ObjectiveTo explore the central neuroregulation mechanism of heat-sensitive moxibustion for knee osteoarthritis on pain relief. MethodsThirty patients who did not have experience of Deqi （得气） during heat-sensitive moxibustion treatment were assigned to the "non-Deqi group"， while another 30 patients who had experience of Deqi were assigned to the "Deqi group". Both groups received moxibustion at the left Heding （EX-LE2） acupoint. In the Deqi group， after the patients experienced sensation of Deqi at the acupoint， moxibustion was applied at approximately 3 cm from the skin for 10 minutes； in the non-Deqi group， moxibustion was also applied at approximately 3 cm from the skin for 10 minutes. Both groups received treatment once daily for 10 consecutive days. Knee joint pain was assessed before and after treatment using the visual analog scale （VAS）. Resting-state functional magnetic resonance imaging （rs-fMRI） scans were performed on all participants before the first treatment session and after the final session on the 10th day. The fractional amplitude of low-frequency fluctuations （fALFF） maps before and after treatment were processed using the SPM12 module by MATLAB. ResultsAfter treatment， VAS scores in both groups were significantly lower than before treatment （P＜0.05 or P＜0.01）， with the Deqi group showing significantly lower VAS scores than the non-Deqi group （P＜0.01）. Compared to before treatment， the Deqi group exhibited significant activation in the prefrontal cortex （t = 6.28）， white matter （t = 6.36）， and left temporal lobe （t = 9.33）， while significant inhibition was observed in the occipital lobe （t = -9.86） and right cerebrum （t = -4.54， P＜0.01）； in the non-Deqi group， significant changes after treatment were observed in the left occipital lobe （t = -6.42）， left medial frontal gyrus （t = -4.35）， left middle frontal gyrus （t = -4.74）， right superior frontal gyrus （t = -4.82）， right superior temporal gyrus （t = -6.61）， and right cerebellar posterior lobe （t = -8.64）， all of which were in inhibited states （P＜0.01）. Compared to the non-Deqi group， the Deqi group exhibited significant activation after treatment in the external nucleus （t = 5.77）， white matter （t = 3.58）， right cerebrum （t = 5.84）， left cerebellum （t = 5.35）， and left cerebrum （t = 4.32）， while significant inhibition was observed in the prefrontal cortex （t = -4.16）， occipital lobe （t = -4.87）， and precentral gyrus （t = -4.46， P＜0.01）. ConclusionsHeat-sensitive moxibustion provides better analgesic effects for knee osteoarthritis under state of Deqi. Its central neuroregulation mechanism may be related to the involvement of the frontal lobe， temporal lobe， occipital lobe， external nucleus， white matter， right cerebrum， left cerebellum， left cerebrum， and precentral gyrus in modulating pain signals.

Objective:To compare the clinical efficacy of laparoscopic inguinal lymph node dissection(L-ILND)and open inguinal lymph node dissection(O-lLND)in the treatment of penile cancer after radical penile cancer surgery. Methods:The clinical outcomes of 63 patients who were diagnosed with penile cancer(TNM staging:T1_3,N0-3,M0)and received L-ILND(41 cases)or O-ILND(22 cases)after radical penile cancer surgery in Department of Urology,Hubei Cancer Hospital,Tongji Medical College,Huazhong University of Science and Technology from 2008 to 2020 were retrospectively studied.The primary endpoint of this study was overall survival,and the secondary endpoints were 5-year overall survival and 5-year cancer-specific survival.The different clinical characteristics were compared between the L-ILND group and O-ILND group.Univariate and multivariate logistic regression analysis was used to study the risk facotrs for postoperative wound complications.Kaplan-Meier method was used for prognosis analysis.COX regression analysis was used to investigate the factors for overall survival prediction. Results:Among the 63 penile cancer patients studied,41 patients received L-ILND and the remaining 22 received O-ILND.There were no statistically significant differences in the baseline characteristics between the two groups of patients.The median overall survival(78 months vs 72 months,P=0.844),5-year overall survival rate(74.5％vs 78.3％,P=0.144),5-year cancer-specific survival rate(77.2％vs 71.4％,P=0.228)showed no obvious difference between L-ILND and O-ILND group.The rate of postoperative wound complications in the O-ILND group was significantly higher than that in the L-ILND group(74％vs 15％,P=0.01 2).The result of multivariate COX regression analysis showed that tumor grade[hazard ratio(H-R)=2.774,P=0.021]and lymph node pathological stage(HR=1.482,P=0.024)were significantly correlated with patients'prognosis. Conclusion:The clinical efficacy of L-ILND and O-ILND is similar,but L-ILND has a higher safety profile and lower incidence of postoperative wound complications.Therefore,L-ILND is a more ideal surgical approach for inguinal lymph node dissection after radical penile cancer surgery.

Objective: To observe the application value of right heart contrast echocardiography in the cannulation of veno-venous extracorporeal membrane oxygenation (V-V ECMO). Methods: A total of 18 patients with acute respiratory failure caused by severe pneumonia who underwent V-V ECMO treatment were enrolled. The patients were intubated through right femoral vein and right internal jugular vein cannulation, and then were divided into contrast group (n=8) and control group (n=10) according to whether underwent right heart contrast echocardiography during intubation or not. Central venous pressure (CVP) and cardiac output (CO) of all patients were measured and recorded. After the operation of ECMO, patients in contrast group received cardiovascular routine ultrasound examination and right heart contrast echocardiography simultaneously to observe and adjust the position of the cannula tip in the inferior vena cava (IVC), while patients in control group received only cardiovascular routine ultrasound to observe the direction of blood flow at the valve of IVC and the position of cannula tip in IVC. The distance between cannula tip and diaphragm (DCTD) and the left femoral artery partial pressure were measured and recorded. The differences of DCTD, left femoral artery oxygen partial pressure, CVP and CO of 2 groups were compared between 2 groups. Results: DCTD (5.14[4.68,5.81]mm) and left femoral artery oxygen partial pressure in contrast group(90.05[85.06, 95.33]mmHg) were both higher than those in control group (3.31[2.96,3.69]mm, 78.61[71.82,81.04]mmHg, Z=-1.93, -2.20, both P<0.05). No significant difference of CVP nor CO was found between 2 groups (Z=-1.79, -1.80, both P>0.05). Conclusion: Right heart contrast echocardiography can help to optimize the position of cannula tip in IVC during intubation of V-V ECMO and improve clinical therapeutic effect by reducing recirculation.

Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.

Objective:To investigate whether coxsackievirus A 16 (CVA16) infection would affect the expression of N6-methyladenosine (m 6A) methylation-related proteins in human bronchial epithelial cells (16HBE), ICR suckling mice and SCRBA2 humanized mice and influence their subcellular localization. Methods:CVA16 was used to infect 16HBE cells at a multiplicity of infection (MOI) of 0.1 and mice at 10 7 CCID 50/ml. Changes in the expression of methyltransferases, demethylases and methylated reading proteins were analyzed by Western blot. Cellular localization of these proteins was observed using immunofluorescence. Results:The expression of m 6A methylation-related proteins was gradually reduced in CVA16-infected cells with time, but showed no obvious change in ICR suckling mice or SCRBA2 humanized mice. After infection, m 6A methylation-related proteins were redistributed in both the nucleus and cytoplasm and even degraded. Conclusions:CVA16 replication in host cells altered the expression and cellular localization of m 6A methylation-related proteins, which indicated that m 6A modification might be a new potential target for enterovirus therapy.

Objective To investigate the efficacy and safety of intravesical instillation of BCG vaccine in the prevention of early recurrence of middle and high risk non-muscle invasive bladder cancer.Methods From July 2015,patients with non-muscle invasive bladder cancer aged 18-75 years with informed consent were screened and underwent transurethral resection of bladder tumor (TURBT).Immediately intravesical instillation of epirubicin 50 mg was given postoperatively.After pathology was comfirmed,patients was enrolled in group 1 (BCG15) or group 2 (BCG 19) or the control group (epirubicin 18) randomly with SAS 9.3 software.Data of follow-up and Adverse event was collected and analyzed.Results By May 31,2019,531 patients were enrolled in the study.The drop-off rate was 20.1％.167 patients (143 males and 24 females)in group 1,172 patients (141 males and 31 females)in group2 and 84(75 males and 9 females) in the control group with follow-up data were analyzed.There were no significant differences in age,gender,BMI,ECOG score,risk stratification between the three groups (P =0.8641,P =0.2906,P =0.9384,P =0.6126).The median follow-up time makes no statistical difference between the groups (P =0.9251),12.0 (6.0,22.5) months,13.0 (6.0,22.3) months,and 13.0 (7.0,22.3) months.The median recurrence time of the three groups was 4.0 (3.0,6.0) months,4.5 (3.0,9.8) months,4.5 (3.0,8.8) months.There was no statistical difference between the three groups (P =0.2852).Risk stratification in the patients got no significant difference between the three groups (P ＞ 0.05).The 1-year recurrence-free survival rates were 80.0％ in the group 1 and 88.3％ in the group 2 and 73.7％ in the control group.The group 2 was superior to the group 1 and the control group (P =0.0281,P =0.0031).There was no significant difference between group 1 and control group (P =0.2951).There was no significant difference in the cumulative recurrence-free survival between the experimental group 1 and the experimental group 2,(95％ CI 0.80-2.43,P =0.2433).The cumulative recurrence-free survival in the group 1 and the group 2 was better than the control group (95 ％ CI 0.31-0.92,P =0.0266;95 ％ CI 0.20-0.65,P =0.0008).All the cases underwent instillation were analyzed for adverse events.The incidence of overall AE(adverse events) in group 1 was 68.5％ (152/222),the incidence of grade Ⅰ-Ⅱ AE was 53.2％ (118/222),the incidence of grade Ⅲ-Ⅳ AE was 15.3％ (32/222).The incidence of overall AE in the group 2 was 71.8％ (160/223),the incidence of grade Ⅰ-Ⅱ AE was 60.1％ (134/223),and the incidence of grade Ⅲ-Ⅳ AE was 11.7％ (26/223).The overall AE rate in the control group was 53.2％ (59/111),of which the incidence of grade Ⅰ-Ⅱ AE was 42.4％ (47/111),and the incidence of grade Ⅲ-Ⅳ AE was 10.8％ (12/111).There was no difference in the incidence of overall AE between the group 1 and the group 2 (P =0.4497).The incidence of AE in the two experimental groups was higher than that in the control group (P =0.0062,P =0.0008).There was no difference in the incidence of grade Ⅲ-Ⅳ AE between the three groups (P =0.3902).Conclusions BCG(19 instillation schedule) has a better effect on preventing recurrence after 1 year of bladder surgery,which is superior to epirubicin group.The long-term efficacy of BCG in preventing recurrence and the efficacy of different schedules need to be further followed up.The lower urinary tract symptoms,which are mainly urinary frequency,are one of the causes of case fallout and should be fouced in future.Compared with epirubicin,BCG perfusion does not increase the incidence of grade Ⅲ-Ⅳ adverse reactions,and is safe to use.

Objective To analyze the effects of 24-hour diurnal blood pressure rhythm ( BPCR) changes on diastolic function in elderly hypertensive patients. Methods From February 2016 to February 2018,one hundred and twenty elderly patients with hypertension were divided into two groups according to their 24-hour ambulatory blood pressure status: dipper group with 65 cases ( nocturnal blood pressure drop rate (＞10%) and non-dipper group with 55 cases ( nocturnal blood pressure drop rate＜10%); ambulatory blood pressure and echocardiographic relaxation were detected. Posterior wall (PW),interventricular septum (IVS),left ventricular diameter (LVEDD),left ventricular mass index (LVM) and left ventricular mass index (LVMI) were examined. Fractional shortening ( FS),stroke volume ( SV),cardiac output ( CO) and cardiac index (CI) were calculated,and peak flow time (A peak flow time total integration,ATVI) and peak flow velocity (A Pea) were measured. K flow rate ventricular (APFV); E peak flow time ventricular integral (ETVI ), early Peak flow Velocity ( EPFV ) and left ventricular ejection fraction ( LVEF ) were detected. Results The 24 h DBP, 24 hSBP, nocturnal DBP, and nocturnal SBP in dipper group were (80. 27±7. 29) mmHg,(125. 29±10. 38) mmHg,(69. 98±6. 36) mmHg,(110. 39±10. 52) mmHg,which were lower than those of the noninvasive group ((83. 82±7. 51) mmHg,(130. 89±10. 71) mmHg,(79. 81 ±6. 84) mmHg,( 126. 83 ± 10. 92) mmHg), the differences were statistically significant ( t ＝ 12. 809, 13.954,11.053,13.289,P＝0.042,0.021,0.014,0.006).The EPFV in the dipper group was (65.02 ±11. 83) cm/s,which was higher than that in the non-dipper group ((60. 84±11. 29) cm/s). The A/E, ATVI,and APFV in the dipper group were (1.03±0.58),(5.59±1.72) cm,(63.74±11.06) cm/s, respectively,lower than those in non-dipper group( (1. 14±0. 54),(6. 11±1. 68) cm,(68. 82±11. 17) cm/s),the differences were statistically significant (t＝10. 895,11. 643,12. 339,10. 854,P＝0. 032,0. 027, 0. 013,0. 006). Left ventricular diastolic function was negatively correlated with daytime DBP (r＝－ 0. 195,－0. 217,－0. 174,－0. 173,P＜0. 05) and positively correlated with nighttime SBP( r＝0. 194,0. 171,0. 220, 0. 206,P＜0. 05). Conclusion In elderly hypertensive patients,the left ventricular diastolic function and left ventricular hypertrophy are more serious in non-dipper patients, and it is necessary to strengthen the control of nocturnal blood pressure in elderly hypertensive patients.

Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

Objective To investigate the early application value of echocardiography (UCG)after orthotopic heart transplantation (OHT). Methods A total of 29 patients were monitored by UCG early after OHT. On the 1st,7th,14th,30th day after operation,the left ventricular end-diastolic diameter (LVDd)and right ventricular end-diastolic diameter (RVDd),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT)and the tricuspid regurgitation area (TRA)were measured,and the left ventricular ejection fraction (LVEF ) and left ventricle Tei index (LV-Tei ) were calculated. The blood pressures (BP),central venous pressure (CVP)of the patients were recorded simultaneously. Results The LVDd were larger on the 7th,14th and 30th day after operation,while the RVDd were smaller,compared with those on the 1st day after operation (all in P<0.05). The IVST,LVPWT were lower on the 1th,14th and 30th day after operation,compared with those on the 7th day after operation (all in P<0.05). The BP,CVP,LV-Tei were all significantly lower on the 1st,14th and 30th day after operation,compared with those on the 7th day after operation (P<0.05 ). There was no significant difference in LVEF between each time points(P>0.05 ).The tricuspid regurgitation was detected in 3-4 d after operation by UCG,and the TRA reached the peak value [(9.2 ±2.5)cm2]in 5-8 d after operation,then gradually decreased to (4.7 ±2.4)cm2 at 1 month after operation. Conclusions Early phase after OHT,the structure and function of transplanted heart can be monitored effectively by echocardiography,and it can timely provide multiple parameters as the basis of diagnosis and treatment for clinical doctors.

Objective To explore the relationship of plasma NT-proBNP and age in elderly patients with severe heart failure with left ventricular ejection fraction (LVEF) preserved. Methods According to LVEF, 450 inpatients with severe heart failure (NYHA III-Ⅳ) were divided into two groups.They were LVEF≥50%(LVEF preserved) group and LVEF<50%(LVEF decreased) group. Clinical data were compared and analysed between the two groups. Linear correlation analysis was applied between Log (NT-proBNP) values of patients and ages. Results LVEF preserved group of elderly patients with severe heart failure were 183 cases. LVEF decreased group of elderly patients with severe heart failure were 267 patients. LVEDD and Log(NT-proBNP) values in LVEF preserved group of elderly patients with severe heart failure were lower than that in LVEF decreased group(P<0.01). Log(NT-proBNP) values of LVEF preserved group of elderly patients with severe heart failure were positively correlated with ages (r=0.207, P<0.01). Conclusion Diagnostic value of plasma NT-proBNP on LVEF preserved patients in elderly with severe heart failure was far inferior to LVEF decreased patients in elderly with severe heart failure. The level of plasma NT-proBNP increased with age.