Objective To construct large medical model named by "Huaxi HongYi"and explore its application effectiveness in assisting medical record generation. Methods By the way of a full-chain medical large model construction paradigm of "data annotation - model training - scenario incubation", through strategies such as multimodal data fusion, domain adaptation training, and localization of hardware adaptation, "Huaxi HongYi" with 72 billion parameters was constructed. Combined with technologies such as speech recognition, knowledge graphs, and reinforcement learning, an application system for assisting in the generation of medical records was developed. Results Taking the assisted generation of discharge records as an example, in the pilot department, after using the application system, the average completion times of writing a medical records shortened (21 min vs. 5 min) with efficiency increased by 3.2 time, the accuracy rate of the model output reached 92.4%. Conclusion It is feasible for medical institutions to build independently controllable medical large models and incubate various applications based on these models, providing a reference pathway for artificial intelligence development in similar institutions.

Objective To compare the short-term clinical effects of unilateral dual-channel endoscopic discectomy(UBED)and percutaneous endoscopic intervertebral discectomy(PEID)in the treatment of L5S,Lumbar disc herniation,LDH.Methods From January 2019 to January 2021,a total of 57 cases of L5S,LDH treated by UBED or PEID were analyzed retrospectively,including 30 cases in UBED group and 27 cases in PEID group.The operation time,intraoperative fluoroscopy times,postoperative hospitalization days and surgical complications were compared between the two groups.The visual analogue scale(VAS)and oswestry disability index(ODI)were used to compare the postoperative quality of life of the two groups,and the modified MacNab criteria was used to evaluate the clinical efficacy in the last follow-up.Results The operation time of UBED group and PEID group was(75.30±8.44)minutes and(68.37±4.63)minutes,respectively,and the difference between the two groups was statistically significant(P＜0.05).VAS and ODI of 1 week,3 months,1 year and 1.5 years after surgery in 2 groups were significantly decreased compared with those before surgery,with statistical significance(P＜0.05).The VAS score of low back pain in UBED group was higher than that in PEID group[(3.87±1.14)points vs(2.70±0.67)points]at 1 week after surgery(P＜0.05),and there was no significant difference in VAS and ODI at the other time points(P＞0.05).There was no statistical difference in the results of modified MacNab criteria in the last follow-up(P＞0.05).There were 2 cases of dural tear in PEID group,1 case of dural tear in UBED group and 1 case of temporary nerve root injury in PEID group after operation,all of which were cured after symptomatic treatment.Conclusion Compared with PEID,UBED has a longer operation time,more trauma and more obvious low back pain in the short term after operation.The short-term curative effect of the two operations on L5S1 LDH is similar,the incidence of complications is low,and the times of fluoroscopy are few.Both operations are safe and effective.

Objective:To explore the effect of moderate intensity physical exercise on depression, anxiety and cognitive function of schizophrenic patients and its possible biochemical mechanism.Methods:Totally 148 patients with schizophrenia who were hospitalized in hospital from March 2019 to March 2021 were randomly divided into control group ( n=75) and exercise group ( n=73). The patients of the two groups were given drug treatment and routine exercise according to clinical practice, and the patients in exercise group were given additional medium-intensity physical exercise.Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the poor mental state of the subjects.The verbal fluency task(VFT), digital span test(DST), trail making test-A(TMT-A) and the positive and negative symptom scale (PANSS) were used to evaluate cognitive function.The levels of endocannabinoids (eCBs) receptors were detected by high performance liquid chromatography, and the levels of monoamine neurotransmitters and eCBs in the patients' serum were determined by enzyme-linked immunosorbent assay (ELISA). SPSS 19.0 software was used for statistical analysis.The measurement data between the two groups were compared by t-test and the counting data between the two groups were compared by χ2 test. Results:(1) After effective intervention, the scores of SAS, SDS, TMT-A and PANSS of the two groups were significantly lower than those before intervention, and the difference before and after intervention between the two groups was statistically significant( t=6.00, 6.52, 25.79, 17.03, all P<0.01). The scores of SAS, SDS, TMT-A and PANSS after intervention in the exercise group were significantly lower than those in the control group( t=4.66, 20.88, 6.61, 8.95; all P<0.01). The number of VFT and DST in the two groups after intervention were significantly higher than those before intervention, and the differences before and after intervention between the two groups were statistically significant( t=13.78, 22.76, both P<0.01). After effective intervention, the number of VFT and DST in exercise group were significantly higher than those in the control group( t=5.02, 5.15, both P<0.01). (2) After effective intervention, the contents of monoamine neurotransmitters and eCBs in serum of the two groups were significantly higher than those before intervention, and HVA level ((63.68±6.99) pg/mL), MHPG level ((175.90±16.22) pg/mL), 5-HIAA level ((29.94±4.19) pg/mL) and CBR1 level ((6.70±1.40)μg/L), 2-AG level ((61.90±5.73)pmol/g) and AEA level ((76.48±6.59) pmol/g) in exercise group were significantly higher than those in the control group ((52.97±5.37)pg/mL, (138.50±11.52)pg/mL, (23.87±3.15)pg/mL, (5.71±1.29)μg/L, (52.13±5.14)pmol/g, (67.66±5.88)pmol/g)( t=10.43, 16.21, 10.91, 8.65, all P<0.01). Conclusion:Moderate intensity physical exercise can significantly improve their depression, anxiety and cognitive function, which may be related to regulating the levels of ECBS and their receptors in patients with chronic schizophrenia to increase monoamine neurotransmitters.

Objective To analyze the correlation between detection of influenza pathogenic subtypes and epidemic situation in Hefei City during the surveillance years of 2015-2021, and to provide references for developing influenza prevention and control strategies. Methods The relevant data of influenza-like illness (ILI) surveillance, influenza etiology, and outbreak/cluster outbreaks reported from influenza surveillance sentinel hospitals in Hefei City from 2015 to 2021 in the China Influenza Surveillance Information System were analyzed. The statistical analysis was carried out. Results A total of 3 332 553 outpatient and emergency visits in 2 sentinel hospitals were reported in Hefei City from 2015 to 2021, of which 139,082 were ILI cases, accounting for 4.17%. The monthly proportion ranged from 1.60% to 7.15%. A total of 14 663 ILI specimens were submitted for detection, the submission rate was 10.54%, and the positive rate of influenza virus detection was 11.30%. There was no correlation between the proportion of monthly influenza like cases and the detection rate (r_s=0.176, P=0.107). The composition ratio of each subtype of influenza virus varied greatly, showing diversified seasonality, and the epidemic strains changed constantly. The Victoria subtype (BV subtype) was dominant (40.21%). There was a moderate correlation between the positive rate of ILI in sentinel hospitals and the number of outbreaks per month (r_s=0.696, P=0.000). There was a strong correlation between the monthly number of outbreaks and the detection rate (r_ss=0.696, P=0.000). There was a strong correlation between influenza A virus H3 subtype and BV subtype (r_{s -H3}=0.686, P=0.030; r_{s -BV}=0.632, P=0.000). There was a moderate correlation between the new A1 subtype and B Yamagata subtype (r_{s -new A H1}=0.481, P=0.000 0; r_{s -BY}=0.515, P=0.000). Conclusion There are two epidemic peaks in spring and winter in Hefei. Influenza subtypes are diverse. The results of ILI etiology can predict the outbreaks of different subtypes of influenza. Prediction and surveillance should be used for influenza control and outbreak management in a timely manner.

Three cases of lower lumbar nerve root gangliomas with spinal instability or lumbar disc herniation are reported. The first patient was treated for lumbosacral pain and discomfort for more than 10 days. Preoperative diagnosis was L 5S 1 intervertebral instability, L 5 bilateral spondylolysis, and L 5S 1 left intervertebral foraminal space occupying lesions to be investigated, the tumor was removed intraoperatively and sent to pathology. Meanwhile, L 5S 1 posterior interbody bone graft fusion and internal fixation were performed. The second patient presented for 1 month due to left lumbar and leg pain and discomfort. Preoperative diagnosis was L 4-5 intervertebral instability and L 4-5 intervertebral disc herniation. Intraoperative exploration revealed a nerve root mass on the left side of L 5, which was surgically removed and sent to pathology. Meanwhile, posterior decompression of L 4 and L 5 intervertebral bone grafting and internal fixation were performed. The third patient presented for 4 days with right lumbar and leg pain and discomfort. Preoperative diagnosis was L 3-4, L 4-5 and L 5S 1 intervertebral disc herniation. Intraoperative exploration found a right nerve root mass of S 1, which showed invasive growth and was closely surrounded by nerve fibers. Partial resection of the mass was sent to pathology, and posterior decompression and internal fixation of L 4-5 and L 5S 1 bone grafting and fusion were performed at the same time. All 3 patients were confirmed to be ganglion neuroma by postoperative pathological examination. Three patients recovered well after surgery. Spinal ganglion cell tumor is mainly originated from primitive neural crest cell migration differentiation of sympathetic ganglion cells, and can also be derived from the sympathetic nerve and peripheral nerves. It is seen more at retroperitoneal and mediastinal, lumbosacral nerve root ganglion cells tumor is rare. Clinically, it is very close to intervertebral disc herniation and difficult to distinguish, often found during operations and less can be clearly diagnosed before operation. Surgical resection is the main treatment for ganglion cell neuroma.

Objective:To preliminarily disclose the biological properties of recombinant human tau441 (P301S) protein, such as aggregation, antigenicity and immunogenicity.Methods:The recombinant plasmid tau441 (P301S) was expressed by prokaryotic expression system and purified by nickel column affinity chromatography. The protein concentrations were determined via BCA kit. The purity of protein was determined by SDS-PAGE gel coomassie brilliant blue staining. Western blot (WB) and negative staining transmission electron microscopy (TEM) were used to identify the recombinant proteins. The antigenicity was detected through indirect enzyme linked immunosorbent assay (ELISA), and the immunogenicity was detected by specific antibody titers of mouse immune serum.Results:The purity of recombinant human tau441 (P301S) was 70%. WB showed specific bands at relative molecular mass (Mr.×10 3) 64 and higher relative molecular mass. Negative staining TEM showed that tau441 (P301S) was aggregated, and the area was significantly larger than tau wild-type control protein (t=6.439, P=0.003). After 9 days of incubation at 4 ℃, tau441 (P301S) formed obvious fibrotic structure. Indirect ELISA result showed that tau441 (P301S) could be recognized by anti-tau monoclonal antibody HT7 (1∶80 000). The specific antibody titer of the immunized serum was 1∶128 000 and WB showed that the immunized serum recognized the brain lysate extract of Alzheimer’s disease (AD) transgenic mice. Conclusions:The recombinant human tau441 (P301S) protein had the characteristics of enhanced aggregation in vitro, but its antigenicity and immunogenicity were not changed.

BACKGROUND: There is no standard treatment for advanced non-small cell lung cancer (NSCLC) after the failure of two lines of chemotherapy, S-1 as the third generation of fluorouracil derivate with well safety and low toxicity, presented some efficacy in lung cancer treatment. The aim of this study is to explore the efficacy of S-1 for advanced NSCLC patients treated with two or more prior chemotherapy regimens. METHODS: We performed a retrospective analysis of 105 NSCLC patients treated with S-1 monotherapy or S-1 contained chemotherapy as the third or more line of treatment in our hospital from January 2014 to April 2017. S-1 was administrated orally twice daily for 2 weeks, followed by one week of rest, the dose of drug was determined by body surface area (<1.25 m2, 80 mg/d; 1.25 m2-1.5 m2, 100 mg/d; ≥1.5 m2, 120 mg/d), platinum or the third-generation chemotherapy drugs could be combinedly used. Clinical response was assigned every cycle according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, Kaplan-Meier analysis was used to estimate progression-free survival (PFS). RESULTS: 42 patients received S-1 monotherapy, the other 63 patients received combined regimens, the median treatment line was 4 (3-11) and the median treatment cycle was 2 (1-14). No complete response (CR) were observed, there were 4 patients with partial response (PR), 34 patients with stable disease (SD) and 67 patients with progressive disease (PD), the objective response rate (ORR) was 3.81%, disease control rate (DCR) was 36.19%. The median PFS was 1.90 months (0.67 months-10.83 months), no difference between monotherapy and combined group (DCR: 28.56% vs 41.27%, P=0.185), the liver metastasis showed poorer PFS (1.40 months vs 1.93 months , P=0.042). CONCLUSIONS S-1 presented some activity in advanced NSCLC treated with more than two lines of treatment. The addition of other drugs cannot improve efficacy. S-1 monotherapy can be used as a choice for heavily-treated patients.
Adult ; Aged ; Antineoplastic Agents ; adverse effects ; pharmacology ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Drug Combinations ; Female ; Fluorouracil ; adverse effects ; therapeutic use ; Humans ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged ; Oxonic Acid ; adverse effects ; pharmacology ; therapeutic use ; Retrospective Studies ; Safety ; Survival Analysis ; Tegafur ; adverse effects ; pharmacology ; therapeutic use ; Treatment Outcome

Objective To compare the efficacy and safety of two concurrent chemoradiotherapy regimens between paclitaxel plus fluorouracil( TF) and cisplatin plus fluorouracil ( PF) in the treatment of locally advanced esophageal squamous carcinoma. Methods 103 patients with locally advanced esophagus carcinoma were treated in Affiliated Hospital of Jiangnan University from December 2014 to February 2016, and randomly assigned to either study group ( TF ) or control group ( PF ) according to random number table, of which 52 patients in the TF group while 51 patients in the PF group. The primary outcome was overall survival(OS), and secondary outcomes include progression-free survival(PFS), local progression-free survival( LPFS) and side effects. Results The 1-year OS for TF group was 76. 9％ versus 74. 5％ for PF group( P>0. 05 ) , and the 2-year OS for TF group was 59. 6％ versus 56. 9％ for PF group ( P >0. 05). The 1-year LPFS for TF group and PF group were 71. 2％ and 66. 7％ respectively(P>0. 05), and the 2-year LPFS for TF group and PF group were 61. 5％ and 58. 8％ respectively(P>0. 05). The 1-year PFS for TF group was 63. 5％ versus 62. 7％ for PF group ( P>0. 05 ) , and the 2-year PFS for TF group was 51. 9％ versus 39. 2％ for PF group ( P>0. 05 ) . The incidence rate of serious ( grade 3- 4 ) leukopenia for TF group was 36. 5％ versus 17. 6％ for PF group(χ2 =4. 642, P<0. 05). The incidence rate of serious (grade 3-4) acute radiation pneumonitis was 15. 4％ in the TF group, higher than that in the PF group with the rate of 3. 9％(χ2 =3. 859, P<0. 05), while the incidence rate of severe nausea and vomiting for PF group was 17. 6％ versus 1. 9％ for TF group(χ2 =7. 262, P <0. 05). The difference between the two groups was statistically significant. Conclusions Patients who were treated with two concurrent chemoradiotherapy regimens showed no difference in OS, PFS and LPFS. The regimen on the basis of Paclitaxel has higher risk of adverse effects incidence rates of hematological toxicity and acute radiation pneumonitis, while digestive system toxicity must be concerned when concurrent chemoradiotherapy is performed on the basis of cisplatin plus fluorouracil.

Objective To summarize the diagnosis and treatment of epispadias with complete prepuce.Methods Between January 2007 and April 2017,clinical records were reviewed for 5 patients diagnosed as epispadias with complete prepuce.The patients were 34 to 66 months old (mean age 44.3 months),who presented with short beaked penis and nonretractile prepuce.A dorsal midline gap between corpora cavernosa could be felt on palpation.There was dorsal chordee with broad spade like glans.The preputial opening was stenosed and dorsally placed urethral opening after retraction of the prepuce.Two patients were incontinent before surgery.Epispadias were coronal type in 2 cases and penile type in 3 cases.All 5 cases were repaired by Thiersch-Duplay procedure.Results The mean follow-up time was 44.5 months (ranged 3 to 98 months).The stricture occurred in 1 patient 1 month after operation,and after dilation and indwelling catheter for a month,the problem resolved.One needed a secondary preputial plasty due to redundant ventral foreskin 8 years after operation.In 3 of 5 cases,parental satisfaction was not achieved mainly due to short length.Only 1 case was incontinent after surgery and the other four achieved urinary continence.Voiding cystourethrogram (VCUG) and ultrasonography (USG) were done in 2 patients who were incontinent before surgery.One case presented right vesicoureteral reflux of Grade Ⅱ and the other was normal.The urodynamic results of 2 patients were normal.Conclusions Epispadias with complete prepuce is extremely rare and its preoperative diagnosis remains difficult.A definitive diagnosis is based upon history,physical examination and imaging tests.Fewer complications and better continence rates were achieved in the boys with epispadias and intact prepuce.Penile length is an important factor affecting surgical outcome.

Objective To discuss the lymph node metastasis of chromophobe renal cell carcinoma (chRCC) in children.Methods One case of chRCC was reported.A eleven-year-old boy was admitted to our hospital on November 2,2017 and presented gross hematuria 4 weeks.No mass was palpable in the abdomen and he felt tenderness in the left back.The ultrasound showed a solid mass in the lower pole of the left kidney.There were a lot of tortuous blood vessels in the tumor.Contrast enhanced CT suggested a mass of 4.5 cm × 6.3 cm × 4.9 cm.The left renal artery and vein were thickened.There was no enlarged lymph nodes were seen in both examinassions.During the operation,the tumor was located in the lower pole of the kidney.The frozen section diagnosis was benign renal tumor.Nephron-sparing surgery was performed.Results The pathology showed that the tumor cells had well-defined cell borders and characteristic perinuclear halos surrounded by eosinophilic cytoplasm that was positive for Hale's colloidal iron stain.Immunohistochemical studies were positive for EMA (+),Ki-67 (5％ +),CK19 (+),CK (+),CD10 (+),CD117(+),CD56(+).Fluorescence in situ hybridization showed absence of TFE3 protein,a strong immune marker of Xp11.2/TFE renal cell carcinoma.1 year after the operation,contrastenhancement magnetic resonance showed long T1 signal near the left renal hilum and the mass showed slight enhancement.ChRCC with regional lymph node metastasis hereby was considered.Intraoperatively,an approximately 2.5 cm × 2.0 cm × 2.0 cm mass was seen near the the left renal hilum.The tumor did not involve left kidney,abdominal aorta and inferior vena cava.The mass was completely removed and introoperative fast-frozen pathology revealed chRCC.Nephron-sparing surgery was performed.Postoperative pathology report chRCC local lymph node metastasis.Follow-up at six months after resection,there was no recurrence or metastatic disease identified.Conclusions chRCC is rare in children and clinical stage is low with a good prognosis.Local recurrence and distant metastasis is rare.