Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

OBJECTIVE: To construct the differential expression profile of microRNA (miRNA) in plasma of patients with type 2 diabetes mellitus (T2DM) and explore the possibility of using miRNA as the target for diagnosis and treatment of T2DM. METHODS: Agilent miRNA microarray was used to determine the expression profiles of miRNA in the plasma of patients with T2DM (FC> 2, P< 0.05). The result was verified by real-time quantitative PCR (RT-qPCR). Candidate miRNA was analyzed by bioinformatic tools. RESULTS: In total 122 differentially expressed miRNAs were identified. Among these, 14 were selected by multi-source intersection screening, which included 5 up-regulated genes and 9 down regulated genes. RT-qPCR showed that the expression of hsa-miR-185-5p and hsa-miR-328-5p have significantly increased in T2DM patients (P< 0.05). Bioinformatic analysis suggested that these miRNAs may be involved in the pathogenesis of T2DM through insulin secretion and PI3K-AKT signaling pathway. CONCLUSION Differential expression of hsa-miR-185-5p and hsa-miR-328-5p in the plasma may be closely associated with the pathogenesis of T2DM.
Computational Biology ; Diabetes Mellitus, Type 2/genetics* ; Humans ; MicroRNAs/genetics* ; Phosphatidylinositol 3-Kinases ; Signal Transduction

Objective:To investigate the relationship between the activation level of Nod-like receptor pyrin domain-containing 3 (NLRP3) inflammasome and the change of cognitive functions in patients with acute ischemic stroke.Methods:A total of 88 patients with acute ischemic stroke in Department of Neurology from October 2018 to July 2020 were selected as case group and 100 healthy physical examinees were selected as control group.Peripheral blood of the case group and the control group was collected, and peripheral blood mononuclear cells (PBMCs) were isolated by centrifugation.Then the NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), Caspase-1 and interleukin-1β (IL-1β) expression were detected by Western blot.The cognitive function of patients with acute ischemic stroke was detected by Montreal Cognitive Assessment (MoCA). The differences in expression levels of NLRP3, ASC, Caspase-1 and IL-1β were compared between the case group and the control group.Pearson correlation analysis was used to analyze the correlation between expression levels of NLRP3, ASC, Caspase-1, IL-1β and MoCA score.Logistic multivariate regression was used to analyze the relationship between expression levels of NLRP3, ASC, caspase-1, IL-1β and the cognitive dysfunction.Results:(1)Western blot results showed that NLRP3, ASC, Caspase-1 and IL-1β expressions in PBMCs cells in the case group were higher than those in the control group (all P<0.05). (2)The expression level of NLRP3 in stroke patients with hypertension, hyperlipidemia, National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 points was significantly higher than that in patients without hypertension, hyperlipidemia and NIHSS score<8 points ( P<0.05); (3)The incidence of cognitive dysfunction in the case group was 34.09% (30/88). The MoCA scores of the cognitive dysfunction group and the non-cognitive dysfunction group were 20 (24, 28) and 27 (26, 28) points respectively, and the difference between the groups was statistically significant ( P<0.05); (4)Pearson correlation analysis showed that NLRP3, ASC, caspase-1 and IL-1β expression in PBMCs cells were negatively correlated with MoCA scores ( r=-0.426, -0.396, -0.417, -0.320 respectively, all P<0.05). (5)Logistic regression analysis showed that hyperlipidemia, NIHSS scores, frontotemporal lobe infarction, and NLRP3 expression were the influencing factors for the occurrence of cognitive dysfunction (all P<0.05). Conclusion:Patients with acute ischemic stroke have high activated NLRP3 inflammasome, and its activation degree is closely related to the condition and the occurrence of cognitive dysfunction after stroke.Targeted inhibition or regulation of NLRP3 inflammasome activation may become a new idea of neuroprotection for acute ischemic stroke.

Objective: To investigate the application values of immunophenotypic analysis and molecular genetics in the diagnosis of acute promyelocytic leukemia (APL) . Methods: The retrospective analyses of flow cytometric (FCM) immunophenotypic anyalysis, chromosome karyotype and chromosome fluorescence in situ hybridization (FISH) of 798 outpatient or hospitalization APL patients referred to our hospital between May 2012 and December 2017 were performed to further study the application values of FCM and molecular genetics in the diagnosis of APL. Results: The sensitivity and specificity of FCM were 91.9% and 98.7% respectively. The typical characteristic immunophenotype for APL was as of follows: a high SSC, absence of expression of cluster differntiation (CD) CD34 and HLA-DR, and expression or stronger expression of CD33, consistent expression of CD13, CD9, CD123, expression of CD56, CD7, CD2 (sometimes) . The rest 10% of the cases harbored atypical APL phenotypes, generally accompanied by CD34 and/or HLA-DR expression, decreased SSC and often accompanied by CD2 expression, it was difficult to definitively diagnose APL by this FCM phenotype, and their diagnoses depended on the results of genetics or molecular biology tests. Compared with normal individuals, complex karyotypes APL with t (15;17) translocation, other variant translocations and variant t (11;17) , t (5;17) had no significant differences in terms of their FCM phenotypes. Conclusions FCM could rapidly and effectively diagnose APL. Despite the fact that complex karyotypes with various additional chromosomal abnormalities were detected in approximately one third of APL cases in addition to the pathognomonic t (15;17) (q22;q21) , they had no observable impact on the overall immunophenotype. Molecular and genetic criteria were the golden criteria for the diagnosis of APL. About 10% of immunophenotyping cases relied on molecular genetics for diagnosis.

Objective: To analyze the urination behavior in spring among college students in Hebei Province. Methods: In March 2017, the subjects were recruited in a college in Baoding, Hebei Province. And 156 students completed the investigation. The urine samples of 24 hour was collected for 3 consecutive days by special device, and the volume, the voids and the time of urine were measured. Results: The average volume of urine per day was 1 279 mL, the average void of urine per day was 6.2, and the average volume of urine per time was 209 mL. The volume of urine and void were mainly at the time of after lunch, the volume, the proportion of the volume and void of urine were 406 mL, 31.0% and 1.7 times respectively. The volumes and the voids of urine were different in different time periods(P<0.05). The volume of urine, the proportion of the volume and the voids of urine were mainly at the time of morning, followed by the afternoon. The average volume of urine per day was 535 mL, the proportion of the volume was 44.1% and the average void of urine was 2.3, in the morning. There were significant differences in the voids of urine, the volumes of urine and the voids of urine in different time periods between boys and girls(χ2=73.71, 47.48, 34.92; 35.17, 21.30, 20.69; 37.02, 25.30, 15.32, P<0.05). The void of urine was negatively correlated with the average volume of urine per time(r=-0.61, P<0.01); the volume of urine was positively correlated with the average volume of urine per time(r=0.79, P<0.01); the void was not correlated with the volume of urine(P<0.05). Conclusion The urination behaviour of college students in Hebei Province was mainly at the time of after lunch, in the morning and in the afternoon. The college students had unhealthy urination behavior, which was in need of related health education.

ObjectiveTo investigate the clinical effect of endoscopic dense ligation in the treatment of esophageal variceal bleeding. MethodsA total of 156 patients who underwent endoscopic ligation for the first time due to esophageal variceal bleeding caused by cirrhotic portal hypertension in Shijiazhuang Fifth Hospital from July 2015 to June 2016 were enrolled, and according to the treatment method, they were divided into dense ligation group with 76 patients and non-dense ligation group with 80 patients. The patients were followed up for 1-2 years, and a statistical analysis was performed for the eradication or disappearance rate of varices, the number of times of ligation, early rebleeding rate, late-onset rebleeding rate, and the incidence rate of adverse reactions. The t-test was used for comparison of continuous data between two groups, and the chi-square test or Fisher′s exact test was used for comparison of categorical data between two groups. ResultsThere were significant differences between the dense ligation group and the non-dense ligation group in the eradication or disappearance rate of varices (71.05% vs 55.00%, χ2=4.300, P=0.038) and number of times of ligation (χ2=8.511, P=0.014), and there were no significant differences between the two groups in early rebleeding rate (5.26% vs 2.50%, P＞0.05), late-onset rebleeding rate (7.89% vs 10.00%, P＞0.05), recurrence rate of varices (13.16% vs 18.75%, P＞0.05), and incidence rate of adverse reactions (26.32% vs 21.25%, P＞0.05). There was a significant difference in the time to recurrence of varices between the two groups (11.90±1.89 months vs 7.07±1.17 months, t=2.295, P=0.031). Of all 156 patients, 2 (1.28%) died during follow-up, with 1 patient in the dense ligation group and 1 in the non-dense ligation group. There was no significant difference in mortality rate between the two groups (P＞0.05). ConclusionEndoscopic dense ligation is a safe technique for the treatment of esophageal variceal bleeding and is better than non-dense ligation in terms of the disappearance rate of varices and number of times of ligation. Endoscopic dense ligation also allows a longer time to recurrence of varices than non-dense ligation.

In order to explore the significance of enterovirus environmental surveillance of sewage,two sewage treatment plants in Fuzhou City were selected as sentinel surveillance sites.One sewage sample was collected from entrance of each plant every month,and total 48 samples were studied from 2013 to 2014 in Fuzhou City.Using the RD,L20B and Hep-2 cell lines to isolate the viruses,44 of the 48 sewage samples (91.67％) were positive,268 strains were isolated which covered at least 22 enterovirus serotypes.The peak season of virus isolation from sewage was in February and July which was two months earlier than patient surveillance.Eehovirus type 7 (Echo 7) was the predominant serotype in 2013 with 58 isolations (43.61％),and in 2014 echovirus type 6 (ECHO 6) became the predominant serotype with 85 isolates (62.96％),among the strains isolated from sewage sample.Phylogenetic analysis found that the predominant serotype Echo 6 and Echo 7 isolated from sewage were more diversified than that from clinical cases during the same period,and were high homology with isolates form patients which belong to same branch in phylogenetic tree.In conclusion,enterovirus environmental sewage surveillance is an effective approach,and could be more sensitive than patient surveillance.

Severe infectious diseases,i.e.antibody-dependent enhancement (ADE) resulted from successive infection with different serotypes of dengue virus.After its introduction into Brazil in 2015,Zika virus has spread rapidly to more than 60 countries and regions by the end of November 2016.Some south-east Asian countries including China have also reported cases of ZIKV infection.In recent studies,it was observed that sera cross-reactivity antibodies or such monoclonal antibodies have been elicited by two domains,ED1 and ED2,of envelope (E) protein on Zika or/and Degue virus,and ADE was easily induced by such antibodies.Dengue fever epidemic often occurred in Chinese coastal provinces each year.Then,it will be followed by Zika virus disease.Therefore,we must pay attention to and propose replying measurement for it.

The situation of the ongoing fifth epidemic (beginning October,2016) of human infection with avian influenza A (H7N9) virus are more serious than the first four ones.As of March 8,2017,the fifth epidemic reported 40.00％ of the cumulative cases.Recently,the pathogenic study reported two new human infections in Guangdong with an influenza A(H7N9)virus strain for which gene sequencing analysis revealed mutations in the haemagglutinin (HA) gene that resulted in the insertion of basic amino acids at the cleavage site of this protein,known to confer increased pathogenicity in chickens.However,most strains show no obvious difference in pathogenic characteristics compared with those detected during the first four waves.Although epidemiological studies showed that 3 clusters with limited human-to-human transmission have been investigated during the current wave,there are no indications of sustained person-to-person spread.Based on epidemic analysis and risk assessment results,it's likely that human infections with H7N9 virus will continue to occur in China,but epidemiological and pathogenic analysis suggested that it's unlikely to have a continued transmission of this virus.Profound public health significance would be presented by strengthening etiology and epidemiology studies of avian influenza A(H7N9) virus.