Objective:To investigate the risk factors of post-stroke depression (PSD) in patients with first acute stroke 6 months after onset.Methods:Three hundred and sixty-seven patients with acute stroke who were treated for the first time in the Affiliated Hospital of Xuzhou Medical University were selected retrospectively. After onset for 6 months, the patients were followed up and divided into PSD group and non-PSD group. The clinical data, blood index, imaging data, degree of nerve damage and the patient's stigma level were compared between the two groups.Results:Totally 182 and 185 cases were included in the PSD and non-PSD groups, respectively. The incidence of PSD at 6 months post-stroke was 49.6% (182/367). The results of univariate analysis showed that diseased region, drinking history, monthly income, standard of culture, serum cortisol, total cholesterol (TC), high sensitivity C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Stigma Scale for Chronic Illness-8 Chronic Disease Stigma Scale-8(SSCI-8) scores, National Institute of Health Stroke Scale (NIHSS) scores and subtype of stroke were risk factors for PSD ( P<0.05). Binary Logistic regression analysis showed that diseased region at frontal lobe ( OR = 3.245, P = 0.011), basal ganglia region ( OR = 2.820, P = 0.007), cerebellar hemisphere ( OR = 4.594, P = 0.010) and serum cortisol ( OR = 1.174, P<0.001), hs-CRP ( OR = 1.057, P<0.001), SSCI-8 scores ( OR = 1.674, P<0.001), NIHSS scores ( OR = 1.283, P<0.001) were independent risk factors for PSD. Conclusions:PSD is a common complication in patients with stroke. Diseased region (at frontal lobe, basal ganglia region, cerebellar hemispheres), hs-CRP, serum cortisol, level of morbidity stigma and degree of neurological impairment are development risk factors for the PSD at 6 months of acute stroke.

Objective:To investigate the clinical imaging features and prognosis of von Hippel-Lindau (VHL) syndrome associated with pancreatic lesions.Method:The retrospective case-control study was conducted. The clinicopathological data of 161 patients with VHL syndrome who were admitted to Peking University First Hospital from September 2010 to August 2022 were collected. There were 83 males and 78 females, with age of onset as 27.0(range, 8.0-66.0)years. Observation indicators: (1) imaging results of VHL syndrome associated with pancreatic lesions; (2) clinical characteristics of VHL syndrome associated with pancreatic lesions; (3) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions; (4) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic neuroendocrine neoplasms (pNENs). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) Imaging results of VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, there were 151 patients associated with pancreatic lesions and 10 patients not associated with pancreatic lesions. Of the 151 patients with VHL syndrome associated with pancreatic lesions, there were 136 patient with pancreatic cystic lesions and 34 patients with pNENs, 22 patients with both pNENs and pancreatic cystic lesions, and the type of pancreatic lesions could not be accurately determined in 3 cases. (2) Clinical characteristics of VHL syndrome associated with pancreatic lesions. The age of onset in 151 patients with VHL syndrome associated with pancreatic lesions was 33.0(range, 14.0-68.0)years. Cases with gene site mutation of exon 1, exon 2, exon 3 and other types of gene site was 51, 16, 43 and 41, respectively. There were 116 patients of VHL type 1 and 35 patients of VHL type 2. There were 92 patients with family history of VHL syndrome and 59 patients without family history of VHL syndrome. There were 127 patients combined with renal cell carcinoma, 112 patients combined with central nervous system lesions, 46 patients combined with retinal hemangioblastoma. Patients may combined with multiple lesions. (3) Comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions. The age of onset, VHL syndrome type (VHL1 type, VHL2 type) and cases combined with renal cell carcinoma were 32.5(range, 14.0-68.0)years, 110, 26 and 115 in 136 patients with VHL syndrome associated with pancreatic cystic lesions, versus 22.0(range, 8.0-64.0)years, 13, 12 and 14 in 25 patients with VHL syndrome not associated with pancreatic cystic lesions, showing significant differences in the above indicators between them ( Z=-3.384, χ2=9.770, 10.815, P<0.05). (4) Comparison of clinicopathological factors in patients with VHL syndrome associated with pNENs. The age of onset, gene mutation sites (exon 1, exon 2, exon 3, other types of gene site) and VHL syndrome type (VHL1 type, VHL2 type) were 33.5(range, 14.0-64.0)years, 12, 5, 14, 3 and 18, 16 in 34 patients with VHL syndrome associated with pNENs, versus 27.0(range, 9.0-66.0)years, 41, 12, 32, 42 and 105, 22 in 127 patients with VHL syndrome not associated with pNENs, showing significant differences in the above indicators between them ( Z=-4.030, χ2=8.814, 13.152, P<0.05). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, 3 patients underwent surgical treatment, and the remaining patients were followed up. All 161 patients with VHL syndrome were followed up for 6 (range, 1-12)years, in which 15 patients died and 146 patients alive during the follow-up. The follow-up time of 3 patients undergoing surgical treatment was 4, 14, 9 years, respectively, and all of them were alive. Conclusions:The clinical imaging features of pancreatic lesions related to VHL syndrome are cystic lesions and pNENs, which with the characteristics of multiple lesions and benign tumors. Such patients usually do not requiring surgical treatment and have good prognosis.

Objective:Cushing′s disease(CD) is caused by the pituitary adrenocorticotroph hormone(ACTH) secreting adenomas, leading to increased serum cortisol levels and various abnormal metabolic processes. Untreated CD is linked to high mortality, thus it is critical to elucidate its pathogenesis. This study aims to explore the pathogenesis of pituitary ACTH adenomas using whole-genome sequencing analysis.Methods:Fresh tumor tissues and peripheral blood samples were collected in 9 confirmed cases of pituitary ACTH adenomas who underwent surgery. Whole genome sequencing was then performed, followed by analysis and verification of single nucleotide mutations, copy number variation(CNV) and chromosome structure variations.Results:Somatic USP8 mutations(p.Ser718del, p. Ser718Pro, p. Pro720Arg, p. Pro720Gln) were found in 5 patients, with a rate of 55.6%; CNV of USP8 was detected in 1 patient; TP53(p.Cys135Tyr), NF1(p.Val1049Glufs*11) and KMT2C(c.3323+ 1G>A) mutations were identified in 1 patient harboring wild-type USP8. CNV analysis showed a loss of heterozygosity in multiple chromosomes in a wild-type USP8 patient. Structural variations were found in 2 with unknown significance. No germline gene mutations were detected in this study.Conclusion:Somatic USP8 mutations, increased copy number of USP8, variations of tumor-related genes such as TP53 and extensive somatic CNV all contribute to pathogenesis of CD. Chromosomal structure variations may suggest high-risk pituitary ACTH adenomas, and call for frequent follow-up and aggressive treatment.

Objective:To explore the relationship between input and output of occupational health funds, and to provide basis for relevant departments to make decisions.Methods:In September 2018, a state-owned iron ore in Hebei Province (mining history of more than 10 years, which can represent the general type of iron ore) was selected as the research object. Through the investigation and collection of enterprise general situation, occupational health input, loss and output related indicators, the iron mine occupational health expenditure input-output table and model were established, and the digital relationship between the investment and output was solved by MATLAB software.Results:The labor consumption in the departments of underground mining, open pit mining, crushing and rock discharging, transportation, tailings and mineral processing (taking labor wages as reference) were 756.46, 1.281.78, 987.61, 1 570.71, 50.956 and 18.9116 million yuan/year respectively. The output value of each sector is 11 207.19, 18 989.95, 15 176.40, 25 294.00, 7.704.94 and 280.1797 million yuan/year respectively. The ratio of health input to total output was 0.004 5, and the ratio of occupational health input to output was 1/0.046.Conclusion:The input-output table model of occupational health in iron mine can reflect the relationship between input and output of occupational health funds. The input situation of the coal mine is poor, and the input does not bring obvious occupational health benefits.

Objective:To explore the relationship between input and output of occupational health funds, and to provide basis for relevant departments to make decisions.Methods:In September 2018, a state-owned iron ore in Hebei Province (mining history of more than 10 years, which can represent the general type of iron ore) was selected as the research object. Through the investigation and collection of enterprise general situation, occupational health input, loss and output related indicators, the iron mine occupational health expenditure input-output table and model were established, and the digital relationship between the investment and output was solved by MATLAB software.Results:The labor consumption in the departments of underground mining, open pit mining, crushing and rock discharging, transportation, tailings and mineral processing (taking labor wages as reference) were 756.46, 1.281.78, 987.61, 1 570.71, 50.956 and 18.9116 million yuan/year respectively. The output value of each sector is 11 207.19, 18 989.95, 15 176.40, 25 294.00, 7.704.94 and 280.1797 million yuan/year respectively. The ratio of health input to total output was 0.004 5, and the ratio of occupational health input to output was 1/0.046.Conclusion:The input-output table model of occupational health in iron mine can reflect the relationship between input and output of occupational health funds. The input situation of the coal mine is poor, and the input does not bring obvious occupational health benefits.

Objective:To evaluate the effect of electroacupuncture (EA) on lung injury caused by extremity ischemia-reperfusion.Methods:Forty-five American Society of Anesthesilogists physical status ⅠorⅡpatients, aged 20-60 yr, with body mass index of 18-28 kg/m 2, undergoing unilateral lower extremity operation requiring tourniquet with neuraxial anesthesia were divided into 3 groups ( n=15 each) using a random number table method: control group (C group), EA group and EA at non-acupoint group (group N). Bilateral acupoints Feshu and Zusanli were stimulated with disperse-dense waves, frequency 2/15 Hz, the current intensity the maximum current that patients could tolerant until the end of surgery in group EA.EA was performed at the points 1 cm lateral to the acupoints of Feshu and Zusanli in group N. Before anesthesia (T 1) and at 10, 30 and 60 min after tourniquet loosening (T 2-4), blood samples were collected from the radial artery for blood gas analysis, the partial pressure of arterial oxygen(PaO 2) and arterial carbon dioxide partial pressure (PaCO 2) were recorded, alveolar-arterial oxygen partial pressure difference (P A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated, the malondialdehyde (MDA) content was measured by thiobarbituric acid method, the concentration of serum nitric oxide (NO) was determined by nitrate reductase method, and the concentrations of serum endothelin-1 (ET-1) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay. Results:Compared with the baseline at T 1, OI and RI were significantly decreased, P A-aO 2 was increased, and serum MDA, IL-6, ET-1 and NO levels were increased at T 2-4 in three groups ( P<0.05). Compared with group C, OI was significantly increased, P A-aO 2 and RI were decreased, serum MDA, IL-6, ET-1 and NO levels were decreased at T 2-4 in group EA ( P<0.05). Conclusion:EA can reduce lung injury caused by extremity ischemia-reperfusion, and the mechanism may be related to maintaining NO/ET-1 balance.

Objective:To evaluate the role of melatonin in electroacupuncture (EA)-induced reduction of lung injury induced by limb ischemia-reperfusion (I/R) in rabbits.Methods:Fifty clean-grade healthy male New Zealand white rabbits, weighing 2.0-2.5 kg, aged 3 months, were divided into 5 groups ( n=10 each) using a random number table method: sham operation group (group Sham), limb I/R group (group IR), EA group, sham EA group (group SEA) and EA plus melatonin receptor antagonist luzindele group (group EA+ L). The model of limb I/R injury was established by clamping the femoral artery for 3 h followed by 4-h reperfusion in anesthetized animals.In group EA and group EA + L, bilateral Zusanli and Feishu acupoints (4-6 mm depth) were stimulated with constant voltage (2/15 Hz, l-2 mA, disperse-dense waves) for 30 min once a day during 1-7 days before establishing the model and during establishment of the model.EA was performed at the points (3 mm depth) 0.5 cm lateral to the acupoints of Zusanli and Feishu instead in group SEA.Luzinole 30 mg/kg was intraperitoneally injected at 30 min before establishing the model in group EA+ L.Blood samples from the right internal jugular vein were collected before ischemia (T 0), at 3 h of ischemia (T 1) and 4 h of reperfusion (T 2) for determination of the serum melatonin concentrations by enzyme-linked immunosorbent assay.Bronchoalveolar lavage fluid (BALF) was collected at 4 h of reperfusion for measurement of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6 concentrations (by enzyme-linked immunosorbent assay), superoxide dismutase (SOD) activity (by xanthine oxidase method), and malondialdehyde (MDA) concentration (by thiobarbituric acid method). Then the rabbits were sacrificed, and the lung tissues were taken for determination of wet to dry weight ratio (W/D ratio) and for microscopic examination of the pathological changes (with a light microscope) which were scored and ultrastructure (with a transmission electron microscope). The number of mitochondria and relative cross-sectional area of mitochondria were calculated. Results:Compared with group Sham, lung injury scores and W/D ratio were significantly increased, the number of mitochondria was decreased, the relative cross-sectional area of mitochondria was increased, levels of TNF-α, IL-1β, IL-6 and MDA in BALF were increased, and activities of SOD in BALF were decreased in the other four groups, and the serum melatonin concentration was decreased at T 1 and T 2 in group I/R and increased at T 0 in EA and EA+ L groups ( P<0.05). Compared with group IR, the lung injury score and W/D ratio were significantly decreased, the number of mitochondria was increased, the relative cross-sectional area of mitochondria was decreased, levels of TNF-α, IL-1β, IL-6 and MDA in BALF were decreased, and activities of SOD in BALF were increased in group EA, the serum melatonin concentration was increased at each time point in EA and EA+ L groups ( P<0.05), and no significant change was found in the parameters mentioned above in group SEA ( P>0.05). Compared with group EA, lung injury scores and W/D ratio were significantly increased, the number of mitochondria was decreased, the relative cross-sectional area of mitochondria was increased, levels of TNF-α, IL-1β, IL-6 and MDA in BALF were increased, and activities of SOD in BALF were decreased in SEA and EA+ L groups, and the serum melatonin concentration was decreased at each time point in group SEA ( P<0.05). Conclusion:EA can reduce lung injury induced by limb I/R by increasing serum melatonin level in rabbits.

Objective: To identify risk factors for positive surgical margin after laparoscopic radical prostatectomy. Method: The study retrospectively analyzed the records of 177 patients with prostate cancer who eventually underwent laparoscopic radical prostatecto-my from January 2016 to December 2017 in Peking University First Hospital. Age, prostate volume, prostate-specific antigen (PSA) be-fore needle biopsy, number of positive cores, positive percentage of needle biopsy and biopsy, and postoperative Gleason scoreand pathological stage were analyzed. Results: The overall positive surgical margin rate was 32.2% (57/177). Age, prostate volume, PSA be-fore needle biopsy, positive percentage of biopsy, and postoperative Gleason score were not significantly different (P>0.05). The study demonstrated significant differences between the number of positive cores, positive percentage of needle biopsy, and pathological stage (P<0.05). Multiple logistic regression revealed that the pathological stage was an independent factor affecting the positive surgi-cal margin rate (odds ratio, 1.616; 95% confidence interval, 1.062-2.459). Conclusions: The number of positive cores, positive percent-age of needle biopsy, and pathological stage significantly correlated with a positive surgical margin. The postoperative pathological T stage is an independent factor affecting positive surgical margins.

Objective To evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma.Methods Perioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed.There were 39 males and 41 females,with mean age of 45.1 years (13-76 years old).The median tumor length was 5.1 cm (1.5-14.0 cm),with 25 cases (31.3％) on the left side,55 cases (68.8％) on the right side.There were 37 cases combined with coronary heart disease or diabetes or BMI≥24 kg/m2.Patients were divided into hemodynamic instability (HI group) and hemodynamic stability group (HS group) by whether intraoperative hemodynamic instability occurred.The differences of demographic characteristics and clinical parameters between the two groups were compared.Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery.Results There were 54 cases (67.5％) in the HS group and 26 cases (32.5％) in the HI group.Univariate analysis showed that there was no significant difference in age [(44.06 ± 13.58) years old vs.(47.35 ± 16.11) years old],combined with coronary heart disease or diabetes or BMI≥24 kg/m2 [50.0％(27/54) vs.38.5％ (10/26)],tumor long diameter [median 5.0 cm(1.5-14.0 cm) vs.6.0cm(1.5-13.5 cm)],tumor location [left:29.6％ (16/54) vs.34.6％ (9/26)],preoperative catecholamine test positive [44.4％ (20/45) vs.50.0％ (10/20)],open surgery [27.8％ (15/54) vs.34.6％ (9/26)]and preoperative non-alpha blockers[13.0％ (7/54) vs.30.8％ (8/26)] between HS group and HI group (P ＞ 0.05).Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability.Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI (OR =4.574,95 ％ CI 1.273-16.432,P =0.020).Conclusions Preoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability.Therefore,it is recommended that patients with adrenal incidental tumors,especially those who fail to rule out pheochromocytoma,take preoperative alpha blockers.

BACKGROUND: In clinical practice, inducible grafting from trimmed spinous process of hinge groove combined with different internal fixators is primarily applied to prevent postoperative axial pain after unilateral open-door cervical expansive laminoplasty. OBJECTIVE: To investigate the influence of autologous grafting of hinge groove combined with two internal fixators on postoperative axial pain after unilateral open-door cervical expansive laminoplasty. METHODS: We retrospectively reviewed 106 patients with multilevel ossification of cervical posterior longitudinal ligament who had underwent unilateral open-door cervical expansive laminoplasty with pedicle screw fixation (n=52, including grafting in 24 cases and non-grafting in 28 cases) or with mini-plate fixation (n=54, including grafting in 37 cases and non-grafting in 17 cases). Fusion rate of hinge groove, characteristics of postoperative axial pain and postoperative efficacy were evaluated by means of imaging methods. RESULTS AND CONCLUSION: All the 106 patients were followed up for 3.2-5.9 years, with no appearance of breaking or loosening of fixed appliances, disruption of the interior cortex of hinge groove. The 19 of 106 cases appeared to have postoperative axial pain, including 9 cases in the pedicle screw group (grafting: 4 cases, non-grafting: 5 cases) and 10 cases in the mini-plate group (grafting: 3 cases, non-grafting: 7 cases). Under the condition of pedicle screw fixation, there were no significant differences in the fusion rate at 3 months postoperatively and improvement rate of Japanese Orthopaedic Association Scale (JOA) score at final follow-up between the grating and non-grafting groups. After the implementation of mini-plate fixation, there was also no difference in JOA improvement rate at final follow-up between the grafting and non-grafting groups, but the fusion rate in the grafting group was significantly higher than that in the non-grafting group at 3 months postoperatively (P < 0.05). After pedicle screw fixation, there was no significant difference in incidence, onset time and severity of initial onset, duration, pain improvement between grafting and non-grafting groups. When fixed by mini-plates, pain duration and pain improvement were better in the grafting group than the non-grafting group (P < 0.05), and there were still no significant differences in the other indices between the two groups. To conclude, hinge grafting combined with pedicle screw fixation cannot affect onset characteristics of postoperative axial pain, while hinge grafting combined with mini-plate fixation can reduce duration of postoperative axial pain, improve prognosis, promote definite fusion of hinge groove, thereby remodeling alignment balance and biomechanical stability as soon as possible.