Objective To explore the surgical procedure coding for cholelithiasis,analyze common coding errors,and propose improvement solutions.Methods The knowledge on cholelithiasis was illustrated.Common surgical procedures for cho-lelithiasis and their ICD-9-CM-3 codes were introduced.The search path for surgical procedure codes was summarized.Errors in coding were analyzed by combining clinical cases.Results Open cholecystectomy for gallbladder stones was coded as 51.04,for common bile duct stones as 51.41,and other bile duct stones as 51.49.Laparoscopic and endoscopic removal of biliary stones were coded as 51.88,percutaneous gallbladder stone extraction as 51.88,common bile duct as 51.96,and other bile duct as 51.98.Non-standard writing by clinical physicians and insufficient coding skills of coders was easy to lead to coding errors.Con-clusion Errors in surgical procedure coding for cholelithiasis can be reduced by strengthening clinical communication,standardi-zing medical record writing,promoting mutual learning between coders and clinical physicians,enhancing their own professional skills,and establishing a multi-level quality control system for coding in the Medical Record Department

Objective:To investigate the clinical features and therapeutic efficacy of patients with hereditary leiomyomatosis and renal cell carcinoma(RCC) syndrome-associated RCC (HLRCC-RCC) in China.Methods:The clinical data of 119 HLRCC-RCC patients with fumarate hydratase (FH) germline mutation confirmed by genetic diagnosis from 15 medical centers nationwide from January 2008 to December 2021 were retrospectively analyzed. Among them, 73 were male and 46 were female. The median age was 38(13, 74) years. The median tumor diameter was 6.5 (1.0, 20.5) cm. There were 38 cases (31.9%) in stage Ⅰ-Ⅱand 81 cases (68.1%) in stage Ⅲ-Ⅳ. In this group, only 11 of 119 HLRCC-RCC patients presented with skin smooth muscle tumors, and 44 of 46 female HLRCC-RCC patients had a history of uterine fibroids. The pathological characteristics, treatment methods, prognosis and survival of the patients were summarized.Results:A total of 86 patients underwent surgical treatment, including 70 cases of radical nephrectomy, 5 cases of partial nephrectomy, and 11 cases of reductive nephrectomy. The other 33 patients with newly diagnosed metastasis underwent renal puncture biopsy. The results of genetic testing showed that 94 patients had FH gene point mutation, 18 had FH gene insertion/deletion mutation, 4 had FH gene splicing mutation, 2 had FH gene large fragment deletion and 1 had FH gene copy number mutation. Immunohistochemical staining showed strong 2-succinocysteine (2-SC) positive and FH negative in 113 patients. A total of 102 patients received systematic treatment, including 44 newly diagnosed patients with metastasis and 58 patients with postoperative metastasis. Among them, 33 patients were treated with tyrosine kinase inhibitor (TKI) combined with immune checkpoint inhibitor (ICI), 8 patients were treated with bevacizumab combined with erlotinib, and 61 patients were treated with TKI monotherapy. Survival analysis showed that the median progression-free survival (PFS) of TKI combined with ICI was 18 (5, 38) months, and the median overall survival (OS) was not reached. The median PFS and OS were 12 (5, 14) months and 30 (10, 32) months in the bevacizumab combined with erlotinib treatment group, respectively. The median PFS and OS were 10 (3, 64) months and 44 (10, 74) months in the TKI monotherapy group, respectively. PFS ( P=0.009) and OS ( P=0.006) in TKI combined with ICI group were better than those in bevacizumab combined with erlotinib group. The median PFS ( P=0.003) and median OS ( P=0.028) in TKI combined with ICI group were better than those in TKI monotherapy group. Conclusions:HLRCC-RCC is rare but has a high degree of malignancy, poor prognosis and familial genetic characteristics. Immunohistochemical staining with strong positive 2-SC and negative FH can provide an important basis for clinical diagnosis. Genetic detection of FH gene germ line mutation can confirm the diagnosis. The preliminary study results confirmed that TKI combined with ICI had a good clinical effect, but it needs to be confirmed by the results of a large sample multi-center randomized controlled clinical study.

Objective:To explore the relationship between parental psychological control,school climate and future orientation of high school students.Methods:Totally1 430 senior high school students were evaluated with parental control questionnaire,Adolescent perceived Campus atmosphere questionnaire and Adolescent Future orien-tation questionnaire.The moderating effect of school climate was analyzed using Modell of the PROCESS mac-ro.The bridge function in the network analysis methodology was usedto calculate the bridge expected influence in-dex to evaluate the bridge nodes between parental psychological control and future orientation network,school cli-mate and future orientation network.Results:The analysis of moderating effects shows a negative correlation be-tween parental psychological control and future orientation(β=-0.11,P＜0.001).Both positive and average school climates demonstrated a positive moderating effect(β=-0.11,-0.17,P＜0.001).The bridge expected impact index showed that the bridge connection nodes of parental psychological control and campus atmosphere on future orientation were guilt-thoughtfulness(bridge El=0.23,0.19)and teacher support-optimism(bridge EI=0.19,0.15).Conclusion:A positive school climate could mitigate the negative effects of parental psychological control on high school students'future orientation,with future emotional experience being a key aspect in how both influence the students'future direction.

Objective:To design and construct a bone nonunion organoid on chip and explore the mechanism of aseptic bone nonunion.Methods:First a semi-open microfluidic chip was designed, on which human bone marrow mesenchymal stromal cells (BMSC), human fetal lung fibroblast 1, (HFL1) and human umbilical vein endothelial cells (HUVEC) were co-cultured, and a three-dimensional organ on chip system was established. Different proportions of HFL1 and HUVEC were co-cultured with BMSC, which were divided into the control group (HFL1∶HUVEC=1∶1), the fibrosis group (HFL1∶HUVEC=3∶1) and the vascularization group (HFL1∶HUVEC=1∶3). The osteogenic differentiation of BMSC was observed by alkaline phosphatase (ALP) and Alizarin red staining. The transcription level of osteogenic marker genes SP7, RUNX2, ALPL, and BGLAP, and vascularization related genes KDR and VWF were analyzed by qPCR. The expression levels of RUNX2 and ALP were determined by Western Blot. Results:In the co-culture system of BMSCs, HFL1, and HUVECs, BMSCs exhibited normal growth and apparent biomineralization behavior. Endothelial cells were capable of forming structured vascular networks, confirming the successful establishment of the system. Compared to the baseline group, the fibrotic group showed no significant decrease in BMSC osteogenic differentiation. The relative expression levels of the mineralization marker genes ALPL and BGLAP were 0.55±0.19 ( P<0.001) and 0.42±0.27 ( P<0.001), respectively. Vascularization genes KDR and VWF were downregulated, with relative expression levels of 0.49±0.17 ( P<0.001) and 0.49±0.21 ( P<0.001). In contrast, in the vascularized group, BMSC osteogenic differentiation genes SP7, RUNX2, ALPL, and BGLAP were upregulated, with relative expression levels of 2.91±0.52 ( P<0.001), 3.83±1.87 ( P<0.001), 3.22±1.29 ( P<0.001), and 5.21±1.46 ( P<0.001), respectively. Vascularization genes KDR and VWF were also upregulated, with relative expressions of 8.24±2.84 ( P<0.001) and 5.32±1.67 ( P<0.001). Western blot results indicated increased expression of RUNX2 and ALP in the vascularized group and decreased expression in the fibrotic group. Conclusion:The bone nonunion organoid on chip could partially simulate the local microenvironment of bone nonunion. Fibrosis may lead to a significant decrease in bone formation ability and vascularization level, which might be an important reason for the occurrence of aseptic bone nonunion.

Objective To explore the relationship between levels of serum 25-(OH) D3 and changes in Th1/Th2 cell balance in infants with recurrent wheezing.Methods Sixty cases of infants with recurrent wheezing were involved and 60 cases of healthy children were selected as controls.Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of serum 25-(OH) D3 and double-antibody sandwich (ABC-ELISA) was used to detect the serum levels of interferon-γ(IFN-γ),interleukin (IL)-4,IL-13,and then the relationship between the levels of serum 25-(OH) D3 and changes in Th1/Th2 balance in infants with recurrent wheezing were explored.Results Serum 25-(OH) D3 levels decreased significantly in the infants with recurrent wheezing group compared with those of the healthy control group [(18.24 ± 5.64) μg/L vs (37.85 ± 7.78) μg/L] (t =15.810,P =0.000).Serum IFN-γ levels decreased significantly in the infants with recurrent wheezing group compared with those of the healthy control group [(11.20 ± 2.08) ng/L vs (20.68 ± 3.87) ng/L] (t =16.700,P =0.000).In contrast,serum IL-4,IL-13 levels increased significantly in the infants with recurrent wheezing group compared with those of the healthy control group[IL-4:(28.61 ±6.44) ng/L vs (22.14±5.29) ng/L;IL-13:(20.02±4.83) ng/L vs (17.72± 4.06) ng/L] (t =6.201,P =0.000 ; t =2.829,P =0.006).Th1/Th2 in the infants with recurrent wheezing group were lower than that those of the healthy control group,and there was statistically significant difference between two groups(0.41 ± 0.12 vs 1.00 ± 0.36) (t =11.796,P =0.000).Serum 25-(OH) D3 levels were negatively correlated with Th1/Th2 in the infants with recurrent wheezing(r =-0.649,P =0.000).There were no correlation between serum 25-(OH) D3 levels and Thl/Th2 in the healthy control group(r =-0.217,P =0.096).Conclusions Low serum 25-(OH) D3 may be the risk factor for recurrent wheezing in infants.Serum 25-(OH) D3 levels were negatively correlated with Th1/Th2 in the infants with recurrent wheezing group,which show that recurrent wheezing in the infants is closely related to allergic reaction.

OBJECTIVETo study the effect of targeted Sox4 gene-knock-down on the growth of xenografts of Xuanwei female lung cancer cell line XWLC-05 cells in nude mice.

METHODSRecombinant plasmid pGFP-V-RS-Sox4 shRNA was constructed and transfected into XWLC-05 cells. Real-time quantitative PCR and Western blot were applied to confirm the effect of Sox4 gene-knock-down. XWLC-05 cells stably transfected with the plasmids were inoculated into nude mice to establish the xenograft model. The nude mouse status, tumor formation and tumor growth were observed, and the tumor inhibition rate was calculated. CT scan was performed to assess the metastasis of xenografts. Immunohistochemical staining was applied to detect Sox4 and ki-67 protein expression.

RESULTSRecombinant plasmid pGFP-V-RS-A-Sox4 shRNA which can effectively knocking-down Sox4 gene was successfully constructed and the stable transfected cells were selected by puromycin-screening. The success rate of tumor cell inoculation was 100% in the mice of all groups except those inoculated with saline. The body weight of all mice inoculated with parental XWLC-05 cells (blank control), pGFP-V-RS-scram shRNA trsfected XWLC-05 cells (negative control), and pGFP-V-RS-Sox4 shRNA transfected XWLC-05 cells was increased to a varying degree, but there was no significant difference among the groups (P > 0.05 ). The growth of xenografts was significantly inhibited after silencing the Sox4 gene expression when compared with that of the blank and negative controls (P < 0.05) . The volume of removed tumors of the Sox4 gene-inhibited mice was (2.30 ± 0.34) cm(3) , significantly smaller than that of the negative control (3.99 ± 0.45) cm(3) and the blank control (4.03 ± 0.42) cm(3) (P < 0.05) . The weight of removed tumors of Sox4 gene-inhibited mice was (0.86 ± 0.14) g, significantly lower than that of the negative control (1.84 ± 0.27) g and blank control (1.86 ± 0.22) g, (P < 0.05). Immunohistochemical staining showed that Sox4 and ki-67 proteins mainly expressed in cell nuclei. The staining was significantly decreased in xenografts of Sox4-inhibited mice when compared with the negative and blank controls (P < 0.05). No distant metastasis was found in any mouse by CT imaging and pathological examination during the observation period.

CONCLUSIONSThe xenograft model of Xuanwei female lung cancer cell line XWLC-05 cells in nude mice is successfully established. Knocking-down of Sox4 gene can suppress the xenograft tumor growth.

Animals ; Female ; Gene Knockdown Techniques ; Heterografts ; Humans ; Lung Neoplasms ; genetics ; pathology ; Mice ; Mice, Nude ; SOXC Transcription Factors ; metabolism

Objective To explore the inhibitory effect of Oldenlandia diffusa extract on colorectal cancer angiogenesis in BALB/c mice. Methods Thirty-two BALB/c mice with subcutaneous CT26 colon cancer animal model were randomly equally divided into four groups,including the control group (groupⅠ,saline 0.1 mL/(10. d), O. diffusa ethanol extract of 90 mg/(kg.d) (groupⅡ), O. diffusa ethanol extract of 180 mg/(kg.d) (groupⅢ) and O. diffusa ethanol extract of 360 mg/(kg.d) (group Ⅳ) . Each group of mice were treated with intragastric administration of law administration 12 days after vaccination, then stopped and continue fed to 32 days, and the mice were killed. Micro-vascular dense ( MVD) was observed and countered under the microscopy by immunohistory chemistry. Results The murine colon tumor volumes of GroupⅡ,ⅢandⅣwere significantly less than that of groupⅠ,with significant difference ( <0.05) . The tumor microvessel density values of four groups was (7.83±2.87), (5.32±1.27), (1.77±0.70) and (1.87±0.68),respectively. The number of tumor blood vessels in GroupⅡ,Ⅲ and Ⅳ were significantly less than that of Ⅰ group, with significant difference ( <0.05) . Conclusion Within a certain dose range, the ethanol extract of O. diffusa can significantly inhibit the mouse colon cancer and the mechanism may be realated to inhibiting tumor angiogenesis.

Objective To explore the inhibitory effect of the ethanol extract of Oldenlandia diffusa on the proliferation of CT-26 colon cancer cells which come from BALB/c mice. Method We determined the inhibitory effect of different concentrations of ethanol extract of Oldenlandia diffusa on CT-26 cells' proliferation by using methyl thiazolyl tetrazolium (MTT), and calculated the 50% inhibiting concentration (IC50) . Results As to the same concentration, the inhibitory effect of the ethanol extract of Oldenlandia diffusa on CT-26 cells was increased with time, for exsample:after treated with 0.08 mg/mL of ethanol extract of Oldenlandia diffusa for 24 h, 48 h and 72 h, the inhibitory rates of CT-26 cells were (16.67 ±9.35)%, (34.66 ±9.23)%and (40.07 ±9.16)%, respectively. After treating CT-26 cancer cells for 24 h, 48 h and 72 h, the IC50 values of the ethanol extract of Oldenlandia diffusa were 0.315,0.155 and 0.115 mg/mL, respectively. In the same treatment time, the inhibitory effect of the ethanol extract of Oldenlandia diffusa on CT-26 cells was increased with the increase of concentration:after treatment for 72 h with different concentrations (0.06 mg/mL,0.08 mg/mL,0.10 mg/mL,0.12 mg/mL, 0.14 mg/mL,0.16 mg/mL,0.18 mg/mL and 0.20 mg/mL) of the ethanol extract of Oldenlandia diffusa,the inhibitory rates of CT-26 cells were (35.46 ±3.59)%, (40.07 ±9.16)%, (40.77 ±6.92)%, (52.81 ±1.87)%, (54.22±2.35)%, (68.72±3.71)%, (70.04±8.03)%and (71.84±3.12)%, respectively. Conclusion The ethanol extract of olenlandia diffusa can inhibit the proliferation of CT-26 colon cancer cells from BALB/c mice in a time and dose dependent manner.

Animal experiment is indispensable for biomedicine research,and contributes much to the development of biomedicine.With the development of society and advance of human civilization,the welfare of experimental animals and ethical issues of animal researches are drawing extensive attention.The current study investigated the application of experimental animals in the hospital researches,explored the relationship between animal experiment and ethics of animal welfare,and analysed the status of ethics of animal welfare.Further it discussed how to strengthen ethical review of animal experiment so as to promote the ethics management of hospital researches.

BACKGROUND:To obtain more quantum dot (QD) barcodes,the overlay peaks of fluorescence occur,leading to difficulties in identifying QD barcodes.OBJECTIVE:To identify QD barcodes of two adjacent wave length using wavelet transform technique.METHODS:Through the microscopy,the spectrum of fluorescence induced by 375 nm light was captured by spectroscopy.The spectral signal was split into multi-scale components by wavelet transform.After transformed by spline function,every component constructed a new spectrum with peaks expanded by inverse wavelet transform.RESULTS AND CONCLUSION:Interpolation operation was performed on original data to control the data length to 2n.Following wavelet transform,peak location remained unchanged,so the eigenvalue of spectrum of coding fluorescence was extracted.The spectrum of fluorescence mixed with microspheres was split,and two QD barcodes were identified.The improved barcodes identification of adjacent spectrum increase color of QD barcodes,thereby enhancing code information volume.Results show that following spectrum was processed by wavelet transform,overlay peaks of fluorescence has be expanded,and enhanced the efficiency of recognition,which lays a foundation for detecting tumor markers.