ObjectiveTo construct the syndrome differentiation and treatment process in the diagnosis and treatment guideline into a visual knowledge graph using knowledge graph technology， and visualize the process from the input of clinical manifestations to the output of corresponding traditional Chinese medicine （TCM） diagnosis and prescriptions through programs， to visually display the diagnosis and treatment process as well as the data relationship for TCM practitioners. This paper facilitated the standardized and normalized TCM diagnosis and treatment of coronary heart disease， and provided technical support for the inheritance and promotion of TCM diagnosis and treatment. MethodNeo4j and py2neo were used to construct a knowledge graph based on the Guideline for Diagnosis and Treatment of Coronary Heart Disease with Stable Angina Pectoris published by China Association of Chinese Medicine Cardiovascular Disease Branch. A knowledge graph regarding the input of clinical manifestations was built through programs， visually displaying the standardized TCM diagnosis and treatment process of coronary heart disease with stable angina pectoris. ResultThe structured data were extracted from the guideline by py2neo connecting to Neo4j and imported into Neo4j to construct the knowledge graph of TCM diagnosis and treatment of coronary heart disease with stable angina pectoris， which had graph database query function. ConclusionAiming at the problems existing in the inheritance of TCM diagnosis and treatment， this paper proposed a diagnosis and treatment guideline integrating the experience of TCM experts and evidence-based evidence for coronary heart disease with stable angina pectoris， and realized the visualization process of knowledge graph based on TCM diagnosis and treatment guideline and the experience of TCM experts. It is helpful to intuitively display the whole TCM diagnosis and treatment process from symptom input to prescriptions and inherit TCM experience， providing a new paradigm for standardized and normalized TCM diagnosis and treatment.

BACKGROUND: Clinical trial evidence is limited to identify better topical non-steroidal anti-inflammatory drugs (NSAIDs) for treating knee osteoarthritis (OA). We aimed to compare the clinical efficacy and safety of flurbiprofen cataplasms (FPC) with loxoprofen sodium cataplasms (LSC) in treating patients with knee OA. METHODS: This is an open-label, non-inferiority randomized controlled trial conducted at Peking University Shougang Hospital. Overall, 250 patients with knee OA admitted from October 2021 to April 2022 were randomly assigned to FPC and LSC treatment groups in a 1:1 ratio. Both medications were administered to patients for 28 days. The primary outcome was the change of pain measured by visual analog scale (VAS) score from baseline to day 28 (range, 0-10 points; higher score indicates worse pain; non-inferiority margin: 1 point; superiority margin: 0 point). There were four secondary outcomes, including the extent of pain relief, the change trends of VAS scores, joint function scores measured by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and adverse events. RESULTS: Among 250 randomized patients (One patient without complete baseline record in the flurbiprofen cataplasms was excluded; age, 62.8 ± 10.5 years; 61.4% [153/249] women), 234 (93.6%) finally completed the trial. In the intention-to-treat analysis, the decline of the VAS score for the 24-h most intense pain in the FPC group was non-inferior, and also superior to that in the LSC group (differences and 95% confidence interval, 0.414 (0.147-0.681); P <0.001 for non-inferiority; P = 0.001 for superiority). Similar results were observed of the VAS scores for the current pain and pain during exercise. WOMAC scores were also lower in the FPC group at week 4 (12.50 [8.00-22.50] vs . 16.00 [11.00-27.00], P = 0.010), mainly driven by the dimension of daily activity difficulty. In addition, the FPC group experienced a significantly lower incidence of adverse events (5.6% [7/124] vs . 33.6% [42/125], P <0.001), including irritation, rash and pain of the skin, and sticky hair uncovering pain. CONCLUSIONS This study suggested that FPC is superior to LSC for treating patients with knee OA in pain relief, joint function improvement, and safety profile.
Humans ; Female ; Middle Aged ; Aged ; Osteoarthritis, Knee/drug therapy* ; Flurbiprofen/therapeutic use* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Pain/drug therapy* ; Treatment Outcome ; Double-Blind Method

Objective:To evaluate the efficacy and safety of docetaxel plus hormone therapy in metastatic prostate cancer.Methods:From April 2016 to April 2019, 204 cases with bone metastatic prostate cancer in the Second Hospital of Tianjin Medical University were analyzed retrospectively. There were 97 patients responded to hormone therapy including 92 cases with high-burden metastasis (more than 4 bone metastases with one or more beyond the axial skeleton) and 5 cases with low-burden metastasis, with average age of 70 years (range 42-87 years) and median prostate specific antigen (PSA) of 74.1 ng/ml (range 11.0-145.0 ng/ml). Among them, there were 35 patients (36.1%) with a Gleason score of 7 or lower, and 62 patients (63.9%) with a Gleason score of 8 or higher. There were 26 patients suffering from bone pain, with average numerical rating scales(NRS) score of 3.7. In addition, there were 107 patients being resistant to hormone therapy, with average age of 73 years (range 56-83 years), and median PSA of 84.5 ng/ml (range 12.4-490.2 ng/ml), including 32 patients (29.9%) with a Gleason score of 7 or lower, and 75 patients (70.1%) with a Gleason score of 8 or higher. Among them, there were 75 patients suffering from bone pain, with average NRS score of 5.4. All patients received continuous hormone therapy combined with docetaxel (at a dose of 75 mg per square meter of body-surface area every 3w, plus prednisone 5 mg twice a day), and PSA progression-free survival (PSA-PFS), NRS score, pain relief, and adverse events were analyzed. Additional analysis of the correlation between PSA-PFS and subgroups with age, PSA level and Gleason score were performed.Results:For patients with metastatic hormone sensitive prostate cancer (mHSPC), 6 (6.2%) cases only received 1-2 cycles of chemotherapy due to different reasons, and the others received 3-6 cycles(average 4.7)with the median follow-up of 15 months. Of patients who received ≥3 cycles, there were 36 cases presenting PSA progression, with the median PSA-PFS of 22 months, average NRS score decline from 3.9 to 3.0, and pain relief rate of 72.0%(18/25). For patients with metastatic castration-resistant prostate cancer (mCRPC), 9 (8.4%)cases only received 1-2 cycles of chemotherapy, and the others received 3-14 cycles (average 5.6). Of patients who received≥3 cycles, there were 51 cases with PSA progression, with the median PSA-PFS of 11 months, average NRS score decline from 5.6 to 4.4, and pain relief rate of 48.6%(35/72). Subgroup analysis showed a significant correlation between PSA level and PSA-PFS for patients with mCRPC( P=0.026). Age or Gleason score was not significantly correlated to PSA-PFS in mHSPC or mCRPC( P>0.05). For patients with mHSPC, grade 3 or 4 neutropenia occurred in 17 cases(17.5%), nausea and vomiting in 27 cases(27.8%), and fatigue in 25 cases(25.8%). For patients with mCRPC, grade 3 or 4 neutropenia occurred in 24 cases (22.4%), nausea and vomiting in 34 cases(31.8%), and fatigue in 26 cases(24.3%). Allergic reaction and sensory neuropathy toxicity were occasional. Conclusion:Efficacy of docetaxel plus hormone therapy was confirmed in metastatic prostate cancer and adverse events were tolerable.

Objective:To explore the feasibility of radical prostatectomy without biopsy for patients with highly suspected localized prostate cancer diagnosed by multiparametric magnetic resonance imaging (mpMRI) and 68Ga-PSMA PET/CT. Methods:Patients were enrolled in this single-arm prospective study from March 2019 to January 2022 in the Second Hospital of Tianjin Medical University. Eligible patients were aged ≤80 years with an Eastern Cooperative Oncology Group (ECOG) performance-status score of 0 or 1. Based on mpMRI and 68Ga-PSMA PET/CT, patients were diagnosed with highly suspected localized prostate cancer with no evidence of distant lymphatic, bone or visceral metastases. Patients were excluded if they had obvious important organs dysfunction, suspected metastatic lesions or history of other malignant tumor. After fully informed of the surgical risks and possibilities of final pathology, patients received laparoscopic or robot-assisted laparoscopic radical prostatectomy. According to final pathological results, the diagnostic accuracy of mpMRI and 68Ga-PSMA PET/CT was evaluated. Pathological features were compared between low 68Ga-PSMA PET/CT maximum standardized uptake value (SUV max) group (SUV max<10) and high SUV max group (SUV max≥10). Baseline characteristics were compared between clinically significant prostate cancer (CsPCa) and clinically insignificant prostate cancer (cisPCa) + high grade prostatic intraepithelial neoplasia (HGPIN) patients. Additional analysis of the correlation between baseline parameters and different subgroups including pathological stage, ISUP grades and risk groups were performed in CsPCa patients. Results:31 patients were enrolled. Median age was 68 (ranging 48-79)years old. Median BMI was 25.6(ranging 21.9-31.4)kg/m 2. Median prostate specific antigen (PSA) was 23.5 (ranging 5.6-94.7)ng/ml. Median prostate volume was 37.6(ranging 16.2-127.9)ml. Median PSA density (PSAD) was 0.56(ranging 0.11-2.86)ng/ml 2. Fifteen cases were scored prostate imaging reporting and data system (PI-RADS) 4 and 16 cases were scored PI-RADS 5. Median 68Ga-PSMA PET/CT SUV max was 13.3 (ranging 4.6-36.7). All surgeries were successfully accomplished without open conversion. Median postoperative hospitalization time was 5 (ranging 4-7)d. No major complication occurred perioperatively. Recovery of urinary continence was within 6 months in all patients. According to the final pathological results, 1(3.2%) patient was confirmed with HGPIN. 30 (96.8%) patients were confirmed with adenocarcinoma, including 26 (86.7%) patients with CsPCa and 4(13.3%) patients with cisPCa. Among prostate cancer cases, the pathological stage of 11(36.7%) was T 2 and 19(63.3%) was T 3. Four(13.3%) cases were with ISUP grade 1, 7(23.3%) cases were with ISUP grade 2, 7(23.3%) cases were with ISUP grade 3 and 12 (40.0%) cases were with ISUP grade≥4.Two(6.7%) cases were in low risk group, 3(10.0%) cases were in intermediate risk group and 25 (83.3%) cases were in high risk group. Twelve(40.0%) patients had positive surgical margins. Standard pelvic lymph node dissection was carried out in 18 (17 prostate cancer and 1 HGPIN) cases. Sixty-two lymph nodes were dissected and none of them was positive. The diagnostic accuracy of mpMRI and 68Ga-PSMA PET/CT was 96.8%(30/31) in prostate cancer. Compared to low SUV max group, patients in high SUV max group had higher ISUP grade ( P=0.003) but there was no significant difference in positive surgical margin, seminal vesical invasion or pathological stage ( P>0.05). Among CsPCa patients, 10 (38.5%) cases were scored PI-RADS 4 and 16(61.5%) cases were scored PI-RADS 5. Median 68Ga-PSMA PET/CT SUV max was 14.3 (range 6.1-36.7). Compared to cisPCa and HGPIN patients, a smaller median prostate volume (34.3 vs. 73.0 ml, P=0.006), higher median PSAD (0.70 vs. 0.13 ng/ml 2, P=0.001), higher rates of PI-RADS 5 patients (61.5% vs. 0, P=0.018) and higher 68Ga-PSMA PET/CT SUV max (14.3 vs. 6.1, P=0.001) were found in CsPCa patients. Subgroup analysis showed no significant difference between SUV max and pathological stage (25.5 vs. 13.9), ISUP grades (15.4 vs. 14.4 vs. 14.0) and risk groups (9.7 vs. 14.9) in CsPCa patients ( P>0.05). Conclusions:The diagnostic accuracy of mpMRI and 68Ga-PSMA PET/CT is high in prostate cancer. With efficient communication, radical prostatectomy without biopsy for patients with highly suspected localized prostate cancer diagnosed by mpMRI and 68Ga-PSMA PET/CT is safe.

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Objective:To observe the changes of biomarkers in patients with non-ST segment elevation myocardial infarction (NSTEMI) after intervention with Salvianolate.Methods:A total 81 patients with NSTEMI who met the inclusion criteria from January 2016 to December 2019 were randomly divided into two groups. The control group dropped 6 cases, the treatment group dropped 6 cases, and finally each group had 35 cases. The control group was treated with conventional medicine therapy, and the treatment group was treated by intravenous drip of 0.9% NS 250 ml + Salvianolate on the basis of the control group. Both groups were treated continuously for 10 days. The latex immunoturbidimetric method was used to detect hypersensitive-C-Reactive-Protein (hs-CRP), double antibodysandwich immune chemiluminescence method for procalcitonin (PCT), electrochemiluminescence method for N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP), coagulation method for plasma fibrinogen (FIB), and immunoassay for D-dimer. The number of episodes of angina pectoris after infarction, recurring myocardial infarction, malignant arrhythmia, and death in the hospital were recorded and collected during the hospitalization period (0-10 d).Results:After treatment, hs-CRP (2.46 ± 1.76 mg/L vs. 3.45 ± 0.67 mg/L, t=2.324), PCT (0.52 ± 0.30 ng/L vs. 0.11 ± 0.08 ng/L, t=2.059), FIB (1.30 ± 0.63 g/L vs. 1.97 ± 0.67 g/L, t=2.168) in the treatment group were significantly lower than those in the control group ( P<0.05). After treatment, the level of NT-proBNP and D-dimer showed a downward trend, but there was no statistically significant difference within and between groups ( P>0.05). During hospitalization, the number of angina pectoris after infarction in the treatment group was significantly lower than that of the control group ( t=4.019, P=0.045), while the incidence of acute heart failure, recurring myocardial infarction, malignant arrhythmia and death in the hospital showed no significant difference ( P>0.05). Conclusion:Salvianolate can reduce the inflammatory response of NSTEMI patients on the basis of western medicine, relieve the hypercoagulable state, and reduce the number of angina pectoris after infarction.

Perlman syndrome is a rare autosomal recessive congenital overgrowth syndrome caused by pathogenic variants of the DIS3L2 gene at 2q37 region. Clinically this syndrome is characterized by polyhydramnios, macrosomia, distinctive facial appearance, and renal dysplasia. Prognosis of the disease is poor, and survivors usually have mental delay and a high risk of developing Wilms tumor. At present, the pathogenesis of this disease is still poorly understood. This article intends to provide a review for this disease.
Female ; Fetal Macrosomia ; Humans ; Kidney Tubules, Proximal ; Pregnancy ; Syndrome ; Wilms Tumor

Objective:To investigate the correlation of preoperative peripheral lymphocyte-to-monocyte ratio(LMR)with the biochemical relapse and prognosis in prostate cancer(PCa)patients treated with endocrine therapy after radical prostatectomy(RP).Methods:Clinical data of 306 prostate cancer patients treated with endocrine therapy after radical prostatectomy were retrospectively analyzed in our hospital from June 2008 to June 2019.The end point of observation was biochemical relapse-free survival(RFS)in all patients receiving RP.The best cutoff value of preoperative LMR was calculated by receiver operating characteristic(ROC)curve.All patients were divided into the high LMR group(LMR≥2.8, n=93, 30.4%)and the low LMR group(LMR<2.8, n=213, 69.6%). The differences in clinical indicators of PCa were compared between high and low LMR groups.CoX regression model on the risk ratio of single and multiple factors were used to analyze the survival effect of preoperative LMR on the prognosis of PCa patients undergoing endocrine therapy after operation.Results:The median follow-up time was ranged from 4 to 132 months.The area under the ROC curve of LMR was 0.582(95% CI: 0.511-0.652, P<0.05), and the cutoff value of the preoperative LMR was 2.8, which was significantly associated with clinical T stage( P=0.023)and lymphatic metastasis( P=0.031). Kaplan-Meier analysis demonstrated that the low LMR group had a short RFS and a poor prognosis(31.0 months vs.38.5 months)than those in the high LMR group( P<0.05). Lymphatic metastasis and preoperative LMR were independent predictors for RFS in PCa patients treated with endocrine therapy after radical prostatectomy. Conclusions:Preoperative peripheral LMR can be used as an auxiliary indicator of the prognosis in PCa patients treated with endocrine therapy after radical prostatectomy.

Objective:To investigate the correlation between chronic inflammation and biopsy results in the first prostate biopsy and the predictive effect of chronic inflammation on the results of repeated prostate biopsy.Method:From January 2016 to January 2019, 771 patients who underwent transperineal prostate biopsy for the first time in the Second Hospital of Tianjin Medical University were included. The average age was 69.6 years old(39-89), with PSA level of 16.1 ng/ml(4-50), PSAD level of 0.6 ng/ml 2(0.1-1.3), prostate volume(PV)of 40.2 ml(16.7-129.5), transition zone volume(TZ) of 23.9 ml(0.7-49.5). The biopsy was performed under general anesthesia in the lithotomy position, and transrectal ultrasound(TRUS)and prostate puncture template were used to guide the biopsy. The association between chronic inflammation and pathological results or Gleason scores in prostate cancer (PCa) were analyzed. The univariate and multivariate logistic regression analyses were performed to select the independent risk factors for prostate biopsy results. The relationship between chronic inflammation and pathological results in patients with repeated biopsy within 3 years after the first biopsy was assessed. The independent risk factors related to the results of the repeated biopsy were also evaluated. Result:A total of 771 patients were included, including 354 cases of PCa and 144(40.7%) cases associated with chronic inflammation. In addition, 332 cases were benign prostatic disease (BPD), including 263(79.2%) cases with chronic inflammation, and 85 cases were prostate high-grade intraepithelial neoplasia group (HGPIN), including 13(15.3%) cases with chronic inflammation. The PV, TZ and chronic inflammation rates were statistically significantly lower in PCa and HGPIN than those in BPD, while the level of PSA and PSAD were significantly higher than those in BPD. Multivariate logistics regression analysis showed that PSAD and chronic inflammation rates were independent risk factors for PCa and HGPIN. According to the biopsy results of Gleason score from 6 to 10, the chronic inflammation rates was 70%(35/50), 61%(36/59), 33%(69/209), 12%(3/25) and 9%(1/11) respectively ( P<0.05), which indicated that the chronic inflammation was negatively correlated with higher grade tumors. The repeated biopsy was performed in 30 patients within 3 years after the first biopsy. The average age was 71.2 years old (45-80), with PSA level of 20.1 ng/ml (4-39), PSAD level of 0.7 ng/ml 2(0.2-1.3), PV of 39.3 ml(18.5-119.0), and TZ of 19.9 ml(12.5-40.5). The results of the repeated biopsy showed that there were 9 cases with PCa(3 cases with chronic inflammation)and 21 cases without PCa (16 cases with chronic inflammation). The level of PSA ( P=0.031) and PSAD ( P=0.032) were statistically significantly higher in PCa than those in benign disease, while the chronic inflammation rates were significantly lower than those in benign disease( P=0.042). Multivariate logistics regression analysis showed that PSAD ( OR=0.7, P=0.012) and chronic inflammation( OR=13.7, P<0.001)were independent risk factors in the positive repeated biopsy. In patients with repeated biopsy, considering PSAD (cut off value 0.15) and first biopsy with chronic inflammation, the predicted results were positive in 8 cases and negative in 22 cases. The real number of cases in the two groups is 6 and 19 respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of repeated biopsy results were 66.7%, 90.4%, 75.0%, and 86.3%, respectively. Conclusion:Chronic inflammation was negatively correlated with positive biopsy results and high-grade tumors. For the patients with PSAD<0.15 and the first biopsy with chronic inflammation, the repeated biopsy should be avoided in most of the cases.

Objective: To evaluate the safety and efficacy of oblique lateral interbody fusion (OLIF) in the surgical treatment of lumbar degenerative diseases. Methods: All literatures of OLIF performed in lumbar degenerative diseases were searched in recognized databases including Pubmed, OVID, Embase, Cochrane Library, Science Direct, springer, CNKI, Wanfang and VIP databases. Methodological Indexfor Non-randomized Studies (MINORS) was used to evaluate the quality of the literatures. The meta-analysis was performed using Review Manager 5.3 and Stata 15.0 statistical software. Results: A total of 35 literatures were included, including 22 English literatures and 13 Chinese literatures. There were 3 630 patients with 45.2% of males, aged from 14 to 89 years old (mean, 62.6 years). The average of length of stay (LOS), operation time (OT) and blood loss (BL) of OLIF procedure were 6.7 days, 117 minutes, and 128 ml, respectively. The VAS scores of low back pain of postoperative and final follow-up decreased by 4.33 and 4.70, respectively. The VAS scores of leg pain decreased by 4.57 points and 5.31, respectively. Compared with preoperative, the postoperative JOA score increased by 7.58 and the postoperative ODI were also improved by 33.89%. All the postoperative imaging data were significantly different from those before surgery. The surgical level intervertebral heightincreased 4.14 mm, and the intervertebral foramen height and intervertebral foramen area increased by 3.54 mm, 53.96 mm², while the dura sac cross-sectional area increased by 36.61 mm², and the overall lumbar lordosis increased by 13.78° with the local segmental lordosis increased by 4.62°. The overall incidence of complications of OLIF was 32%, with a 95% confidence interval of 25%-38%. Conclusion OLIF is a minimally invasive procedure for the treatment of lumbar degenerative diseases. OLIF has a simply procedure and short learning curve, with short LOS and operation time, less blood loss. OLIF can effectively open the narrow intervertebral space and increase the spinal canal and nerve root canal, significantly improve the symptoms, while the complication rate is low, so OLIF is worthy of widespread clinical application.