Flubromazolam(Flub)is a novel psychoactive substance of benzodiazepines and the mechanism underlying its addiction still remains elusive.This study investigated the reward effect of Flub using conditioned place preference(CPP)mouse model.The neuronal activity was evaluated by c-Fos expression,and the neural circuit was tracked by virus tracing.This study also investigated the regulatory effect of neural circuits on Flub-induced reward effects through chemogenetic approach.The results showed that,at the dose of 3 mg/kg,Flub significantly increased CPP score and c-Fos expression in dopaminergic(DA)neurons of ventral tegmental area(VTA).Inhibition of VTA dopaminergic neuron activity dramatically decreased Flub-induced CPP score.Virus tracing verified GABAergic neuronal projection of medial rostrum tegmental nucleus(RMTg)to VTA dopaminergic neurons.Activation of RMTgGABA→VTADA circuit or blockade of benzodiazepine receptors(BZR)in RMTg significantly decreased Flub-induced CPP score.These results indicate that Flub produced reward effect via BZR-mediated RMTgGABA→VTADA circuit.

Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.
Humans ; Venous Thromboembolism/etiology* ; Multiple Myeloma/diagnosis* ; Risk Assessment ; Risk Factors ; ROC Curve ; Retrospective Studies

Objective:To investigate the distribution and epidemic characteristics of respiratory pathogens in children before and after COVID-19 epidemic in Lanzhou.Methods:Two hundred and eighty-six children hospitalized with acute upper respiratory tract infection in Central Hospital of Gansu Province and Gansu Maternal and Child Health Hospital from October to November of 2020 and October to November of 2021 were selected respectively as the research objects, and a retrospective analysis was made.IgM antibodies of nine pathogens, including influenza virus A(IVA), influenza virus B(IVB), parainfluenza virus(PIV), adenovirus(ADV), mycoplasma pneumoniae(MP), chlamydia pneumoniae(CP), respiratory syncytial virus(RSV), echovirus(ECHO)and coxsackie virus B(CVB), were detected, and the basic information and epidemic characteristics were statistically analyzed.Results:The total positive rates of IgM antibodies of nine pathogens before and after the epidemic in COVID-19 were 31.8%(91/286)and 5.9%(17/286)respectively, after the epidemic, the detection rates dropped significantly, and there was significant difference among them( χ2= 62.505, P<0.05); After the epidemic, the detection rates of ADV, MP and CVB were all lower than those before the epidemic, and there were significant differences among these groups( χ2= 39.281, 12.167, 10.155, all P<0.05). The positive detection rates in the age group of 1 month ~1 year, ~3 years, ~6 years and>6 years before the outbreak were 37.4%(37/99), 38.3%(36/94), 16.7%(12/72)and 28.6%(6/21)respectively, and there were significant differences among these groups( χ2=34.055, P<0.05); Among them, the detection rates of MP in the age group 1 month ~1 year, ~3 years, ~6 years and>6 years were 16.2%(6/37), 25.0%(9/36), 16.7%(2/12)and 100%(6/6)respectively, and there were significant differences among these groups( χ2=10.289, P<0.05); CVB was not detected in>6 years group, the positive detection rates of CVB were 16.2%(6/37), 22.2%(8/36)and 25.0%(3/12)in the age group of 1 month ~1 year, ~3 years, ~6 years respectively, and there were significant differences among these groups( χ2= 27.742, P< 0.05). After the epidemic, the positive detection rates of the patients in the age group of 1 month ~1 year, ~3 years, ~6 years and>6 years were 5.9%(4/68), 4.0%(3/75), 5.7%(6/106)and 10.8%(4/37), with no statistical significance( χ2=2.235, P>0.05); Among them, the positive rates of IVB were 25.0%(1/4), 33.3%(1/3)and 66.7%(4/6)in the age group of 1 month ~1 year, ~3 years, ~6 years respectively, and in the age group>6 years was not detected, and there were significant differences among these groups( χ2= 96.022, P< 0.05). The detection rates of mixed infection of pathogens before and after the epidemic were 5.6%(16/286)and 0.3%(1/286)respectively, with no statistical significance( χ2= 2.314, P>0.05). Conclusion:The distribution of common pathogens of acute upper respiratory tract infection among children in Lanzhou was different before and after COVID-19 epidemic.

Alpha-fetoprotein producing gastric cancer (AFPGC) is a special type of gastric cancer. AFPGC is considered to be the most highly invasive tumor with a high degree of malignancy and prone to metastasis. As a consequence, it usually causes unsatisfied treatment effect and the prognosis is poor. At present, treatment methods and monitoring indicators have limited effect on AFPGC. VEGF, HER2, AFP, GPC3 and SALL4 are cogently associated with tumor genesis and development. If we can reasonably guide the treatment and prognosis of AFPGC patients, it will greatly improve the situation of patients and improve the survival of patients. This article reviews the research progress of the genes related to the treatment and prognosis of AFPGC.

Objective:To compare modified load-sharing rip-stop (mLSRS) technique with suture bridge (SB) for repair of massive rotator cuff tears.Methods:A retrospective analysis was conducted of the 68 patients who had been treated for massive rotator cuff tears from January 2017 to June 2019 at Department of Orthopedics, Dongyang People's Hospital. They were 26 males and 42 females, aged (63.4±1.0) years (from 45 to 84 years), with 56 right and 12 left sides affected. Of them, 32 were treated by mLSRS and 36 by double-line SB. The 2 groups were compared in terms of visual analog scale (VAS), Constant-Murley scoring, University of California Los Angeles (UCLA) scoring and American Shoulder and Elbow Surgeons (ASES) scoring at the final follow-ups, and Sugaya ultrasonic evaluation of the repair integrity at postoperative 12 months.Results:There was no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05). Operations were successful in all patients who were followed up for 13 to 44 months (average, 19.7 months). No patient suffered from such complications as joint infection or anchor withdrawal. At the final follow-up, the mLSRS group scored respectively 0.9±0.6, 85.3±4.8, 33.1±1.0 and 86.4±5.0 in VAS, Constant-Murley, UCLA and ASES scores, significantly improved than their preoperative values (7.2±0.8, 47.0±3.1, 15.8±3.0 and 48.5±4.5) ( P<0.05); the SB group scored respectively 1.1±0.6, 86.6±3.4, 33.2±1.1 and 86.9±4.6 in the above indicators, also significantly improved than their preoperative values (7.3±0.7, 46.5±4.7, 14.4±2.7 and 48.8±4.3) ( P<0.05); there were no significant differences between the 2 groups in preoperative or postoperative values ( P> 0.05). The Sugaya ultrasonic evaluation showed no significant difference in rotator cuff healing between the 2 groups at postoperative 12 months ( P>0.05); according to the positions of re-tears, the SB group had significantly more type Ⅱ re-tears (20%, 2/10) than the mLSRS group (0, 0/4) ( P<0.05). Conclusion:Although both mLSRS and SB techniques can achieve satisfactory and comparable clinical outcomes in arthroscopic repair of massive rotator cuff tears, mLSRS may lead to fewer postoperative type Ⅱ re-tears than SB.

Atherosclerosis(AS), characterized with the accumulation of lipids on the vessel wall, is an immune-related inflammatory disease which promotes the progression of cardiovascular diseases(CVD). The imbalance of Treg/Th17 accelerates the progression of AS. Yangyin Huoxue Prescription(YHF)is an efficient traditional Chinese medicine used in the treatment of AS, but the effects of YHF on the balance of immunity have still not been clarified. This project was designed to investigate the effects of YHF on the imbalance of Treg/Th17 and AS in ApoE-/- mice induced by high-fat diet(HFD). ApoE-/- mice were given HFD to induce AS and administered low-dose YHF(18 g/kg)or high-dose YHF(36 g/kg)for 20 weeks. Atherosclerotic plaque area was analyzed by oil red O staining. Serum lipids were measured by biochemical kits. Treg or Th17 cells in peripheral blood were detected by flow cytometry. mRNA and protein expression of Foxp3 and RORγt of aortas were determined by qRT-PCR, Western blot and immunohistochemistry. Splenic CD4+T cells of mice were isolated and activated by anti-CD3/CD28, and then treated with lipopolysaccharide(LPS)and YHF. The expression of mRNA and protein of Foxp3 and RORγt were detected by qRT-PCR and immunofluorescence. It was found that YHF reduced the plaque area, decreased lipid level and increased the ratio of Treg cells in peripheral blood. Moreover, YHF increased mRNA or protein expression of Foxp3 in aortas in vivo or CD4+T cells in vitro while decreasing mRNA or protein expression of RORγt. These results suggested that YHF can regulate the imbalance of Treg/Th17 in ApoE-/- mice induced by HFD, and reduce the inflammatory stimulation of LPS on CD4+T cells, thereby improving AS.

Objective:To investigate the application value of Clavien-Dindo classification in evaluation of postoperative short-term complications of Da Vinci robotic-assisted or laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy. Methods:The retrospective cohort study was conducted. The clinicopathological data of 262 patients with gastric cancer who were admitted to the 940th Hospital of Joint Logistic Support Force of Chinese People′s Liberation Army from January 2016 to January 2019 were collected. There were 214 males and 48 females, aged (58±11) years, with a range from 17 to 81 years. Of 262 patients, 120 cases undergoing Da Vinci robotic-assisted total gastrectomy + D 2 lymphadenectomy + Roux-en-Y anastomosis were divided into robotic group, and 142 cases undergoing laparoscopic-assisted total gastrectomy + D 2 lymphadenectomy + Roux-en-Y anastomosis were divided into laparoscopic group. Observation indicators: (1) intraoperative and postoperative situations; (2) postoperative pathological examination; (3)complications; (4) stratified analysis; (5) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect complications, tumor recurrence and survival of patients within postoperative 2 months. The follow-up was up to May 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data between groups was analyzed using the rank sum test. Results:(1) Intraoperative and postoperative situations: cases undergoing conversion to open surgery, the operation time, volume of intraoperative blood loss, the number of lymph node dissected, time to first flatus, time to initial fluid diet intake, duration of postoperative hospital stay of the robotic group were 1, (243±42)minutes, 100 mL(range, 100-150 mL), 38±15, (2.8±1.0)days, 3 days(range, 3-4 days), 11 days(range, 9-13 days), respectively. The above indicators of the laparoscopic group were 2, (244±38)minutes, 100 mL(range, 100-150 mL), 34±14, (3.2±1.0)days, 4 days(range, 3-5 days), 10 days(range, 9-13 days), respectively. There were significant differences in the number of lymph node dissected, time to first flatus, time to initial fluid diet intake between the two groups ( t=2.068, -3.030, Z=-3.370, P<0.05), and there was no significant difference in cases undergoing conversion to open surgery, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay between the two groups ( χ2=0.000, t=-0.158, Z=-1.824, -0.088, P>0.05). (2) Postoperative pathological examination: cases with well differentiated tumor, moderately differentiated tumor, poorly differentiated tumor, signet ring cell carcinoma or other types of tumor, cases in stage T1b, T2, T3 or T4a (pT staging), cases in stage N0, N1, N2, N3a or N3b (pN staging), cases in stage ⅠB, ⅡA, ⅡB, ⅢA, ⅢB or ⅢC (pTNM staging) of the robotic group were 6, 50, 55, 9, 10, 22, 63, 25, 42, 19, 19, 24, 16, 17, 22, 23, 20, 23, 15, respectively. The above indicators of the laparoscopic group were 4, 42, 84, 12, 6, 18, 81, 37, 39, 27, 32, 19, 25, 13, 19, 28, 39, 16, 27, respectively. There was no significant difference in the above indicators between the two groups ( Z=-1.880, -1.827, -0.140, -1.460, P>0.05). (3) Complications: cases with complication classified as grade Ⅰ, grade Ⅱ, grade Ⅲa, grade Ⅲb, grade Ⅳa, grade Ⅳb of Clavien-Dindo classification, cases with death, cases with overall complications, cases with severe complications of the robotic group were 9, 6, 3, 2, 2, 0, 0, 22, 7, respectively. The above indicators of the laparoscopic group were 12, 15, 9, 6, 3, 1, 1, 47, 20, respectively. There were significant differences in cases with overall complications, cases with severe complications between the two groups ( χ2=7.309, 4.790, P<0.05), and there was no significant difference in cases with complication classified as grade Ⅰ, grade Ⅱ, grade Ⅲa, grade Ⅲb, grade Ⅳa, grade Ⅳb of Clavien-Dindo classification, cases with death between the two groups ( χ2=0.080, 2.730, 1.042, 0.704, 0.000, 0.000, 0.000, P>0.05). (4) Stratified analysis: of the patients with overall complications in robotic group, cases of male or female, cases aged ≥65 years or <65 years, cases with body mass index (BMI) ≥24 kg/m 2 or <24 kg/m 2, cases with tumor diameter ≥5 cm or <5 cm, cases with or without abdominal surgery, cases with tumor located at upper stomach or middle stomach, cases in Ⅰ-Ⅱ grade or Ⅲ grade of American Society of Anesthesiologists (ASA) classification, cases with well differentiated tumor or undifferentiated tumor, cases in stage Ⅰ-Ⅱ or stage Ⅲ (pTNM staging), cases with operation time ≥250 minutes or <250 minutes, cases with volume of intraoperative blood loss ≥150 mL or <150 mL, cases with the number of lymph node dissected ≥25 or <25 were 15, 7, 14, 8, 11, 11, 16, 6, 4, 18, 19, 3, 15, 7, 7, 15, 8, 14, 12, 10, 12, 10, 14, 8, respectively. The above indicators of patients with overall complications in the laparoscopic group were 33, 14, 17, 30, 16, 31, 36, 11, 11, 36, 27, 20, 31, 16, 13, 34, 14, 33, 24, 23, respectively. Of the patients with overall complication, there were significant differences in cases of male, cases aged ≥65 years or <65 years, cases with BMI<24 kg/m 2, cases with tumor diameter≥5 cm, cases without abdominal surgery, cases with tumor located at middle stomach, cases in Ⅰ-Ⅱ grade or Ⅲ grade of ASA classification, cases with well differentiated tumor, cases in stage Ⅲ (pTNM staging), cases with operation time ≥250 minutes, cases with volume of intraoperative blood loss <150 mL, cases with the number of lymph node dissected ≥25 between the two groups ( χ2=6.683, 4.207, 6.761, 7.438, 4.297, 6.325, 9.433, 3.970, 4.850, 4.911, 3.952, 3.915, 6.865, 4.128, P<0.05) and there was no significant difference in cases of female, cases with BMI≥24 kg/m 2, cases with tumor diameter <5 cm, cases with abdominal surgery, cases with tumor located at upper stomach, cases with undifferentiated tumor, cases in stage Ⅰ-Ⅱ (pTNM staging), cases with operation time < 250 minutes, cases with volume of intraoperative blood loss ≥150 mL, cases with the number of lymph node dissected <25 between the two groups ( χ2=0.277, 1.052, 1.996, 1.552, 2.172, 2.594, 2.244, 3.771, 1.627, 3.223, P>0.05). (5) Follow-up: 262 patients were followed up postoperatively for 2 months. During the follow-up, no patient was diagnosed with tumor recurrence, and one patient in the laparoscopic group died of severe infection. Conclusions:The Clavien-Dindo classification can be used in evaluating postoperative short-term complications of Da Vinci robotic-assisted or laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy. Compared with laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy, Da Vinci robotic-assisted total gastrectomy with D 2 lymphadenectomy has the advantages of minimally invasiveness, low incidence of overall and severe complication.

Objective To explore the safety and feasibility of robot splenectomy.Methods 65 patients undergoing robotic or laparoscopic splenectomy at No.940 Hospital of Chinese people's Liberation Army Joint Service Support Force from Jan 2015 to Sep 2019 were analyzed retrospectively.Results The operation time and total hospitalization cost of robot spleen resection group and laparoscopic splenectomy group were [(167 ± 34) min vs.(123 ± 24) min,t =8.554,P =0.00] and (73 002 ± 21 009) yuan vs.(42 095 ± 9 999) yuan,(t =6.484,P =0.00),respectively.In laparoscopy group,3 cases were converted to laparotomy.In the subgroup of splenic hilum thickness ≥ 5 cm,the intraoperative bleeding volume of robot group and laparoscopic group was (145 ± 67) ml vs.(263 ± 180) ml,(t =-2.195,P =0.04).There were significant differences in VAS score (3 ±1) vs.(4 ±1),(t=2.175,P=0.04).Conclusion Robotic splenectomy is safe and feasible.For patients with splenomegaly,robot surgery has more minimally invasive advantages than laparoscopy,but it is expensive and time-consuming.

Objective To compare the short-term clinical effects of Da Vinci robotic surgical systemassisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST).Methods The retrospective cohort study was conducted.The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People's Liberation Army from June 2016 to May 2018 were collected.Of 98 patients,45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group.The associate senior and above doctors performed the surgery.The wedge resection was applied to patients with diameter of gastric stromal tumor ＜ 5 cm,and subtotal gastrectomy + digestive tract reconstruction (gastrojejunostomy and Brauns anastomosis) were applied to patients with diameter of gastric stromal tumor ＞ 5 cm or tumor located in the cardia and pylorus.Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018.Measurement data with normal distribution were represented as x-±s,and comparison between groups was done using the independent-sample t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using nonparametric test.Comparisons of count data were analyzed using chi-square test.Results (1) Surgical and postoperative situations:98 patients underwent successful surgery.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of gastrointestinal decompression tube removal,time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152± 49) minutes,100 mL (range,10-300 mL),(2.6 ± 0.6) days,(1.1 ± 0.3)days,(5.7±1.2)days,(8.3±1.3)days in the robotic group and (201±62)minutes,100 mL (range,5-600 mL),(3.1±0.7) days,(2.1 ± 1.5) days,(6.9 ± 3.4) days,(11.6 ± 7.0) days in the laparoscopic group,with statistically significant difference between groups (t =-3.983,Z =2.104,t =-3.776,-3.637,-2.018,-2.817,P＜0.05).(2) Follow-up:98 patients were followed up for 2-24 months,with a median time of 13 months.During the follow-up,there was no tumor recurrence or metastasis between groups.Conclusion Compared with laparoscopy-assisted surgery,Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible,with advantages of shorter operation time,faster postoperative recovery and shorter duration of hospital stay.

Objective To investigate the risk factors for reoperation after pancreaticoduodenectomy (Whipple). Methods Clinical data of 339 patients who underwent Whipple in the First Afifliated Hospital of Sun Yat-sen University from January 2000 to December 2009 were analyzed retrospectively. The informed consents of all patients or relatives were obtained and the ethical committee approval was received. There were 206 males and 133 females with age ranging from 1 to 86 years old and the median age of 55 years old. According to whether the patients received reoperation after operation, they were divided into reoperation group (n=24) and non-reoperation group (n=315). The reoperation of patients and its risk factors were analyzed. The relations between reoperation and clinical parameters were analyzed using Chi-square test and the risk factors for reoperation were analyzed using Logistic regression analysis. Results The reoperation rate of patients was 7.1%(24/339). The main causes of reoperation included abdominal bleeding (n=8, 5 cases were complicated with pancreatic fistula), upper gastrointestinal bleeding (n=7, 2 cases were complicated with pancreatic ifstula), pancreatic ifstula complicated with abdominal infection (n=2), biliary leakage (n=1) and wound rupture (n=6). In 24 patients receiving reoperation, 9 cases were related with pancreatic ifstula. Four out of 5 death cases were with pancreatic ifstula. The reoperation was related to preoperative diabetes, intraoperative blood loss (χ2=5.588, 4.565;P<0.05). Preoperative diabetes, intraoperative blood loss>400 ml were independent risk factors for reoperation after Whipple (OR=5.80, 2.74; P<0.05). Conclusions The main causes of reoperation after Whipple are pancreatic ifstula and wound rupture. Preoperative diabetes, intraoperative blood loss>400 ml are independent risk factors for reoperation after Whipple.