Objective To explore the relationship between the expression levels of serum cingulate protein(CGN)and polyligand glycan 1(SDC-1)and the disease condition and outcome of hypertensive basal ganglia hemorrhage(HBGH).Methods A total of 123 patients with HBGH admitted to the Second People's Hospi-tal of Lianyungang from February 2019 to February 2022 were selected as the study objects,and 120 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the health group.Serum CGN and SDC-1 expression levels were detected in the two groups.According to the dis-ease outcome,the patients were divided into the improved group(92 cases)and the deteriorated group(31 ca-ses).Receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the predictive value of serum CGN and SDC-1 expression levels on the disease outcome of patients with HB-GH.Results Serum CGN and SDC-1 expression levels in the severe group were higher than those in the mod-erate group and the mild group,and serum CGN and SDC-1 levels in the moderate group were higher than those in the mild group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in HBGH patients in three groups were higher than those in health group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in the deteriorated group were higher than those in the improved group,and the differences were statistically significant(P＜0.05).The AUC of serum CGN and SDC-1 for predicting the disease outcome of HBGH patients was 0.742(95％CI:0.792-0.697)and 0.861(95％CI:0.906-0.910),respectively,and the AUC of the combination of the two was 0.917(95％CI:0.962-0.870).The amount of blood loss and ventricular rupture in the deteriorated group were higher than those in the improved group,and the Glasgow Coma Scale(GCS)score on admission was lower than that in the improved group,and the differences were statistically significant(P＜0.05).Multi-variate Logistic regression analysis showed that serum CGN≥51.63 pg/mL(OR=3.815),serum SDC-1≥450.67 μg/L(OR=4.230)and GCS score ≤8(OR=5.333)were the influencing factors for disease outcome of HBGH patients(P＜0.05).Conclusion The increased expression levels of serum CGN and SDC-1 are closely related to the disease aggravation and the deterioration of the disease outcome in patients with HBGH,and they have certain predictive value for the disease outcome in patients with HBGH.

Objective:To evaluate the feasibility, accuracy, effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods:A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021. There were 16 males and 19 females, with an age of (52.7±13.2) years. The core of this placement was to determine the entry point of cervical 7 pedicle screws. After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B, the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point, with the screw placement angle perpendicular to the lamina line or slightly inclined from 30° to 40° to the head side and outward. The length, diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement. According to the Rampersaud method, the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement. The visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score were compared between preoperation, 1 week and 6 months after operation to evaluate the effectiveness of this placement. The postoperative complications were counted to evaluate the safety of this method. Loosening, displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results:This case series was followed up for (9.8±1.7) months. There was no significant difference in the length, diameter or placement angle of the screws between the left and right sides ( P>0.05). A total of 66 cervical 7 pedicle screws were placed. There was no change in the screw position grading at 1 week or 6 months after surgery. Grade A was achieved in 64 screws, Grade B in 2 screws, and Grade C or D in none. The VAS scores before operation, 1 week and 6 months after operation were respectively 4.4±1.7, 3.8±1.0 and 1.1±1.1, and the JOA scores respectively 6.7±2.2, 13.2±1.5 and 15.3±1.2. The VAS and JOA scores at 1 week and 6 months after operation were significantly improved compared with the preoperative values ( P<0.05). The improvement rates in JOA at 1 week and 6 months after operation were 62.7%±13.3 % and 83.9%±11.6%, respectively. There were no complications related to the placement of cervical 7 pedicle screws; there was no wound hematoma or infection. No loosening, displacement or breakage of the screws was observed by the 6-month follow-up. Conclusion:The novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction is feasible, accurate, effective and safe.

Objective:To investigate the consistency and correlation of the respiratory synchronization tracking and fiducial marker respiratory synchronization tracking in the Cyberknife stereotactic body radiotherapy (SBRT) with the diaphragm as the tracking target.Methods:A total of 11 patients hospitalized at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2018 to November 2019 were enrolled, including 8 cases of lung cancer, 2 cases of liver cancer with lung metastasis and 1 case of colorectal cancer with lung metastasis. All enrolled cases used fiducial marker tracking plan (RT) and diaphragm contour tracking plan (DT), and then all received tumor visualization simulation tests. Bland-Altman method was used to make the consistency analysis of the offset in the visualization tests process of 2 tracking plans at each respiratory time point. The minimum tolerance distance, uncertainty and average standard deviation and maximum standard deviation in the optimal model state plans were compared between the both plans by using t test. Results:Compared with RT, the translational standard deviations of DT tracking were listed as follows: head-foot direction (0.4±2.9) mm, left-right direction (0.3±4.4) mm, anterior-posterior direction (-1.8±6.8) mm. The Bland-Altman method showed that the consistency between RT and DT was better in the head-foot and left-right directions, and worse in the anterior-posterior direction; the synchronization was only better in the head-foot direction, and worse in both the left-right and anterior-posterior directions. Results of the model quality comparison showed that the uncertainty of RT was higher than that of DT, and the difference was statistically significant [(23±6)% vs. (9±4)%, t=-5.24, P = 0.001], while the differences of the minimum tolerance distance, average standard deviation and maximum standard deviation were not statistically significant (all P>0.05). Conclusions:Patients who use respiratory synchronization Cyberknife SBRT with the diaphragm as the tracking target have better consistency and synchronization in the head-foot direction, but worse in the left-right and anterior-posterior directions. Under the corresponding marginal margin of the target area in the left-right direction, for tumors near the diaphragm that are not visible in the visual test, it is potentially feasible to use the diaphragm as a tracking target to implement respiratory synchronization SBRT. For larger motion amplitudes in the left-right and anterior-posterior directions, more caution is required.

Objective:To explore the efficacy and safety of transvaginal anterior pelvic floor reconstruction with mesh in treatment of patients with cystocele and lower urinary tract symptoms.Methods:A retrospective analysis of 32 patients who underwent transvaginal anterior pelvic reconstruction with mesh from June 2015 to February 2019 was performed. The age of the patients was 57-86 years old, with an average of (67.8±7.6) years; body mass index(BMI) (22.6±3.0) kg/m 2; mean duration of disease (2.9±2.3) years; delivery 1-7 times, mean(3.0±1.5) times. All patients underwent transvaginal anterior pelvic reconstruction. The anterior wall of the vagina was incised, and the space between the pelvic floor and the bladder was bluntly separated. The mesh was placed under the guidance of the puncture needle after locating marks of body surface. Patients underwent the American Urological Association Symptom Scoring (AUASS) with (14.2±3.5) points, the residual urine (71.3±53.0) ml and the maximum urine flow rate (16.9 ± 3.8) ml/s were measured preoperative. The Pelvic Organ Prolapse Distress Inventory(POPDI-6), Urogenital Distress Inventory(UDI-6) and Pelvic Floor Impact Questionnaire(PFIQ-7) were recorded as the value of (48.0±7.3) points, (41.7 ± 8.2) points and (62.5 ± 16.4) points, respectively. Thirty-two patients were divided into 2 groups as the group of urinary storage symptom (22 patients) and the group of voiding symptom (10 patients) according to the preoperative lower urinary tract symptoms. The operative time, intraoperative bleeding volume and average hospital stay were recorded. The patients were followed up with AUASS, maximum urine flow rate, residual urine, POPDI-6, UDI-6, PFIQ-7 and complications during and after operations. Results:All the operations of 32 cases were successfull. The average operation time was (61.1±18.6) min, the average intraoperative blood loss was (41.5±12.3)ml, and the average hospital day was (9.1±1.8)d. There were no major organ injuries such as bladder, ureter, iliac vessels and rectum. 27 patients were followed up for 3 to 36 months, with an average of (24.7±10.8) months. There significant improvement of LUTS. At the last follow-up, the AUASS storage phase score (3.4±1.9) points in the urinary storage symptom group(19 patients) and the AUASS urinating phase score (3.9±1.7) points in the voiding symptom group(8 patients) were compared with the preoperative AUASS scores (11.6±1.9) points and (13.9±1.2) points which were significantly reduced. By the last follow up of all the 27 patients, residual urine (23.4±11.0)ml, POPDI-6(3.1±5.4) points, UDI-6 (3.2±5.1) points and PFIQ-7 (12.4±1.7) points were significantly lower than preoperative data. The maximum urinary flow rate(22.4±4.1)ml/s, was significantly higher than that before the operation. All the differences were statistically significant ( P<0.05). All patients had no recurrence of cystocele. One patient had anterior vaginal wall mesh exposure 3 months after surgery. After removing excess mesh in the outpatient clinic, she was cured by smearing with estrogen ointment. One patient experienced frequent urination and urgency who was cured by oral tolterodine tartrate. One patient with de novo mild SUI during the 1-year follow-up. The symptoms were improved in the outpatient clinic after pelvic floor muscle exercise. At 2-year follow-up, one patient was observed de novo mild posterior wall prolapse with no clinical manifestations and no treatment was carried out. Conclusions:Transvaginal anterior pelvic reconstruction with mesh could be effective in treating cystocele with lower urinary tract symptoms with less surgical trauma, fewer complications and lower recurrence rate. It could effectively improve lower urinary tract symptoms such as frequent urination, urgency and difficulty urinating.However, safety issues such as the incidence of long-term de novo SUI and mesh exposure still require further long-term follow-up.

ObjectiveTo investigate the gastroscopic manifestations of gastric mucosa in portal hypertensive gastropathy (PHG) and the association of PHG with gastroesophageal varices, ulcers, and liver cirrhosis complications. MethodsA retrospective analysis was performed for the clinical data of 867 patients with liver cirrhosis who were treated in Daping Hospital of Army Medical University from August 2012 to June 2018, and the incidence rates of gastroesophageal varices, PHG, and ulcers were recorded. Meanwhile, the data of spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC) were collected. The chi-square test was used for comparison of categorical data between groups, and a Spearman correlation analysis was also performed. ResultsThe incidence rate of PHG in the patients with liver cirrhosis reached 66.2% (574/867), and gastric mucosa abnormalities in mild PHG were mainly red-spot lesions (68.6%) and snakeskin (56.8%), while diffuse erythema (76.5%) was the main gastric mucosa abnormality in severe PHG. There was a significant difference in the incidence rate of PHG between the patients with different severities of esophageal varices (χ2=304712, P＜0.05), and the severity of PHG increased with the aggravation of esophageal varices (r=0.515, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with different severities of gastric varices (χ2=81.004, P＜0.05), and the severity of PHG was positively correlated with that of gastric varices (r=0.292, P＜0.05). There was a significant difference in the incidence rate of PHG between the patients with varices at different locations (χ2=41.361, P＜0.05); the patients with gastric varices alone had the lowest incidence rate of PHG (34.8%) and only had mild PHG, and those with gastroesophageal varices had the highest incidence rate of PHG (85.6%). Among the patients without PHG, 71 (24.2%) were hospitalized due to hematemesis and/or tarry stool, and among the 574 patients with PHG, 316 (55.1%) were hospitalized, and there was a significant difference between the two groups (χ2=74562, P＜0.05). ConclusionPatients with different severities of PHG have different features of gastric mucosa abnormalities. The development and severity of PHG are closely associated with the severity of gastroesophageal varices and are important causes of gastrointestinal bleeding in liver cirrhosis. PHG should be treated and prevented to reduce the risk and complications of gastrointestinal bleeding.

Objective: To improve the understanding of thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1(MEN1) through analyzing the clinical diagnosis and treatment process, as well as outcomes in one case of this disorder. Methods: The clinical manifestations, biochemical and hormone levels, imaging presentations, medical and surgical treatments, and post-operational pathologic findings in the process of diagnosis and treatment of a patient with thyrotropin-secreting adenoma in MEN1 were analyzed. The next generation sequencing followed by Sanger method was used for analyzing MEN1 and related genes. The results were evaluated with online PolyPhen2 and PROVEAN for variation hazard. Results: One 19-year old male patient was diagnosed with hyperthyroidism due to thyrotoxicosis and high level of thyroid hormones(THs) with measurable TSH(2.78 mIU/L) and negative thyrotropin receptor antibody(TRAb). Meanwhile, primary hyperparathyroidism was suggested by hypercalcemia, hypophosphatemia, and elevated intact parathyroid hormone(PTH) level, all the parameters were returned to normal after surgical resection of the mass which was below the left thyroid lobe indicated by ultrasound and ^99mTc scan. Thyrotoxicosis remained in spite of one year treatment with antithyroid drug, thyrotropinoma was then suspected, and subsequent MRI scan found a macroadenoma at right pituitary. TSH and THs returned to normal 1 month after transsphenoidal removal of the adenoma. As expected, immunohistochemical staining revealed TSH positive. In addition, a pancreatic mass was found by both CT and MRI scan, which was considered as a silent neuroendocrine tumor. Gene analysis revealed a missense mutation of MEN1 as c. 415C>T and p. His139Tyr(H139Y), which was predicted highly hazard. Only five cases of thyrotropinoma in MEN1 were previously reported. Conclusion Thyrotropinoma should be cautiously identified from hyperthyroidism to avoid misdiagnosis and mistreatment, and it should keep in mind that thyrotropinoma may be associated with MEN1 though it would be very rare.

The development of new proton-pump inhibitors (PPIs) with less adverse effects by lowering the pKa values of nitrogen atoms in pyrimidine rings has been previously suggested by our group. In this work, we proposed that new PPIs should have the following features: (1) number of ring II = number of ring I + 1; (2) preferably five, six, or seven-membered heteroatomic ring for stability; and (3) 1 < pKa1 < 4. Six molecular scaffolds based on the aforementioned criteria were constructed, and R groups were extracted from compounds in extensive data sources. A virtual molecule dataset was established, and the pKa values of specific atoms on the molecules in the dataset were calculated to select the molecules with required pKa values. Drug-likeness screening was further conducted to obtain the candidates that significantly reduced the adverse effects of long-term PPI use. This study provided insights and tools for designing targeted molecules in silico that are suitable for practical applications.
Computer Simulation ; Drug Design ; Humans ; Proton Pump Inhibitors ; toxicity ; Toxicological Phenomena

To explore the differentiation of gastrointestinal stromal tumor(GIST) with synchronous carcinoma clinical and pathological features,diagnosis and differential diagnosis.Methods Clinical characteristics,pathological morphology and immunohistochemical staining were observed in 9 cases of GIST with synchronous carcinoma,with review of the relevant literature.Results Microscopically,in 4 cases GIST with esophageal carcinoma,most of tumor cells in central focus were squamous cells and keratin pearls which were well differentiated and the rest of tumor cells are basal like cells on the edge.In the other 5 cases (4 of them with gastric carcinoma and 1 with rectal cancer).Microscopically,the tumors were composed of dysplastic glands which presented as adenoid structures and poorly differentiated.The majority of gastric GIST were spindle cell tumors,which resembled smooth muscle tumors histologically and showed a variety of histological pattern,such as lace like pattern,palisading pattern,antique coins like pattern and eddy pattern.And a perinuclear vacuolization pattern was common.Immunohistochemistry showed that the tumor cells were positive for CK5/6,CK14 and p53,but negative for S-100,CK7 of the 4 cases GIST with esophageal carcinoma.In the other 5 cases (4 of them with gastric carcinoma and 1 with colorectal cancer),showed that CK7,CK20,CEA and HER-2 were positive and negative for S-100.In all the 9 case of GIST,the tumor cells were positive for CD34,CD117 (+),DOG1 and SMA,but negative for S-100,desmin,etc.Conclusion There are no special clinical symptoms in most of GIST with synchronous carcinoma,because these GISTs are generally incidental findings.The proliferative index of GIST with synchronous carcinoma is observably lower than that of GIST without synchronous carcinoma.Most GISTs with synchronous carcinoma can be treated by the standard treatment for the accompanying carcinoma,and do not need specific additional treatments.

Objective Primary renal mucosa associated lymphoid tissue lymphoma (MALT lymphoma)is very rare,here dis-cuss the clinical pathological characteristics and diagnosis,differential diagnosis of primary renal MALT lymphoma.Methods A case of primary renal MALT lymphoma was assayed for clinical and histopathological morphology,an well as immuno-histochemical staining,then reviewed the relevant literature.Results The clinical and imaging characteristics of renal lym-phoma lack of specific performance,the tissue section of the kidney biopsy showed diffuse infiltration of small lymphocytes. The small lymphocytes were centrocytes-like,monocytes-like,and plasma cell differentiation was recognized.Lymphoepithe-lial lesions were scattered.Follicular implanted phenomenon could been seen.Immunohistochemically result:the tumor cells were positive for CD20,PAX-5,CD79αand MUM-1,but negative for CD3,CD5,CD45RO,bcl-2,CD10,bcl-6 and CyclinD1. CD2 1 showed damage FDC network,positive for Kappa,negative for lambda,and it showed monoclonal phenotype,the Ki-6 7 index was about 35%.Final pathology diagnosis was primary renal MALT lymphoma.Conclusion Primary renal MALT lymphoma is very rare,the clinical manifestations and imaging characteristic of renal lymphoma are non-specific and misdiag-nosis frequently occurs in clinical practice,definite diagnosis depends on pathological examination,immunohistochemical stai-ning is helpful to differential diagnosis.

Objective Objective To explore the best dog urethra rectum fistula operation method.Methods In June 2016 to October 2016,15 healthy male dogs were selected as research objects,aged 2-3 years (mean 2.5 years),with a body mass of 12-15 kg (mean 13.5 kg).They were randomly divided into three groups,each group of five.5 male dogs were cut through the rectum.5 male dogs were cut through the perineum.5 male dogs were cut through the rectal sphincter of the anus.Postoperative retrograde urethrectomy rectum angiography,the urethral pressure injection of methylene blue white gauze aizen rectum fistula and histologic evaluation of each group were compared 1,2,3 moths after the operation.Results Anal rectum drag cold knife cut group,1,2,3 moths after the operation,postoperative indicated the exist of orificium fistulae.The urethral pressure injection of methylene blue could observe rectum white gauze aizen,and pathological histology suggested the mucosal lamina propria disorder.There were a large number of inflammatory cells,5 dogs models were successfully built.Abdominal perineal pathway group:1 dog was killed by itself.1 dog one month after operation in anus at 2 cm below diameter about 3 cm appeared in a mixture of urine fistula and urethral orifice outflow,no urine outflow.More than 3 dogs after a week in the edge of serious infection,a canine model of severe dysuria,1,2,3 moths after the operation,postoperative indicated the exist of orificium fistulae.The urethral pressure injection of methylene blue could observe rectum white gauze aizen.3 dogs models were built.Through anal sphincter incision group:five dogs of the urethral fistula were successful,and one dog was incontinent with fecal incontinence.Conclusions The rectal rectum could successfully produce the animal model of the urethral rectal fistula and provide the experimental subjects for the treatment of iatrogenic urethral fistula.