Objective To investigate the risk factors of postoperative severe hypocalcemia (SH) occur-rence in the patients with secondary hyperparathyroidism (SHPT) treated by ultrasound-guided radiofrequen-cy ablation (RFA).Methods A total of 41 patients with SHPT receiving RFA treatment in the Affiliated Nanchong Central Hospital of North Sichuan Medical College from May 2019 to March 2023 were selected as the study subjects.The retrospective analysis was adopted to collect the data such as the basic information,disease information,laboratory and imagiological examination.The patients were divided into the SH group and non-SH group according to whether or not the corrected serum calcium level being lower than 1.8 mmol/L on 1 d after RFA.The univariate and multivariate logistic regression models were used to analyze the related risk factors of SH occurrence after RFA.The receiver operating characteristic (ROC) curve was drawn to test the predictive efficiency of the related risk factors.Results There were 41 patients with SHPT,inclu-ding 19 males and 22 females,with an average age of (49.56±13.64)years old,and 22 cases developed SH on 1 d after RFA.The univariate analysis results showed that preoperative alkaline phosphatase (ALP),C-reac-tive protein (CRP),parathyroid hormone (PTH) and serum calcium levels had statistical differences between the two groups.The multivariate logistic regression analysis results showed that ALP was an independent risk factor for postoperative SH occurrence.The area under the curve (AUC) of adopting ALP for predicting SH occurrence after RFA in the patients with SHPT was 0.895,and the best predicted cut-off value was 323.34 U/L.Conclusion Paying attention to the level of ALP before operation and correcting it reasonably could be conducive to reduce the incidence rate of postoperative SH.

Objective:Using bioinformatics methods to study the immune infiltration mechanism of lupus nephritis(LN)and to explore potential target Chinese medicines,which can provide new directions for clinical treatment of LN.Methods:Gene expres-sion profile microarray dataset of LN was downloaded from GEO database,differential expressed genes(DEGs)were screened using R software,and GO and KEGG enrichment analysis were performed on these DEGs.Protein interaction network analysis of DEGs was performed by applying STRING database,key genes were screened by using Cytoscape,core gene expression was validated by Nephro-seq database,and the infiltration and correlation of 22 kinds of immune cells in LN were calculated by CIBERSORT deconvolution algorithm.Finally,herbal prediction of significantly enriched immune-related biological processes and key target genes were performed by Coremine Medical database.Results:A total of 367 LN-related DEGs were obtained,of which 253 were up-regulated and 114 were down-regulated.GO was mainly enriched in response to viruses,defense response to viruses,regulation of viral life cycle,regulation of viral processes,etc;KEGG was mainly enriched in S.aureus infection,COVID-19,influenza A,complement and coagulation cascade,pertussis,etc.Ten key genes were screened:IFIT3,OAS2,MX1,OAS1,RSAD2,XAF1,ISG15,IFIT1,ITGAM and PTPRC.Immune infiltration by CIBERSORT deconvolution algorithm showed that monocytes and initial B cells were highly expressed in LN,while memory B cells,naive CD4+T cells,follicular helper T cells and resting natural killer cells were lowly expressed in LN.Immune cell correlation analysis showed a positive correlation between initial B cells and plasma cells,a positive correlation between resting natural killer cells and resting dendritic cells,a negative correlation between monocytes and regulatory T cells,and a negative correlation between resting CD4+memory T cells and monocytes.Coremine Medical predicted that Salvia miltiorrhiza,Panax notogin-seng,Scutellaria baicalensis,ginseng,honey,monkey mushroom and peony were found to be most closely related to immunity in LN.Conclusion:The development and progression of LN are results of the combined involvement of multiple genes and pathways.Mono-cytes,memory B cells,initial CD4+T cells and initial B cells are most closely associated with LN.The predicted Salvia miltiorrhiza,Panax notoginseng,Scutellaria baicalensis,ginseng,honey,monkey mushroom and peony may be used as target herbs for the poten-tial treatment of LN.

Objective Using bioinformatics methods to study the immune infiltration mechanism of Primary Sj?gren's syndrome(pSS)and to explore potential target Chinese medicines,which can provide new directions for the clinical treatment of pSS.Methods Gene expression profile microarray dataset of pSS was downloaded from the GEO database,differential genes were screened using R software,and gene ontology(GO)and gene pathway enrichment(KEGG)enrichment analysis was performed on these differential genes.Protein interaction network analysis of differential genes was performed by applying the STRING database,key genes were screened by using Cytoscape,and ELISA for the verification of key genes expression.Immune infiltration and correlation of immune cells in pSS were calculated by CIBERSORT inverse convolution method in 22.Finally,the herbal prediction of key target genes was performed by using the Coremine Medical database.Results A total of 232 differential genes were obtained,of which 207 were up-regulated and 25 were down-regulated.GO was mainly enriched in:leukocyte mediated immunity,lymphocyte mediated immunity,leukocyte cell-cell adhesion,etc;KEGG was mainly enriched in Hematopoietic cell lineage,Primary immunodeficiency,Intestinal immune network for IgA production,Phagosome,Leishmaniasis.Ten key genes were screened:PTPRC,CD19,LCP2,CCR5 and CD69 etc.The hub genes expression in the pSS is the same as that of GSE40611.Immune infiltration showed that memory B cells,T cells CD4 memory activated,and T cells CD4 na?ve were highly expressed in the pSS.Immune cell correlation analysis showed a positive correlation between initial Monocytes and T cells regulatory(Tregs),a positive correlation between Macrophages M1 and B cell na?ve,and a negative correlation between Plasma cells and T cells CD4 memory activated.COREMINE Medical predicted that Ginseng,Panax notoginseng,Tripterygium wilfordii,Burnet,Magnolia,and Strychni may treat pSS.Conclusion The development and progression of pSS are the results of the combined involvement of multiple genes and pathways.Memory B cells,T cells CD4 memory activated,and T cells CD4 na?ve may promote the development of pSS.The predicted Ginseng,Panax notoginseng,Tripterygium wilfordii,Burnet,Magnolia,Strychni may be used as target herbs for the potential treatment of pSS.

Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Objective: Taking human A549 cells as the research object, to construct the paraquat-induced pulmonary fibrosis model in vitro, and to explore the role of TSP-1 (Thrombospondin-1, TSP-1) and its receptor CD47 in PQ-induced pulmonary fibrosis. Methods: Human A549 cells were cultured in vitro, divided into normal control group, PQ group, Anti-TSP1 group (PQ with neutralizing anti-TSP1 antibody at a final concentration of 10 μg/ml) . A549 cells were stimulated with different concentrations (50, 100, 200, 400, 600, 800, 1 000 μmol/L) for different time (12, 24, 48 h) , and then CCK8 method was used to detect the cell viability to screen out the concentration and time of half cell viability. The subsequent test will be performed at this concentration point.The morphology of the cells was observed under inverted microscope. The expression levels of Fibronectin (FN) and type I collagen were determined by Enzyme Linked Immunosorbent Assay (ELISA) . Immunocytochemistry (ICC) and Immunofluorescence (IF) were used to observe the expression of TSP-1 and CD47 protein and the co-expression.The mRNA expression of TSP-1 and CD47 was detected by Real Time PCR (RT-PCR) . The protien expression of TSP-1 and CD47 was detected by Western Blot (WB) . The levels of Reactive Oxygen Species (ROS) were measured by flow cytometry. Results: Before neutralizing anti-TSP1 antibody intervention: (1) When the time of PQ was constant, the cell viability decreased with the increase of PQ concentration. (2) The cells in the control group were closely connected, cobble-like, arranged neatly; with the increase of PQ concentration, the cell gap of PQ group gradually increased, spindle shape or long spindle shape. (3) With the increase of PQ concentration, the relative expression of FN and I collagen in PQ group was gradually increased compared with the control group in a concentration-dependent manner, and 200 μmol/L is the most obvious. (4) Compared with the control group, the mRNA level and the protein expression of TSP-1 and CD47 in PQ group was significantly increased, and 200 μmol/L is the most obvious, and Immunofluorescence showed they were co-expression in cytoplasm. (5) Compared with the normal group, the level of ROS in A549 cells was significantly increased at 24 h after PQ stimulation. (6) Compared with PQ group, the cell viability of Anti-TSP1 group was significantly increased, and the morphology changed to normal cell morphology, and the mRNA level and the protein expression of TSP-1 and CD47 decreased, and the overexpression of ROS was inhibited, and the relative expression of FN and I collagen decreased. Conclusion PQ stimulation induced morphological changes of A549 cells, increased expression of TSP-1, CD47, FN and type I collagen, and increased production of ROS.Neutralizing anti-TSP1 antibodies against TSP-1 can partially improve the above lesions. TSP-1-CD47 may be associated with oxidative stress-mediated PQ-induced pulmonary fibrosis.

Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14％,that in splenectomy group decreased 23％ (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P ＜0.01).The postoperative complication rate (24％ vs.39％),and portal venous thrombosis (10％ vs.31％) were all in favour of splenectomy free group (x2 =0.036,P ＜0.05).The 1-and 3-year's recurrent bleeding rate were 4％ and 8％ compared with 4％ and 8％ (all P ＞ 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.

Objective: To establish a rat model of paraquat (PQ) -induced pulmonary fibrosis and observe the changes in thrombospondin-1 (TSP-1) and its receptor CD47 in lung tissue, and to investigate their roles in the pathogenesis of PQ-induced pulmonary fibrosis. Methods: Fifty-four clean adult male Sprague-Dawley rats were randomly divided into normal control group (n=6) and 2 h, 12 h, 1 d, 3 d, 7 d, and 14 d PQ poisoning groups (n=8 per group). A rat model of PQ poisoning was established by a single gavage of 20 wt.% PQ solution (50 mg/kg). Flow cytometry was used to determine the concentration of reactive oxygen species (ROS) in blood and lung tissue. Enzyme-linked immunosorbent assay was used to determine the concentrations of hydroxyl radicals, malondialdehyde, and hydroxyproline in lung tissue. HE staining and Masson staining were used to observe the pathological damage of lung tissue after PQ poisoning. The expression of TSP-1 and CD47 in lung tissue was measured by Immunohistochemistry. Results: Compared with the normal control group, the 2 h to 7 d PQ poisoning groups showed significant increases in ROS fluorescence intensity in red blood cells and lung tissues and the concentrations of malondialdehyde and hydroxyl radicals in lung tissue (P<0.05) , and the 14 d PQ poisoning group had a significant increase in the concentration of hydroxyproline in lung tissue (P<0.05). HE staining showed that the 2 h to 7 d PQ poisoning groups had significantly higher semiquantitative pathological scores of pulmonary alveolitis than the normal control group (P<0.05). The Masson staining showed that the 7 d and 14 d PQ poisoning groups had significantly higher semiquantitative pathological scores of pulmonary fibrosis than the normal control group (P<0.05). Compared with the normal control group, all PQ poisoning groups (except the 12 h group) had significantly increased expression of TSP-1 in lung tissue (P<0.05) , and all PQ poisoning groups (except the 1 d group) had significantly increased expression of CD47 in lung tissue (P<0.05). Within 2 h after PQ poisoning, the expression of TSP-1 and CD47 was positively correlated with the concentrations of ROS, hydroxyl radicals, and malondialdehyde and the degree of pulmonary alveolitis (P<0.01) ; at 1 d after PQ poisoning, the expression of TSP-1 and CD47 was positively correlated with the concentration of hydroxyproline in lung tissue (P<0.01) . Conclusion The expression of TSP-1 and CD47 is closely related to oxidative stress and subsequent pulmonary fibrosis, and they may be involved in the development and progression of pulmonary alveolitis and subsequent pulmonary fibrosis in rats with PQ poisoning.

Objective To investigate the significance of tumor markers CEA and CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.Methods A retrospective analysis of 110 cases with primary duodenal carcinoma treated in our hospital from January 1999 to December 2016 was conducted.ROC analysis,univariate and multivariate analysiswere performed to investigate the relationship between CEA,CA19-9 and the clinicopathologic characteristics of primary duodenal carcinoma.Kaplain-Meier method was used to analyze the relationship between CEA and CA19-9 and the prognosis of primary duodenal carcinoma.Results CEA level was of value for predicting the depth of infiltration,lymphatic involvement,metastasis and TNM stage.The receiver operating characteristic was 0.629,0.672,0.749,0.692 respectively.Univariate analysis showed serum CA19-9 lever was related to the depth of infiltration and serum CEA lever were related to tumor differentiation,lymphatic invasion,metastasis and TNM stage.Logistic analysis showed that CEA value was only associated with metastasis (OR:9.853,P ＜ 0.01).Patients with elevated serum CEA level had a significant worse prognosis than patients with normal serum CEA level (P ＜ 0.05).Conclusion Serum CEA level was closely associated with the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.