OBJECTIVE To evaluate the efficacy and safety of letermovir in preventing cytomegalovirus （CMV） infection after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. METHODS A retrospective cohort study was conducted， enrolling patients who underwent allo-HSCT at the Department of Hematology， Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine， from August 30， 2022， to February 21， 2024. Patients who initiated letermovir prophylaxis within 28 days post-transplantation were assigned to the experimental group （99 cases）， while those who did not initiate letermovir within this period were assigned to the control group （18 cases）. The incidence and clinical characteristics of CMV infection （including the number of wangranran@xinhuamed.com.cn CMV infection cases， the number of cases progressing to CMV disease， recurrent CMV disease， onset time of CMV infection， and treatment duration）， immune function recovery within 120 days post-transplantation， and the occurrence of transplantation-related complications （including CD4+ and CD8+ T-cell recovery， Epstein-Barr virus infection， acute graft-versus-host disease， human herpesvirus 6 infection， and posttransplant lymphoproliferative disorders） and adverse events were recorded. Univariate and multivariate Cox regression analyses were performed to identify factors influencing CMV infection. RESULTS A total of 117 patients were included， among whom 15 developed CMV infection， 5 progressed to CMV disease， and 2 experienced recurrent CMV disease. The CMV infection rate in the experimental group was significantly lower than that in the control group （P＜0.001）， and the onset time of CMV infection was significantly delayed （P＝0.014）. The proportion of patients with CD4+ T-cell counts ≥200 cells/μL in the experimental group was significantly lower than that in the control group （P＝0.022）. During the follow-up period， elevated creatinine levels were observed in 1 patient， and nausea and vomiting were observed in 2 patients. Multivariate Cox regression analysis revealed that the use of high-dose corticosteroids was a risk factor for CMV infection （HR＝6.230， 95%CI of 1.255-30.926， P＝0.025）， while initiating letermovir within 28 days post-transplantation was a protective factor （HR＝0.125， 95%CI of 0.045-0.348， P＜0.001）. CONCLUSIONS Early initiation of letermovir after allo-HSCT significantly reduces the CMV infection rate and delays the onset of infection， with favorable short-term safety.

OBJECTIVE: To compare the accuracy and effectiveness of orthopaedic robot-assisted minimally invasive surgery versus open surgery for limb osteoid osteoma. METHODS: A clinical data of 36 patients with limb osteoid osteomas admitted between June 2016 and June 2023 was retrospectively analyzed. Among them, 16 patients underwent orthopaedic robot-assisted minimally invasive surgery (robot-assisted surgery group), and 20 patients underwent tumor resection after lotcated by C-arm X-ray fluoroscopy (open surgery group). There was no significant difference between the two groups in the gender, age, lesion site, tumor nidus diameter, and preoperative pain visual analogue scale (VAS) scores ( P>0.05). The operation time, lesion resection time, intraoperative blood loss, intraoperative fluoroscopy frequency, lesion resection accuracy, and postoperative analgesic use frequency were recorded and compared between the two groups. The VAS scores for pain severity were compared preoperatively and at 3 days and 3 months postoperatively. RESULTS: Compared with the open surgery group, the robot-assisted surgery group had a longer operation time, less intraoperative blood loss, less fluoroscopy frequency, less postoperative analgesic use frequency, and higher lesion resection accuracy ( P<0.05). There was no significant difference in lesion resection time ( P>0.05). All patients were followed up after surgery, with a follow-up period of 3-24 months (median, 12 months) in the two groups. No postoperative complication such as wound infection or fracture occurred in either group during follow-up. No tumor recurrence was observed during follow-up. The VAS scores significantly improved in both groups at 3 days and 3 months after surgery when compared with preoperative value ( P<0.05). The VAS score at 3 days after surgery was significantly lower in robot-assisted surgery group than that in open surgery group ( P<0.05). However, there was no significant difference in VAS scores at 3 months between the two groups ( P>0.05). CONCLUSION Compared with open surgery, robot-assisted resection of limb osteoid osteomas has longer operation time, but the accuracy of lesion resection improve, intraoperative blood loss reduce, and early postoperative pain is lighter. It has the advantages of precision and minimally invasive surgery.
Humans ; Robotics ; Osteoma, Osteoid/surgery* ; Orthopedics ; Blood Loss, Surgical ; Retrospective Studies ; Neoplasm Recurrence, Local ; Minimally Invasive Surgical Procedures ; Bone Neoplasms/surgery* ; Analgesics ; Treatment Outcome

Objective: To compare the effectiveness of blonanserin and olanzapine in the treatment of first-episode schizophrenia, so as to provide the basis for the medication choice for the treatment of first-episode schizophrenia. Methods: A total of 98 patients with first-episode schizophrenia admitted to the Second People's Hospital of Taizhou City were selected and randomly divided into the olanzapine group and the blonanserin group for a treatment period of two months. The Positive and Negative Syndrome Scale (PANSS), Pittsburgh Sleep Quality Index (PSQI), MATRICS Consensus Cognitive Battery (MCCB) were used to investigate the improvement of symptoms, sleep quality and cognitive function before and after treatment, respectively, and the level of prolactin was detected. The generalized estimation equation was used to compare the differences between the two groups. The adverse reactions of the two groups were recorded and the safety of medication was evaluated. Results: Forty-nine patients each group were included, with 29 males and a mean age of (37.22±7.17) years in the olanzapine group, and 27 males and a mean age of (37.54±7.31) years in the blonanserin group. There were no significant differences in gender, age, disease course and educational duration between the two groups (all P>0.05). The scores of positive symptom, negative symptom, general psychopathology and overall PANSS in the two groups after treatment were decreased compared with those before (all P<0.05). However, there was no significant difference between the two groups, and no interaction between the drugs and treatment duration (all P>0.05). The MCCB score of the blonanserin group was higher than that of the olanzapine group, while the PSQI score and the prolactin level of the blonanserin group were lower than that of the olanzapine group, and there was an interaction between the drugs and treatment duration (all P<0.05). The incidence of adverse reactions in the blonanserin group was 6.12%, which was lower than that in the olanzapine group of 20.41% (P<0.05). Conclusion Either blonanserin or olanzapine can improve psychotic symptoms inpatients with first-episode schizophrenia, while blonanserin is more effective than olanzapine in improving sleep quality, cognitive function and reducing prolactin level, and has higher safety.

Objective: To study anti⁃hepatitis C virus NS3/4A protease activity of Lonicera fulvotomentosa based on fluorescence method and molecular docking. Methods: The activity of HCV NS3/4A protease inhibition of L.fulvotomentosa extracts was tested by fluorescence method. The binding of the main active ingredients to HCV NS3/4A virus protease was analyzed based on molecular docking. Results: The water extract and alcohol extract of L.fulvotomentosa had a good inhibitory effect on the activity of HCV NS3/4A protease with IC50 of 0. 005 - 0. 019 mg/ml.Based on molecular coupling and interaction analysis , it was found that chlorogenic acid , isochlorogenic acid A , cynaroside and luteolin combined well with HCV NS3/4A protease , forming multiple hydrogen bonds. Conclusion The active components of L. fulvotomentosa against HCV NS3/4A protease activity were isochlorogenic acid A and luteolin.

Objective:To investigate the strategy and feasibility of surgery for iatrogenic perforation of colorectum following colonoscopic examination or treatment.Methods:A retrospectively descriptive study was conducted. Twenty-one patients aged from 35 to 84 years old from the Department of General Surgery of the First Affiliated Hospital of Nanjing Medical University between Jan. 2015 and Dec. 2020 were enrolled in this study. There were 15 male and 6 female patients with a median age of 64 years.Observation indicators included patient demographics, including sex, age, comorbidity, abdominal surgical history; findings and outcomes of colonoscopy, including purpose of colonoscopy, time to the diagnosis of perforation; findings and outcomes of surgical treatment, including perforation site, perforation size, surgical methods, postoperative complications.Results:Eight patients were found with diagnostic colonoscopic perforation, 13 patients with therapeutic perforation (2 patients with endoscopic mucosal resection, 7 patients with endoscopic submucosal dissection and 4 patients with stent placement). Thirteen perforation occurred during the procedure of colonoscopy. Eleven patients with perforation occurred in the sigmoid colon, 3 in the ascending colon, 3 in the rectum, 2 in the descending colon, 1 in the cecum and 1 in the hepatic flexure. The perforation size ranged from 0.3 cm to 10.0 cm with a high likelihood of a bigger perforation occurred in diagnostic colonoscopy than therapeutic colonoscopy. Seven patients received primary surgical repair with 3 patients receiving diversion. Four patients received direct colostomy in the perforation site. Six patients received segmental colectomy or radical resection with primary anastomosis, among them 2 patients received defunctioning ileostomy. Four patients received resection with the Hartmann procedure. Nine patients were performed with laparoscopic surgery with 3 patients converted to open surgery. Six patients developed postoperative complications, including 1 bowel leakage, 2 wound infection, 1 wound infection accompanied with abdominal infection, 1 kidney infection. One patient with hepatic flexure perforation after stent placement died from septic shock after the Hartmann procedure.Conclusion:With proper indication, the performance of optimal surgical treatment will save lives of patients with colonoscopic perforation.

Objective:To investigate the clinical value of stylized laparoscopic hemicolec-tomy for left colon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 174 patients who underwent laparoscopic hemicolectomy for left colon cancer in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 106 males and 68 females, aged 59(range, 17?86)years. All patients underwent stylized laparoscopic hemicolectomy for left colon cancer. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) postoperative histopathological examinations; (4) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect tumor recurrence and metastasis and survival of patients up to October 2021. Follow-up was performed once every 3 months within postoperative 2 years, once every 6 months within postoperative 2 to 5 years and once a year after postoperative 5 years, with the end point as tumor recurrence and metastasis or death of patients. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range) or M( Q1, Q3). Count data were described as absolute numbers or percentages. Kaplan-Meier method was used to draw survival curve and calculate survival rate. Results:(1) Surgical situations. All the 174 patients underwent stylized laparoscopic hemicolectomy for left colon cancer successfully, including 6 cases receiving preoperative enteral stent placement due to bowel obstruc-tion, 3 cases receiving defunctioning ileostomy and 1 case receiving Hartmann procedure. The operation time, volume of intraoperative blood loss, time to postoperative initial defecation and duration of postoperative hospital stay of the 174 patients were 97(80,106)minutes, 45(25,60)mL, 5(3,6)days and 7(6,8)days, respectively. (2) Postoperative complications. Twelve of the 174 patients had complications, including 4 cases with incision infection or fat liquefaction, 3 cases with anastomotic leakage, 2 cases with incomplete bowel obstruction, 1 case with abdominal hemo-rrhage, 1 case with chylous leakage and 1 case with pulmonary infection. The 2 cases with anastomotic leakage underwent ileostomy. The patient with abdominal hemorrhage underwent laparotomy to stop bleeding. One elder patient died of postoperative pulmonary infection. The other patients with complications recovered with conservative treatment. (3) Postoperative histopatho-logical examinations. Of the 174 patients, there were 27 cases in stage Ⅰ of TNM staging, 68 cases in stage Ⅱ, 77 cases in stage Ⅲ and 2 cases in stage Ⅳ. There were 9 cases with well differentiated tumor, 107 cases with moderately differentiated tumor and 58 cases with poorly differentiated tumor. The number of lymph node detected, the number of positive lymph node and tumor diameter of the 174 patients were 19(15,23), 0(0,2) and 4(3,5)cm, respectively. Of the 174 patients, there were 79 cases with lymph node metastases, 21 cases with cancerous nodules, 35 cases with vascular invasion and 29 cases with nerve invasion. (4) Follow-up. Of the 174 patients, 157 cases were followed up for 27(range, 1?70)months. Of the 157 patients who conducted follow-up, 20 cases had tumor metastasis, including 9 cases with multiple metastasis, 5 cases with liver metastasis, 4 cases with lung metastasis, 1 case with bone metastasis and 1 case with spleen metastasis. The 5-year overall survival rate and tumor free survival rate of the 157 patients were 90.9% and 80.8%, respectively.Conclusion:The stylized laparoscopic hemicolectomy for left colon cancer is safe and feasible.

Objective:To investigate the characteristics of No.253 lymph node metastasis in middle and low rectal cancer and its influencing factors.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 316 patients with middle and low rectal cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to October 2021 were collected. There were 1 339 males and 977 females, aged (61±12)years. All patients underwent D 3 radical surgery for rectal cancer. Observation indicators: (1) No.253 lymph node metastasis in patients with middle and low rectal cancer; (2) analysis of influencing factors for No.253 lymph node metastasis in patients with middle and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD. Count data were expressed as absolute numbers and percentages, and comparison between groups was performed by the chi-square test. Logistic regression model was used for multivariate analysis. Results:(1) No.253 lymph node metastasis in patients with middle and low rectal cancer. There were 128 of 2 316 patients with positive No.253 lymph node and 2 188 cases with negative No.253 lymph node. The No.253 lymph node metastasis rate was 5.527%(128/2 316). There were 568 of 2 316 patients with the distance from distal margin of tumor to anal margin as 8?10 cm, 766 cases as ≥6 cm and<8 cm, 982 cases as <6 cm. Of the 568 patients with the distance from distal margin of tumor to anal margin as 8?10 cm, 57 cases had positive No.253 lymph node, including 3 cases(5.263%) of high differentiated tumor, 9 cases(15.789%) of moderate differentiated tumor, 45 cases(78.948%) of low differentiated tumor, respectively. There was 0 case of the above 57 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 20 cases(35.088%) in TNM stage Ⅲ, 37 cases(64.912%) in TNM stage Ⅳ, respectively. Of the 766 patients with the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 42 cases had positive No.253 lymph node, including 4 cases(9.524%) of high differentiated tumor, 11 cases(26.190%) of moderate differentiated tumor, 27 cases(64.286%) of low differentiated tumor, respectively. There was 0 case of the above 42 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 19 cases(45.238%) in TNM stage Ⅲ, 23 cases(54.762%) in TNM stage Ⅳ, respectively. Of the 982 patients with the distance from distal margin of tumor to anal margin as <6 cm, 29 cases had positive No.253 lymph node, including 1 case (3.448%) of high differentiated tumor, 3 cases (10.345%) of moderate differentiated tumor, 25 cases (86.207%) of low differentiated tumor, respectively. There was 0 case of the above 29 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 12 cases(41.379%) in TNM stage Ⅲ, 17 cases(58.621%) in TNM stage Ⅳ, respectively. (2) Analysis of influencing factors for No.253 lymph node metastasis in patients with middle and low rectal cancer. Results of univariate analysis showed that tumor T staging, tumor N staging, tumor TNM staging, tumor differentiation degree, the distance from distal margin of tumor to anal margin were related factors for No.253 lymph node metastasis in patients with middle and low rectal cancer ( χ2=28.48, 44.58, 172.62, 227.67, 34.57, P<0.05). Results of multivariate analysis showed that tumor T staging as stage T4, tumor N staging as stage N2, tumor TNM staging as stage Ⅳ, low differentiated tumor, the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 8?10 cm were independent risk factors for No.253 lymph node metastasis in patients with middle and low rectal cancer ( odds ratio=2.74, 3.48, 10.72, 21.47, 1.92, 3.67, 95% confidence intervals as 1.91?3.92, 2.42?4.98, 7.36?15.62, 10.33?44.60, 1.27?2.91, 2.31?5.81, P<0.05). Conclusions:The risk of No.253 lymph node metastasis is relatively high in middle and low rectal cancer patients with long distance from distal margin of tumor to anal margin, low differentiated tumor, and in high TNM stages. Tumor T staging as stage T4, tumor N staging as stage N2, tumor TNM staging as stage Ⅳ, low differentiated tumor, the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 8?10 cm are independent risk factors for No.253 lymph node metastasis in patients with middle and low rectal cancer.

【Objective】 To explore the effect of Zhikepipa Mixture on the treatment of COVID-19 through network pharmacology analysis and molecular docking technology. 【Methods】 First, we performed the network pharmacology method to screen active compounds and targets so as to explore the mixture’s potential mechanisms in the treatment of COVID-19. In line with ADME screening index, like oral bioavailability (OB) ≥30% or drug likeness index (DL) ≥0.18, the active compounds against COVID-19 related targets were selected to construct the 'herb-compound-target’ network. Mechanism prediction of Zhikepipa mixture in the treatment of COVID-19 was analyzed by the interaction of the target sites, the bioinformatic annotation, and the metabolic pathway. Then, we used a molecular docking model to evaluate the binding ability between active compounds and 2019-nCoV (SARS-CoV-2) 3-chymotrypsin-like cysteine protease (3CL^pro) receptor-binding domain (PBD ID 6LU7), which was involved in mediating viral replication and transcription functions. 【Results】 The'herb-compound-target’ network showed 34 key compounds and 30 disease targets after overlapping with disease targets. The network topology analysis showed that those selected compounds with higher degree would produce marked anti-inflammatory effects by regulating 30 targets like PTGS1, IL1B, IL6, IL10, CXCL8 and JUN. AGE-RAGE signaling pathway, IL-17 signaling pathway, TNF signaling pathway, PI3K-Akt signaling pathway, and MAPK signaling pathway were involved in regulating hepatitis B and diabetic complications. In addition, Folium eriobotryae and Radix stemonae played important roles in the network. The molecular docking results showed that nine compounds were identified with higher docking score rank against 2019-nCoV 3CL^pro protease, and most of them were attributed to flavonoids. 【Conclusion】 Zhikepipa Mixture could exhibit both anti-inflammatory and anti-virus actions through multi-component, multi-target, and multi-pathway.

The Genome Sequence Archive (GSA) is a data repository for archiving raw sequence data, which provides data storage and sharing services for worldwide scientific communities. Considering explosive data growth with diverse data types, here we present the GSA family by expanding into a set of resources for raw data archive with different purposes, namely, GSA (https://ngdc.cncb.ac.cn/gsa/), GSA for Human (GSA-Human, https://ngdc.cncb.ac.cn/gsa-human/), and Open Archive for Miscellaneous Data (OMIX, https://ngdc.cncb.ac.cn/omix/). Compared with the 2017 version, GSA has been significantly updated in data model, online functionalities, and web interfaces. GSA-Human, as a new partner of GSA, is a data repository specialized in human genetics-related data with controlled access and security. OMIX, as a critical complement to the two resources mentioned above, is an open archive for miscellaneous data. Together, all these resources form a family of resources dedicated to archiving explosive data with diverse types, accepting data submissions from all over the world, and providing free open access to all publicly available data in support of worldwide research activities.

Objective:To explore the clinical characteristics and prognosis of multiple primary colorectal carcinoma.Methods:The clinical data of 42 cases of colorectal cancer admitted to the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2018 were retrospectively analyzed. The clinicopathological features, diagnosis, treatment and prognosis were summarized.Results:There were 42 patients with multiple primary colorectal carcinoma, accounting for 1.20% (42/3 499) of all colorectal carcinoma patients in the same period. The main pathological type was adenocarcinoma. Among them, 32 cases were synchronous multiple primary carcinoma. And the age ranged 38-86 years old, and the median age was 66 years old. A total of 73 colorectal cancer lesions were detected, mostly located in the proximal colon, sigmoid colon and rectum. A total of 527 lymph nodes were detected, and the positive rate was 1.9% (10). Patients with positive lymph nodes accounted for 37.5% (12/32), including 27 cases of multiple primary carcinoma, 3 cases of triple primary carcinoma, 2 cases of five primary carcinoma. The 1-year and 3-year overall survival rates were 83.75% and 74.38%, respectively. There were 10 cases of metachronous multiple primary carcinoma. Patients were aged 33-86 years old. The first cancer was mostly located in the rectum and sigmoid colon, and the second cancer was mostly located in the ascending colon area. A total of 276 lymph nodes were detected, and the positive rate was 12.3% (34). The 1-year and 3-year overall survival rates were 100.00% and 66.67%, respectively.Conclusions:Multiple primary colorectal cancer is not rare clinically and its distribution shows a certain regularity. More attention should be paid to improve the early diagnosis rate. Early operation is needed to improve the survival rate of patients.