Objective:This study aimed to evaluate the efficacy and safety of venetoclax (VEN) combined with hypomethylating agents (HMA) in the treatment of higher-risk myelodysplastic syndromes (HR-MDS) and analyze the factors influencing their therapeutic effect.Methods:The clinical data of 83 patients with HR-MDS who were diagnosed at the First Affiliated Hospital of Zhengzhou University between November 2019 and May 2023 were retrospectively analyzed. All patients were treated with VEN combined with HMA. The Kaplan-Meier method was used to depict the survival curves, and the log-rank test was used to compare survival between the groups.Results:The median age was 57 (15-82) years old, and 51 patients (61.4%) were male. Forty-five patients (54.2%) were initially treated with HMA, 23 (27.7%) received ≤4 cycles of HMA, and 15 (18.1%) demonstrated HMA failure. At the median follow-up of 10.3 (0.6-34.4) months, the overall response rate (ORR) was 62.7% (52/83), including 18 patients (21.7%) with a complete response (CR), 14 (16.9%) with a bone marrow CR (mCR) with hematological improvement, and 20 (24.1%) with a mCR. The ORR of patients with initial treatment, ≤4 HMA cycles, and HMA failure were 66.7%, 60.9%, and 53.3%, respectively ( P=0.641). The median overall survival time was 14.6 (95% CI 7.2-22.0) months, and the median progression-free survival time was 8.9 (95% CI 6.7-11.1) months. The multivariate analysis showed that serum alkaline phosphatase (ALP) ≥90 U/L (OR=14.574, 95% CI 3.036-69.951, P=0.001), TP53 mutation ( OR=13.052, 95% CI 1.982-85.932, P=0.008), and U2AF1 mutation ( OR=7.720, 95% CI 1.540-38.698, P=0.013) were independent risk factors for poor efficacy of VEN combined with HMA. Hematological toxicity occurred in all patients, and the incidence of treatment-induced grade 3-4 leukopenia was 48.2% (40/83). Infection was the most common non-hematological adverse event, mainly pulmonary infection (31.3%) . Conclusion:VEN combined with HMA had a high response rate in patients with HR-MDS, both at initial treatment and with HMA failure. ALP ≥ 90 U/L, TP53 mutation, and U2AF1 mutation were independent risk factors for non-response to treatment.

Objective:To investigate the clinical characteristics and prognostic factors of primary urethral cancer.Methods:The clinical data of 35 patients with primary urethral cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to April 2022 were retrospectively analyzed. There were 12 males (34.3%) and 23 females (65.7%). The average age was 61.1 ± 13.0 years old. The clinical symptoms included 13 cases of urethral obstruction (37.1%), 7 cases of hematuria (20.0%), 6 cases of urethral bleeding (17.1%), 5 cases of urinary tract irritation (14.3%), 1 case of Urinary incontinence (2.9%), 1 case of low back pain (2.9%), 1 case of scrotal ulcer (2.9%), and 1 case (2.9%) by self examination. All patients underwent cystourethroscopy and tissue biopsy. The biopsy pathology showed 16 cases of urothelial carcinoma, 7 cases of squamous carcinoma, 4 cases of adenocarcinoma, 3 cases of malignant melanoma, 1 case of urothelial carcinoma with squamous carcinoma, 1 case of Signet ring cell carcinoma, 1 case of sarcomatoid carcinoma, 1 case of embryonic Rhabdomyosarcoma, and 1 case of epithelioid angiosarcoma. The tumors were located in the proximal urethra in 13 cases (37.1%) and in the distal urethra in 22 cases (62.9%). There were 14 cases (40.0%) with a maximum diameter of less than 3 cm, 16 cases (45.7%) with a diameter of ≥ 3 cm, and 5 cases (14.3%) with mucosal abnormalities. There were 12 cases of T 1 stage, 9 cases of T 2 stage, 7 cases of T 3 stage, and 7 cases of T 4 stage in tumor staging. Imaging evaluation of lymph nodes showed 25 cases of N 0 stage, 2 cases of N 1 stage, and 8 cases of N 2 stage; A total of 11 cases of lymph node biopsy were performed (including 8 cases of intraoperative lymph node dissection and 3 cases of preoperative lymph node biopsy), of which 6 cases had lymph node metastasis, and 1 case was initially diagnosed with distant metastasis. Thirty-one cases underwent surgical treatment, of which 16 cases underwent radical urethrectomy, and 8 cases underwent intraoperative pelvic and bilateral inguinal lymph node dissection, 8 cases underwent resection of urethral tumors, and 7 cases underwent transurethral resection of tumors. Four cases did not undergo surgical treatment, while 1 case had epithelioid angiosarcoma and received radiotherapy combined with chemotherapy, 2 cases received chemotherapy with GC (Gemcitabine+ cisplatin) regimen, and 1 case received immunotherapy with immune checkpoint inhibitors. The risk factors that affected patient prognosis were analyzed. Results:All 35 cases in this group were followed up, with a median follow-up time of 22 (2, 122) months. Seventeen cases survived, 18 cases died, and the overall median survival duration was 23 (13 to not reached) months. The overall 5-year survival rate was 45%. The results of univariate analysis showed that clinical T-stage ( P=0.019), maximum tumor diameter ( P=0.016), and tumor location ( P=0.006) were independent risk factors affecting patient prognosis. Result of multivariate analysis showed that the maximum diameter of the tumor ≥ 3 cm ( HR=2.673, P=0.029) and the proximal location of the tumor ( HR=3.064, P=0.023) were independent risk factors affecting patient survival. Gender, age, treatment method, lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, clinical manifestations, pathological type, clinical N staging, and pathological N staging had no significant impact on patient survival rate ( P>0.05). Single factor analysis was conducted on female patients separately, and only tumor location was found to be a prognostic factor ( χ2=17.246, P<0.01). Conclusions:Primary urethral cancer is a rare disease with various symptoms and poor prognosis. The maximum diameter of the tumor ≥3 cm and the tumor located at the proximal end of the urethra are clinical risk factors affecting the prognosis of patients with primary urethral cancer.

In order to solve the problems of quality control and traceability of medical test lung for meeting the calibration conditions of JJF 1234-2018 Calibration Specification for Ventilators, the calibration device and method are researched for compliance and airway resistance of medical test lung in this paper. A calibration device for medical test lung is designed using constant volume active piston technology to simulate human breathing. Through comparison experiment, the deviation between this device and the similar foreign device can be found. The deviation is lower than 0.4% for lung compliance and lower than 0.7% for airway resistance. The calibration of lung compliance and airway resistance can be completed by this device. This device has a clear and complete traceability path to ensure quality control from the source. The calibration of ventilator is improved. This paper provides a reference for related metrology departments and medical institutions to study on quality inspection of respiratory medical instruments.
Humans ; Calibration ; Ventilators, Mechanical ; Respiration ; Quality Control ; Lung

Objective:To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method:The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively. There were 42 males and 47 females and patients’median age was 53 (26-78). Sixty-five cases were treated by operation in our hospital, and 24 cases were primarily treated by the operation in another hospital. The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases, abdominal distension in 12 cases, abdominal pain in 10 cases, fever in 11 cases, nausea, vomiting and poor appetite in 8 cases, frequent urination and dysuria in 6 cases, and bilateral lower limb edema in 1 case. Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases, while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases. There were 55 single cases and 34 multiple cases. The median tumor length was 20(3-52) cm. Among the primarily treated 65 patients, 47(72.3%) were considered as primary retroperitoneal liposarcoma by preoperative imaging examination. Among the 89 patients treated by surgery, 78 underwent endoscopic surgery, among which 21 underwent laparoscopic surgery, 38 cases of retroperitoneal laparoscopic surgery, 19 cases of Da Vinci robot-assisted laparoscopic surgery. Open operation was performed in 11 cases. There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection. Forty-two patients underwent intraoperative combined resection of the adjacent organs. The recurrence and survival status of patients were followed up.Results:All the 89 patients underwent the operation successfully, with the median operative blood loss of 200 (10-2000) ml. There were 23 cases being diagnosed of well differentiated liposarcoma, 40 cases of dedifferentiated, 20 cases of myxoid/round, 5 cases of myxoid liposarcoma, and 1 cases of mixed type. Pathologically, there 42 cases with low grade histology and 47 cases with high grade histology. In this study, 89 patients were followed up for 3 to 108 months, and the median follow-up time was 28 months. The 5-year recurrence free survival rate, disease-free survival rate and overall survival rate of the patients were 16.7%, 16.1% and 52.6%, respectively. There were 57 patients presenting local recurrence, 1 patient of lung metastasis, and 1 patient of liver metastasis, and the median disease-free survival time was 24 months. There were 42 patients died of the disease, with a median survival time of 64 months. Univariate analysis showed that intraoperative blood loss( P<0.01), whether multiple cases( P<0.01), pathologic types( P<0.01), and histological grades ( P<0.01) were related to disease-free survival.The intraoperative blood loss( P<0.01), multiple cases( P<0.05), pathologic types ( P<0.05), and recurrence ( P<0.01)were related with overall survival. Gender, age, tumor size, tumor location, whether primary surgery, radical resection or combined resection of adjacent organ had no effect on the prognosis of patients ( P>0.05). Cox regression model multivariate analysis revealed that surgical bleeding ( RR=2.360, 95% CI 1.313-4.241, P=0.004), multiple tumor ( RR=1.899, 95% CI 1.068-3.375, P=0.029), and pathological type ( RR=4.976, 95% CI 1.622-15.264, P=0.005) were independent factors affecting disease-free survival. The recurrence was an independent factor affecting the overall survival of patients ( RR=31.495, 95% CI 1.062-933.684, P=0.046). Conclusions:Retroperitoneal liposarcoma is a rare disease with high recurrence rate. The intraoperative blood loss, whether multiplicity and pathological type are independent factors affecting the disease-free survival, and recurrence is independent factors affecting the overall survival.

Objective:To investigate the efficacy and safety of transperitoneal robot-assisted nephroureterectomy (RANU) with a single body position and original ports for upper urinary tract urothelial carcinoma(UTUC).Methods:Clinical data of 21 patients from March 2018 to November 2019 in the First Affiliated Hospital of Zhengzhou University was retrospectively analyzed, including 14 males and 7 females. The age was (63.8±11.4) years and the BMI was (23.6±2.5) kg/m 2.Of the 21 localized UTUC patients, 8 pelvic tumors, 3 middle ureter tumors, 10 lower ureter tumors; 11 on the left, 10 on the right; 20 of 21 tumors (95.2%) were high risk. Surgery was done by the same urologist. Under general anesthesia, the patients were in 75 ° healthy side lying position and overall 15 ° head down and foot high position. Improved layout of ports: camera port C was located at two fingers lateral to the umbilicus, 2 cm below the umbilicus; robotic arm port 1 and 2 were respectively located at pararestus line, close to costal margin and 2 cm below the midpoint between C and the affected iliac crest. Assistant port 1 and 2 were respectively located at 2 cm above the umbilicus and 4 cm below the umbilicus. The right cases need an additional assistant port under the xiphoid to provoke the liver. Hem-o-lok cliped the ureter distal to the tumor and the affected kidney was radically removed. Under the principle of tumor free, the ureter and the surrounding bladder wall within 1 cm were excised and the bladder was sutured. Lymphadenectomy was performed when the kidney and ureter were dissociated. Results:All 21 procedures were successful without open surgery or position change and intraoperative complications. No patients required a blood transfusion. The operation time was (205.2±57.3) min. The median intraoperative blood loss was 50 ml (20-120 ml). The median drainage tube indwelling time was 4d(3-7 d) and the median urinary catheter indwelling time was 7 d(5-8 d), the median postoperative hospital stay was 7 d(6-12 d).7 cases(33.3%)of Clavien-Dindo grade Ⅰ complications after surgery and they all relieved after giving symptomatic treatment. All postoperative pathology showed UTUC and negative resection margins. The median follow-up time was 12 months (4-22 months), 1 patient died of an accident 7 months after surgery and 3 patients had recurrence at 6, 8, and 10 months after surgery, survival at the last follow-up after treatment.Conclusions:The transperitoneal RANU with a single body position and original ports is safe and effective. The operation time is saved, the incidence of intraoperative and postoperative complications is low, the postoperative patients recover quickly.Short-term follow-up results prompt low recurrence rate and good tumor control effect.

BACKGROUND AND PURPOSE: This study investigated the contribution of white-matter hyperintensities (WMH) and lacunar infarcts (LI) to the risk of Alzheimer's disease (AD) in an elderly cohort in China. METHODS: Older adults who were initially cognitively normal were examined with MRI at baseline, and followed for 5 years. WMH were classified as mild, moderate, or severe, and LI were classified into a few LI (1 to 3) or many LI (≥4). Cognitive function was assessed using the Mini Mental State Examination and the Activities of Daily Living scale. RESULTS: Among the 2,626 subjects, 357 developed AD by the end of the 5-year follow-up period. After adjusting for age and other potential confounders, having only WMH, having only LI, and having both WMH and LI were associated with an increased risk of developing AD compared with having neither WMH nor LI. Moderate and severe WMH were associated with an increased risk of developing AD compared with no WMH. Furthermore, patients with many LI had an increased risk of developing AD compared with no LI. CONCLUSIONS: Having moderate or severe WMH and many LI were associated with an increased risk of developing AD, with this being particularly striking when both WMH and LI were present.
Activities of Daily Living ; Adult ; Aged* ; Alzheimer Disease* ; China* ; Cognition ; Cohort Studies ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Strikes, Employee ; Stroke, Lacunar*

Objective To understand the physical activity of early stage pregnant women and explore its influential factors. Methods From June 2015 to June 2016, 2122 pregnant women with early pregnancy card in Ma An Shan Maternal and Child Health Hospital were selected and surveyed with a questionnaire. The Physical Activity Questionnaire was used to understand the physical activity of pregnant women in their early pregnancy. Analysis of variance and t-test were used to describe the distribution of energy expenditures of physical activity of pregnant women with different demographic characteristics, and multiple linear regression analysis was used to analyze the factors influencing the energy expenditure of their physical activity. Result The duration of activities of sleep and sitting type was (16.56 ± 3.54) h, accounting for 83.38％of total activity time;the energy consumption value was (17.17±5.59) METs·h;mild physical activity time was (2.62±1.86) h, accounting for total time. 13.19％and the energy consumption value was (6.06±4.43) METs·h;the average time of moderate to severe physical activity was (0.68±0.93) h, accounting for 3.42％of total physical activity time, and the energy consumption value was (3.22±4.58) METs·h. In the univariate analysis, the energy expenditures of physical activity between the different groups (t=-3.551), education level (F=1.347), and occupation type (F=1.485) were different, and the difference was statistically significant (P<0.05). In multiple linear regression analysis, different occupational types and education were the energy expenditure levels of physical activity during early pregnancy. Influencing factors (P<0.05). Conclusion Pregnant women have longer periods of sleep and meditation during the first trimester, and shorter duration of physical activity than mild and above;the energy expenditure of physical activity during the first trimester of pregnancy is affected by the occupational type and educational level of the pregnant woman.

BACKGROUND: Low-frequency ultrasound combined with Tongluo Zhitong herbs can effectively relieve pain and improve joint function of patients with osteoarthritis, but the underlying mechanisms are still unclear.OBJECTIVE: To investigate the effects of low-frequency ultrasound combined with Tongluo Zhitong herbs on urokinase-type plasminogen activator (uPA) and inflammatory cytokines of osteoarthritis rabbits and the related mechanisms.METHODS: Forty rabbits were randomly divided into four groups: normal, model, control, and experimental groups. The normal group was treated with normal feeding, not for any processing. For the other three groups, papain was injected into the rabbit knee articular cavity to establish osteoarthritis models. One week later, the experimental group was treated with low frequency ultrasound combined with Tongluo Zhitong herbs for 3 weeks, the control group treated with the same volume of normal saline, and the model group received no intervention. The levels of inflammatory cytokines in the serum and synovial fluid were measured, the histological changes of synovial tissues and articular cartilage were evaluated using Mankin's score, and the expression levels of uPA and its receptor were determined by western blot assay.RESULTS AND CONCLUSION: The levels of inflammatory cytokines in the model group were significantly higher than those in the normal and experimental groups (P < 0.05). The Mankin's scores of synovial tissue in the experimental group were significantly lower than those in the model and control groups (P < 0.05), while Mankin's scores of the cartilage tissue had no significant difference between the experimental and model groups (P > 0.05). Compared with the model group, in the experimental group, the expression levels of uPA and its receptor were significantly downregulated,and the expression of uPA inhibitor was notably upregulated. These data show that low-frequency ultrasound combined with Tongluo Zhitong herbs attenuates inflammatory reaction in the synovial tissues, by inhibiting the formation of joint fluid and production of inflammatory cytokines, which is an effective treatment for knee osteoarthritis.

Objective To explore the method of limb salvage therapy for hand and foot destructive injury, and to clarify the role of free tissue transplantation in limb salvage therapy in patients with hand and foot destructive injury. Methods From January, 2015 to January, 2016, 17 hand and foot destructive injuried patients were treated with limb salvage. The anterolateral thigh free flap, free fibular flap and arterial vein flap were used to repair the skin, soft tissue and bone defects. All patients were followed-up for 12 months. The appearance and function of the patients were evalu-ated after the treatment. The hand scoring criterion was the finger replantation function evaluation standard on probation of the Chinese Medical Association of Hand Surgery. The foot scoring criterion was the Maryland score system. Re-sults All flaps survived in 17 patients. One flap had vascular crisis after operation, and survived after vascular ex-ploratory operation. One case had infection postoperation and healed after several debridements. After 12 months, the functional scores were excellent in 5 cases, good in 5 cases, moderate in 3 cases and poor in 4 cases. Conclusion The early repair with free tissue transplantation can preserve limb length, cover the exposed bone and tendon, and improve the anti-infective ability, so as to improve the function of limb salvage and patient 's satisfaction.

Objective To explore the correlation between pregnancy-related anxiety and serum 25 (OH)D level during early pregnancy. Methods A radioimmunoassay was used to determine the serum 25 (OH)D levels of 2 122 early pregnant women in Maanshan Maternal and Child Health Care Hospital, from June 2015 to 2016. Data were collected using a questionnaire. Results The mean serum 25(OH)D level was(29.71±32.27)nmol/L.About 15.2% of the subjects had adequate,22.6% had insufficient,45.1% had deficient,and 17.1% had severely deficient serum 25(OH)D levels.The type of housing and testing seasons were significantly associated with the serum 25(OH)D level.Single factor logistic regression analysis results show that pregnancy-related anxiety incidence in the group deficient in 25(OH)D was higher than that in the adequate group, which has a statistically significant difference (P<0.05). After adjusting for the maternal age,BMI,and educational level,multivariate logistic regression analysis results showed that the difference was statistically significant. Conclusion The serum 25(OH)D level in early pregnant women was inadequate. Furthermore, lack of serum 25(OH)D in early pregnancy and pregnancy-related anxiety were negatively correlated.