Objective To investigate the expression level of serum miR-486-5p in patients with pancreatic cancer and the value of serum miR-486-5p combined with carbohydrate antigen 19-9 (CA19-9) in predicting the resectability of pancreatic cancer. Methods A total of 60 patients who were diagnosed with pancreatic cancer in Qingdao Municipal Hospital from September 2018 to December 2020 were enrolled, among whom 32 patients had resectable or borderline resectable pancreatic cancer (operable group) and 28 had unresectable pancreatic cancer (non-operable group), and a benign pancreatic disease group with 30 patients and a healthy control group with 44 individuals were also established. Quantitative real-time PCR was used to measure the serum level of miR-486-5p in each group, and the relative expression level of miR-486-5p was calculated to analyze its association with the clinical features of pancreatic cancer, including age, sex, tumor location, tumor size, TNM stage, lymphatic metastasis, and distant metastasis. The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups, and the chi-square test was used for comparison of categorical variables. The receiver operating characteristic (ROC) curve was plotted, and a binary logistic regression analysis was used to calculate the combined predictive value and then investigate the value of serum miR-486-5p combined with CA19-9 in predicting the resectability of pancreatic cancer. Results The relative expression level of serum miR-486-5p in the operable group [2.16 (1.38~3.30)] and the non-operable group [4.65 (2.80~9.90)] was significantly higher than that in the benign pancreatic disease group [1.01 (0.52~1.53)] and the healthy control group [0.99 (0.24~1.01)] (all P < 0.001). There were significant differences in the number of patients with low or high expression of miR-486-5p between the patients with different TNM stages, presence or absence of lymphatic metastasis, and presence or absence of distant metastasis ( χ 2 =13.765, 5.157, and 6.638, all P < 0.05). Compared with CA19-9 alone, miR-486-5p+CA19-9 had a significantly better value in distinguishing the operable group from the benign pancreatic disease group (area under the ROC curve [AUC]=0.87, 95% confidence interval [ CI ]: 0.760-0.942; with a sensitivity of 81.3% and a specificity of 83.3%), distinguishing the operable group from the healthy control group (AUC=0.92, 95% CI : 0.836-0.970; with a sensitivity of 90.6% and a specificity of 86.4%), and distinguishing the operable group from the non-operable group (AUC=0.94, 95% CI : 0.884-0.998; with a sensitivity of 85.7% and a specificity of 93.7%) ( Z =2.841, 2.510, and 2.387, all P < 0.05), and the optimal cut-off values were 3.12, 3.21, and 6.63, respectively. Conclusion MiR-486-5p can be used as a serum biomarker for the diagnosis of pancreatic cancer, and miR-486-5p combined with CA19-9 has a better clinical value than CA19-9 alone in predicting the resectability of pancreatic cancer in the patients with benign pancreatic diseases and the healthy population.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

AIM: To establish a population pharmacokinetics (PPK) model of vancomycin in patients with hematological diseases who developed neutropenia. METHODS: Patients from department of hematology with neutropenia in our hospital were taken into oue study.The patients (n=77) were performed trough and peak serum concentration of vancomycin, and their clinical data and medication information were collected. The Nonlinear mixed effect modeling approach (NONMEM) was used to establish the PPK model of those patients and model assessment and validation was carried out. Goodneess of fit plots and visual predictive check plus Bootstrap approach were used to assess validate our model. RESULTS: The model was a two compartment model, the final formulas were: clearance rate CL=6.84×(BW/70)

AIM: To discuss the application and clinical significance of the ratio of area under the curve over 24 hours to minimum inhibitory concentration (AUC

Objective:To analyze the HIV and HBV coinfection in HIV/AIDS cases who newly received highly active antiretroviral therapy during 2005-2019 in Jiangsu province.Methods:According to the base data of HIV/AIDS cases on HAART enrolled between January 2005 and December 2019; the National Information system was retrospectively collected for HIV/AIDS Control and Prevention of Chinese System Disease for Control and Prevention. Excel database was established, and statistical analysis was performed using the SPSS 16.0 software. A Chi-square test was used to assess differences in rates of HBsAg testing and HIV/HBV coinfection between potential risk factors. The unconditional logistic regression model entered risk factors with P values <0.05 in the Chi-square test. Results:There were 29 288 HIV/AIDS cases newly received HAART during 2005-2019. The rate of HBsAg test was 49.8% (14 594/29 288) the rate of HBsAg test increased from 0.0% (0/80)to 75.2%(3 448/4 586), showing an increasing trend year by year during 2005 to 2019. Among HIV/AIDS cases tested HBsAg, 81.6% (11 915/14 594) cases were from Jiangsu province; the ratio of male to female was 7.34∶1 (12 845∶1 749), the average age was (38.5±13.8) years old, 96.1% (14 023/14 594) were Han nationality,48.9% (7 131/14 594) of the HIV/AIDS cases married, 97.9%(14 294/14 594) were infected with HIV through homosexual and heterosexual transmission. Unconditional logistic regression modeling showed that the proportion of HIV/AIDS cases initiated HAART in 2015 or after that, married, not Jiangsu province resident, college education or above, and drug injection infected were more likely to have HBsAg testing. 8.6%(95% CI:8.2%-9.1%) were HBsAg positive. The HIV and HBV coinfection rates were more than 10% before 2016 while showed stability from 6.7% to 8.2% since 2016. Unconditional logistic regression modeling showed that the proportion of HIV/AIDS cases who were male, elder, married, non-Han, primary education or below were more likely to have HBV coinfection. Conclusion:More HBsAg testing should be strengthened when the HIV/AIDS cases initiated HAART in Jiangsu province, 2005-2019.

Objective: To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic. Methods: This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m²), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone position and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%. Results: A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed. Conclusions The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic, and security is acceptable.

Objective:To explore the expression of serum miR-224-5p in PDAC and its significance for early clinical diagnosis.Methods:From August 2018 to April 2020, 40 patients with PDAC (11 patients with early PDAC, 29 patients with advanced PDAC), 21 patients with chronic pancreatitis and 40 healthy volunteer controls admitted in Qingdao Municipal Hospital were enrolled. The level of serum miR-224-5p in each group was detected by qRT-PCR method, and the correlation with clinicopathological parameters was analyzed. The receiver-operating characteristic (ROC) curve of miR-224-5p, CA19-9 and miR-224-5p combined with CA19-9 were drawn, and the sensitivity and specificity of the diagnosis were calculated.Results:The serum miR-224-5p levels in early PDAC group, middle and late PDAC group, chronic pancreatitis group and healthy control group were 3.21(2.01, 4.60), 4.70(3.50, 8.26), 1.72(1.02, 2.78) and 1.38(0.89, 2.11), respectively; and the level of serum miR-224-5p in the middle and late PDAC group was significantly higher than that in the early PDAC group, and that in the early PDAC group was significantly higher than that in the chronic pancreatitis group and the healthy control group, and all the differences were statistically significant ( P<0.05). The sensitivity of serum miR-224-5p combined with CA19-9, miR-224-5p, and CA19-9 in the diagnosis of overall PDAC was 95.0%, 85.0% and 67.5%, respectively; and the specificity was 70.0%, 82.5% and 87.5%, respectively. The sensitivity for early PDAC was 90.9%, 72.7% and 63.6%, and the specificity was 85.0%, 72.5% and 87.5%, respectively. MiR-224-5p combined with CA19-9 has the highest specificity in the diagnosis of PDAC. The level of serum miR-224-5p in patients with PDAC was correlated with TNM stage, lymph node metastasis and distant metastasis (all P values <0.05). Conclusions:The expression of serum miR-224-5p was significantly up-regulated in patients with early PDAC, and The level of serum miR-224-5p in patients with PDAC was correlated with TNM stage, lymph node metastasis and distant metastasis. The sensitity of serum miR-224-5p and miR-224-5p combined with CA19-9 for early PDAC diagnosis were superior to CA19-9 alone, which can be used as a potential sensitive biological marker for early screening of PDAC.

Objective: To identify the independent risk factors of esophageal varices (EV) in cirrhosis by endoscopic ultrasonography (EUS), and further to establish a risk assessment model for predicting EV occurrence and evaluate the clinical predictive value of the model. Methods: A retrospective cohort study was used in this study. Data of patients with cirrhosis without varicosity, who were hospitalized in Tianjin Second People's Hospital from September 2014 to March 2017 were collected. The location, diameter, and number of esophageal collateral circulation were measured by EUS. The non-selective beta blocker (NSBB) medication history and antiviral therapy were recorded. The time of the first EUS examination was taken as the starting point and the follow-up period was set up as 18 months. The end point was the occurrence of EV or the end of follow-up. The independent risk factors of EV occurrence were determined by univariate and multivariate logistic regression analysis, and the risk assessment model of EV occurrence was constructed. The predictive value of evaluation model for disease was studied by ROC analysis. Hosmer-Lemeshow goodness of fit was used to test the fitting efficiency of the evaluation model. Results: A total of 638 subjects were recruited initially, 13 of them were lost in the course of the study. Finally, 625 cases were included in the study. Among them, 369 cases did not develop EV (the non-progress group) and 256 cases developed EV (the progress group). (1) Multivariate logistic regression analysis showed that 7 independent risk factors were selected into the risk assessment model of EV occurrence, and were assigned corresponding scores: no NSBB (3 points), no antiviral treatment (2 points), Child-Pugh stage B (1 point), the diameter of peri-ECV>2 mm (1 point), the number of peri-ECV≥5 (3 points), the diameter of para-ECV≥5 mm (4 points), and the number of para-ECV≥5 (4 points). (2) In the risk assessment model, the risk factor scores ranged from 1 to 4 with a total score of 0-18. The predicted incidence of EV increased from 0.003 to 1.000 with the increase of the score. (3) In the risk assessment model, the total risk score ≤2 was assigned into low-risk group, 3-5 into medium-risk group, and ≥6 into high-risk group. The actual EV incidence of each risk stratification was 2.78% in the low-risk group, 36.36% in the medium-risk group and 93.91% in the high-risk group, respectively. (4) The ROC analysis showed that area under curve (AUC) was 0.947 (P<0.05), suggesting that the risk assessment model had a good effect on predicting disease progression. Hosmer-Lemeshow test showed that P was 0.450, suggesting that the model fitted well. Conclusion The risk assessment model based on EUS can accurately predict the occurrence of EV, and is simple and easy to use. The model can provide scientific basis for the prevention and rational treatment of EV in liver cirrhosis.

OBJECTIVE： To evaluate the application of individualization dosage auxiliary system JPKD and SmartDose in individualization administration of vancomycin. METHODS： A retrospective study was conducted among adult inpatients in Hainan Provincial People’s Hospital from Apr. 2018 to Mar. 2019 with intravenous use of vancomycin. SmartDose was used to predict the steady blood trough concentration of vancomycin in the initial dosage regimen， and the absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The effects of body mass index （BMI） and acute kidney injury （AKI） on absolute weight deviation were analyzed by χ2 test or continuously corrected χ2 test. Vancomycin drug delivery scheme was adjusted for patients with ungualified steady blood drug trough concentration. JPKD and SmartDose system were used to predict the blood concentration of vancomycin after adjusting the dosage regimen. The absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The prediction ability of the two systems was evaluated and 3 examples was analyzed. RESULTS： Predicted steady blood trough blood concentration of 85 included patients in SmartDose predicted initial dosage regimen were （11.36±5.96） μg/mL （2.34-29.33   μg/mL）； the measured concentration was （11.44±6.57） μg/mL （3.10-29.50 μg/mL）； absolute weight deviation was 22.95％， and the relative prediction error was 2.72％. Whether BMI was normal or not had significant effects on the absolute weight deviation   （χ2＝4.75， P＝0.029）， and whether AKI occurred or not had no significant effects on the absolute weight deviation （χ2＝0.236， P＝0.627）. JPKD and SmartDose predicted that predicted steady blood trough concentrations of vancomycin in 22 included patients were （11.06±3.58） and （12.15±4.35） μg/mL， and the measured concentration was （12.57±4.50） μg/mL； absolute weight deviations were 18.30％ and 18.68％； relative prediction errors were －8.65％ and －0.44％， respectively. The absolute weight deviations of the predicted values of the two systems were less than 30％. The absolute weight deviations of prediction results were also less than 30％ in 3 patients. CONCLUSIONS： JPKD and SmartDose system have good predictive ability for blood concentration of vancomycin in clinical application， and can be used to optimize the individualized administration of vancomycin.

A 48-year-old male was suffered from slowly progressive dysuria over twenty years. Although multiple urethral dilatation was treated, the effect was unsatisfactory. He was diagnosed with penile lichen sclerosus related to urethral stricture due to the lichenification of glans penis, the stenosis of urethral meatus, and the long anterior urethral stricture shown by urethrography. Finally, the patient underwent an enlarged urethroplasty with lingual mucosal graft (17 cm in length), and obtained a good outcome. During the two-year postoperative follow-up, the patient maintained a satisfactory urination without any complication.