In order to preliminarily evaluate the efficacy and safety of endoscopic intermuscular dissection (EID) for the treatment of rectal neuroendocrine tumors (R-NETs), a retrospective observational study was conducted on 8 consecutive patients with R-NETs confirmed by postoperative pathology at South China Hospital, Medical School, Shenzhen University from January 2022 to October 2023. The therapeutic efficacy, incidence of complications, and follow-up results were mainly analyzed. The results showed that all 8 cases achieved complete resection after EID, with operation times ranging from 40 to 90 minutes. No bleeding, perforation, fever or electrocoagulation syndrome occurred after operation. The hospital stay was 4 to 6 days. During follow-up of 3 to 24 months, there was no local recurrence or metastasis. Therefore, a preliminary conclusion can be drawn that EID is a safe and feasible treatment for R-NETs.

Using novel virtual reality (VR) technology to carry out the construction of clinical medical examination question bank, while deepening the reform of clinical medical course examination, it continues to innovate the medical professional evaluation system and improve the flexibility, diversity and scientificity of clinical medicine in teaching and assessment. It is of great and far-reaching significance to improve the teaching level and the quality of medical education in medical colleges and universities. This paper analyzes and discusses the necessity and feasibility of building a clinical medical examination question bank, and the advantages and prospects of integrating VR technology to carry out the construction of clinical medical examination question bank. At the same time, the exploration and practice of the examination question bank construction based on VR technology disscussed in detail would provide innovative thinking and reference for the clinical medical teaching and evaluation, medical personnel training and other aspects in China.

Objective: To explore the predictive effect of American Society of Anesthesiologists (ASA) classification on prognosis of elderly patients with hip fracture. Methods: A retrospective case-control study was conducted to analyze the clinical data of 814 elderly patients with hip fracture admitted to the 7th Medical Center of the General Hospital of the PLA from January 2012 to December 2015. There were 272 males and 542 females, with the age range of 60-99 years [(80.0±8.0)years]. According to ASA classification, the patients were divided into four groups: 23 cases (2.8%) of ASA grade I, 380 cases (46.7%) of ASA grade II, 389 cases (47.8%) of ASA grade III and 22 cases (2.7%) of ASA grade IV. Data compared among the groups included gender, age, comorbidities, fracture type, anesthesia methods, surgical methods, length of hospital stay, complications, and 30-day and 1-year mortality rates. Multiple Logistic analysis was conducted to seek independent risk factors for 1-year mortality. Results: There were no significant difference among the four groups with regards to gender, fracture type, surgical methods (P>0.05 ). With the improvement of ASA classification, the age of patients increased gradually, the length of hospital stay increased, and the rate of nerve block anesthesia increased ( allP<0.01). Incidence of complications of ASA grade IV patients was the highest [59%(13/22)], followed by 31.4%(122/389) of ASA grade Ⅲ patients, 17.6%(67/380) of ASA grade II patients, 4%(1/23) of ASA grade I patients (all P<0.01). The 30-day and 9-0day mortality of ASA grade IV patients were 32% (7/22), 64% (14/22), ASA grade III patients were 4.6% (18/389), 17.0% (66/389), ASA grade II patients were 3.4% (13/380), 12.1% (46/380), and ASA grade I patients were 0 and 4% (1/23), respectively. The differences between these groups were significantly different ( allP<0.01). Univariate analysis showed that male, advanced age, coronary heart disease, pulmonary infections, chronic obstructive pulmonary diseases (COPD), renal insufficiency, ASA classification, anesthesia methods, and length of hospital stay were related to postoperative 1-year death (P<0.05 or 0.01). A total of 127 patients (15.6%) died within 1 year after operation. Multivariate Logistic regression analysis showed age (OR=1.037, 95%CI 1.007-1.068), ASA grade(ASA grade II : OR=1.851, 95%CI 1.238-14.386; ASA grade III : OR=2.092, 95%CI 1.266-16.482; ASA grade IV: OR=15.368, 95%CI 1.626-145. 283), length of hospital stay (OR=1.038, 95%CI 1.015-1.061) were independent risk factors for 1-year mortality. Conclusions The outcome of the elderly hip fracture is poor. The ASA classification is closely related to the incidence of complications, 30-day mortality, and 1-year mortality. Advanced age, ASA grade II, III and IV, hospital length of stay are the independent risk factors for poor prognosis of hip fractures. The ASA classification can be used as a screening tool to intervene for the high-risk population as early as possible.

Objective:To explore the clinical effect of R-MAD (rituximab, methotrexate, cytarabine, dexamethasone) regimen in the treatment of primary ocular adnexal double-expression diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of an elderly patient with primary ocular adnexal double-expression DLBCL who was treated with R-MAD regimen in June 2019 in Fujian Medical University Union Hospital was retrospectively analyzed. The clinical manifestations, diagnosis and treatment, prognosis were also analyzed, and the related literature was reviewed.Results:The patients was a 71-year-old male. After initial treatment of R-CHOP chemotherapy, the patient's eye mass did not shrink, the swelling and pain became worse, the curative effect was not good, and the disease progression continued. After the patient was given R-MAD chemotherapy for 3 courses, the eye swelling subsided and pain symptoms were significantly improved, satisfactory results were obtained, and no obvious adverse reactions occurred.Conclusions:R-MAD regimen has an ideal effect on the patient with primary ocular adnexal double-expression DLBCL, which can significantly improve symptoms, delay disease progression, and improve the quality of life of patients, but the prognosis still needs to be followed up in the long-term.

Objective:To explore the clinical characteristics, diagnosis, treatment and prognosis of patients with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).Methods:The main clinical manifestations, auxiliary examination results, diagnosis and treatment process, and follow-up data of 5 patients with POEMS syndrome in Fujian Medical University Union Hospital from April 2017 to November 2018 were retrospectively analyzed, and the features of diagnosis and treatment were discussed with review of literature.Results:The patients with POEMS syndrome had typical manifestations of polyneuropathy (5 cases), organomegaly (4 cases), increased extravascular volume load (4 cases), endocrine changes (5 cases), etc. The patients were also accompanied by clinical manifestations of skin changes (2 cases), bone damage (3 cases), kidney damage (2 cases), anemia (4 cases), etc. Three cases were misdiagnosed as chronic Guillain-Barré syndrome. Five patients were followed up regularly, with a median follow-up time of 16 months (13-33 months). Until the end of follow-up, 1 patient who received DVD regimen chemotherapy had a disease-free survival time of 22 months and a survival time of 24 months; 1 patient underwent autologous hematopoietic stem cell transplantation after receiving pretreatment of melphalan scheme, and the survival time was 6 months; the remaining 3 patients were in the disease-free survival period, and among which 1 patient survived 9 months without disease after autologous hematopoietic stem cell transplantation, 1 patient survived 16 months without disease, and 1 patient survived 18 months without disease.Conclusions:The onset of POEMS syndrome is insidious, its clinical manifestations are complex, and it is easy to be misdiagnosed or missed. Clinicians should strengthen their understanding of this disease.

Objective:To analyze the clinical efficacy and safety of decitabine combined with CAG regimen in treatment of elderly patients with acute myeloid leukemia (AML).Methods:Decitabine combined with CAG regimen (experimental group) and CAG regimen alone (control group) were used to treat elderly patients with AML. The randomized controlled trials (RCT) were retrieved from PubMed database, Cochrane Library, Embase database, China Notional Knowledge Infrastructure (CNKI), Wanfang database and VIP database and references listed in all studies. The data of RCT that met the inclusion criteria were extracted, and the quality was evaluated and cross-checked independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then Meta-analysis was conducted by using StataMP 14.0 software.Results:A total of 16 studies and 1 090 patients were included. Compared with the control group, the experimental group had a higher complete remission rate and total effective rate, and the differences were statistically significant ( RR=1.63, 95% CI 1.40-1.89, P < 0.01; RR=1.39, 95% CI 1.27-1.51, P < 0.01). In terms of adverse reactions, the incidence of fever in the experimental group was higher than that in the control group, and the difference was statistically significant ( RR=2.06, 95% CI 1.54-2.75, P < 0.01). Conclusion:Meta-analysis showed that decitabine combined with CAG regimen has a better clinical efficacy in the treatment of elderly patients with AML, but there are more severe adverse reactions.

BACKGROUND: Age, sex, body mass index, hepatitis C infection, immunosuppressive drugs and family history of diabetes mellitus are shown to be risk factors for new-onset diabetes mellitus after kidney transplantation, but their effects remain controversial. OBJECTIVE: To systematically assess the risk factors for new-onset diabetes mellitus after kidney transplantation, so as to provide evidences for preventing and controlling the disease. METHODS: PubMed, Embase, Cochrane Library and CBMdisc databases were searched for the articles concerning risk factors for new-onset diabetes mellitus after kidney transplantation published between January 2005 and May 2018. Two researchers extracted data from each study based on inclusion and exclusion criteria. Quality assessment was conducted in accordance with New castle-Ottawa Scale standard. Meta-analysis was performed on Revman 5.3 software to identify the risk factors for new-onset diabetes mellitus after kidney transplantation. RESULTS AND CONCLUSION: (1) Twenty-one studies involving 8 206 patients were included. There were 1 489 cases of new-onset diabetes mellitus after kidney transplantation, and the morbidity was 18.15％. (2) The meta-analysis identified the following seven significant risk factors, non-modifiable risk factors: age ≥ 50 years, and donor type; modifiable risk factors: body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney. (3) Uncertain risk factor was family history of diabetes. (4) To conclude, age, donor type, body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney are risk factors for new-onset diabetes mellitus after kidney transplantation. But whether the family history of diabetes mellitus is the risk factor remains uncertain.

Objective To investigate the protective effect of FLPNF and the improvement of glucose-stimulated insulin secretion against dexamethasone-induced apoptosis of islet cells. Methods INS-1 cells were treated with oligopeptide FLPNF and dexamethasone, either separately or in combination. Proliferation of INS-1 cells in each group was assessed with CCK-8 assay and the insulin secretion stimulated by glucose was detected by ELISA. The apoptotic condition of the cells was observed and assessed with TUNEL and the apoptosis rate of each group was detected using flow cytometry. The expression of major target protein molecules related to apoptosis and Glut2 was detected by Western blotting analysis. Results Dexamethasone inhibited the growth of INS-1 cells in the group treated with dexamethasone. Cell damage was obvious with observable nuclear shrinkage and nuclear rupture. In addition, apoptosis rate was found to be 40.6％±2.4％. The expression of the apoptosis-related protein Bcl-2 and Glut2 was significantly reduced, whereas that of Bax and caspase-3 was significantly increased. After the combined treatment of oligopeptide FLPNF and dexamethasone, the results were reversed, and the apoptosis rate declined to 27.2％±2.0％ (P ＜ 0.001), cell morphology was improved, and the expression of apoptosis-related protein molecules of islet cells and protein Glut2 was significantly improved. Conclusion FLPNF has the ability of protecting islet cells from dexamethasone-induced apoptosis and improving the glucose-stimulated insulin secretion of islet cells.

To explore the effect of epigallocatechin gallate (EGCG) on oxidative stress and Nrf2/HO-1 pathway in neurons subjected to oxygen-glucose deprivation/reperfusion (OGD/R).
 Methods: Primary cultured cerebral cortical neurons were prepared from Sprague-Dawley rats, and the OGD/R cell model was established. After pretreatment with EGCG at different concentrations (12.5, 25.0, 50.0 or 100.0 μmol/L), the neurons were subjected to OGD/R. The cell viability, reactive oxygen species (ROS) level and malondialdehyde (MDA) content were assessed after reperfusion. The superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were measured. The expression of Nrf2 protein in nucleus, HO-1 mRNA and protein were detected.
 Results: OGD/R treatment reduced the cell viability, elevated ROS level and MDA content, decreased SOD and GSH-Px activities. The expression of Nrf2 protein in nucleus, HO-1 mRNA and protein were increased (P<0.01). Pretreatment with EGCG promoted the survival of neurons exposed to OGD/R, decreased ROS level and MDA content while increased SOD and GSH-Px activities. The levels of Nrf2 protein in nucleus, HO-1 mRNA and protein were upregulated (P<0.01).
 Conclusion: EGCG can reduce the oxidative stress of neurons subjected to OGD/R, which may be related to activation of Nrf2/HO-1 signal pathway and enhancement of the antioxidant ability of neurons.
Animals ; Catechin ; analogs & derivatives ; pharmacology ; Cell Survival ; drug effects ; Cells, Cultured ; Gene Expression Regulation ; drug effects ; Glucose ; Heme Oxygenase-1 ; genetics ; metabolism ; NF-E2-Related Factor 2 ; genetics ; metabolism ; Neurons ; drug effects ; Neuroprotective Agents ; pharmacology ; Oxidative Stress ; drug effects ; Oxygen ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control