Patients who undergo sphincter-preserving surgery for rectal cancer may face intestinal dysfunction, psychological issues, and social problems. Patient self-management is of great significance for their recovery and quality of life. This paper mainly reviews the concept, evaluation tools, current situation, and intervention measures of self-management for patients after sphincter-preserving surgery for rectal cancer, in order to provide reference for clinical self-management education for those patients.

Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Multiple myeloma (MM) is still an incurable hematologic malignancy, which is eagerly to the discovery of novel therapeutic targets and methods. N-acetyltransferase 10 (NAT10) is the first reported regulator of mRNA acetylation that is activated in many cancers. However, the function of NAT10 in MM remains unclear. We found significant upregulation of NAT10 in MM patients compared to normal plasma cells, which was also highly correlated with MM poor outcome. Further enforced NAT10 expression promoted MM growth in vitro and in vivo, while knockdown of NAT10 reversed those effects. The correlation analysis of acetylated RNA immunoprecipitation sequencing (acRIP-seq) and ribosome profiling sequencing (Ribo-seq) combined with RIP-PCR tests identified centrosomal protein 170 (CEP170) as an important downstream target of NAT10. Interfering CEP170 expression in NAT10-OE cells attenuated the acceleration of cellular growth caused by elevated NAT10. Moreover, CEP170 overexpression promoted cellular proliferation and chromosomal instability (CIN) in MM. Intriguingly, remodelin, a selective NAT10 inhibitor, suppressed MM cellular growth, induced cellular apoptosis in vitro and prolonged the survival of 5TMM3VT mice in vivo. Collectively, our data indicate that NAT10 acetylates CEP1 70 mRNA to enhance CEP170 translation efficiency, which suggests that NAT10 may serve as a promising therapeutic target in MM.

Metabolic-associated fatty liver disease (MAFLD), which is previously known as non-alcoholic fatty liver disease (NAFLD), represents a major health concern worldwide with limited therapy. Here, we provide evidence that ferroptosis, a novel form of regulated cell death characterized by iron-driven lipid peroxidation, was comprehensively activated in liver tissues from MAFLD patients. The canonical-GPX4 (cGPX4), which is the most important negative controller of ferroptosis, is downregulated at protein but not mRNA level. Interestingly, a non-canonical GPX4 transcript-variant is induced (inducible-GPX4, iGPX4) in MAFLD condition. The high fat-fructose/sucrose diet (HFFD) and methionine/choline-deficient diet (MCD)-induced MAFLD pathologies, including hepatocellular ballooning, steatohepatitis and fibrosis, were attenuated and aggravated, respectively, in cGPX4-and iGPX4-knockin mice. cGPX4 and iGPX4 isoforms also displayed opposing effects on oxidative stress and ferroptosis in hepatocytes. Knockdown of iGPX4 by siRNA alleviated lipid stress, ferroptosis and cell injury. Mechanistically, the triggered iGPX4 interacts with cGPX4 to facilitate the transformation of cGPX4 from enzymatic-active monomer to enzymatic-inactive oligomers upon lipid stress, and thus promotes ferroptosis. Co-immunoprecipitation and nano LC-MS/MS analyses confirmed the interaction between iGPX4 and cGPX4. Our results reveal a detrimental role of non-canonical GPX4 isoform in ferroptosis, and indicate selectively targeting iGPX4 may be a promising therapeutic strategy for MAFLD.

Objective:To evaluate the mixed team-based learning (TBL) teaching method in the practical teaching of critical obstetric diseases.Methods:A total of 72 undergraduate students majoring in "5+3" clinical medicine who practiced in The First Affiliated Hospital of Chongqing Medical University from April to June 2019 were selected in the study. The typical cases of obstetric critical illness were selected, and the students were taught by TBL teaching combined with flipped classroom. After the class, a questionnaire survey was conducted to evaluate the teaching effect.Results:Totally 72 questionnaires were recovered and the results showed that all the students thought this kind of mixed TBL teaching method was helpful to develop clinical thinking ability, and the process of "group discussion" and "extra-curricular preparation" was very helpful to understand the learning. A percentage of 93 (67/72) of the students liked this teaching mode, while 28% (20/72) of the students thought this learning mode was very stressful.Conclusion:This mixed TBL teaching method is effective and feasible in the practical teaching of critical obstetric diseases.

Objective:To investigate the clinical symptoms and cone-beam CT (CBCT) imaging characteristics of temporomandibular joint osteoarthritis (TMJOA) with chewing side preference (CSP).Methods:One hundred patients with TMJOA diagnosed in the Department of Stomatology, General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled, including 32 males and 68 females, with an median age of 27.5 years (16-71 years). According to the habit of CSP, 100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group. The clinical symptoms were observed, including pain, TMJ sounds, limited mouth opening as well as the radiograph imaging changes of condylar bone. When analyzing the radiograph imaging changes of condylar, the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint. SPSS 25.0 was used to analyze the statistical data. Age data did not conform to normal distribution so that median and quartile spacing were used for description, and Mann-Whitney U test was used for nonparametric test. Qualitative data such as gender, clinical symptoms and condylar lesion types were described by composition ratio and chi-square test was performed. Results:There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP ( P>0.05). The incidence of pain in CSP group [83.1% (59/71)] was marginally higher than that in non-CSP group [65.5% (19/29)] but without statistical difference (χ2 =3.71, P=0.054). There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups (χ2 =0.11, P=0.742; χ2 =0.48, P=0.489). Among all of joints, the most common types of TMJOA were articular flattening and shortening and erosion. CBCT showed that erosion [65.0% (130/200)], flattening and shortening [73.0% (146/200)], subcortical sclerosis [42.0% (84/200)], osteophyte [30.5% (61/200)] and subcortical cystic [15.5% (31/200)]. According to the different groups of chief complaint sides, intra-group comparisons show that the proportion of erosion in symptomatic sides of CSP group [80.0% (40/50)] was significantly higher than that in asymptomatic sides of CSP group [50.0% (25/50)] (χ2=9.89, P=0.002). Inter-group comparisons show that the proportion of condyle flattening and shortening in symptomatic sides of CSP group [84.0% (42/50)] was significantly higher than that in bilateral joint of non-CSP group (8/15) (χ2=8.81, P=0.032). There was no significant difference in the proportion of subcortical sclerosis, osteophyte and subcortical cystic between the group with or without CSP ( P>0.05). Conclusions:TMJOA patients with CSP may be more prone to clinical symptoms of pain and CBCT imaging changes of condyle erosion as well as flattening and shortening. CSP may be a promoting factor for the development of TMJOA.

Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.

Objective To investigate and analyze the relationship between hepatitis B virus (HBV) S gene mutations and the occurrence of HBV-related acute on chronic liver failure (HBV-ACLF).Methods A total of 377 patients were enrolled in this study,including 51 inactive hepatitis B surface antigen (HBsAg)carriers,78 chronic hepatitis B (CHB) patients,101 HBV-ACLF patients,69 HBV-related liver cirrhosis (LC) patients and 78 HBV-related hepatocellular carcinoma (HCC) patients.Serum samples were collected from July 2012 to September 2017 in Guangzhou Eighth People's Hospital.Nested polyoneras chain reaction (PCR) was performed for all the samples,the HBV whole genome and HBV S gene were amplified.PCR products were sequenced by Sanger sequencing method.HBV genotypes were determined by the phylogenetic tree based on HBV S gene constructed by Mega 7.0 software with the neighbor-joining method.Geneious R10.0.5 software was used to analyze the mutations of the HBV genome.The data in different groups were compared by x2 test or Fisher's exact test.The correlation analysis was done by logistic regression.Results Among the 377 patients enrolled in this study,the HBV-ACLF,CHB,inactive HBsAg carriers,and HCC patients infected with HBV genotype B were 83,51,34,31,and 35 cases respectively,and the patients infected with HBV genotype C were 18,27,17,38,and 43 cases respectively.The results of this study showed that 11 mutations were significantly higher in HBV-ACLF patients than CHB patients who were infected with HBV genotype B,including T216C,G285A and A529G in HBV S gene,A1317G in HBV enchanter I,A1762T/G1764A in basal core promoter (BCP) gene,A1846T,C1913A,G1896A,T2045A,C2078G,C2304A in HBV preC/C gene.However,no significant difference mutations were found in HBV-ACLF patients and CHB patients who were infected with HBV genotype C.In the patients infected with HBV genotype B,the prevalence of T216C (sL21S) mutation in HBV-ACLF was significantly higher than those in inactive HBsAg carriers,CHB and HCC patients (x2 =14.474,10.982,and 5.440,respectively,all P ＜ 0.05),whereas T216C mutation did not differnce between HBV-ACLF and LC patients (x2 =2.641,P =0.106).The prevalence of G285A (sG44E) mutation in HBV-ACLF was significantly higher than those in inactive HBsAg carriers,CHB,LC and HCC patients (x2 =27.301,29.287,15.719,and 16.076,respectively,all P ＜0.01).However,in the patients infected with HBV genotype C,the mutations in HBV S gene did not differnce between HBV-ACLF,inactive HBsAg carriers,CHB,LC and HCC patients (P ＞ 0.05).Logistic regression analysis showed that male (OR =6.90,95％ CI:1.52-24.39,P =0.010),hepatitis B e antigen negative (OR=4.73,95％ CI:1.60-13.94,P=0.005),HBV genotypeB (OR=4.80,95％ CI:1.82-12.16,P =0.006) and G285A mutation (OR =7.72,95％ C1:5.64-16.37,P =0.006) were the independent risk factors associated with HBV-ACLF.Conclusions The HBV S gene mutation may be associated with HBV-ACLF.

Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.