Objective:To investigate the application value of transanal intersphincteric resec-tion under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 patients with ultra-low rectal cancer who underwent transanal intersphincteric resection under direct vision in the Jackknife position, combined with laparoscopic total mesorectal excision in Huizhou Municipal Central Hospital from September 2021 to November 2022 were collected. There were 9 males and 6 females, aged (63±9)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative outcomes. All the 15 patients underwent operations successfully, without conversion to open abdo-minal operation. There were 5 cases of partial ISR and 10 cases of subtotal ISR. The operation time and volume of intraoperative blood loss of 15 patients were (260±30)minutes and 20(range, 10-30)mL, respectively. The distance from anastomosis to anal margin was (1.6±0.8)cm. The duration of post-operative hospital stay was 10(range, 8-13)days, and all 15 patients underwent colonic and anasto-mosis with staplers and protective ileostomy at the terminal ileum. Three patients had postoperative complications within 30 days after surgery, of whom 1 case with grade A anastomotic leakage was cured after conservative treatment and 2 cases with anastomotic membranous stenosis were cured by anal enlargement. (2) Postoperative pathological examination. The number of lymph nodes dissected of 15 patients was 18 ±6, and the distance between the tumor and distal resection margin was 1.3(range, 1.0-2.0)cm. The surgical specimens of all 15 patients showed complete mesorectum and negative for proximal, distal and circumferential margins. Results of postoperative pathological examination showed that there was 1 case in stage pT1N0M0, 9 cases in stage pT2N0M0, 1 case in stage pT2N1M0, 1 case in stage ypT0N0M0, 2 cases in stage ypT2N0M0, 1 case in ypT3N1M0 stage. The histological subtype showed 11 cases of moderately differentiated adenocarcinoma and 4 cases of well-differentiated adenocarcinoma. (3) Follow-up. All 15 patients were followed up for 15(range, 12-24)months. No local recurrence and distant metastasis of the tumor was found, and no tumor-related death occurred. All 15 patients underwent stoma closure. The postoperative anal function assessment of 15 patients showed no disorder in 5 cases, mild disorder in 8 cases and severe disorder in 2 cases.Conclusion:Transanal intersphincteric resection under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer is safe and feasible.

CRISPR-Associated Protein 9 ; Gene Editing ; CRISPR-Cas Systems/genetics*

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To identify a pathogenic strain JM-1 isolated from the pus of a patient stabbed by a sea shrimp and to analyze its antibiotic susceptibility and virulence genes, aiming to provide reference for screening clinically related infections caused by Cysteiniphilum litorale as a rare pathogen and improving prognosis. Methods:Biochemical phenotype identification, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), 16S rRNA gene sequencing, analysis of average nucleotide identity (ANI) and average amino acid identity (AAI) based on the whole genome and phylogenetic analysis of the 16S rRNA gene and the whole genome were performed to accurately determine the taxonomic status of the strain JM-1. E-test was used to detect antibiotic susceptibility, and the results were interpreted according to the interpretation standards of Francisella tularensis in CLSI M45-A3. The virulence factor database (VFDB) was used for genome-wide annotation and analysis of virulence genes. Results:After culturing the strain JM-1 on the Columbia blood plate for 3 d, some grey-white, medium-sized, smooth, round and convex hemolytic colonies were observed. Gram staining result showed lightly colored Gram-negative Coccobacillus. API NH identification results suggested that the isolate JM-1 was Moraxella catarrhalis (biochemical code: 3010), while there was no identification result in Vitek2 system NH card (biochemical code: 0211002121). The EXS3000 mass spectrometer self-built database identified the isolate JM-1 as Cysteiniphilum litorale. The phylogenetic analysis based on the 16S rRNA gene and the whole genome showed that the isolate JM-1 and Cysteiniphilum litorale DSM 101832 T clustered into the same branch, and the ANI and AAI values between the two strains were 95.07% and 95.65%, respectively. The biochemical phenotype identification indicated the isolate JM-1 producing β-lactamase and penicillinase. Antibiotic susceptibility test results showed the strain was resistant to penicillin and sensitive to gentamicin, streptomycin, doxycycline, tetracycline, ciprofloxacin, levofloxacin, and chloramphenicol. Genome annotation suggested the virulence genes of the isolate JM-1 were similar to those of Francisella, including Francisella pathogenicity island (FPI), type Ⅳ fimbriae, capsule and lipopolysaccharide. Conclusions:Cysteiniphilum litorale was a rare pathogen with virulence genes similar to those of Francisella, and its antibiotic susceptibility was also similar to that of Francisella. This study confirmed a case of clinical infection caused by Cysteiniphilum litorale. The self-built MALDI-TOF MS system could be used for its rapid identification.

Renal clear cell carcinoma metastasis to the gallbladder is rare. This paper reported a case of gallbladder metastasis of renal clear cell carcinoma detected after two years of left radical nephrectomy. The patient underwent laparoscopic cholecystectomy and followed by postoperative targeted therapy of sunitinib. No new metastasis was found after 5 months of follow-up.

Objective To discuss primary experience the clinical use of "All-seeing needle set" combined with Holmium laser to treat the single renal stone lesser than 2 cm in diameter through a super minimal tract (F12).Methods From January 2015 to December 2016,43 patients were enrolled into this retrospective study.There were 23 males and 20 females who were diagnosed as single renal stone less than 2 cm in diameter(age range from 23-65 years).There were 8 upper pole renal stones,13 lower pole renal stones and 22 renal pelvis stones.The mean stone size was (1.63 ± 0.32) cm in diameter (range from 1.2 cm to 2.0 cm)."All-seeing needle system" was applied during percutaneous puncture.After building a F12 minimal tract by fascia dilator,all patients received lithotripsy with Holmium laser.Indwelling catheters for 3 days and an F6 double-J tube was left for 2 weeks without a tube in the percutaneous tract after operation.Finally,KUB and/or urinary CT were used to check the results on day 1.Result All operations were completed successfully.The operation time was 23-65min [averaged (31.0 ±9.2) min].41 cases' renal stones were store free,and the 2 stone residues was clear with later extracorporeal shock wave lithotripsy.No severe complications occurred.Conclusion As an alternative to standard procedures for treatment of renal stones less than 2 cm in diameter,adopting "All-seeing needle set" with Holmium laser through a super minimal tract (F12) is safe,minimally invasive,fast and effective with a low complication rate.

Brewer's yeast is crucial in beer fermentation, mainly beer flavor diversity and stability. Beer flavor stability is one of the most influential beer quality aspects, and screening or breeding brewer's yeast with enhanced anti-staling capacity will be an effective solution. In recent decades, with the progress of genetic engineering and detailed description of brewer's yeast genome, great efforts have been made to improve brewer's yeast. This review highlights recent advances in classical and genetic engineering improvement of yeasts to produce more antioxidant compounds or less beer aging substances and precursors. Therein, improvement targets, evaluation methods and development strategies of anti-staling brewer's yeast are also discussed. Furthermore, hotspot and future trend of anti-staling yeast strain development are also proposed.

Purpose To investigate the feasibility of 30 ml low-dose contrast medium in reducing the accumulation of contrast medium in venous system while maintaining enough artery enhancement in 256-slice CT angiography (CTA) of intracranial and cervical arteries.Materials and Methods Sixty patients with head and neck CTA were recruited prospectively,and they were randomly divided into group A and group B.The scan parameters of the two groups were identical,but the protocol of contrast medium injection was different.Group A was injected 60 ml contrast medium and 30 ml saline successively with the rate of 4.0 ml/s.Group B was injected 30 ml contrast medium and 50 ml saline successively with the rate of 5.0 ml/s.CT attenuation values of aortic arch,common carotid artery,subclavian artery,cerebral middle artery,superior vena cava,innominate vein,subclavian vein,internal jugular vein were measured,and the image quality was evaluated.Results The average CT values of superior vena cava,right innominate vein,right subclavian vein in two groups had significant differences (P＜0.05).The average CT values of left brachial vein,left subclavian vein,left and right internal jugular vein in two groups had no significant differences (P＞0.05).The average CT values of aortic arch,left and right common carotid artery,left and right subclavian artery,left and right cerebral middle artery in two groups had significant differences (P＜0.05).The scores of image quality in two groups also had significant difference (P＜0.05).Conclusion Head-and-neck CTA with 30 ml low-dose contrast medium is feasible and the images are satisfactory for diagnosis,which can reduce the dose of contrast medium and accumulation of contrast medium in venous system,while maintaining enough artery enhancement.

Objective To compare the clinical efficacy of nedaplatin and cisplatin combined with docetaxel in the treatment of cervical cancer.Methods 80 patients with cervical cancer were selected as the research subjects.According to different chemotherapy regimens,they were divided into observation group(40 cases)and control group(40 cases).The observation group adopted nedaplatin combined with docetaxel chemotherapy regimen,while the control group used cisplatin plus docetaxel chemotherapy regimens.The clinical curative effect,adverse reaction of chemotherapy,hospitalization related indicators,etc were compared between the two groups.Results The total effective rate of the observation group was 85.0%,which of the control group was 77.5%,the difference was not statistically significant(x2=0.739,P=0.739).The incidence rate of gastrointestinal reaction(Ⅰ-Ⅳ)in the observation group was 25.0%,which was lower than 82.5% in the control group(x2=26.560,P=0.000).The incidence rate of renal toxicity(grade Ⅰ-Ⅱ)of the observation group was 2.5%,which was lower than 17.5% of the control group(x2=5.000,P=0.025).The length of hospital stay of the observation group was(2.93 ±0.39)days,which was shorter than(4.97 ±0.81)days of the control group(t=14.352,P=0.000).The incidence rate of bone marrow inhibition(grade Ⅰ-Ⅱ)of the observation group was 43.0%,which was significantly higher than 25.0% of the control group(x2=4.381,P=0.036).1 year overall survival(OS),no local recurrence rate(LRF)and no distant metastasis survival rate(DMF)between the two groups had no statistically significant differences(all P>0.05).Conclusion Efficacy of nedaplatin or cisplatin combined with docetaxel in adjuvant chemotherapy of cervical cancer has similar prognosis,nedaplatin has less toxicity,and can shorten the time of hospitalization,patients are more likely to accept,it is worthy of clinical promotion.

Objective To investigate the protective effect of Gui Zhi Fuling Jiaonang on endurance to ischemia and hypoxia .Methods Mice were randomized into four groups :control group ,positive drug control group ,Gui Zhi Fuling Jiaonang high‐dose group (0 .93 g/kg) ,and Gui Zhi Fuling Jiaonang low‐dose group (0 .465 g/kg) . All mice were treated with corresponding drugs for 7 days .The hypoxia mice model was established through hypoxia in the closed jars , cerebral anoxia by decapitation , poisoning with sodium nitrite and isoprenaline . Then the hypoxia‐ischemia rat model was established by injecting isoproterenol . The anti‐hypoxic effects were observed . Results Compared with control group ,Gui Zhi Fuling Jiaonang high‐dose group (0 .93 g/kg) had a tendency to extend the survival time of mice model established through hypoxia in the closed jars ;Gui Zhi Fuling Jiaonang high‐dose (0 .93 g/kg) and low‐dose (0 .465 g/kg) groups had a tendency to extend the survival time of mice model established through cerebral anoxia by decapitation (P>0 .05) .Compared with that in control group ,the survival time of mice in Gui Zhi Fuling Jiaonang low‐dose group under poisoning with sodium nitrite and Gui Zhi Fuling Jiaonang high‐dose group under poisoning with isoprenaline were significantly prolonged .Besides ,Gui Zhi Fuling Jiaonang relieved myocardial tissue damage caused by ischemia and hypoxia ( P< 0 .05 ) .Conclusion Gui Zhi Fuling Jiaonang has an obviously protective effect on isoprenaline‐induced hypoxia and myocardial ischemia .