. The expert authority coefficient was represented by the arithmetic mean of the expert's judgment basis and familiarity with the indicator. The coordination of expert opinions was represented by the Kendall's W. Results:Around two rounds of consultation, the effective recovery rates of the questionnaire were 100.0% (15/15) and 93.3% (14/15), respectively, and the expert authority coefficients were 0.815 and 0.860, respectively, and the expert Kendall's W were 0.297 and 0.121 ( P<0.01). The final evaluation index system for continuous nursing outcomes of patients undergoing knee arthroplasty included 3 primary indicators, 7 secondary indicators, and 47 tertiary indicators. Conclusions:The evaluation index system for continuous nursing outcomes of patients undergoing knee arthroplasty is strongly scientific and reliable, and has guiding significance for standardizing the continuous nursing of knee arthroplasty patients.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.

Rearranged during transfection (RET) fusions are found in 0.7% to 2% of non-small cell lung cancer (NSCLC). Fusions between RET gene and other domains represent the distinct biological and clinicopathological subtypes of NSCLC. Recent years have witnessed the remarkable advancement of RET fusion-positive advanced NSCLC therapy. Conventional chemotherapy produced moderate clinical benefits. Prior to the introduction of targeted therapy or in the context of unavailability, platinum-based systemic regimens are initial therapy options. Immunotherapy predicted minimal response in the presence of RET fusions while currently available data have been scarce, and the single-agent immunotherapy or in combination with chemotherapy regimens are not recommended as initial systemic therapy in this population. The repurpose of multi-target kinase inhibitors in patients with RET fusion-positive NSCLC showed encouraging therapeutic activity, with only cabozantinib and vandetanib being recommended as initial or subsequent options under certain circumstances. However, there are still unmet clinical needs. Pralsetinib and selpercatinib have been developed as tyrosine kinase inhibitors (TKI) selectively targeting RET variation of fusions or mutations, and both agents significantly improved the prognosis of patients with RET fusion-positive NSCLC. Pralsetinib and selpercatinib have been established as preferred first-line therapy or subsequent therapy options. As observed with other TKIs treatment, resistance has also been associated with RET targeted inhibition, and the acquired resistance eventually affect the long-term therapeutic effectiveness, leading to limited subsequent treatment options. Therefore, it is essential to identify resistance mechanisms to TKI in RET fusion-positive advanced NSCLC to help reveal and establish new strategies to overcome resistance. Here, we review the advances in the treatment of RET fusion-positive advanced NSCLC.
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Carcinoma, Non-Small-Cell Lung/genetics* ; Humans ; Lung Neoplasms/genetics* ; Mutation ; Protein Kinase Inhibitors/therapeutic use* ; Proto-Oncogene Proteins c-ret/genetics*

Objective:To compare the efficacy and safety of gemcitabine and epirubicin curing for patients with non-muscle invasive bladder cancer (NMIBC).Methods:From October 2014 to October 2017, 86 patients with NMIBC diagnosed by transurethral resection of bladder tumor (TURBT) in Wenling Hospital Affiliated to Wenzhou Medical University were analyzed retrospectively. Among them, 42 were treated with gemcitabine (gemcitabine group) and the other 44 with epirubicin (epirubicin group). In gemcitabine group, there were 37 males and 5 females. The average age was 63.9 (48-81) years old. 30 cases were single tumor while 12 cases were multiple. 35 cases with tumor diameter less than 3cm and 7 cases with tumor diameter greater than 3cm. There were 28 cases in T a stage and 14 cases in T 1 stage. 13 patients’ tumor were high grade and 29 patients’ tumor were low grade. In the epirubicin group, there were 36 males and 8 females. The average age was 65.4 (48-88) years. 31 cases were single tumor while 13 cases were multiple. 36 cases with tumor diameter less than 3cm and 8 cases with tumor diameter greater than 3cm. There were 30 cases in T a stage and 14 cases in T 1 stage. 15 patients’ tumor were high grade and 29 patients’ tumor were low grade. There was no significant difference in the above general information between the two groups ( P > 0.05). The two groups were treated with epirubicin or gemcitabine within 24 hours after operation, and bladder perfusion once a week was performed continuously after the first week of operation, a total of 8 times, and after that once a month till one year after operation. The clinical efficacy and adverse reactions were compared between the two groups. Kaplan-Meier was used to compare the recurrence free survival time of tumor after operation. The prognostic factors were analyzed by Cox proportional hazards model. Results:The adverse reactions of the two groups were mainly bladder irritation, gross hematuria, fever, nausea and vomiting. The incidence of bladder irritation and gross hematuria in epirubicin group was 25.0% (11 / 44) and 18.2% (8 / 44), which were significantly higher than those in gemcitabine group [7.1% (3/42) and 2.4% (1/42)], and the difference was statistically significant ( P<0.05). There was no significant difference in other adverse reactions between the two groups ( P> 0.05). Kaplan-Meier survival analysis showed that the median tumor recurrence free survival time of gemcitabine group was 29.7 (6.3-58.8) months, and the 1-year and 2-year tumor recurrence free survival rates were 71.4% (30/42) and 45.2% (19/42), respectively; the median tumor recurrence free survival time of epirubicin group was 28.8 (4.5-57.8) months, and the 1-year and 2-year tumor recurrence free survival rates were 70.5% (31/44) and 47.7% (21/44), respectively. There was no difference in the tumor recurrence free survival rates between the two groups( P>0.05). Cox analysis showed that age ( HR=1.1, 95% CI 1.034-1.113) and tumor grade ( HR=12.2, 95% CI 5.776-25.680) were independent risk factors for prognosis. Conclusions:The efficacy of bladder perfusion chemotherapy with gemcitabine and epirubicin in patients with NMIBC was not significantly different, but the incidence of adverse reactions with gemcitabine was lower, which was safe and reliable. The risk factors affecting postoperative survival rates of NMIBC were patient's age and tumor grade.

Preeclampsia is a multiple system disease in obstetrics, which often leads to adverse pregnancy outcome.Twin pregnancy is a high-risk pregnancy.When preeclampsia occurs, the condition is very serious, and the complications of mother and child are increasing.The pathogenesis of preeclampsia is diversified.The high risk factors of twin pregnancy with preeclampsia are bichorionic, assisted reproductive technology pregnancy, primipara, and advanced age.The timing of termination of pregnancy should be selected according to chorionic nature, and the indications of cesarean section should be relaxed to reduce the adverse pregnancy outcomes.Clinical studies mostly use comprehensive indicators combined with screening to predict preeclampsia.How to prevent preeclampsia still needs further clinical and basic research.

OBJECTIVE: To analyze the incidence and risk factors of benign liver space-occupying mass in patients with chronic hepatitis B (CHB) and the ultrasound features that differentiate these masses from small hepatocellular carcinoma. METHODS: We retrospectively analyzed the color Doppler and clinical data of 17 721 patients with CHB treated in the Hepatology Unit of Nanfang Hospital between January, 2016 and December, 2017. The data were compared with those of 21629 healthy control subjects undergoing routine physical examination in the Center of Heath Management of Nanfang Hospital during the same period. RESULTS: Compared with the control subjects, the patients with CHB had significantly higher incidences of hepatic cysts (11.8% 8.7%, < 0.05), hepatic hemangioma (8.2% 1.6%, < 0.05) and hepatic cirrhosis nodules (20.6% 2.4%, < 0.05). The incidences of hepatic cysts and cirrhosis nodules increased with age and was significantly higher in male than in female patients ( < 0.001). The highest incidence of hepatic hemangioma was found in CHB patients aged 30-49 years without a gender difference (>0.05). Sonographically, the benign liver masses commonly showed homogeneous echo within the lesion with clear boundaries and regular shape. Hepatic hemangioma was distinctively hyperechoic in 83.32% (1579/1895) of the patients, while small hepatocellular carcinoma presented with weaker peripheral and internal blood flow signals with a lower flow velocity in the arteries and a higher flow velocity in the portal vein. Liver cirrhosis nodules mostly showed a mixture of strong and weak echoes (79.60%; 7637/9595) without blood flow signal within or around the nodule; an increased volume of the nodule accompanied by heterogeneous echoes within the nodule indicated an increased probability of malignant lesion. Hepatic cysts often displayed no echo within the lesion, but the echo could be enhanced posteriorly. CONCLUSIONS The patients with CHB are at a significantly higher risk of developing hepatic cysts, hepatic hemangiomas and hepatic cirrhosis nodules than the control population, and an older age and the male gender are associated with a higher incidence of hepatic cysts or cirrhosis. The differences in the sonographic and hemodynamic features can help to differentiate hepatic benign mass from malignant lesions, and kinetic changes in sonography can be used to monitor potential malignant transformation of the cirrhotic lesions.