BACKGROUND:Mesenchymal stem cell-derived exosomes may play a crucial role in tissue damage repair,and miRNA is an important component of exosomes for therapeutic effects.Among them,miR-29b-3p has the effect of reducing cell apoptosis,promoting axonal regeneration,and angiogenesis. OBJECTIVE:To study the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on a neural cell injury model simulated by H2O2-treated PC12 cells,and explore the relevant mechanisms. METHODS:(1)First,the collagenase digestion method was used to extract rat adipose-derived mesenchymal stem cells.Adipose-derived mesenchymal stem cells were transfected with miR-29b-3p mimics and inhibitors.Exosomes were extracted from the culture supernatant by ultracentrifugation and identified so as to construct adipose-derived mesenchymal stem cell-derived exosomes with high expression and knockdown miR-29b-3p.(2)By constructing a neural cell injury model simulated by PC12 cells treated with H2O2,the relevant mechanisms of the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on the simulated neuronal cell injury model were studied. RESULTS AND CONCLUSION:(1)Adipose-derived mesenchymal stem cell-derived exosome had a typical cup-shaped shape and a diameter distribution in the range of 50-140 nm,expressed membrane proteins Alix,CD63,and TSG101,which were specific markers on the surface of exosomes,and could be successfully ingested by PC12 cells.(2)Adipose-derived mesenchymal stem cell-derived exosome pretreatment could reduce cell apoptosis induced by H2O2 treatment in PC12 cells,and this protective effect was enhanced with the increase of miR-29b-3p expression in the exosomes and weakened with the decrease of miR-29b-3p expression in the exosomes.The mechanism of its effect was related to adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p promoting the expression of anti-apoptotic protein Bcl-2 and inhibiting the expression of apoptotic protein Bax.

Objective:To evaluate and analyze the ultrasonic findings of idiopathic clubfoot and positional clubfoot deformities.Methods:Forty-nine newborn babies with congenital clubfoot were examined in the Department of Ultrasound of the Third Affiliated Hospital of Zhengzhou University from December 2020 to January 2022, Including 21 newborn babies(32 feet) with idiopathic clubfoot, and 28 babies(53 feet) with positional clubfoot. Twenty-two normal infants in the same period and the normal feet of the single clubfoot were selected as control group. The distance between medial malleolus and scaphoids of all feet were measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone, medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data of idiopathic clubfoot group, positional clubfoot group and control group were statistically analyzed.Results:A total of 71 newborn babies with 142 feet were evaluated.The idiopathic clubfoot group had born and joint changes in the medial, lateral and posterior side, and the differences were statistically significant compared with the control group (all P<0.05). Compared with the control group, there were statistically significant differences in the medial and lateral side of the positional group(all P<0.05). But no significant changes in the posterior side( P>0.05). There were significant differences between medial and posterior side of idiopathic and positional clubfoot group (all P<0.05), but no significant differences in lateral side ( P>0.05). Conclusions:Ultrasonography can clearly display the tarsus bones in clubfoot, and observe the deformity changes of the idiopathic clubfoot and positional clubfoot.

The incidence of portal vein tumor thrombus (PVTT) in patients with hepato-cellular carcinoma (HCC) is high and the prognosis is poor. The treatment mode of HCC+PVTT is changing to multidisciplinary comprehensive treatment. The authors make a deep investigation on the occurrence basis, classification, surgical treatment indication, postoperative adjuvant treatment and preoperative conversion treatment plan of HCC+PVTT, in order to provide reference for the diagnosis and treatment of this disease.

Objective:To summarize the clinical characteristics of patients with unicentric Castleman disease(UCD).Method:The clinical data of 8 abdominal UCD patients who received surgical resection at the Second Hospital of Hebei Medical University from Oct 2019 to Oct 2022 were analyzed, and the imaging characteristics, pathological types and prognosis were summarized.Result:There were 2 males and 6 females. The average age of patients was (33.0±13.7) years old, and their BMI was (23.2±4.5) kg/m 2. The median maximum diameter of the tumor was 4.5 (3.0-4.9) cm. The average postoperative hospital stay was 6.5 (3.3-12.0) days. One was lost during follow up, there was no recurrence or other postoperative complications in the remaining 7 patients. Conclusion:The incidence of unicentric Castleman disease is rare. Complete resection of the tumor is the main treatment for UCD patients, and the prognosis of UCD is good.

Objective:To investigate the application value of three dimensional (3D) imaging fusion navigation system (hereinafter referred as navigation system) in laparoscopic pan-creatic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of two volunteers, including volunteer 1 undergoing laparoscopic pancreaticoduodenectomy for cholangiocarcinoma and volunteer 2 undergoing laparoscopic pancreaticotomy + splenectomy for pancreatic cancer, who were admitted to the Second Hospital of Hebei Medical University from December 2020 to May 2021 were collected. The 2 volunteers were females, aged 68 years and 40 years, respectively. The self-developed navigation system was applied in laparoscopic simulator model test, including in rigid-body model and prosthesis model, and clinical test. Observation indicators: (1) results of model test; (2) results of clinical test. Measurement data with normal distribution were represented as Mean± SD. Results:(1) Results of model test. The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator. The rigid-body model or prosthesis model with occlusion and rigid-body model or prosthesis model without occlusion can be seen in the 3D visual reconstruction image of enhanced computer tomography (CT) examination. The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image. Both of the rigid-body model and prosthesis model were in high consistency, with the distance error of marker points were (0.26±0.11)mm and (0.29±0.18)mm, respectively. (2) Results of clinical test. The abdominal organs and blood vessels with occlusion of the 2 volunteers can be seen in the initial laparoscopic visual field. The location of tumor, important organs and blood vessels can be seen in the navigation system using the 3D visual reconstruction image of enhanced CT examination. The location of tumor, important organs and important blood vessels can be seen in the laparoscopic visual field after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image. The distance error of marker points of the volunteer 1 was (1.36±0.57)mm and the distance error of marker points of the volunteer 2 was (1.24±0.33)mm.Conclusions:The self-developed navigation system can integrate the preoperative 3D visual reconstruction image of enhanced CT examination and the intraoperative real-time laparoscopic image with a good effect. The relationship between deep tissue and blood vessels which is not clarified in conventional laparoscopy can be shown in the navigation system assisted laparoscopic pancreatic surgery.

Objective:Anlotinib is an oral multi-target tyrosine kinase inhibitor (TKI) with dual effects of anti-proliferation and anti-angiogenesis. Phase Ⅰ clinical trials showed anlotinib was well tolerated and had therapeutic effects on a variety of tumors. The aim of this study is to explore the safety and efficacy of anlotinib in the treatment of metastatic renal cell carcinoma.Methods:Between January 2014 and November 2015, a single-center data was obtained from a phase Ⅱ clinical study of anlotinib versus sunitinib on advanced renal cell carcinoma and a phase Ⅱ clinical study of anlotinib on advanced renal cell carcinoma which failed to respond to TKI treatment. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates.Results:A total of 36 patients with advanced renal cell carcinoma were enrolled in this study, including 19 patients without any target drug treatment, 12 patients with sunitinib treatment and 5 patients with sorafenib treatment. The median number of treatment cycle was 16. Partial response (PR) was obtained in 11 patients (30.6%) and stable disease (SD) was obtained in 24 patients (66.7%). The disease control rate (DCR) was 97.2%. The median progression free survival (PFS) was 12.6 months, the 1-year survival rate was 80.6%, and the median survival time was 22.2 months. Up to the follow-up deadline, 3 patients still received treatment, the PFSs were 52.6 months, 65.0 months, and 66.7 months. The most common treatment-related adverse events of grade 3 or 4 included hypertension (19.4%), hand-foot skin reaction (11.1%), proteinuria (5.6%) and anemia (5.6%).Conclusions:Anlotinib shows good anti-tumor activity and is generally well-tolerated in the treatment of advanced renal cell carcinoma. The adverse reactions of anlotinib are milder than sunitinib or pazopanib.

Objective:Anlotinib is an oral multi-target tyrosine kinase inhibitor (TKI) with dual effects of anti-proliferation and anti-angiogenesis. Phase Ⅰ clinical trials showed anlotinib was well tolerated and had therapeutic effects on a variety of tumors. The aim of this study is to explore the safety and efficacy of anlotinib in the treatment of metastatic renal cell carcinoma.Methods:Between January 2014 and November 2015, a single-center data was obtained from a phase Ⅱ clinical study of anlotinib versus sunitinib on advanced renal cell carcinoma and a phase Ⅱ clinical study of anlotinib on advanced renal cell carcinoma which failed to respond to TKI treatment. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates.Results:A total of 36 patients with advanced renal cell carcinoma were enrolled in this study, including 19 patients without any target drug treatment, 12 patients with sunitinib treatment and 5 patients with sorafenib treatment. The median number of treatment cycle was 16. Partial response (PR) was obtained in 11 patients (30.6%) and stable disease (SD) was obtained in 24 patients (66.7%). The disease control rate (DCR) was 97.2%. The median progression free survival (PFS) was 12.6 months, the 1-year survival rate was 80.6%, and the median survival time was 22.2 months. Up to the follow-up deadline, 3 patients still received treatment, the PFSs were 52.6 months, 65.0 months, and 66.7 months. The most common treatment-related adverse events of grade 3 or 4 included hypertension (19.4%), hand-foot skin reaction (11.1%), proteinuria (5.6%) and anemia (5.6%).Conclusions:Anlotinib shows good anti-tumor activity and is generally well-tolerated in the treatment of advanced renal cell carcinoma. The adverse reactions of anlotinib are milder than sunitinib or pazopanib.

Objective To introduce the detailed surgical procedure of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD),and to study its clinical results.Methods A retrospective study was conducted on 31 patients who underwent parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy between January 2016 and June 2018 in our department.Results Of 31 patients who underwent total laparoscopic pancreaticoduodenectomy,5 patients underwent two-dimensional (2D) LPD and 26 underwent three-dimensional (3D) LPD.Total mesopancreas excision (TMpE) was performed in 12 patients,including 2 patients combined with PV-SMV segmental resection and reconstruction.The mean operative duration,and mean estimated blood loss,post-operative hospital stay were 412.8 ± 102.4 min,462.8 ± 396.7 ml,14.7 ± 8.9 d,respectively.The operating time of parachute-like-suture double-pouch pancreaticojejunostomy was 29.7 ± 6.8 min (20 ～45 min).Post-operative complications occurred in 8 patients (25.8％),3 of whom suffered from more than two types of complications.There were 2 patients (6.5％) with postoperative B/C grade pancreatic fistula,4 patients with postoperative biliary leakage (12.9％),3 patients with delayed gastric emptying (9.7％),1 patient with portal vein thrombosis (3.2％) and 1 patient with peritoneal effusion (3.2％).One patient died during perioperative period due to gastrointestinal hemorrhage.Conclusions Parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy was a simple,convenient,reliable method.It is worthy of clinical promotion and further studied.

Objective: To understand the changes of smoking behavior among primary and middle school students in Beijing during 2005-2015. Methods: The primary and middle schools in Beijing were classified and then taken as a sampling frame. Twophase stratified random cluster sampling was conducted with school as primary sampling unit (PSU) and class as the minimum sampling unit, respectively. Beijing Schoolbased Smoking Monitoring Questionnaire was surveyed in 2005 and 2005, 2010, 2011, 2013 and 2015 anonymously. Results: In 2015, the smoking rate among primary and middle school students in Beijing was 9.41%. Among them, for primary, junior, high school and vocational high school students, the rates were 7.05%, 7.06%, 12.41% and 34.11%, respectively. The smoking rates were now 3.26%, with 1.99%, 1.80%, 3.48% and 20.22%, respectively, among primary, middle and high school and vocational high school students. male, vocational school students were more likely to report smoking across six waves of surveillance. Results from the surveillance in 2015 showed a decreasing trend in ever smoking rate and current smoking rate compared with previous survey. About half of the current student smokers were reported to take 1 cigarette/day, and about 10% smokers were reported to take 10 cigarettes/day. Students were most likely to smoke at home(24.02%), followed by smoking at schools(12.74%). The percentage of buying cigarettes by themselves was increased from 17.10% in 2008 to 66.09% in 2015. Conclusion From 2005 to 2015, both ever smoking and current smoking rate among middle school students in Beijing decreased in general, however smoking among vocational high school students warrants further attention.

To compare the efficacy and safety of cetuximab biweekly regimen with those of standard weekly regimen as a first-line therapy of KRAS/RAS wild-type metastatic colorectal cancer. Methods: Patients who received weekly or biweekly administra-tion of cetuximab plus FOLFOX/XELOX as a first-line therapy from July 2010 to December 2017 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively screened for eligibility. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and frequencies of adverse events (AEs) between the two groups were compared. Results: Of 152 eligible patients, 55 were in the biweekly group and 43 were in the weekly group. The biweekly group had significantly higher ORR than the weekly group (76.3% vs. 54.8%, P=0.025). Median PFS in the biweekly and weekly groups were 10.3 and 8.8 months, respectively (P=0.288), and the median OS were 33.5 and 27.4 months, respectively (P=0.563). The two groups showed no significant difference in PFS and OS. For overall AEs, the biweekly group presented significantly more stomatitis (32.7% vs. 14.0% , P=0.032) and tended to show substantially more acne-like rash (80.0% vs. 62.8%, P=0.058) and leukopenia and/or neutropenia (72.7% vs. 55.8%, P=0.081). The frequency of 3/4 grade acne-like rash in the biweekly and weekly groups were 18.2% and 7.0%, respectively (P=0.105). The frequency of all grade 3/4 AEs between the two groups showed no significant difference (P>0.05). Conclusions: Biweekly regimen of cetuximab plus FOLFOX/XE-LOX had similar efficacy and higher ORR compared with those of standard weekly regimen. Cetuximab administered biweekly may be an optional choice in clinical practice, with close attention paid to increased frequency of certain AEs.