OBJECTIVE To investigate the intervention effect and potential mechanism of breviscapine on hepatic fibrosis （HF） in rats based on the transforming growth factor-β（1 TGF-β1）/Smad2/extracellular signal-regulated protein kinase 1（ERK1） and Kelch-like epichlorohydrin-associated protein 1（Keap1）/nuclear factor-erythroid 2-related factor 2（Nrf2）/heme oxygenase-1（HO-1） pathways. METHODS Totally 60 rats were randomly divided into normal control group， model group， breviscapine low-dose， medium-dose and high-dose groups （5.4， 10.8， 21.6 mg/kg）， and colchicine group （positive control， 0.45 mg/kg）， with 10 rats in each group， half male and half female. Except for the normal control group， HF model of the other groups was induced by carbon tetrachloride. Subsequently， each drug group was given corresponding medicine by gavage once a day for 28 days. The liver appearance of rats in each group was observed and their liver coefficients were calculated. The levels of alanineaminotransferase （ALT） and aspartate aminotransferase （AST）in serum， those of ALT， AST， superoxide dismutase （SOD），malondialdehyde （MDA） and glutathione peroxidase （GSH- Px） in liver tissue were detected. The liver tissue inflammatory and fibrotic changes were observed. The protein and mRNA expressions of TGF-β1， Smad2， ERK1， Nrf2， Keap1 and HO-in liver tissue were detected. RESULTS Compared with the normal control group， the model group showed large areas of white nodular lesions in the liver， obvious inflammatory cell infiltration and collagen fiber deposition. The body weight， the levels of SOD and GSH-Px in liver tissue， the protein and mRNA expressions of Nrf2 and HO-1 were significantly lowered in the model group （P＜0.05）； the liver coefficient， the percentage of Masson staining positive area， ALT and AST levels of serum and liver tissue， MDA level of liver tissue， the protein and mRNA expressions of TGF-β1， Smad2， ERK1 and Keap1 were significantly increased （P＜0.05）. Compared with the model group， the liver lesions of rats in each drug group were improved， and the above quantitative indexes were generally reversed （P＜0.05）. CONCLUSIONS Breviscapine has a good intervention effect on HF rats， which may be related to inhibiting TGF-β1/Smad2/ERK1 pathway for anti-fibrosis and regulating Keap1/Nrf2/HO-1 pathway to inhibit oxidative stress.

Objective:To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies.Methods:A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed.Results:A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common.Conclusions:Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.

Objective:To systematically evaluate the qualitative studies on the psychological experience of living donors after liver transplantation, analyzing the psychological experience of living donors after liver transplantation, so as to provide a basis for formulating intervention measures to meet their inner needs.Methods:Qualitative studies on postoperative psychological experience and life experience of living liver transplant donors were searched by computer on PubMed, Web of Science, Embase, Cochrane Library, EBSCO, CNKI, Wanfang Database, China Biology Medicine disc, VIP and other databases. The search period was from the establishment of the database to November 30, 2022. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Evidence-Based HealthCare Quality Evaluation Criteria (2016) , and the results were integrated using a pooled integration approach.Results:A total of 10 articles were included, 29 main results were extracted and summarized into 6 new categories. The 3 integrated results were negative psychological experience of living liver transplant donors after surgery, positive psychological experience of living liver transplant donors after surgery, and psychological support needs of living liver transplant donors after surgery.Conclusions:Nurses should pay attention to the negative psychological experience of living donors after liver transplantation, strengthen their positive psychological experience, help them get more family and social support after liver transplantation and meet their psychological and physiological support needs.

Objective: To observe the effect of Tuina (Chinese therapeutic massage) on creatine kinase (CK), mitochondrial Ca2+ concentration, and ultrastructure of skeletal muscle in delayed onset muscle soreness (DOMS) model rats.Methods: A total of 130 healthy male Sprague-Dawley rats were randomly divided into a blank group, an exercise control group, a pre-exercise Tuina group, and a post-exercise Tuina group. According to the time points for sample collection, the exercise control group was divided into a 0 h exercise control group, a 24 h exercise control group, a 48 h exercise control group, and a 72 h exercise control group; the pre-exercise Tuina group was further divided into a 0 h pre-exercise Tuina group, a 24 h pre-exercise Tuina group, a 48 h pre-exercise Tuina group, and a 72 h pre-exercise Tuina group; and the post-exercise Tuina group was divided into a 0 h post-exercise Tuina group, a 24 h post-exercise Tuina group, a 48 h post-exercise Tuina group, and a 72 h post-exercise Tuina group. Rats in all groups except for the blank group received DOMS modeling. Professionals performed Nie-Pinching manipulation and finger Nian-Twisting manipulation on the lower limbs of the rats. The samples were collected at 0 h, 24 h, 48 h, or 72 h after exhaustive exercise for each pre-exercise Tuina group. The samples were collected at 0 h, 24 h, 48 h, or 72 h after Tuina for each post-exercise Tuina group. The changes in serum CK, skeletal muscle mitochondrial Ca2+ concentration, and Ca2+-adenosine triphosphatase (ATPase) were determined. The ultrastructure changes of skeletal muscles in each group were observed by a transmission electron microscope. Results: The electron microscope showed that compared with the exercise control group, the skeletal muscle structures of the pre-exercise Tuina group and the post-exercise Tuina group were significantly improved, and the overall performance of skeletal muscle in the pre-exercise Tuina group was more similar to that of the blank group. The level of serum CK in the pre-exercise Tuina group and the post-exercise Tuina group was significantly lower than that in the exercise control group (P<0.01). The Ca2+ concentration of skeletal muscle in the 24 h, 48 h, and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.01). The Ca2+-ATPase concentration of skeletal muscle in the 24 h and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.05).Conclusion: Tuina effectively prevents muscle damage caused by heavy exercise and long-term exercise, which may be related to the increase of skeletal muscle Ca2+-ATPase activity and mitochondrial Ca2+ transport.

Objective:To explore the strategies for the treatment of difficult iliac artery approach in endovascular repair of abdominal aortic aneurysm.Methods:The clinical data of 275 patients with abdominal aortic aneurysm who underwent endovascular surgery at the Department of Vascular Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2010 to March 2019 were retrospectively analyzed, and the general clinical data such as age, gender, and comorbidities of the patients were recorded. The resource index was to carry out corresponding measures to perform surgery for patients with difficult access, analyze the incidence of the type of difficult access, treatment measures and effects.Results:Two hundred and seventy-five patients underwent endovascular repair, 78 of them (28.3%) had difficulty in accessing the iliac artery, including 29 cases (10.5%) with mild iliac artery stenosis, 7 cases (2.54%) with severe stenosis, and 3 cases with occlusion ( 1.09%), 39 cases (14.2%) were twisted. For patients with vascular twist, super-hard guide wire was used to correct iliac artery angulation. For patients with iliac artery stenosis, balloon dilation was performed. For severe stenosis, the artificial blood vessel was passed through the lateral peritoneum. After road transplantation, stent placement and other treatments were successfully performed endovascular repair.Conclusions:Pathway vascular disease can cause difficulties in endovascular treatment of abdominal aortic aneurysms. Endovascular repair can be successfully performed after corresponding treatments according to different difficulties, and the long-term patency rate is good.

Objective:To investigate the clinical application value of blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) to the protection of language function in patients with unilateral frontal and temporal lobes glioma receiving postoperative intensity modulation radiation therapy (IMRT).Methods:A total of 27 patients with unilateral frontal and temporal lobe gliomas were treated with postoperative radiotherapy. The planning CT and BOLD-fMRI were performed before radiotherapy, and the language functional areas were delineated based on the fused images of 3D T1 and CT. IMRT technology was used to develop radiotherapy plans with and without language function area protection, naming conventional and protective radiotherapy plans respectively. The maximum radiation dose ( Dmax), average radiation dose ( Dmean), target conformal (CI) and dose uniformity (HI) of PTV of the two plans were compared and analyzed to ensure that the protective radiotherapy plan could meet the radiotherapy standard. Then, the Dmax and Dmean of the language function area were compared and analyzed to evaluate whether the Dmax and Dmean of the language function area were decreased in the protective radiotherapy plan. Results:There were no significant differences in CI, HI, Dmax and Dmean of PTV between the conventional radiotherapy plan and protective radiotherapy plan ( P>0.05). There were statistically significant differences in Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) between the conventional radiotherapy plan and protective radiotherapy plan ( t=3.073-12.707, P<0.05). Dmax and Dmean of Wernicke′s and Broca′s (healthy side and affected side) were decreased in the protective radiotherapy plan compared with the conventional radiotherapy plan, and the decrease was significant in the healthy side. Conclusions:BOLD-fMRI combined with IMRT can not only guarantee the target dose of patients with glioma receiving postoperative radiotherapy, but also reduces the radiation dose to the language function area. Chinese reading task and paragraph comprehension task are the stimulation mode of language function in patients after brain tumor surgery. These tasks are simple and the effect is accurate.

Objective:To evaluate the efficacy of holographic image technology in robot-assisted laparoscopic radical prostatectomy (RARP).Methods:The clinical data of 34 patients with prostate cancer who underwent RARP in our hospital during October 2020 and December 2020 was analyzed retrospectively. The average age of the patients was 67.8 (52-78) years. The mean BMI was 25.8 (18.0-32.3) kg/m 2. The median level of PSA before surgery was 13.4 (2-149) ng/ml. Median prostate volume was 31.7 (9.5-159.1) ml. EAU risk groups for biochemical recurrence of localised and locally advanced prostate cancer were list as below: 5 cases of low-risk, 7 cases of medium-risk, 22 cases of high-risk. There were 9, 16, 9 cases with the ASA score of 1, 2, 3 point, respectively. Preoperative Gleason score of 34 patients were list as below: 9 cases in score ≤6 group, 15 cases in score=7 group, 10 cases in score ≥8 group. For clinical stage before the surgery, 13 cases ≤T 2a stage, 1 case in T 2b stage, 20 cases ≥T 2c stage. The engineers established holographic images of 34 patients based on multiparametric magnetic resonance imaging (mpMRI) and the reports before the operation. Surgeons can obtain the size and location of tumors, surrounding neurovascular bundles visually by revolving, assembling, disassembling and concealing images, which was helpful for pre-surgery planning. By manipulating the holographic images extracorporeally, surgeons can discriminate Internal sphincter of urinary bladder and vesicoprostatic muscle, neurovascular bundles, membranous part, seminal vesicle easily, which improves the operation accuracy. Results:All 34 cases underwent operation successfully without transferring to open surgery. The median operative time was 157.5 (95-276) min with an estimated blood loss of 50 (20-300) ml. The median drainage removal time was 2 d and median hospitalization time was 3.5 d, respectively. The catheters were removed within an average time of 20.5 d. For postoperative Gleason score, there were 2 cases in score ≤6 group, 16 cases in score =7 group, 8 cases in score ≥8 group and 8 cases can’t make a score. For clinical stage after the surgery, 10 cases were ≤T 2a stage, 1 case was T 2b stage, 23 cases were ≥cT 2c stage. 22 cases underwent pelvic lymph node dissection, including a patient with right iliac fossa lymph node metastasis. There were 2 cases with positive surgical margin and 3 cases with Clavien-DindoⅠcomplications. The rate of 1-month and 3-month urinary continence were 47.1% and79.4%, respectively, 8 cases recovered erectile function after 3 month. Conclusions:Holographic image technology can promote cancer dissection completely, achieve urinary continence early and reduce perioperative complications tremendously. The technology is the "intraoperative security" for the accurate surgical treatment of prostate cancer.

Objective Verification the changes in expression and mechanism of serum inflammatory factor IL-1 beta and related biomarkers by establishing an animal model of deep vein thrombosis (DVT) in lower extremity of rats.Methods Seventy male SPF SD rates,weighing (200 ± 20) g,randomly divided into groups of ten and made each group of rats equal in weight.Recorded as control group,sham operation group,model experiment 2,8,24,48,72 h group.The control group was fed normally without any treatment;the sham operation group,laparotomy was performed without vein ligation;the model experimental group was divided into different groups according to different time periods.The model of venous thrombosis of lower extremities was established through venous ligation surgery in rats,they were sacrificed at the 2 hours,8 hours,24 hours,48 hours and 72 hours after the modeling,and blood samples and tissues were collected.The expression levels of IL-1 β,tissue factor and xanthine oxidase (XOD) in blood samples of 7 groups of rats were measured by ELISA.DVT morphology were analyzed by Pathology,flow cytometry were used to count peripheral blood circulating endothelial cells in rats separated after injury.The expressions of IL-1 β,tissue factor,XOD,pathological and flow results were compared between the normal control group,the sham operation group and the lower extremity deep vein thrombosis model group at different time periods.All data were represented by mean standard deviation (Mean ± SD).One-way anova was performed on the measurement data,and the LDS method was used to compare the two pairs.The test level was α =0.05.Results IL-1β,tissue factor,XOD showed no significant difference between the control group and the sham operation group,P ＞ 0.05.The model experimental group showed an upward trend in the process of 2 h-24 h and reached a peak value at 24 h.The histopathology showed that red thrombus and mixed thrombus could be seen within 2 h-48 h in the thrombosis model experiment group.The blood vessel wall was accompanied by inflammatory cell infiltration.After 72 h,the thrombus was obviously organized.The CD31 concentration of the control group and the sham operation group were (4.04 ± 1.00),(4.82 ± 1.12),and the difference between the two difference between the two groups was not statistically significant (P ＜ 0.05);the CD31 concentration of model experimental group had significant differences from 2 h,(5.188 ±0.895);8 h,(5.614 ± 1.243);24 h,(9.785 ± 1.996);48 h,(14.198 ± 2.172);72 h,(18.118 ± 1.025),it continued to increase,P ＜ 0.05.Conclusion High expression of inflammatory IL-1β and related markers tissue factor,XOD confirmed the mechanism of injury of deep venous endothelial cells in lower extremities caused by IL-1β and the mechanism of further aggravation of thrombosis after injury.

Objective To evaluate the impact of gonadotropin-releasing hormone agonist(GnRH-a) used before surgery on natural pregnancy rates in patients with ovarian endometriomas. Methods In this retrospective study, 57 patients with ovarian endometriomas who had a consecutive laparoscopic surgery between June, 2010 to September, 2015 in Peking Union Medical College Hospital were included. Those patients were divided into preoperative GnRH-a treatment group(n=31)and non-GnRH-a treatment group (n=26). There were no differences in patients'characteristics between the two groups. All of them had a desire for natural pregnancy postoperatively. GnRH-a was no longer used after surgery. After the surgical procedure, the patients were observed over a period of 12 months, during which the frequency of natural pregnancy was assessed. The two groups were compared in terms of natural pregnancy rates. Results Totally 33 patients had natural pregnancy after surgery. The univariate analysis showed that the pregnancy rates of age, r-AFS stage, infertility, preoperative use of GnRH-a, tumor size, tumor side, deep infiltrating endometriosis and adenomyosis did not have statistically significant differences (all P>0.05). The two classified logistic regression showed that OR for preoperative use of GnRH-a was 0.250(95％CI: 0.064-0.978)with a statistical difference(P=0.046). Conclusion The use of GnRH-a preoperatively may have a negative effect on natural pregnancy rates of patients after surgery with ovarian endometriomas.

Objective To discuss the application of double parallel stent for preserving arch branch vessels during thoracic endovascular aortic repair.Methods During the period from June 2015 to June 2016,double parallel stents were carried out in 9 cases at department of vascular surgery,the People's Hospital of Xinjiang Uygur Autonomous Region.Results One patient died of an acute ischemic stroke and subsequently resulted in multiple organ failure after thoracic endovascular aortic repair.Eight patients received an aorta CT angiography during follow up at 1,3,6 months.During follow up,the patency rate for double parallel stents was 100％.There were no endoleak in 8 cases.Conclusion Double parallel stents are suited to patients with emergency situation and unsuited to open surgery in complicated aortic arch pathologies.Surgical approach is determined by preoperative evaluation.Prevention of endoleak and stroke is important in all cases.