Objective:To explore the value in differentiating Borrmann Ⅳ type gastric cancer (BT4-GC) from gastric diffuse large B-cell lymphoma (DLBCL) using a nomogram based on CT texture analysis (CTTA) and morphological characteristics.Methods:From June 2011 to December 2020, a total of 60 patients with BT4-GC and 24 patients with DLBCL were retrospectively collected in Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. Morphological characteristics were evaluated, including major location, long axis range, circumferential range, mucosal line status, and perigastric enlarged lymph nodes. CTTA parameters were calculated using venous CT images with a manual region of interest. The morphological characteristics and CTTA parameters between BT4-GC and DLBCL were compared by χ 2 test, Fisher exact test or Mann-Whitney U test. The multivariate binary logistic regression analysis was used to filter factors into the diagnostic model and construct a nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of CTTA parameters and the diagnostic model in differentiating BT4-GC from DLBCL. Results:For morphological characteristics, mucosal line status showed a significant difference between BT4-GC and DLBCL (χ 2=12.99, P<0.001). For CTTA parameters, 16 parameters showed significant differences between BT4-GC and DLBCL (all P<0.05). The area under the ROC curve (AUC) of 16 CTTA parameters in differentiating BT4-GC from DLBCL was 0.662-0.833. Percentile 90 showed the highest AUC of 0.833 (95%CI 0.736-0.906). The mucosal line status (OR 4.82, 95%CI 1.21-19.25, P=0.026) and percentile 90 (OR 1.09, 95%CI 1.04-1.15, P=0.001) were brought into the diagnostic model and constructed a nomogram. The AUC of the model in differentiating BT4-GC from DLBCL was 0.898 (95%CI 0.813-0.953), sensitivity was 0.833, and specificity was 0.817. Conclusions:The nomogram based on CTTA percentile 90 and morphological characteristics mucosal line status can effectively distinguish BT4-GC from DLBCL and shows high diagnostic efficacy.

OBJECTIVE To systematically evaluate the efficacy and safety of oral Janus kinase （JAK） inhibitor in the treatment of alopecia areata （AA）in order to provide evidence -based reference for clinical use . METHODS PubMed，Embase， Web of Science ，the Cochrane Library ，CNKI，Wanfang and CBM were searched from the inception to March 29，2022. Randomized controlled trials （RCTs）of oral JAK inhibitors （trial group ）versus placebo （control group ）in the treatment of AA were collected . Two researchers independently screened the literature ，extracted the data ，and evaluated the quality of the included studies. RevMan 5.4 software was used for meta -analysis and analysis of publication bias . RESULTS A total of 2 170 patients were enrolled in 5 RCTs，including 1 619 in the trial group and 551 in the control group . Meta-analysis results showed that ：compared with control group ，the ratio of the patients with the Severity Alopecia Tool （SALT）score ≤20 at 24th week [RR＝6.10，95%CI （3.86，9.63），P＜0.000 01] and 36th week [RR＝6.59，95%CI（4.16，10.43），P＜0.000 01] were both higher ；Hospital Anxiety and Depression Scale -Anxiety （HADS-A） score [RR＝0.35， 95%CI （0.07，0.64），P＝0.02] and Hospital Anxiety and 1009） Depression Scale -Depression （HADS-D） score [RR＝0.50， 95%CI（0.22，0.77），P＝0.000 4] were more decreased at 24th week . HADS-A score [RR＝0.55，95%CI（0.21，0.89）， 话：0371-66913047。 P＝0.001] and HADS -D score [RR＝0.50， 95%CI （0.16，0.84），P＝0.004] were also significantly decreased at 36th week . The incidence of acne [RR＝4.07，95%CI（1.83，9.08），P＝0.000 6] and low density lipoprotein （LDL）elevation [RR＝1.66，95%CI（1.21，2.28），P＝0.002] in trial group were incr eased significantly （P＜0.05）. There were no significant differences in the incidence of urinary tract infection，upper respiratory tract infection ， headache，nasopharyngitis and creatine phosphokinase elevation between 2 groups （P＞0.05）. There was little possibility of publication bias in this study based on the publication bias analysis . CONCLUSIONS Oral JAK inhibitor can significantly improve AA patients ’hair regrowth ，anxiety and depression . Acne and LDL elevation are the main adverse events .

Objective:To explore the epidemiological and pathological characteristics of multiple primary malignant tumors (MPMTs) accompanied with colorectal malignancies.Methods:The MPMTs patients with colorectal malignant tumors admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2019 were screened, and the data of gender, age, onset interval, lesion distribution, TNM stage, and pathological type were collected. Then we analyzed the epidemiological characteristics and clinicopathological characteristics.Results:A total of 235 MPMTs patients with colorectal malignancies were treated, accounting for 4.00% of the 5878 patients with colorectal malignancies during the same period. There were 154 males and 81 females, with a male-to-female ratio of 1.90∶1. The median age at diagnosis of the first primary cancer was 64 years. There were 90 synchronous multiple primary carcinomas (SC) patients (38.30%) and 145 metachronous multiple primary carcinomas (MC) patients (61.70%), and the age of first primary cancer diagnosis in SC patients was older than that in MC patients (65 and 62 years, respectively, P=0.022). The median onset interval was 13.25 months (95% CI: 19.61, 27.23 months), and the age at diagnosis of the first primary cancer was negatively correlated with the onset interval ( r=-0.224, P<0.001). There were 257 colorectal malignant tumor lesions in 235 patients, which were distributed in all intestinal segments. The TNM stages were mainly Ⅱ and Ⅲ, and the pathological type was mainly adenocarcinoma. There were no significant differences in the distribution of intestinal segments, TNM stages and pathological types of colorectal malignant tumors between the SC group and the MC group (all P>0.05). There were 234 extraintestinal lesions, mainly distributed in the lung (48), stomach (45), and liver and gallbladder (25). The proportion of extraintestinal lesions located in the stomach of SC patients was 32.18% (28/87), which was higher than that of MC patients [11.56% (17/147), P<0.001]; the proportion of extraintestinal lesions located in the thyroid of SC patients was 2.30% (2/87), lower than that of MC patients [10.20% (15/147), P=0.024]. Conclusions:Approximately 4% of patients with colorectal malignant tumors suffer from two or more malignant tumors, slightly higher in male than in female, and slightly higher in MC patients than in SC patients. The diagnosis age of the first and second primary malignant tumors is mainly concentrated among 55-75 years old, and the interval is inversely related to the diagnosis age of the first primary malignant tumor. The colorectal malignant tumors of SC and MC patients are distributed in all intestinal segments, and the pathological stages are mainly stage Ⅱ and Ⅲ, while the pathological types are mainly adenocarcinoma. Extraintestinal lesions are mostly located in the lungs and stomach.

Objective:To explore the epidemiological and pathological characteristics of multiple primary malignant tumors (MPMTs) accompanied with colorectal malignancies.Methods:The MPMTs patients with colorectal malignant tumors admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2019 were screened, and the data of gender, age, onset interval, lesion distribution, TNM stage, and pathological type were collected. Then we analyzed the epidemiological characteristics and clinicopathological characteristics.Results:A total of 235 MPMTs patients with colorectal malignancies were treated, accounting for 4.00% of the 5878 patients with colorectal malignancies during the same period. There were 154 males and 81 females, with a male-to-female ratio of 1.90∶1. The median age at diagnosis of the first primary cancer was 64 years. There were 90 synchronous multiple primary carcinomas (SC) patients (38.30%) and 145 metachronous multiple primary carcinomas (MC) patients (61.70%), and the age of first primary cancer diagnosis in SC patients was older than that in MC patients (65 and 62 years, respectively, P=0.022). The median onset interval was 13.25 months (95% CI: 19.61, 27.23 months), and the age at diagnosis of the first primary cancer was negatively correlated with the onset interval ( r=-0.224, P<0.001). There were 257 colorectal malignant tumor lesions in 235 patients, which were distributed in all intestinal segments. The TNM stages were mainly Ⅱ and Ⅲ, and the pathological type was mainly adenocarcinoma. There were no significant differences in the distribution of intestinal segments, TNM stages and pathological types of colorectal malignant tumors between the SC group and the MC group (all P>0.05). There were 234 extraintestinal lesions, mainly distributed in the lung (48), stomach (45), and liver and gallbladder (25). The proportion of extraintestinal lesions located in the stomach of SC patients was 32.18% (28/87), which was higher than that of MC patients [11.56% (17/147), P<0.001]; the proportion of extraintestinal lesions located in the thyroid of SC patients was 2.30% (2/87), lower than that of MC patients [10.20% (15/147), P=0.024]. Conclusions:Approximately 4% of patients with colorectal malignant tumors suffer from two or more malignant tumors, slightly higher in male than in female, and slightly higher in MC patients than in SC patients. The diagnosis age of the first and second primary malignant tumors is mainly concentrated among 55-75 years old, and the interval is inversely related to the diagnosis age of the first primary malignant tumor. The colorectal malignant tumors of SC and MC patients are distributed in all intestinal segments, and the pathological stages are mainly stage Ⅱ and Ⅲ, while the pathological types are mainly adenocarcinoma. Extraintestinal lesions are mostly located in the lungs and stomach.

Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.

Objective:To investigate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) with the aid of neurophysiological monitoring under general anesthesia.Methods:From August 2016 to October 2019, 58 patients underwent PELD under general anesthesia were selected in our hospital; 30 were via transformational approach and 28 were via interlaminar approach. The whole operative procedures were performed under continuous monitoring of spontaneous electromyography (SEMG), and the peak value, waveform and motor unit of SEMG at the surgical side were observed. The clinical outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI).Results:PELD was successfully performed in all 58 patients. Abnormal SEMG reactions were recorded in 8 patients (13.8%), manifested as clustered or frequent high amplitude action potentials; 5 patients (16.7%, 5/30) were via transformational approach and 3 (10.7%, 3/28) were via interlaminar approach. Two patients relapsed at 3 and 6 weeks after surgery, respectively; one was treated with PELD again and the other one was treated with lumbar fusion and instrument fixation. The pain at the lumbago and leg was alleviated obviously after surgery in the 56 patients; the VAS scores were 7.43±1.32, 2.55±0.87 and 1.59±0.87 before surgery, and 3 d and 3 months after surgery, respectively, with significant differences ( P<0.05); the mean ODI before surgery and 3 months after surgery were 67.36±7.13 and 12.39±5.48, respectively, with significant difference ( P <0.05). Conclusion:PELD with the aid of neurophysiological monitoring under general anesthesia is safe and reliable, which can achieve good clinical efficacy.

Objective To investigate the expression levels of serum miR-210and miR-375in patients with non-small cell lung cancer (NSCLC).Methods A total of 25NSCLC patients (NSCLC group) and 14healthy volunteers (control group) were enrolled in this study.The relative expression levels of 9miRNAs (miR-182, miR-126, miR-31, miR-21, miR-221, miR-200b, miR-183, miR-210and miR-375) in 6 NSCLC patients and 6healthy volunteers were measured by RT-qPCR.The dysregulated miRNAs will be selected as candidate miR-NAs.The diagnostic value were evaluated by ROC curve.Results Compared with control group, 2 (miR-210and miR-375) out of 9miRNAs were up-regulated in NSCLC group, and the differences were statistically significant (P＜0.05), while the other 7miRNAs were not consistent with the reported literatures.Therefore, miR-210and miR-375were selected as candidate miRNAs.We found that the relative expression level of miR-210in the lung adenocarcinoma group was significantly different from control group (P＜0.05), while there was no significant difference between the squamous cell carcinoma group and the control group (P＞0.05).There was no significantly statistical difference in the relative expression level of miR-375between lung squamous cell carcinoma group, lung adenocarcinoma group and the control group (P＞0.05).The AUC of serum miR-210of lung adenocarcinoma group was 0.737 5 (95％CI:0.498 3-0.976 7, P=0.091 4) with a medium diagnostic value.Conclusion MiR-210is highly expressed in the serum of patients with lung adenocarcinoma, suggesting that miR-210may be a novel tumor marker for the diagnosis of lung adenocarcinoma.The value of miR-375in the diagnosis of lung cancer still needs to be further explored.

Objective To investigate the clinical effects and safety of spiral stone basket assisted with FURL in the treatment of unilateral upper ureteral stones for diameter>1.0 cm. Methods 140 patients with unilateral upper ureteral stones for diameter>1.0 cm from January 2012 to December 2015 were randomly divided into control group (70 patients) with FURL used alone and observation group (70 patients) with spiral stone basket assisted application on the basis of control group;the perioperative clinical indicators, the lithotripsy success rate, the stone clearance rate, the stone removal rate and the postoperative complication incidence of both groups were compared. Results The operation time of observation group was signiifcantly longer than control group (P<0.05). There was no signiifcant difference in the blood loss volume in operation and hospitalization time between 2 groups (P>0.05). The lithotripsy success rate and the stone clearance rate of observation group was signiifcantly higher than control group (P<0.05). The stone removal rate of observation group was signiifcantly lower than control group (P<0.05). The postoperative complication incidence of observation group was no difference between 2 groups (P> 0.05). The total treatment expenses of observation group was signiifcantly fewer than control group (P<0.05). Conclusion Spiral stone basket assisted with FURL in the treatment of unilateral upper ureteral stones for diameter>1.0 cm can efifciently higher the stone removal effects, reduce the stone removal risk and not increase the postoperative complications incidence.

Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.

To investigate the changes in the expression levels of scavenger receptor class B member 1 (SCARB 1) in the liver tissues before and after liver xenotransplantation and analyze the relationship between the variations in the SCARB1 expression and coagulation regulating dysfunction in the recipients.Methods The Wuzhishan miniature pig with α-1,3-galactosyltransferase gene-knockout(GTKO) was utilized as the donor and Macaca thibetana was chosen as the recipient.Heterotopic auxiliary liver xenotransplantation models were established.The liver tissue specimen was collected before and after liver xenotransplantation.Primary hepatocytes were extracted from the pig using collagenase digestion method.Human peripheral blood mononuclear cells were obtained by immunomagnetic bead sorting.These two types of cells were co-cultured and supplemented with human plasma to establish cell models with coagulation regulating dysfunction following liver xenotransplantation.Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) and Western blot were performed to quantitatively measure and statistically compared the expression levels of messenger ribonucleic acid (mRNA) and protein of SCARB1 in the tissue and cell samples.At the cellular level,the expression of SCARB 1 was interfered by lentiviral vector.The coagulation time was detected to validate the effect upon coagulation function.Results The expression levels of SCARB1 mRNA and protein were significantly down-regulated after liver xenotransplantation (both P＜0.05).In the cell models,the expression levels of SCARB1 mRNA and protein in the porcine hepatocytes co-cultured with human monocytes were significantly down-regulated compared with those in porcine hepatocytes without intervention (both P＜0.05).Compared with the non-intervention group,the coagulation time was significantly prolonged after the expression of SCARB1 was interfered by lentiviral vector (P＜0.05).Conclusions The down-regulated expression of SCARB1 in the liver graft is one of the main causes of mediating coagulation regulating dysfunction.Intervention of SCARB1 expression contributes to resolve the coagulation regulating dysfunction in the recipients after liver xenotransplantation.