Objective: To explore the effects of Cldn14 gene knockout on renal metabolism and stone formation in rats，so as to provide reference for research in the field of urinary calium metabolism and stone formation. Methods: Cldn14 gene knockout homozygous rats and wild-type rats of the same age were randomly divided into 4 groups：wild-type control (WC) group，wild-type ethylene glycol (WE) group，gene knockout control (KC) group and gene knockout ethylene glycol (KE) group，with 10 rats in each group.The WE and KE groups were induced with ethylene glycol + ammonium chloride to form kidney stones，while the WC and KC groups received normal saline gavage.After 4 weeks of standard maintenance feeding，the urine samples were collected to detect the venous blood.The kidneys were collected for HE，Pizzolatto's staining and transmission electron microscopy.The protein in renal tissues was extracted to detect the expressions of Claudin16 and Claudin19. Results: Crystal deposition was observed in the renal tubular lumen of the WE and the KE groups，and more crystals were detected in the KE group.The WE group had a large number of intracytoplasmic black crystalline inclusions observed in renal tubular epithelial cells under transmission electron microscope，followed by the KE and KC groups.Compared with WC and WE groups，KC and KE groups had significantly decreased serum calcium and magnesium levels but significantly increased urinary calcium level.In addition，the urinary calcium level was higher in the WE group than in the WC group and higher in the KE group than in the KC group.The KE group had lower level of Claudin16，but there was no significant difference in the level of Claudin19 among the 4 groups(P>0.05). Conclusion: Knockout of Cldn14 gene alone cannot effectively reduce urinary calcium excretion or reduce the risk of stone formation in rats，which may be related to the decrease of Claudin16 level.

Objective To investigate the frailty status and influencing factors of the elderly stroke pa-tients in community to provide a basis for its prevention and treatment.Methods The convenience sampling was used to select 200 elderly stroke patients as the study subjects in a community hospital in Guangzhou City from October 2020 to January 2022.The general information questionnaire,Chinese version of Tilburg frailty indicator scale,Modified Rankin Index Scale,Barthel index scale,short version of Geriatric Depression Scale and Social Support Rating Scale were used to collect the data.Results The incidence rate of frailty in 200 ca-ses of community elderly stroke was 86.0％.The results of multiple linear regression analysis showed that the degree of disability,ability of daily living,depression and social support were the influencing factors of frailty of the elderly stroke patients in community(F=71.813,P＜0.001).Conclusion The incidence rate of frailty is higher in community elderly stroke patients,the higher the degree of disability,the lower the ability of daily living,the higher the level of depression and the lower the level of social support,the higher the frailty level of community elderly stroke patients.

With the development of society and the awakening of civic consciousness,hospital volunteer service has be-come an indispensable part of modern medical and health system,which plays an important role in improving service mode,im-proving patients'medical experience,and establishing the public welfare image of hospitals.Based on the humanistic hospital construction thinking and combined with the connotation and goal of humanistic hospital construction,this paper is committed to building the hospital volunteer service brand,and summarizes the volunteer management system,service content and process,in order to provide theoretical reference and guidance for the standardization and systematization of hospital volunteer service brand construction.

Transcatheter aortic valve replacement(TAVR)is one of the most important guideline-recommended procedures for severe symptomatic aortic stenosis.Acute cerebral infarction is a serious complication after TAVR,with a high incidence rate and may significantly affect patient prognosis and quality of life.Thrombolysis and mechanical thrombectomy are standard treatments for acute cerebral infarction recommended by guidelines,but evidence of their efficacy and safety in patients undergoing TAVR is limited.We report a patient with acute cerebral infarction after TAVR,who were treated with emergency cerebral angiography and successful transcatheter thrombectomy.

Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei (PMP).Methods:In this descriptive case series study, we retrospective analyzed the records of PMP patients treated with CRS and HIPEC between January 2013 and June 2023 at Affiliated Cancer Hospital and Institute of Guangzhou Medical University. The inclusion criteria were as follows: (1) Aged 18 to 75 years and nonpregnant women. (2) Histologically confirmed diagnosis of pseudomyxoma peritonei. (3) Karnofsky Performance Scale (KPS)>70. (4) The functions of major organs such as the heart, liver, lungs, and kidneys can tolerate major surgery for long periods of time. (5) No evidence of extra-abdominal metastasis. Patients with extensive intra-abdominal adhesions or severe infectious diseases were excluded. The main outcomes were overall survival (OS) and postoperative major complications. The postoperative major complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). We used the peritoneal cancer index (PCI) score to quantitatively assess the peritoneal metastases and the completeness of cytoreduction (CCR) score at the end of surgery (CCR-0 and CCR-1 considered to be complete CRS).Results:A total of the 186 PMP patients with a median age of 56 (interquartile range extremes (IQRE), 48-64) years were included, 65 (34.9%) males and 121 (65.1%) females. The median peritoneal cancer index (PCI) score was 28 (20-34). Appendiceal origin accounted for 91.4%. Histological types were low grade in 99 patients (53.2%), high grade in 57 patients (30.6%), and 55 patients (29.6%) received complete cytoreduction (CCR-0/1). The median operative duration was 300 (211-430) minutes for all patients. Treatment-related 30-day mortality was 2.7%; 90-day mortality 4.3%; reoperation 1.6%; and severe morbidity 43.0%. Within the entire series, anemia(27.4%), electrolyte disturbance(11.6%), and hypoalbuminemia(7.5%) were the most frequent major complications (grade 3-4). The incidences of gastrointestinal anastomotic leakage, abdominal bleeding, and abdominal infection were 2.2%, 2.2%, and 4.3%, respectively. After a median follow-up of 38.1 (95%CI:31.2-45.1) months, the 5-year OS was 50.3% (95%CI: 40.7%-59.9%) with a median survival time of 66.1 (95%CI: 43.1-89.1) months. The survival analysis showed that patients with pathological low grade, low PCI, and low CCR score had better survival with statistically significant differences (all P<0.05). Further stratified into complete and incomplete CRS subgroups, the 5-year OS of the CCR-0 and CCR-1 subgroups was 88.9% (95%CI: 68.3%-100.0%) and 77.6% (95%CI: 62.7%-92.5%), respectively; and 42.0% (95%CI: 29.5%-54.5%) in the CCR-2/3 subgroup. Conclusions:CRS and HIPEC may result in a long-term survival benefit for PMP patients with acceptable perioperative morbidity and mortality. This strategy, when complete CRS is possible, could significantly prolong survival for strictly selected patients at experienced centers.

Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei (PMP).Methods:In this descriptive case series study, we retrospective analyzed the records of PMP patients treated with CRS and HIPEC between January 2013 and June 2023 at Affiliated Cancer Hospital and Institute of Guangzhou Medical University. The inclusion criteria were as follows: (1) Aged 18 to 75 years and nonpregnant women. (2) Histologically confirmed diagnosis of pseudomyxoma peritonei. (3) Karnofsky Performance Scale (KPS)>70. (4) The functions of major organs such as the heart, liver, lungs, and kidneys can tolerate major surgery for long periods of time. (5) No evidence of extra-abdominal metastasis. Patients with extensive intra-abdominal adhesions or severe infectious diseases were excluded. The main outcomes were overall survival (OS) and postoperative major complications. The postoperative major complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). We used the peritoneal cancer index (PCI) score to quantitatively assess the peritoneal metastases and the completeness of cytoreduction (CCR) score at the end of surgery (CCR-0 and CCR-1 considered to be complete CRS).Results:A total of the 186 PMP patients with a median age of 56 (interquartile range extremes (IQRE), 48-64) years were included, 65 (34.9%) males and 121 (65.1%) females. The median peritoneal cancer index (PCI) score was 28 (20-34). Appendiceal origin accounted for 91.4%. Histological types were low grade in 99 patients (53.2%), high grade in 57 patients (30.6%), and 55 patients (29.6%) received complete cytoreduction (CCR-0/1). The median operative duration was 300 (211-430) minutes for all patients. Treatment-related 30-day mortality was 2.7%; 90-day mortality 4.3%; reoperation 1.6%; and severe morbidity 43.0%. Within the entire series, anemia(27.4%), electrolyte disturbance(11.6%), and hypoalbuminemia(7.5%) were the most frequent major complications (grade 3-4). The incidences of gastrointestinal anastomotic leakage, abdominal bleeding, and abdominal infection were 2.2%, 2.2%, and 4.3%, respectively. After a median follow-up of 38.1 (95%CI:31.2-45.1) months, the 5-year OS was 50.3% (95%CI: 40.7%-59.9%) with a median survival time of 66.1 (95%CI: 43.1-89.1) months. The survival analysis showed that patients with pathological low grade, low PCI, and low CCR score had better survival with statistically significant differences (all P<0.05). Further stratified into complete and incomplete CRS subgroups, the 5-year OS of the CCR-0 and CCR-1 subgroups was 88.9% (95%CI: 68.3%-100.0%) and 77.6% (95%CI: 62.7%-92.5%), respectively; and 42.0% (95%CI: 29.5%-54.5%) in the CCR-2/3 subgroup. Conclusions:CRS and HIPEC may result in a long-term survival benefit for PMP patients with acceptable perioperative morbidity and mortality. This strategy, when complete CRS is possible, could significantly prolong survival for strictly selected patients at experienced centers.

Objective: To investigate the correlation between skin elasticity and setup error in optical surface image-guided radiotherapy. Methods: The skin elasticity (R7) data of the head, chest and abdomen were extracted and analyzed its correlation with age by systematic literature review. Fifty-four patients diagnosed with nasopharyngeal carcinoma, breast cancer and cervical cancer were recruited in this study. Firstly, the patients were positioned based on the room laser and markers. Subsequently, the patient position was verified by the Varian On-Board Imager, and then C-Rad Catalyst was adopted to obtain surface images in two states (mask or non-mask) as reference images. In the subsequent fraction treatment, after initial positioning, the local calibration was performed by Catalyst, and setup errors in three directions were recorded. Meanwhile, the patient setup was verified by CBCT twice a week. The Pearson correlation analysis was performed to analyze the correlation between setup error and age. Results: The skin elasticity was negatively correlated with aging (P<0.01). The correlation coefficient between random error and age in head-and-neck cancer were 0.645, 0.624 and 0.866 in the AP, SI and LR directions (all P<0.05) for male patients without mask, respectively. The system error was significantly correlated with age in the LR direction (P<0.05) for male patients, and in the AP direction (P<0.05) for female patients with head-and-neck cancer without mask. The setup error had a significant correlation with skin elasticity in male patients with head-and-neck cancer, and the sequence of absolute value of correlation coefficient was LR>SI>AP. Conclusion In optical surface-guided radiotherapy of head and neck cancer, skin elasticity may be a significant index for assessing the setup errors in male patients.

Objective:To explore the effects of aerobic exercise combined with resistance exercise on cancer-related fatigue and sleep quality in elderly lung cancer patients undergoing chemotherapy after surgery.Methods:From February 2019 to August 2019, this study selected 80 lung cancer patients undergoing chemotherapy after surgery at Affiliated Tumor Hospital of Guangxi Medical University as subjects by convenience sampling. All patients were divided into research group ( n=40) and control group ( n=40) with the method of random number table. Patients of control group received the routine nursing and health education. On the basis of routine nursing, patients of research group carried out the aerobic exercise combined with resistance exercise. The cancer-related fatigue and sleep quality of patients between groups were compared before and after intervention. Results:There were 36 valid questionnaires in research group and 37 in control group. A total of 8 weeks after intervention, scores of affective meaning, behavioral/severity and cognitive/mood in Revised Piper Fatigue Scale (RPFS) , of patients in research group were lower than those in control group with statistical differences ( P<0.05) ; but there was no statistical difference in the score of sensory dimension of patients between two groups ( P>0.05) . The score of sleep quality of patients in research group was lower than that in control group 8 weeks after intervention with a statistical difference ( P<0.05) . Conclusions:The application of aerobic exercise combined with resistance exercise in lung cancer patients undergoing chemotherapy after surgery can effectively alleviate cancer-related fatigue and improve sleep quality of patients which has a value of clinical application and popularization.

Objective To investigate the current situation of labor analgesia in Shanghai, provide data supportion and decision-making basis for further popularization of labor analgesia.Methods Using the self-made questionnaire, Shanghai Medical Doctor Association of Anesthesiologist issued a notice on the purpose of the study and the way how to fill it up.The questionnaire was distributed and recycled through the website wjx.com.Results The 58 hospitals included in this survey accounted for 90.44％ of the total delivery in Shanghai in 2017, and the overall labor analgesia rate was37.22％.The number of deliveries in 13 maternal and child specialist hospitals accounted for 58.44％of 58 hospitals, and the labor analgesia rate was 56.75％.It accounted for 93.50％of the 58 hospitals analgesic deliveries.There are 44 (75.86％) hospitals carrying labor analgesia by intraspinal nerve block as the main method of labor analgesia.42 (95.45％) of these hospitals began to analgesia during the incubation period, 30 (68.18％) of these hospitals closed the analgesic pump during childbirth, and 40 (90.9％) hospitals had a maternal satisfaction of 85 or more, 36 (81.82％) of these hospitals charged labor analgesia in accordance with the anesthesia clause.However, among the 14 hospitals that did not practive labor analgesia, 13 (92.86％) were due to inadequate anesthesiologists and other relevant factors.Conclusion The overall labor analgesia rate in Shanghai was 37.22％.The service has been mainly provided in maternal and child specialist hospitals.The main factors restricting the labor analgesia are the shortage of anesthesiologists and the lack of specific charges.In order to promote the labor analgesia, policy support is an important aspect, and the labor analgesia process and innovative management mode should also be optimized.

Objective To investigate the association between epicedial adipose thickness (EAT)and coronary artery in-stent restenosis (ISR).Methods 617 patients underwent review of coronary angiography in one year of drug-eluting stent implantation in our hospital from October 2013 to October 2015 were enrolled in the study.According to the angiography resluts,patients were divided into ISR group and control group.All cases recieved ultrasonic analysis of epicardial adipose thickness and biochemical test.The correlation of EAT,biochemical concentrations and ISR were determined.Results The EAT in ISR group was significantly higher than that in the control group [(7.78 ± 1.32) mm vs (4.19 ± 0.57) mm,t =22.998,P ＜ 0.001].It was also found that the family history of premature coronary artery disease and the severity of coronary artery lessions based on Syntax scores in the IRS group were higher than those in normal control group.Biochemical tests showed that plasma levels of triglycerides and glycosylated hemoglobin were higher,including plasma homocysteine and hypersensitive C-reactive protein (P ＜ 0.05).Multivariates logistic regression analysis suggested that the EAT was associated with ISR [Exp(B) =0.001,P =0.004].Moreover,one-way linear regression showed that EAT was correlated with the severity of IRS (r =0.891,P ＜0.001).Conclusions Epicardial adipose thickness was correlated with the occurrence and severity of coronary artery in-stent restenosis.