Objective To investigate the predictive value of urinary exosomal microRNA(miR)-29 c in the clinical outcome of organ-and non-organ-confined bladder urothelial carcinoma(BUC).Methods From January 2017 to March 2022,152 patients with BUC were recruited from the Department of Urology in our hospital as a validation set.In addition,126 non-cancer controls were selected from the physical examination center of our hospital.The expression level of urinary exosomal miR-29c was detected by real-time quantitative PCR.Results In the validation set,urinary exosomal miR-29c level in BUC patients was significantly lower than that in non-cancer control group(P＜0.05),while urinary exosomal miR-17-5p level and miR-590-5p level were not significantly different(P＞0.05).The area under ROC curve of urinary exosomal miR-29c for the diagnosis of BUC was 0.969(95％CI:0.953～0.986),and the corresponding sensitivity and specificity were 92.1％and 90.2％,respectively.In subtype analysis,urinary exosomal miR-29c levels were further reduced in patients with non-organ-confined BUC compared with patients with organ-confined BUC(P=0.009).Overall survival(OS),disease-free survival(DFS)and disease-specific survival(DSS)were longer in the urinary exosomal miR-29c high expression group(P＜0.05).Conclusion Low levels of urinary exosomal miR-29c are an adverse prognostic factor for survival in patients with BUC,and are promising as a predictor of adverse clinical outcomes of organ-and non-organ-confined BUC.

Objective To investigate the clinical significance of the differential expression of CD44 in glioblastoma(GBM),and the enrichment of related pathways combined with U87 cell verification.Methods Differential ex-pression and Cox analysis were used to find potential differences in CD44 expression between tumor patients and healthy people as shown by pancancer transcriptome and hazard ratio(HR).Immunoinfiltration and stem-cell re-lated scores of GBM patients with high and low CD44 expression groups were compared and the differences be-tween immune cell subsets,and their correlation with CD44 were further analyzed.Pathway enrichment of differen-tially expressed genes in high and low CD44 expression groups for GBM patients was performed.Over-expression(OE),knockdown(KD)and knockout(KO)of CD44 in U87 cells was done by constructing and packaging lenti-virus and using the electroribonucleoprotein complex;CD44 immunofluorescence staining was performed on U87 and U87 CD44 OE cells.The activity and apoptosis of U87 cells were detected by knocking down CD44 and the mi-gration and invasion ability of U87 cells were detected by knocking down CD44.Results The expression of CD44 in GBM patients was higher than that in healthy people(P＜0.05)and HR＞1.GBM patients with high CD44 ex-pression had higher stromal cell and immunoinfiltration scores,and GBM patients with high and low CD44 expres-sion had significant differences in the ratio of dendritic cells,CD4+memory T cells and regulatory T cells,all posi-tively correlated with CD44 expression(P＜0.05).Differential gene enrichment in GBM patients with high and low CD44 expression was further associated with pathways related to cell migration and apoptosis(P＜0.05).Experi-ments using U87 cells showed that CD44 was normally localized in the cell membrane,but for CD44 OE it accumu-lated in the cytoplasm.CD44 KD can lead to a decrease in cell viability,increased in cell apoptosis,with the cell migration and invasion ability of CD44 KO also decreasing(P＜0.05).Conclusions Low expression of CD44 can decrease viability,migration and invasion of U87 cells and promote apoptosis rate of U87 cells,which leads to the deterioration of GBM and is a related factor potentially affecting the prognosis of GBM patients.

Purpose/Significance To investigate the effectiveness of experiential teaching in perinatal healthcare management contin-uing education.Method/Process The perinatal healthcare team of Peking Union Medical College Hospital holds a four-day experiential learning program for 30 maternity-related medical staffs from China.Through the self-administered experiential teaching questionnaire(ETQ)and satisfaction questionnaire,the researchers analyze the participants'post-teaching skill acquisition,clinical application abil-ity and educational needs,as well as their satisfaction with course content,course duration,teaching design,classroom atmosphere,and teaching format,which are quantified with Likert scale.Result/Conclusion The experiential teaching mode shows good teaching effects in perinatal healthcare management continuing education,and has higher application value.In the future,the researchers should combine it with theoretical teaching and carry out more comprehensive and structured periodic learning classes throughout the country,so as to im-prove both the theoretical foundation and practical ability of healthcare workers for better healthcare services for pregnant women.

Objective:To explore the impact of PM 2.5 concentration in Shanghai on the incidence of allergic rhinitis（AR） in the population, and provide strategies for early warning and prevention of AR. Methods:Collect daily average concentrations of atmospheric pollutants monitored in Shanghai from January 1, 2017 to December 31, 2019, and clinical data of AR patients from five hospitals in Shanghai during the same period. We used a time-series analysis additive Poisson regression model to analyze the correlation between PM 2.5 levels and outpatient attendance for AR patients. Results:During the study period, a total of 56 500 AR patients were included, and the daily average concentration of PM 2.5 was（35.28±23.07）μg/m³. There is a correlation between the concentration of PM 2.5 and the number of outpatient attendance for AR cases. There is a positive correlation between the daily average number of outpatient for AR and levels of PM 2.5 air pollution（（P<0.05）） . We found that every 10 μg/m³ increase in PM 2.5, the impact of on the number of AR visits was statistically significant on the same day, the first day behind, and the second day behind, with the strongest impact being the exposure on the same day. Every 10 μg/m³ increases in PM 2.5, the number of outpatient visits increased by 0.526% on the same day（95%CI 1.000 50-1.010 04）. Conclusion:The atmospheric PM 2.5 concentration in Shanghai is positively correlated with the number of outpatient for AR, and PM 2.5 exposure is an independent factor in the onset of AR. This provides an important theoretical basis for AR.
Humans ; Particulate Matter/analysis* ; Air Pollutants/adverse effects* ; Incidence ; China/epidemiology* ; Air Pollution/adverse effects* ; Rhinitis, Allergic/etiology*

Objective:To evaluate the efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection(TAAD).Methods:In this retrospective study, a total of 481 TAAD patients treated with total arch replacement in our hospital from January 2016 to January 2020 were divided into three groups: aged≤59 years, 60-69 years and ≥70 years.The differences between three groups in surgical method, extracorporeal circulation time, blocking time, circulatory time, stopping time, surgical time, ventilator use time, ICU time, hospitalization time, treatment rate of continued renal replacement, fatality rate, and cause of death were statistically analyzed and compared.Results:There were statistically significant differences in the stopping time between any two groups of the three groups(all P<0.05). The older the age, the shorter the circulatory arrest time.The difference of ventilator time and ICU time between ≤59 and 60-69 years was statistically significant( P<0.01). Patients with continuous renal replacement(CRRT)were 19.0%(71/373)in ≤59 years, 23.1%(18/78)in 60~69 years, and 26.7%(8/30)over 70 years.In-hospital mortality was 35/373(9.4%)in the group of ≤59 years old, 11/78(14.1%)in the group of 60~69 years old, and 5/30(16.7%)in the group of ≥70 years old.There was no death in patients undergoing type Ⅱ hybrid surgery. Conclusions:Age is one of the important death factors after total aortic arch replacement in TAAD patients.Total aortic arch replacement is an acceptable surgical method for elderly patients with TAAD.Hybridization may reduce hospitalization death in elderly patients.

In adult orbital diseases, thyroid associated ophthalmopathy (TAO) is of very high incidence rate, and it can seriously affect patients' appearance, eyesight and binocular visual function and so on, and significantly reduce the patients' quality of life.In addition to the common manifestations such as eyelid retraction, exophthalmos and strabismus, some TAO patients may suffer from obviously increased ocular pressure and even visual field damage, which are often ignored or missed in diagnosis and should be paid more attention to.The pathogenesis of elevated intraocular pressure in TAO is mainly related to the elevated episcleral venous pressure and the extraocular muscles.Because the elevated intraocular pressure resulted from TAO is secondary and its pathogenesis is complex, personalized treatment different from primary glaucoma therapy is needed.In this article, the epidemiology, pathogenesis and therapy of elevated intraocular pressure in TAO including medication, surgery, and radiotherapy were reviewed to provide reference for the clinical diagnosis and treatment for TAO.

Objective    To summarize the clinical feature and treatment experience of patients with acute type A aortic dissection involving coronary arteries. Methods    The clinical data of 107 patients with acute type A aortic dissection involving coronary arteries, who received operation between June 5, 2012 and December 31, 2019 in our hospital, were analyzed retrospectively. There were 80 males and 27 females at age of 24-83 (49.8±11.2) years. Results    The right coronary artery was involved in 65 patients, the left in 17 patients, and both coronary arteries in 25 patients. There were 48 (44.9%) patients undergoing coronary artery bypass grafting, 49 (45.8%) patients undergoing coronary artery plasty. Fifteen patients died 30 d after the operation, with a mortality rate of 14.0%. Patients with preoperative cardiogenic shock and postoperative acute renal failure had increased risk of death (P<0.05). Eighty-two (88.2%) patients were followed up for 2 to 71 months, and 1 patient had sudden cardiac death during the follow-up period. Conclusion    Acute type A aortic dissection with coronary involvement is associated with high misdiagnosis rate and mortality rate. Taking proper strategies for surgical treatment of involved coronary arteries based on precise diagnosis may improve the prognosis of patients.

The aim of the research was to investigate the pharmacokinetics (PK) of enteric-coated mycophenolate sodium (EC-MPS) by quantification of the active metabolite of mycophenolic acid (MPA) after multiple escalating oral doses in Han kidney transplant recipients. A total of 28 Han postoperative kidney transplant recipients were given a multiple-dose of 540, 720 or 900 mg of EC-MPS two times a day in combination with tacrolimus for 6 days. Blood specimens were collected at each time point from 0 to 12 h after EC-MPS administration. MPA plasma concentrations were measured by UPLC-UV. The relationship between the EC-MPS dose and its PK parameters was assessed. In the range from 540 to 900 mg,and AUCdid not increase with dose escalation. The AUC,,andfor the 540 720 and 900 mg doses were not significantly different, respectively (>0.05). AUCandwere increased less than proportionally with increasing EC-MPS dose levels. Inter-individual variability in AUC,andwere considerable. Nonlinear PK relationships were found from the doses of 540-900 mg of EC-MPS.

Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB).Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%.One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.

Objective: To retrospectively investigate the long-term swallowing function of patients with laryngeal carcinoma, who underwent partial laryngectomy, discuss the effectiveness and reliability of Kubota drinking test in the assessment of patients with dysphagia, who underwent partial laryngectomy, and analyze the influence of different ways of operation on swallowing function. Methods: Clinical data were retrospectively analyzed on 83 patients with laryngeal carcinoma, who underwent partial laryngectomy between September 2012 and August 2015. Questionnaire survey, Kubota drinking test and video fluoroscopic swallowing study (VFSS) were conducted for patients during a scheduled interview. Patients were grouped by two ways: the one was whether epiglottis was retained, and the other was whether either arytenoids or both were reserved. The influence of different surgical techniques on swallowing function was analyzed according to the results of Kubota drinking test. The agreement and reliability of Kubota drinking test were statistically analyzed with respect to VFSS treated as the gold standard. SPSS23.0 software was used to analyze the data. Results: Questionnaire results revealed that among 83 patients underwent partial laryngectomy 32.53% suffered from eating disorder, and 43.37% experienced painful swallowing. The incidence of dysphagia was 40.96% according to the results of Kubota drinking test. There was statistical difference between the group with epiglottis remained and that having epiglottis removed in terms of the absence of dysphagia and severity. The statistical values of normal, moderate and severe dysphagia were in the order of 18.160, 7.229, 12.344(P<0.05). Also, statistical difference existed between the groups with either and both arytenoids reserved in terms of the absence of dysphagia as well as that of intermediate severity, and their statistical values were 4.790 and 9.110(P<0.05). A certain degree of agreement and reliability was present between the results of Kubota drinking test and VFSS(Kappa=0.551, r=0.810). Conclusions It was of considerable significance to reserve epiglottis and arytenoids for the retention of swallowing function for patients post partial laryngectomy. There are certain degree of agreement and reliability between the results of Kubota drinking test and VFSS. The test, therefore, could be used as a tool for screening patients suffering from dysphagia post partial laryngectomy.