Objective To analyze the influencing factors of postoperative urinary tract infection in patients undergoing transurethral resection of the prostate with plasmakinetic energy(PKRP)and establish a risk prediction nomogram model.Methods The data of PKRP patients in Department of Urology,the Second Affiliated Hospital of Nanchang University from December 2020 to September 2021 were selected as the modeling set,and the high-risk factors were screened by univariate analysis and Logistic regression analysis.The risk prediction nomogram model was constructed and verified internally and externally.Results The incidence of urinary tract infection after PKRP surgery was 15.38%.Multivariate analysis showed that age,other location infection,diabetes,preoperative catheterization,urethral injury,indwelling catheter material,hair coloring catheter replacement times and number of indwelling catheterization were risk factors for urinary tract infection(P<0.05).Internal verification(area under the curve was 0.875)and external verification(area under the curve was 0.869)show that the risk prediction nomogram model has good discrimination and accuracy.Conclusion The influencing factors of urinary tract infection after PKRP are complex.The risk prediction nomogram model has good prediction performance,which can provide a basis for the prevention and treatment of urinary tract infection after PKRP.

BACKGROUND: The association between sex hormone-binding globulin (SHBG) and renal function has rarely been reported in men. We aimed to investigate the above association in a community-based Chinese population. METHODS: A total of 5027 men were included from the survey on prevalence for metabolic diseases and risk factors, which is a population-based study conducted from 2014 to 2016 in Eastern China. The estimated glomerular filtration rate (eGFR) was calculated according to the chronic kidney disease Epidemiology Collaboration equation. Low eGFR was defined as eGFR <60 mL·min -1 ·1.73 m -2 . RESULTS: After adjusting for age, smoking, metabolic factors, and testosterone, through increasing quartiles of SHBG, a significantly positive association between SHBG quartiles and eGFR was detected in men (Q1 vs. Q4, β -2.53, 95% confidence interval -3.89, -1.17, Ptrend < 0.001). Compared with the highest quartile of SHBG, SHBG in the lowest quartile was associated with 96% higher odds of low eGFR (odds ratio 1.96, 95% confidence interval 1.10, 3.48) in the model after full adjustment. According to the stratified analyses, the associations between a 1-standard deviation increase in serum SHBG and the prevalence of low eGFR were significant in men aged ≥60 years old, waist circumference <90 cm, diabetes (no), hypertension (yes), dyslipidemia (no), and nonalcoholic fatty liver disease (no). CONCLUSIONS Lower serum SHBG levels were significantly associated with lower eGFR and a higher prevalence of low eGFR in Chinese men independent of demographics, lifestyle, metabolic-related risk factors, and testosterone. Large prospective cohort and basic mechanistic studies are warranted in the future.
Humans ; Male ; Middle Aged ; China/epidemiology* ; Kidney/metabolism* ; Prospective Studies ; Sex Hormone-Binding Globulin/physiology* ; Testosterone ; Tomography, Emission-Computed, Single-Photon ; Glomerular Filtration Rate

OBJECTIVE：To establish a method for th e content determination of 7 kinds of triterpenoids in Poria cocos ，and to compare the differences of the above components in P. cocos from different habitats ，so as to provide reference for the quality control of P. cocos . METHODS ：Using 36 batches of P. cocos from different habitats as samples ，HPLC method was used for content determination of dehydrotomorphic acid ， polyporhinic acid C ， 3-epidehydrotomorphic acid ， 3-O-acetyl-16 α-hydroxy-hydrogenolysaccharic acid ，dehydrotomorphic acid ，pachymic acid and dehydrotrametenolic acid. The column was performed on Thermo Acclaim 120 C18 with mobile phase consisted of acetonitrile-phosphoric acid water （gradient elution ）at the flow rate of 1 mL/min. The detection wavelength was set at 210 nm. The column temperature was 30 ℃，and the injection volume was 20 μL. SPSS 21.0 statistical software was used for cluster analysis of 36 batches of P. cocos from different habitats. RESULTS ： The linearity of 7 triterpenoids was good in the range of their mass concentration （all r≥0.999 0）；average recoveries were 96.74％-104.04％（RSD＝0.54％-1.55％，n＝6）. RSDs of precision ，and reproducibility stability （24 h）tests were all lower than 3.0％（n＝6）. RSD of durability test was lower than 5.0％（n＝2）. There were some differences in the single content of 7 indicator components among samples from different habitats ，but the total content difference was not obvious （the total content of most samples was in the range of 1.3-1.9 mg/g）. After cluster analysis ，36 batches of sample were clustered into 5 categories，i.e. S 27 was clustered into class Ⅰ；S30 and S 34 were clustered into class Ⅱ；S2，S8 and S 9 were clustered into class Ⅲ；S10，S11，S12 and S 14 were clustered into class Ⅳ；and the remaining 26 batches of samples were clustered into class Ⅴ. CONCLUSIONS ：The method is simple ，and has good precision ，repeatability and durability. It can be used for the simultaneous determination of above 7 components in P. cocos . There has no significant difference in the quality of P. cocos from different habitats. The content of P. cocos in most producing areas is uniform in content and stable in quality ，only a few of them are different. Δ 基金项目 ：国家重点研发计划中医药现代化研究重点专项

BACKGROUND: Pulmonary fibrosis is a respiratory disease caused by the proliferation of fibroblasts and accumulation of the extracellular matrix (ECM). It is known that the lung ECM is mainly composed of a three-dimensional fiber mesh filled with various high-molecular-weight proteins. However, the small-molecular-weight proteins in the lung ECM and their differences between normal and fibrotic lung ECM are largely unknown. METHODS: Healthy adult male Sprague-Dawley rats (Rattus norvegicus) weighing about 150 to 200 g were randomly divided into three groups using random number table: A, B, and C and each group contained five rats. The rats in Group A were administered a single intragastric (i.g.) dose of 500 μL of saline as control, and those in Groups B and C were administered a single i.g. dose of paraquat (PQ) dissolved in 500 μL of saline (20 mg/kg). After 2 weeks, the lungs of rats in Group B were harvested for histological observation, preparation of de-cellularized lung scaffolds, and proteomic analysis for small-molecular-weight proteins, and similar procedures were performed on Group C and A after 4 weeks. The differentially expressed small-molecular-weight proteins (DESMPs) between different groups and the subcellular locations were analyzed. RESULTS: Of the 1626 small-molecular-weight proteins identified, 1047 were quantifiable. There were 97 up-regulated and 45 down-regulated proteins in B vs. A, 274 up-regulated and 31 down-regulated proteins in C vs. A, and 237 up-regulated and 28 down-regulated proteins identified in C vs. B. Both the up-regulated and down-regulated proteins in the three comparisons were mainly distributed in single-organism processes and cellular processes within biological process, cell and organelle within cellular component, and binding within molecular function. Further, more up-regulated than down-regulated proteins were identified in most sub-cellular locations. The interactions of DESMPs identified in extracellular location in all comparisons showed that serum albumin (Alb) harbored the highest degree of node (25), followed by prolyl 4-hydroxylase beta polypeptide (12), integrin β1 (10), apolipoprotein A1 (9), and fibrinogen gamma chain (9). CONCLUSIONS Numerous PQ-induced DESMPs were identified in de-cellularized lungs of rats by high throughput proteomics analysis. The DESMPs between the control and treatment groups showed diversity in molecular functions, biological processes, and pathways. In addition, the interactions of extracellular DESMPs suggested that the extracellular proteins Alb, Itgb1, Apoa1, P4hb, and Fgg in ECM could be potentially used as biomarker candidates for pulmonary fibrosis. These results provided useful information and new insights regarding pulmonary fibrosis.

Objective We aimed to investigate whether sex hormone levels including total testosterone, estradiol, estradiol/total testosterone, and dehydroepiandrosterone ( DHEA ) were associated with macrovascular complications among Shanghai community-dwelling diabetic men. Methods Relying on the Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study (ChiCTR1800017573, www.chictr.org.cn), 2147 male diabetic participants were recruited from 10 communities. Carotid plaques and common carotid artery ( CCA) diameters were detected by carotid ultrasound. Cardiovascular disease ( CVD) was defined as a self-reported diagnosis of CVD, including coronary heart disease, myocardial infarction, or stroke. Results ( 1) The prevalence of CVD in this study was 36. 0％, and patients with CVD had higher rates of hypertension and dyslipidemia than those without CVD. ( 2) After controlling for multiple factors, serum DHEA levels were negatively correlated with the prevalence of CVD while estradiol levels were positively correlated with both the prevalences of CVD and carotid plaque, estradiol/total testosterone ratio was also positively correlated with the prevalence of CVD. ( 3) In subgroup with unilateral/bilateral CCA plaque, and after controlling for multiple factors, total serum testosterone was negatively associated with the mean CCA diameter. Conclusion The incidence of macrovascular complications was lower in male diabetic patients with higher serum total testosterone and DHEA levels and lower estradiol levels, suggesting that sex hormone levels may be a window for the diagnosis and treatment of diabetic macrovascular complications.

Objective To determine the expression of cathepsin D and advanced glycation end products (AGEs)in skin tissues from patients of different ages or skin tissues with different degrees of sun exposure,to evaluate their correlation,and to preliminarily investigate the role of cathepsin D in the degradation and accumulation of AGEs in photoaged skin.Methods Skin tissues were collected from sunexposed and sun-protected body sites in patients aged 15-20 years,35-40 years,55-60 years or 75-80 years.These skin tissues were divided into 8 groups according to age of patients and degrees of sun exposure,and there were 6 specimens in each group.Immunohistochemical and immunofluorescent methods were used to measure the expression of cathepsin D and AGEs in the skin tissues.Statistical analysis was carried out by factorial design analysis of variance,Wilcoxon rank sum test and Kruskal-Wallis rank sum test for analyzing associations of the expression of cathepsin D and AGEs with age and sun exposure,as well as by Pearson correlation analysis for assessing the correlation between cathepsin D expression and AGEs expression.Results Immunohistochemical study showed that the expression of cathepsin D markedly decreased along with the increase of age,but the accumulation of AGEs gradually increased along with the increase of age.In the same age group,the cathepsin D expression was lower in the sun-exposed skin tissues than in the sun-protected skin tissues,while the accumulation of AGEs was more in the sun-exposed skin tissues than in the sun-protected skin tissues.Factorial design analysis of variance showed that sun exposure could decrease the expression of cathepsin D (F =58.70,P ＜ 0.001),but increase the accumulation of AGEs (F =158.18,P ＜ 0.001).Moreover,the increase of age could lead to decreased expression of cathepsin D (F =79.49,P ＜ 0.001),and increased expression of AGEs (F =106.06,P ＜0.001).Compared with the sun-protected skin tissues,the sun-exposed skin tissues in all the age groups showed significantly lower absorbance value of cathepsin D (35-40 years:0.020 ± 0.005 vs.0.032 ± 0.005;55-60 years:0.012 ± 0.004 vs.0.026 ± 0.002;75-80 years:0.002 ± 0.001 vs.0.013 ± 0.004;all P ＜0.001),but higher absorbance value of AGEs (35-40 years:0.030 ± 0.008 vs.0.010 ± 0.003;55-60years:0.066 ± 0.010 vs.0.021 ± 0.004;75-80 years:0.085 ± 0.015 vs.0.035 ± 0.009;all P ＜ 0.001)except the age group of 15-20 years.No matter whether the skin tissues were sun-exposed or sunprotected,there were significant differences in the expression of cathepsin D and AGEs among different age groups (all P ＜ 0.001).The results of double immunofluorescence staining were similar to those of immunohistochemical study.Pearson correlation analysis showed that the expression of cathepsin D in the sun-exposed skin tissues was highly negatively correlated with the accumulation of AGEs (r =-0.915,P ＜0.05),while they were moderately negatively correlated in the sun-protected skin tissues (r =-0.730,P ＜0.05).Conclusions Along with the increase of age,the expression of cathepsin D in skin tissues decreased,but the expression of AGEs increased.In the sun-protected skin tissues,the expression of cathepsin D was moderately negatively correlated with the expression of AGEs,while they were highly negatively correlated in the sun-exposed skin tissues,suggesting that cathepsin D may play an important role in the degradation and accumulation of AGEs in photoaged skin.

OBJECTIVETo explore the value of criminal fold priority separating (CFPS) in reduction of iatrogenic splenic injury in laparoscopic radical gastrectomy.

METHODSComplete videos of 270 patients undergoing laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. Anatomic features of criminal fold (CF) were summarized. The relationship between CFPS and iatrogenic splenic injury was examined. CF was defined as the ligament between omentum and spleen. CFPS was defined as that CF was separated before the left half gastrocolic omentum was dissected. Splenic injury was further compared between CFPS group and non-CFPS group.

RESULTSCF occurred in 81.5% cases (220/270), presenting one bunch or multiple bunches. CF appeared most commonly in the lower pole of spleen (76.7%, 207/270), then in middle spleen (14.1%, 38/270) and upper pole (9.6%, 26/270). CFPS was performed in 20% cases (54/270) and 80% cases (216/270) were non-CFPS. The incidence of iatrogenic splenic injury was 11.1% (30/270), and this incidence of CFPS group was lower as compared to non-CFPS group (3.7%, 2/54 vs. 13.0%, 28/216), but the difference was not significant (P=0.07). Of 30 patients with splenic injury, 24(80%) were due to traction of CF and all were in non-CFPS group. Instrument injury occurred in 20% cases(6/30) and 2 were in CFPS group and 4 were in non-CFPS group. Most iatrogenic splenic injuries were successfully handled with electrocoagulation, adhesive and compression, except 2 patients underwent open splenectomy for serious splenic injury in non-CFPS group.

CONCLUSIONIn laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly results from improper traction of CF and CFPS can reduce the incidence of iatrogenic splenic injury.

Under the background of current strained doctor-patient relationship,the new Criminal law Amendment stipulates that people who makes medical troubles shall be persecuted for their criminal liability in order to reconstruct harmonious doctor-patient relationship.Through questionnaire survey,this paper investigated the cognitive status,cognitive channel,and improvement measures of doctor-patient relationship after the new Criminal law Amendment in college students in Nanjing,analyzed the causes,and discussed the possible path to construct harmonious doctor-patient relationship.Doctor-patient communication should be enhanced;patients should seek medicine service rationally;hospitals should effectively deal with complaints and disputes and vigorously strengthen the enforcement strength of the new Criminal law Amendment.

BACKGROUND: Preliminary experimental study found that the human amniotic mesenchymal stem cells (hAMSCs)transplantation can improve nerve injury symptoms of rats with cerebral infarction.OBJECTIVE: To observe the survival, colonization and differentiation of hAMSCs in the infarct area of cerebralinfarction rats.METHODS: Sixty Sprague-Dawley rats were randomly assigned into hAMSCs transplantation, model or shamoperation groups (n=20/group). Animal models of middle cerebral artery occlusion were produced in the model andtransplantation groups by Zea-Longa method. One day after modeling, rats in the hAMSCs transplantation groupwere given in situ transplantation of 10 μL of hAMSCs (2×106) into the damaged striatum and cortex, while those inthe model and sham operation group were given the same volume of PBS. Within 1 week after transplantation, ratneurological defects were assessed and changes in their body mass were continuously monitored. Two weeks aftertransplantation, TTC staining was used to observe cerebral infarct size, hematoxylin-eosin staining was used forpathological observation of brain tissues, and immunofluorescent staining was used to detect expression ofneuron-specific nuclear protein.RESULTS AND CONCLUSION: With time, weight loss was increased while neurologic deficit scores were graduallyreduced in the hAMSCs and model groups. Compared with the model group, the weight loss and neurologic deficitscores were lower in the hAMSCs group,; however, there was a significant difference in the neurologic deficit scoresbut not in the weight loss between the two groups. Additionally, the hAMSCs significantly reduced infarct size,attenuated pathologic injury, and decreased the number of inflammatory cells. Immunofluorescence stainingshowed that the hAMSCs were observed at 1 week after transplantation under inverted luorescence microscope,and gradually differentiated into nerve cells at 2 weeks after transplantation. In conclusion, transplanted hAMSCsmay migrate to and survive in the cerebral infarct region, and differentiate into nerve cells in situ in rats with cerebralinfarction.

Objective To compare the effect of Buzhong Yiqi Decoction (BYD) containing different doses of Radix Astragali on fibulin-3 expression in the hemorrhoid tissues of stage Ⅲ internal hemorrhoids patients with spleen deficiency and sinking of qi, and to evaluate its therapeutic efficacy and possible mechanism. Methods Fifty-five qualified patients were randomly divided into control group(N = 15), Chinese medicine group 1(N =20), and Chinese medicine group 2(N=20). All of the 3 groups were treated with operation, and additionally, Chinese medicine group 1 was given BYD containing Radix Astragali 20 g, and Chinese medicine group 2 was given BYD containing Radix Astragali 50 g orally after operation. The scores of anal pendant expansion and anal prolapse were evaluated, and the expression level of fibulin-3 in the hemorrhoid tissues was detected by Western blot method. Results After treatment, the symptoms of anal pendant expansion and anal prolapse were improved in the 2 Chinese medicine groups (P < 0.05) , and the improvement of anal pendant expansion symptom in Chinese medicine group 2 was superior to that of Chinese medicine group 1(P<0.05). Compared with the control group, the expression level of fibulin-3 in the hemorrhoid tissues of the two Chinese medicine groups was increased (P < 0.05); the expression level of Chinese medicine group 2 showed an increasing trend as compared with that of Chinese medicine group 1, but the difference was statistically insignificant (P > 0.05). Conclusion BYD with large dose of Radix Astragali exerts stronger therapeutic efficacy for the treatment of prolapsed hemorrhoids than BYD with small dose of Radix Astragali, and its therapeutic mechanism has no obvious relation with promoting the increase of fibulin-3 expression.