Objective: To investigate the efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction，so as to provide reference for clinical practice. Methods: The clinical data of 44 patients who underwent robot-assisted laparoscopic radical cystectomy，lymph node dissection，and modified Y-shaped ileal orthotopic neobladder reconstruction during Feb.2020 and Aug.2022 were retrospectively analyzed.The surgical position，Trocar position，and key surgical steps were reported.The perioperative conditions，postoperative complications，neobladder volume，maximum urinary flow rate，postvoid residual，renal function，and urinary control function were recorded. Results: All 44 surgeries were successfully completed，with operation time of (314.32±51.02) min，modified Y-shaped ileal orthotopic neobladder reconstruction time of (103.52±9.56) min，and bleeding volume of (128.18±57.27) mL.The postoperative time for fluid intake was (4.16±0.86) days，catheter indwelling time was (14.02±3.20) days，and patients were discharged 1 to 2 days after catheter removal.Clavien-Dindo grade Ⅱ and Ⅲ complications occurred in 15 and 2 patients，respectively.During the follow-up of (20.77±5.90) months，dysuria occurred in 1 case，urethral calculi in 2 cases，and incomplete bowel obstruction in 2 cases. The postoperative neobladder capacity was (195.75±15.51) mL，maximal urinary flow rate (20.30±2.05) mL/s，postvoid residual (19.86±13.80) mL and serum creatinine (81.98±25.97) μmol/L. The incidence of daytime and nocturnal urinary incontinence 3，6 and 12 months after operation were 20.45% and 29.55%，11.36% and 18.18%，and 4.55% and 9.09%，respectively. Conclusion: Robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction has favorable efficacy and safety，and low incidence of postoperative complications，which can be applied in clinical practice.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the role and mechanism of sodium valproate (VPA) in cardiac and cerebral injuries after cardiopulmonary resuscitation (CPR) in pigs.Methods:Twenty-five healthy male domestic pigs, weighing (37±3) kg, were randomly divided into the sham group ( n=6), CPR group ( n=10), and CPR+VPA group ( n=9). Cardiac arrest was induced by alternating current delivered via a pacing catheter in the right ventricle and untreated for 9 min, and then CPR was performed for 6 min, in which this procedure was used to establish the animal model of cardiac arrest and CPR. At 5 min after resuscitation, a dose of 150 mg/kg of VPA was infused with a pump via the femoral vein in 1 h in the CPR+VAP group. At 1 h, 2 h, 4 h and 24 h after resuscitation, blood samples were drawn from the femoral vein, and then used to measure the serum concentrations of cardiac troponin I (cTnI), creatine kinase MB (CKMB), neuron specific enolase (NSE), and S100B protein (S100B) by ELISA. At 24 h after resuscitation, the animals were euthanized, and then tissue specimens in the left myocardium and brain cortex were rapidly harvested to detect the expression levels of C/EBP homologous protein (CHOP), caspase 12, and caspase 3 by Western blot, and the rate of apoptotic cells was detected by TUNEL. Continuous variables were compared with one way analysis of variance among the three groups. Results:(1) After resuscitation, cardiac and cerebral injury biomarkers including cTnI, CKMB, NSE, and S100B in serum were significantly increased in the CPR and CPR+VPA groups compared with the Sham group (all P<0.05). The serum concentrations of cTnI and NSE starting 1 h after resuscitation and the serum concentrations of CKMB and S100B starting 2 h after resuscitation were significantly decreased in the CPR+VPA group compared to the CPR group (all P<0.05). (2) Those proteins related to cell apoptosis mediated by endoplasmic reticulum stress, including CHOP, caspase 12, and caspase 3, were significantly increased, and meanwhile apoptosis index was markedly elevated after resuscitation in the CPR and CPR+VPA groups compared with the Sham group (all P<0.05). Nevertheless, the expression levels of CHOP, caspase 12, and caspase 3 were significantly decreased, and cell apoptosis was markedly reduced in the heart and brain after resuscitation in the CPR+VPA group compared to the CPR group (all P<0.05). Conclusions:VPA can alleviate cardiac and cerebral injuries after CPR in pigs, and its mechanism may be possibly related to the inhibition of cell apoptosis mediated by endoplasmic reticulum stress.

Based on 18 hospitals including the Chinese People's Liberation Army General Hospital and Peking University People's Hospital, and based on the "Specifications for Perioperative Data", explore the construction and application of perioperative multi-center data centers in the era of medical big data. The use of data ferry technology avoids hidden safety hazards in hospitals, realizes the integration and sharing of perioperative medical data of various medical institutions, and forms a complete data chain combining patient medical data and follow-up data.
Hospitals, Military ; Humans ; Military Personnel ; United States

Objective To observe the effect of mitofusion 2 (MFN2) on the proliferation of prostate cancer cells and its molecular mechanism. Methods Lentivirus containing the MFN2 coding sequence (Lenti-MFN2) were used to infect the prostate cancer cell lines DU-145 and LNCaP, and the lentivirus containing the green fluorescent protein gene (Lenti-GFP) were defined as the control. Real-time quantitative PCR (qRT-PCR) and Western blot were used to detect the expression of MFN2 mRNA and protein in the infected cells. MTT assay and colony formation assay were used to detect the cell proliferation. Cell cycle distribution was measured by flow cytometry.Western blot was used to detect the expression of Ras,p-Raf and p-Erk1/2 proteins in infected cells. Results The expressions of MFN2 mRNA in DU-145 and LNCaP cells of Lenti-MFN2 group were 2.79±0.91 and 3.87±1.06, which were higher than those in Lenti-GFP group (1.02± 0.27 and 1.13±0.59),the differences were statistically significant(t=3.726,P=0.010;t=5.209,P =0.002). Compared with Lenti-GFP group, the expression of MFN2 protein in Lenti-MFN2 group was increased. The number of colonies formed in DU-145 and LNCaP cells of Lenti-MFN2 group was 147.42±32.91 and 130.26± 62.47, respectively, which was lower than that of the Lenti-GFP group (255.46±50.91 and 238.10±49.77), the differences were statistically significant (t =3.565, P=0.012; t =2.700, P=0.036). The cell cycle was arrested at G0/G1phase,and the expressions of Ras, p-Raf and p-Erk1/2 proteins were significantly decreased. Conclusion MFN2 can inhibit the proliferation of prostate cancer cells,and its mechanism may be related to the inhibition of activation of Ras-Raf1-Erk1/2 signaling pathway.

Objective To observe the long-term prognosis and analyze the predictive factors of esophageal cancer patients treated with three-dimensional radiotherapy.Methods A total of 373 patients with esophageal squamous carcinoma who received three-dimensional radiotherapy were retrospectively enrolled in this study.Among these,231 cases received three dimensional conformal radiotherapy (3D-CRT) and the other 142 received intensity modulated radiotherapy (IMRT);202 cases received radiotherapy alone,and the other 171 received chemoradiotherapy;249 cases received involved-field irradiation(IFI),and the other 124 received elective nodal irradiation(ENI);60 cases received a total radiation dose of 50-60 Gy,and the other 313 received 60-70 Gy.Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS).The Logrank single factor analysis and Cox multivariate analysis were used to evaluate predictive factors of PFS and OS.Results The 1-,3-,5-year OS and PFS were 69.4％,33.7％,22.9％ and 63.8％,32.8％,22.4％,respectively.The median OS and PFS were 22.7 months (95％ CI 18.6-25.4 months) and 19.2 months (95％ CI 16.7-21.3 months) respectively.Univariate analysis showed that age,gender,tumor location,three-dimensional technology (3D-CRT vs.IMRT),chemotherapy,prophylactic irradiation to lymphatic drainage area and irradiation dose did not influence OS and PFS (P ＞ 0.05).T-stage,N-stage,TNM-stage and gross tumor volume (GTV) were significantly correlated to OS and PFS (x2 =5.836-14.526,P ＜ 0.05).The multivariate analysis showed that N-stage and GTV were independent predictive factors of OS and PFS (x2 =5.345-12.216,P ＜0.05).The OS and PFS of patients with two fields of lymph node metastases were worse than those with only one lymph node field metastasis (x2 =4.467,4.169,P ＜ 0.05).Conclusions The long-term efficacy for esophageal cancer patients could be significantly improved through 3D-CRT technology.N-stage and tumor volume were independent prognostic factors of OS and DFS.The number of lymph node metastasis field is significantly related to prognosis.

Objective To study the effects of PM2.5 on reproductive hormone levels and pregnancy outcome in female rats.Methods Thirty healthy 4-week old female Sprague-Dawley rats were randomly divided into the control group (normal saline), low dose of PM2.5(1.5 mg/kg) group and high dose of PM2.5 (37.5 mg/kg) group.After the blood samples were collected, the animals were exposed to PM2.5for 10 days, and then the rats were mated.On the 19th day of pregnancy, the rats were sacrificed for pregnancy outcome observation and blood samples were collected for hormone test.The blood hormone levels were detected using an ELISA kit.Results The live fetus rates in the control, low dose PM2.5 and high dose PM2.5 groups were 90.77%, 59.49% and 60.27%, respectively (P<0.05).The live fetus rates in the low dose PM2.5 and high dose PM2.5 groups were significantly lower than that in the control group (P<0.05).PM2.5decreased the levels of E2, PROG, CG and LH (P<0.05), compared with that in the control group.Although the blood levels of FSH were not significantly different between the low dose and control groups (P>0.05), the level of FSH in the high dose group was significantly decreased (P<0.05).Conclusions PM2.5may affect pregnancy outcome through influencing the hormone levels.

Objective To investigate the influence of early growth response gene-1 (EGR1) on the autophagy of host cells following infection with human T cell leukemia virus type 1 (HTLV-1).MethodsA HTLV-1-positive cell line MT2 was co-cultured with HeLa cells for 24 h to construct the virus early infection model.Immunoblotting assay was used to detect the expression of HTLV-1 core protein p19 and EGR1.Luciferase reporter gene analysis was used to detect the transcriptional activity of 5′-regulatory sequence of EGR1 at different time points after co-culturing.An effective small interfering RNA (siRNA) targeting EGR1 was screened out and transfected into HeLa cells by Lipofectamine 2000.Then the transfected HeLa cells were co-cultured with the HTLV-1-positive cell line MT2 for 24 h.Immunoblotting assay was used to detect HTLV-1 core protein p19, EGR1 and autophagy-related protein LC3.Real-time PCR was performed to detect viral load.Autophagosome was analyzed by immunofluorescence after co-culturing.Results The expression of EGR1 and the transcriptional activity of pEGR1-luc gradually increased after co-culturing HeLa cells with MT2 cells for 8 h (P<0.01).The expression of EGR1 was positively correlated with host cell autophagy following HTLV-1 infection.The effective siRNA for silencing the expression of EGR1 was obtained and named as siE2.The viral load, the expression of HTLV-1 core protein p19 and the proportion of LC3B/LC3A in the co-culture model were markedly down-regulated by RNA interference with siE2, which was concomitant with a persistent decrease of intracellular autophagosome (P<0.01).Conclusion EGR1 is associated with host cell autophagy and viral replication in HTLV-1 infection.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.

Objective To investigate the effect of microRN-206 (miR-206) on the expression of Cyclin-dependent kinase 4 (CDK4) and Cyclin G-associated protein kinase (GAK), and the growth of prostate cancer cells.Methods Prostate cancer cell lines DU-145 and PC-3 were transfected with miR-NC (the control group) or miR-206 (the experimental group).The expressions of CDK4 and GAK mRNA were detected by real-time quantitative PCR (qRT-PCR).The expressions of CDK4 and GAK protein were detected by Western blotting.Cell cycle distribution was detected by flow cytometry.EdU proliferation assay and colony forming assay were used to analyze the cell proliferation ability.Results In DU-145 and PC-3 cells, the expressions of CDK4 mRNA in miR-NC group were 1.00±0.09, 1.00±0.10, the expressions of GAK mRNA were 1.00±0.05, 1.00±0.06.The expressions of CDK4 mRNA in miR-206 group were significantly decreased in DU-145 (0.36±0.18;t=6.572, P=0.001) and PC-3 cell lines (0.43±0.17;t=5.794, P=0.001).The expressions of GAK mRNA were also significantly decreased in DU-145 (0.23±0.04;t=22.420, P<0.001) and PC-3 cell lines (0.32±0.08;t=14.500, P<0.001).Western blotting results were consistent with qRT-PCR results.The results of flow cytometry showed that compared with the miR-NC group of DU-145 and PC-3 cell lines, the percentage of cells in S phase (23.60%±5.68% vs.32.53%±4.52%, t=2.462, P=0.049;22.09%±4.35% vs.30.96%±4.86%, t=2.720, P=0.035) and G2-M phase (16.28%±7.12% vs.26.63%±4.33%, t=2.484, P=0.048;14.60%±1.62% vs.24.68%±7.13%, t=2.758, P=0.033) decreased after transfection of miR-206, and the percentage of cells in G0-G1 phase (60.13%±5.82% vs.40.84%±5.37%, t=4.872, P=0.003;63.31%±3.27% vs.44.36%±3.82%, t=7.533, P<0.001) increased.The results of EdU proliferation assay showed that the proliferation abilities were significantly attenuated after transfection of miR-206 (22.56±3.81 vs.38.90±8.51, t=3.503, P=0.013;25.12±6.42 vs.48.45±8.92, t=4.244, P=0.005).The results of colony formation experiments showed that the numbers of colonies formed by DU-145 and PC-3 in miR-NC group were 218.66±44.59 and 177.35±24.49, respectively.The numbers of colonies formed in miR-206 group were 125.38±32.80 (t=3.370, P=0.015) and 82.65±14.05 (t=6.708, P=0.001), suggesting that cell proliferation ability in miR-206 group was reduced.Conclusion miR-206 significantly inhibits the growth of prostate cancer cells by interfering with the expressions of CDK4 and GAK, suggesting that miR-206 may be a molecular targeted therapy tool for prostate cancer.