Objective To construct large medical model named by "Huaxi HongYi"and explore its application effectiveness in assisting medical record generation. Methods By the way of a full-chain medical large model construction paradigm of "data annotation - model training - scenario incubation", through strategies such as multimodal data fusion, domain adaptation training, and localization of hardware adaptation, "Huaxi HongYi" with 72 billion parameters was constructed. Combined with technologies such as speech recognition, knowledge graphs, and reinforcement learning, an application system for assisting in the generation of medical records was developed. Results Taking the assisted generation of discharge records as an example, in the pilot department, after using the application system, the average completion times of writing a medical records shortened (21 min vs. 5 min) with efficiency increased by 3.2 time, the accuracy rate of the model output reached 92.4%. Conclusion It is feasible for medical institutions to build independently controllable medical large models and incubate various applications based on these models, providing a reference pathway for artificial intelligence development in similar institutions.

Objective To observe the expression of GLIS3 in triple negative breast cancer(TNBC)and analyze its relationship with the prognosis of TNBC patients.Methods Bioinformatic analysis was applied to analyze the expression level of GLIS3 in Gene Expression Omnibus(GEO).Kaplan-Meier survival curve was plotted to evaluate the impact of GLIS3 expression on the survival rate of patients based on DNA chip data.A total of 125 patients pathologically diagnosed as TNBC in the Fourth Hospital of Hebei Medical University from January to December 2014 were enrolled by cluster random sampling.Among them,53 patients had complete tissue specimens,medical records and follow-up data.Immunohistochemical assay was used to detect the expression of GLIS3 in TNBC and adjacent tissues to tumors,while the relationships between GLIS3 protein expression in breast cancer tissues and clinicopathological parameters such as age,menstrual status,tumor size,clinical stage,histological grade,pathological type,axillary lymph node metastasis,vascular tumor thrombus,and expression of TP53 and Ki-67 were analyzed.Kaplan-Meier survival curve was plotted to analyze the effect of GLIS3 on the overall and disease-free survival of TNBC patients.Cox regression model was established to identify the risk factors impacting the prognosis of the patients.Results Analysis of GEO data showed that the expression of GLIS3 in TNBC was significantly higher than that in paracancer tissues(P＜0.05).The expression of GLIS3 was notably higher in the TNBC tissue than the adjacent tissue to tumor(P＜0.05).A marked augmentation of GLIS3 expression was observed in both the advanced and larger-sized tumors(P＜0.05).Univariate analysis of Cox regression model revealed that lymph node metastasis,TNM stage and GLIS3 expression were all related to disease-free survival of TNBC patients(P＜0.05).Univariate and multivariate analyses displayed that TNM stage was related to the overall survival of TNBC patients(P＜0.05).The patients with high expression of GLIS3 had significant shorter disease-free survival time than those with low expression(P＜0.05),but had no statistical difference in overall survival(P＞0.05).Conclusion GLIS3 protein is highly expressed in TNBC tissues,and tumor size and TNM stage are correlated with its high expression.The high expression of GLIS3 suggests that the patients have poor prognosis and low disease-free survival rate.

Objective To investigate the risk factors for rebleeding after emergency esophageal variceal ligation (EVL) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical and laboratory data of 290 patients with liver cirrhosis who underwent emergency EVL in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2019, and according to the presence or absence of rebleeding within 1-year follow-up, they were divided into rebleeding group and non-rebleeding group. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was performed with the statistically significant factors as independent variables to screen out the independent risk factors for rebleeding after emergency EVL, and the receiver operating characteristic (ROC) curve was plotted to obtain the indices for predicting the probability of rebleeding and establish a predictive model. Results The univariate analysis showed that there were significant differences between the two groups in platelet count ( t =-1.888, P =0.047), Child-Pugh score ( χ 2 =5.975, P =0.049), albumin level ( t =-2.229, P =0.029), and splenic vein diameter ( t =3.808, P =0.001). The multivariate logistic regression analysis showed that Child-Pugh score (odds ratio [ OR ]=0.280, 95% confidence interval [ CI ]: 0.108-0.729, P =0.009), splenic vein diameter ( OR =1.549, 95% CI : 1.197-2.005, P =0.001) and albumin level ( OR =0.832, 95% CI : 0.729-0.949, P =0.006) were independent influencing factors for rebleeding after EVL. The predictive model based on these three factors had an area under the ROC curve of 0.796, with a sensitivity of 83.7% and a specificity of 74.5% at the cut-off value of -0.086. Conclusion Child-Pugh score, albumin level, and splenic vein diameter are independent risk factors for rebleeding after emergency EVL, and the combination of the three indices has the highest sensitivity and specificity in predicting rebleeding.

Objective: To explore the expression of AGR2 gene in breast cancer as well as to predict its relevant biological functions and molecular signaling pathways with bioinformatics tool. Methods: The expression of AGR2 in breast cancer tissues and normal tissues was analyzed in Oncomine and GEPIA databases, and the expression of AGR2 in breast cancer cell lines was evaluated in CCLE database. Meanwhile, HPA database was used to analyze the expression of AGR2 protein in normal and breast cancer tissues. Besides, the gene expression microarray data download from CCLE database was analyzed by using R software to obtain genes co-expressed withAGR2. Functional annotation ofAGR2 co-expressed genes was performed by using GO Enrichment and KEGG pathway analyses. Results: Oncomine and GEPIA databases showed that AGR2 gene was highly expressed in breast cancer tissues, and CCLE database analysis showed that AGR2 was highly expressed in all breast cancer cell lines. Immunohistochemistry results from the HPA database showed that the expression of AGR2 protein was significantly higher in breast cancer tissues compared with normal tissues. A total of 946 genes co-expressed with AGR2 in breast cancer were screened out with the R software. With the GO function Enrichment analysis, the co-expressed genes were demonstrated to be mainly involved in biological functions, such as protein localization to cell periphery, protein localization to plasma membrane, cell junction assembly, cell-substrate adhesion, and cell junction organization etc. In addition, the KEGG analysis results showed that co-expressed genes were mainly involved in the progression of gastric cancer and breast cancer, and were associated with proteoglycans in cancer, as well as proline, leucine and isoleucine degradation pathways. Conclusions:AGR2 is highly expressed in breast cancer tissues, which may be a potential oncogenic gene and a new therapeutic target of breast cancer.

Objective To confirm the noninferiority of mesorectal excision (ME) alone to ME combined with lateral lymph node dissection (LLND) in terms of efficacy. Methods Eligibility criteria included histologically proven rectal cancer at clinical stageⅡ/Ⅲ; main lesion located in the rectum. Patients were intra-operatively allocated to undergo ME combined with LLND or ME alone in a randomized manner. The primary endpoint was relapse-free survival, with a noninferiority margin for the hazard ratio of 1.34. Secondary end points included overall survival and local-recurrence-free survival. Results In total, 502 patients from November 11, 2010 to October 1, 2017 were randomized to the ME combined with LLND (252 patients) and ME alone (250 patients) groups. The 5-year relapse-free survival in the ME combined with LLND and ME alone groups were 73.4% and 73.3%, respectively (hazard ratio:1.07, 90.9% CI 0.84— 1.36), with one sided P value for noninferiority of 0.0547. The 5-year overall survival, and 5-year local-recurrence-free survival in the ME combined with LLND and ME alone groups were 92.6% and 90.2% , and 87.7% and 82.4% , respectively. The numbers of patients with local recurrence were 21 cases (8.3%) and 43 cases (17.2%) in the ME combined with LLND group and ME alone group (P=0.024). Conclusions The noninferiority of ME alone to ME combined with LLND is not confirmed in the intent-to-treat analysis. ME combined with LLND has a lower local recurrence, especially in the lateral pelvis, compared to ME alone.

Objective To explore the molecular genetic characteristics of primary and recurrent glioblastomas (GBMs) from the same patient in vivo, primary glioma stem cells cultured in vitro, and patient-derived xenograft (PDX). Methods (1) The primary and recurrent GBM specimens from one patient during surgical resection were collected; and the expressions of glial fibrillary acidic protein (GFAP), nestin and Ki-67 were detected by immunohistochemical staining; the methylation of O6-methylguanine DNA methyltransferase (MGMT) gene, mutation of isocitrate dehydrogenase (IDH) gene and amplification of epidermal growth factor receptor (EGFR) gene were analyzed. (2) The primary and recurrent GBM stem cells were cultured in vitro and named as SU5-1 and SU5-2 cells, respectively; the expressions of nestin and CD133 were detected by immunohistochemical staining; GFAP expression was detected by immunohistochemical staining after induced differentiation, and the growth curve was detected by CCK-8 assay; Transwell invasion assay was used to detect the invasion ability; cell resistance to temozolomide (TMZ), carboplatin (CBP), cisplatin (DDP) and adriamycin (ADM) was detected by CCK-8 assay; the protein expression of programmed death receptor-ligand 1 (PD-L1) was detected by Western blotting. The rate of PD-L1 positive cells was detected by flow cytometry; genetic testing analysis was as above. (3) The primary and recurrent in situ PDX models in nude mice were established, and the expressions of nestin, GFAP and Ki-67 were detected by immunohistochemical staining. Results (1) As compared with the primary GBM, the recurrent GBM had significantly higher percentages of Ki-67 and nestin positive cells, while statistically lower percentage of GFAP positive cells (P<0.05); genetic analysis showed that there was no mutation in IDH gene in the primary GBM tissues and recurrent GBM tissues; the MGMT gene in the primary GBM tissues was methylated and EGFR gene was not amplified, while the MGMT gene in recurrent GBM tissues was demethylated and EGFR gene amplification was positive. (2) Both SU5-1 and SU5-2 cells expressed nestin and CD133, and GFAP was expressed after induced differentiation; the growth curve showed that the proliferation of SU5-2 cells started earlier than that of SU5-1 cells, the two were equal on the 3rd, 4th, and 5th d, and the proliferation of SU5-1 cells was faster than that of SU5-2 cells from the 6th d; the invasion ability of SU5-2 cells was statistically stronger than that of SU5-1 cells (P<0.05); the inhibition rates of SU5-2 cells treated with 5, 10, and 15 mmol/L CBP, 0.3125, 1.25, and 5 mmol/L DDP, 0.5 and 2 mmol/L ADM, and 125 and 500 mmol/L TMZ were significantly lower than those of SU5-1 cells treated with the same concentrations and same drugs (P<0.05); the protein expression of PD-L1 in SU5-2 cells was higher than that in SU5-1 cells; the positive rate of PD-L1 in SU5-2 cells was statistically higher than that in SU5-1 cells (P<0.05); the results of genetic analysis were consistent with those of the primary and recurrent GBM samples. (3) As compared with those in the primary PDX model, the nestin and Ki-67 expressions were significantly higher and GFAP expression was significantly lower in the recurrent PDX model (P<0.05); the results of genetic analysis were consistent with those of the primary and recurrent GBM samples. Conclusions Genetic differences are detected between primary and recurrent GBMs; recurrent GBM has stronger invasive capacity and multi-drug resistance. The primary stem cells derived from surgical specimens and corresponding PDX models could replicate the molecular genetic characteristics of original tumors, which provide a reliable experimental platform for both tumor translation researches and screening of molecular therapeutic targets.

Objective: To explore the impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications. Methods: We retrospectively analyzed the clinical data from female breast cancer patients treated by either modified radical mastectomy with immediate breast reconstruction(IBR) ( n=108) or modified radical mastectomy alone(n=115), followed by adjuvant chemotherapy at our department between January 2011 and December 2012. Results: There was no significant difference in the overall complication rates between the IBR group and modified radical mastectomy group (49.1% vs. 52.2%, P=0.87). However, more secondary surgery was applied in the IBR group than the modified radical mastectomy group (13.0% vs. 1.7%, P=0.001). However, the incidence of hematoma in the modified radical mastectomy group was significantly higher than the IBR group (17.4% vs. 4.6%, P=0.003). There was a significant difference in the onset of adjuvant chemotherapy between the IBR group and modified radical mastectomy group (21 days vs. 11days, P<0.001). Conclusions Immediate breast reconstruction has no significant impact on the overall complication rate, but increases the incidence of secondary surgery, especially after the initiation of chemotherapy. In addition, it slightly delays adjuvant chemotherapy in the patients.

Animals ; Cell Nucleus ; enzymology ; Drosophila Proteins ; genetics ; metabolism ; Drosophila melanogaster ; Extracellular Signal-Regulated MAP Kinases ; genetics ; metabolism ; Long-Term Potentiation ; physiology ; MAP Kinase Signaling System ; physiology ; Memory Consolidation ; physiology ; Neurons ; cytology ; enzymology

Objective To compare the advantages and disadvantages between the Mammotome ( MMT ) and conventional resection operation in the diagnosis and treatment of breast tumors . Methods A total of 288 patients during the period from February to July of 2014 were divided into MMT group ( 137 cases ) and control group ( 151 cases ) according to patient ’ s willingness .The surgical and post-operative results , postoperative complications and burden of disease were compared between the two groups . Results As compared to the control group, the MMT group had shorter operation time [(28.3 ±9.1) min vs.(37.5 ±14.2) min, t =-6.472, P=0.000], larger amount of tissue cut [(29.2 ±8.1) g vs.(16.5 ±7.9) g, t=13.462, P=0.000], lower visual analogue scales at one day after surgery [(4.2 ±3.6) points vs.(4.9 ±1.5) points, t=-2.189, P=0.029], lower incidence of postoperative breast shape change [10.2% (14/137) vs.55.0% (83/151), χ2 =64.392, P =0.000], and higher patient satisfaction scores [(7.2 ±1.8) points vs.(5.3 ±2.9) points, t=6.601, P=0.000], but more intraoperative bleeding [(22.3 ± 4.3) ml vs.(12.6 ±5.9) ml, t=15.807, P=0.000], higher incidence of postoperative breast hematoma [9.5% (13/137) vs. 2.6%(4/151),χ2 =6.050, P=0.014], and higher total costs [(5.12 ±1.97) ×103 yuan vs.(3.18 ±2.01) ×103 yuan, t=8.258, P=0.000]. Conclusion The MMT operation has advantages of short time , more cut tissue volume, mild postoperative pain, good postoperative breast shape , and high patient satisfaction , but disadvantages of easy development of hematoma and high total costs.

Objective: To analyze the information of patients with acute myocardial infarction (AMI) in a single center during last 6 years, and to distinguish the clinical differences of patients between TakoSTubo cardiomyopathy (TTC) and ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1042 consecutive patients with primarily diagnosed acute anterior ST-segment elevation (STEMI) admitted in our hospital from 2008-01 to 2014-04 were retrospectively enrolled. The relevant patients were studied in 2 groups:TTC group, the patients with coronary angiography (CAG) and the contrast study of left ventricle corrected TTC diagnosis, n=10, and STEMI group, the patients received CAG within 6 hours of on set with conifrmed left anterior descending singlevessel disease at the same period of time as TTC patients,n=32. The basic clinical characteristics, levels of blood lipids, MI related biomarkers, the incidence rate of pathological Q wave, QTc interval and negative T wave in 12-lead ECG were compared between 2 groups. Results: The percentage of corrected TTC diagnosis in patients with primarily diagnosed STEMI was 1.06%. The female gender in TTC group and STEMI group was 100% vs 9%,P<0.01, TTC group had more patients with stress history before on set than that in STEMI group (70% vs 22%,P=0.02), lower levels of MI related biomarkers as CK (486 ± 249) U/L vs (716 ± 132) U/L, CK-MB (13.5 ± 17.1) mg/L vs (47.5 ± 21.9) mg/L, cTnI (22.8 ± 16.3) ng/mL vs (56.4 ± 24.0) ng/mL, allP<0.01. The age of morbidity, the ratios of hypertension, diabetes mellitus and blood lipids were similar between 2 groups. The frequency of abnormal Q-wave in ECG was similar between 2 groups, while the QTc interval was different in TTC group and STEMI group (630 ± 117) ms vs (540 ± 62) ms,P=0.001, the negative T waves in ECG leads II, III, aVF, aVR and V6 were as (100.00% vs 3.13%), (60.00% vs 6.25%), (90.00% vs 3.13%), (100.00% vs 21.88%), (100.00% vs 46.88%), allP<0.05. Conclusion: TTC patients with the main presentation as ST-segment elevation are usually having emotional or physical stress before on set, with obviously prolonged QTc interval and more frequency of negative T waves in ECG.