【Objective】 To investigate the efficacy and surgical technique of total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion, so as to provide reference for the selection of surgery for patients with bladder cancer. 【Methods】 Clinical data of 48 patients with bladder cancer who underwent laparoscopic radical cystectomy during Mar.2017 and Aug.2022 in our hospital were retrospectively analyzed, including 23 cases who received traditional laparoscopic radical cystectomy combined with extracorporeal ileal conduit, and 25 who received total laparoscopic radical cystectomy with intracorporeal ileal conduit.The operation time, blood loss, postoperative intestinal function recovery time, drainage tube removal time and hospital stay were compared between the two groups. 【Results】 All procedures were successfully performed, and no Clavien-Dindo>grade 3 complications were observed.The operation time, and amount of estimated blood loss of the traditional group and total laparoscopic radical group were (227.0±46.4) min vs. (253.6±58.9) min, and (131.7±79.8) mL vs. (154.0±93.0) mL, respectively.There were no differences in postoperative intestinal function recovery time and drainage tube removal time (P>0.05).The hospital stay was shorter in the total laparoscopic radical group than in the traditional group (P=0.035). 【Conclusion】 Total laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion is safe and feasible.which is comparable to the traditional laparoscopic surgery, while the hospital stay in the total laparoscopic group is shorter, which is conducive to rapid postoperative recovery.

Objective To observe the value of clinical and CT radiomics features for predicting microsatellite instability-high(MSI-H)status of gastric cancer.Methods Totally 150 gastric cancer patients including 30 cases of MSI-H positive and 120 cases of MSI-H negative were enrolled and divided into training set(n=105)or validation set(n=45)at the ratio of 7∶3.Based on abdominal vein phase enhanced CT images,lesions radiomics features were extracted and screened,and radiomics scores(Radscore)was calculated.Clinical data and Radscores were compared between MSI-H positive and negative patients in training set and validation set.Based on clinical factors and Radscores being significant different between MSI-H positive and negative ones,clinical model,CT radiomics model and clinical-CT radiomics combination model were constructed,and their predictive value for MSI-H status of gastric cancer were observed.Results Significant differences of tumor location and Radscore were found between MSI-H positive and negative patients in both training and validation sets(all P＜0.05).The area under the curve(AUC)of clinical model,CT radiomics model and combination model for evaluating MSI-H status of gastric cancer in training set was 0.760,0.799 and 0.864,respectively,of that in validation set was 0.735,0.812 and 0.849,respectively.AUC of clinical-CT radiomics combination model was greater than that of the other 2 single models(all P＜0.05).Conclusion Clinical-CT radiomics combination model based on tumor location and Radscore could effectively predict MSI-H status of gastric cancer.

Humans ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Pancreatic Neoplasms ; Pancreas ; Needles

In recent years,the field of nucleic acid therapeutics has been flourishing,progressively establishing itself as the third generation of drug modalities following small molecules and antibody-based drugs.Artificial intelligence technology based on machine learning is advancing rapidly,which can significantly accelerate the development process of nucleic acid therapeutics.This review provides an overview of the foundational aspects of artificial intelligence algorithms,databases,and characterizations in the field of nucleic acid drug development.It elucidates the advances in the application of artificial intelligence in nucleic acid structural prediction,small nucleic acid drug design,and other research and development phases of nucleic acid therapeutics,aiming to offer some reference for the interdisciplinary development of artificial intelligence and nucleic acid drugs.

Objective:To describe the population and area distribution differences in the prevalence of urinary incontinence in middle-aged and elderly adults in 10 areas in China.Methods:A total of 24 913 participants aged 45-95 years who completed the third resurvey of China Kadoorie Biobank during 2020-2021 were included. The prevalence of urinary incontinence was assessed by an interviewer-administered questionnaire, and urinary incontinence was classified as only stress urinary incontinence, only urgency urinary incontinence and mixed urinary incontinence. The prevalence of urinary incontinence and its subtypes were reported by sex, age and area, and the severity of urinary incontinence and treatment were described.Results:The average age of the participants was (65.4±9.1) years. According to the seventh national census data in 2020, the age-standardized prevalence rates of urinary incontinence was 25.4% in women and 7.0% in men. The age-standardized prevalence rates of only stress, only urgency and mixed incontinence were 1.7%, 4.2% and 1.2% in men and 13.5%, 5.8% and 6.1% in women, respectively. The prevalence rates of urinary incontinence and all subtypes in men and the prevalence of urinary incontinence and all subtypes except only stress urinary incontinence in women all increased with age ( P<0.001). After adjusting for age, the prevalence of urinary incontinence in both men and women were higher in rural area than in urban area ( P<0.001). The treatment rates in men and women with urinary incontinence were 15.4% and 8.5%, respectively. Conclusions:The prevalence of urinary incontinence was high in middle-aged and elderly adults in China, and the prevalence rate was higher in women than in men, but the treatment rate of urinary incontinence was low.

Most patients with initial diagnosed lung cancer are at advanced ages.125I seeds implantation for treating lung cancer has advantages of high intratumoral dose and low radiation damage to surrounding tissue,especially suitable for elderly patients not able to tolerate surgery nor external radiotherapy.The efficacy and prospects of 125I seeds implantation for treating middle-late stage lung cancer in elderly patients were reviewed in this article.

Objective:To evaluate the preoperative localization value of endoscopic ultrasound guided fine needle tattooing (EUS-FNT) for laparoscopic distal pancreatectomy in pancreatic lesions with a maximum diameter ≤3 cm.Methods:From November 2017 to October 2022, at the Second Affiliated Hospital of Soochow University, the data of patients with pancreatic lesions ≤3 cm who underwent laparoscopic distal pancreatectomy were retrospectively analyzed. Eight patients who underwent EUS-FNT assisted laparoscopic distal pancreatectomy were included in the fine needle tattooing (FNT) combined laparoscopic group. And 14 patients who underwent simple laparoscopic distal pancreatectomy were taken as the simple laparoscopic group. The success rate and complications of EUS-FNT were observed. The differences in operation time, surgery-related complications and complete resection rate of lesions between the two groups were compared. Mann-Whitney U test and descriptive analysis were used for statistical analysis. Results:In the FNT combined laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 4 cases in the pancreatic tail. In the simple laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 10 cases in the pancreatic tail. There was a significant difference in lesion size between the two groups (14.5 mm (10.8 mm, 16.5 mm) vs. 27.0 mm (23.5 mm, 30.0 mm), Z=-3.09, P=0.001). In the FNT combined laparoscopic group, EUS-FNT was successfully performed in all 8 patients. The average time of laparoscopy after EUS-FNT was (98.4±8.8) min. The marks were clearly visible under the laparoscopic field of view, and no complications such as abdominal hemorrhage and hematoma were observed. Laparoscopic pancreaticocaudectomy was performed in 5 cases and pancreaticocaudectomy plus splenectomy in 3 cases. The median operation time was 192.5 min (176.3 min, 203.8 min). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. The lesions were one-time completely resected in all 8 patients. The postoperative pathology were 6 cases of pancreatic neuroendocrine neoplasm, 1 case of intraductal papillary mucinous neoplasm (IPMN), and 1 case of solid pseudopapilloma. In the simple laparoscopic group, laparoscopic pancreaticocaudectomy was performed in 2 cases and pancreaticocaudectomy plus splenectomy in 12 cases. The median operation time was 202.5 min (192.8 min, 235.0 min), which was longer than that of FNT combined laparoscopic group, but the difference was not statistically significant ( P>0.05). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. In 1 patient with pancreatic body lesions, no lesion was found in the specimen examination after the first pancreatectomy, and the lesions were completely resected after the second partial pancreatectomy. Active abdominal hemorrhage occurred in 1 patient on the second day after operation, and underwent interventional embolization for hemostasis. Two weeks after surgery, 1 patient was found to have a encapsulated fluid with a long diameter of 6 cm around the pancreas by computed tomography re-examination 2 weeks after surgery. The postoperative pathology were 5 cases of pancreatic neuroendocrine neoplasm, 2 cases of IPMN, 1 case of solid pseudopapilloma, 1 case of pancreatic cyst with glandular low-grade intraepithelial neoplasia, 1 case of ectopic spleen, and 4 cases of pancreatic ductal adenocarcinoma. Conclusion:EUS-FNT can effectively localize small pancreatic lesions before laparoscopic distal pancreatectomy, shorten the operation time and improve the complete resection rate under laparoscopy.

Lung cancer is one of the malignant tumors with the highest incidence rate and mortality in the world today. Although significant progress has been made in the treatment of lung cancer, its 5-year survival rate is still very low. Ferroptosis is a cell death mode characterized by an increase in intracellular free iron, lipid peroxidation, and accumulation of reactive oxygen species. More and more evidence suggests that ferroptosis plays a crucial role in the occurrence and development of lung cancer, and exploring the mechanism of ferroptosis in lung cancer is of great significance for finding new diagnostic and treatment methods for lung cancer. This article reviews the regulatory mechanism of cell ferroptosis and its role in the occurrence and development of lung cancer, with the aim of providing new directions and ideas for the diagnosis and treatment of lung cancer.

Objective:To investigate the protective effect of Dictyophora polysaccharide on neurotoxicity induced by sodium arsenite in rats.Methods:Sixty SD rats (half males and half females) were selected and fed adaptively for one week. The rats were divided into a normal group ( n = 20, ordinary feed) and a modeling group [ n = 40, arsenic-containing feed (50 mg/kg sodium arsenite)] according to their body weight (80 - 100 g) by random number table method. After 12 weeks, the arsenic content in brain and blood of the rats ( n = 10) was measured to identify the arsenism model. After successful modeling, the rats in the modeling group were divided into Dictyophora polysaccharide group (arsenic-containing feed + 20 ml·kg -1·bw Dictyophora polysaccharide solution by gavage), and model group (arsenic-containing feed + equal volume distilled water by gavage), while the rats in the normal group (ordinary feed + equal volume distilled water by gavage) were retained, with 10 rats in each group for 4 weeks of intervention. Morris water maze test was used to assess the spatial learning and memory ability of the rats. Nissl staining was used to observe the pathological changes of the brain tissue, and the oxidative stress factors [superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA)], and inflammatory cytokines [tumor necrosis factor-α (TNF-α) and interleukin -1β (IL-1β)] in the brain tissue of each group were measured. Results:Brain arsenic content of rats in the modeling group [(92.02 ± 13.37) μg/g] and blood arsenic content [(51.37 ± 19.33) μg/L] were higher than those of the normal group [(7.42 ± 3.21) μg/g and (2.74 ± 1.29) μg/L, t = - 6.91, - 6.06, P < 0.001]. The rat model of arsenic poisoning was successfully established. Compared with the normal group, the escape latency on the 1st, 3rd and 4th day and the first arrival time of rats in the model group were prolonged, the number of platform crossings was reduced, and the proportion of target quadrant residence time was decreased ( P < 0.05). Compared with the model group, the escape latency on the 4th day and the first arrival time of rats in the Dictyophora polysaccharide group were shortened, and the proportion of target quadrant residence time was prolonged ( P < 0.05). The results of Nissl staining showed that compared with the normal group, the number of Nissl bodies was decreased, the intercellular space increased, and the arrangement was disorderly in the model group; compared with the model group, the number of Nissl bodies was increased, most of the neurons were structurally intact. Compared with the normal group, the levels of SOD and GSH-Px in the brain tissue of rats in the model group were lower, and the levels of MDA, TNF-α and IL-1β were significantly higher ( P < 0.05). Compared with the model group, the levels of SOD and GSH-Px in the brain tissue of rats in the Dictyophora polysaccharide group were higher, while the levels of MDA, TNF-α and IL-1β were lower ( P < 0.05). In addition, the levels of SOD, GSH-Px, MDA and IL-1β in the Dictyophora polysaccharide group were not significantly different from those in the normal group ( P > 0.05). Conclusion:Diactyophora polysaccharide probably reduces the neurotoxicity damage caused by sodium arsenite in rats through antioxidant and antiinflammatory effects.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.