Objective To analyse the clinical efficiency of endolymphatic sac surgery (ESS) in the management of Meniere’s disease (MD). Methods A retrospective analysis was conducted on 274 patients with MD who were hospitalized for treatment in Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University from January 2009 to August 2023. All patients received lifestyle management and drug treatment such as diuretics. For those whose conditions were not well controlled 3 to 6 months after the initial treatment, intratympanic glucocorticoid (ITG) or ESS treatment was carried out. Six months after the treatment, the classes of vertigo relief and hearing changes in the patients were evaluated. After adjusting the confounding factors through propensity score matching (PSM), the impact of ESS on the prognosis of MD patients was evaluated. Results Among 274 patients, 194 and 80 patients underwent ITG and ESS, respectively. Eighty patients were enrolled into each group after PSM. Before and after PSM, the rate of patients reaching vertigo relief class A in ESS group was higher than that in the ITG group (P＝0.004); there was no significant difference in hearing preservation between the two groups. Kaplan-Meier curve analysis showed that vertigo relief in the ESS group was better than that in the ITG group (P=0.029); there was no statistically significant difference in hearing preservation between the two groups. Conclusion When the initial treatment for patients with MD is ineffective, choosing ESS is more beneficial than ITG for controlling vertigo.

Objective To explore the effects and action mechanism of miR-181c-5p on biological behaviors of pros-tate cancer cells.Methods The pathological relationship between BIRC5,miR-181c-5p and prostate cancer was analyzed based on prostate cancer data in TCGA database.The target binding site of miR-181c-5p and BIRC5 was analyzed by miRNA target gene prediction database,and was verified by double luciferase activity assay.The ex-pression of BIRC5 protein in miR-181 c-5p overexpression cells was detected by Western blot.The prostate cancer cells PC3 and DU145 were selected to construct cell line with miR-181c-5p overexpression(miR-181c-5p group)and its negative control(miR-NC group),and qRT-PCR verification was conducted.The cells proliferation[opti-cal density at 450 nm site(OD450 nm)]was detected by CCK-8.Distribution of cell cycles and apoptosis rate were detected by flow cytometry.Expressions of proliferation and apoptosis related proteins were detected by Western blot.The cell line with miR-181c-5p/BIRC5 overexpression was constructed(miR-181c-5p+BIRC5 group).Cells growth,distribution of cell cycles,apoptosis rate and expressions of related proteins were detected by the a-bove methods.Results The expression of BIRC5 was up-regulated in prostate cancer tissues,and it was higher in patients with high tumor invasion,lymph node metastasis and recurrence.Patients exhibiting high expression of BIRC5 demonstrated poor survival rates.The expression of miR-181c-5p was down-regulated in prostate cancer tis-sues.The level of miR-181c-5p was negatively correlated with BIRC5 level,and miR-181c-5p could inhibit BIRC5 expression.In PC3 and DU145,miR-181c-5p level in miR-181c-5p group was higher than that in miR-NC group(P＜0.05);OD450 nm and percentage of S-phase cells were lower than those in miR-NC group(P＜0.05),per-centage of cells in G0/G1 phase;apoptosis rate and expressions of BAX,caspase-3 and PARP proteins were higher than those in miR-NC group(P＜0.05);expressions of CDK2,CCNB1 and BCL-2 proteins were lower than those in miR-NC group(P＜0.05).The expression of BIRC5 protein and OD450 nm in miR-181 c-5p+BIRC5 group were higher than those in miR-181c-5p group(P＜0.05),percentage of cells in G0/G1 phase was lower than that in miR-181c-5p group(P＜0.05);percentage of S-phase cells was higher than that in miR-181c-5p group(P＜0.05);apoptosis rate was lower than that in miR-181c-5p group(P＜0.05);expressions of CDK2,CCNB1 and BCL-2 proteins were higher than those in miR-181c-5p group;expressions of BAX,caspase-3 and PARP proteins were lower than those in miR-181 c-5p group.Conclusion miR-181-5p can inhibit the proliferation of human pros-tate cancer cells by targeting BIRC5,block cells in G0/G,phase and promote cells apoptosis.

Objective:To investigate the clinical and gene variant characteristics of PCDH19 gene related epilepsy, and improve the ability of clinicians in early disease identification. Methods:The clinical data of 3 PCDH19 gene related epilepsy patients admitted to Children′s Hospital Affiliated to Zhengzhou University from October 2018 to August 2023 diagnosed by gene detection were reviewed and analyzed. Results:All the patients are female, and the onset age of seizure ranged in their infancy. Seizures in clusters and fever sensitivity were observed in all patients, and were very hard to control by single-drug treatment. Proband 1 was seizure-free after 2 kinds of anti-epileptic drug treatment, but with mild degree of intellectual disability. Proband 2 had refractory epilepsy with severe degree of intellectual disability. Proband 3 was seizure-free after 2 kinds of anti-epileptic drug treatment and without intellectual disability. In the first family, the proband carried heterozygous c.369C>G variant in the PCDH19 gene which was identified as de novo after parental validation. In the second family, the proband carried c.1652T>A variant inherited from her mother. In the third family, the proband carried c.278G>A variant inherited from her father. The 3 mutations had not been reported in the Human Gene Mutation Database. Conclusions:PCDH19 gene related epilepsy is one special kind of X-linked inherited epilepsy syndrome characterized by seizures in clusters and sensitivity to fever. And gene detection can help with early diagnosis and make rational clinical strategies in time. The variants c.369C>G, c.1652T>A and c.278G>A have enriched the gene variant spectrum of PCDH19.

Objective:To assess the efficacy and safety of the combination therapy of camrelizumab, apatinib, nab-paclitaxel, and S-1 for patients with locally unresectable advanced gastric cancer.Methods:From September 1, 2019 to August 1, 2021, in Beijing Friendship Hospital Affiliated to Capital Medical University, 17 patients with advanced gastric cancer were enrolled in this prospective, single-arm study. All the enrolled patients received camrelizumab, nab-paclitaxel, apatinib and S-1 combination therapy (in each 21 days cycle, camrelizumab 200 mg intravenously, D1; nab-paclitaxel 240 mg/m 2 intravenously, D2; apatinib 500 mg orally, once a day, D1-D21; S-1 40-60 mg twice a day, D1-D14). Patients who have been evaluated by multidisciplinary team to be eligible for radical surgery should stop treatment for at least 2 weeks. Patients were discontinued from the study when disease progression or unbearable toxicity, or withdrew consent. We analyzed the conversion rate, objective response rate (ORR), disease control rate (DCR), overall survival (OS) and safety.Statistical data were show by numbers and persentages(%), and comparisons between subgroups were assessed by Fisher′s exact probability method. Patients survival was analyzed using Kaplan-Meier curves and compared between groups using Log-rank. Results:At the data of cutoff (December 15, 2021), the median follow-up duration was 19.6 months. Eight of 17 patients underwent gastrectomy, and all of them were R0 resection (47.1%, 95% CI: 0.262-0.690). ORR was 47.1%, DCR was 82.4%, the median overall survival was 23.63 months. Grade 3 and 4 adverse events occurred in 3 patients (17.6%), including neutropenia, thrombocytopenia, anemia and upper gastrointestinal hemorrhage. There were no serious treatment-related adverse events or treatment-related deaths. Conclusion:In this trial, the combination of camrelizumab, apatinib, nab-paclitaxel and S-1 as the conversion therapy showed significant anti-tumor activity and manageable adverse events, providing a new option for locally unresectable advanced gastric cancer.

Objective To explore the association between lipid profiles and left ventricular hypertrophy in a Chinese general population. Methods We conducted a retrospective observational study to investigate the relationship between lipid markers [including triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL-cholesterol, apolipoprotein A-I, apolipoprotein B, lipoprotein[a], and composite lipid profiles] and left ventricular hypertrophy. A total of 309,400 participants of two populations (one from Beijing and another from nationwide) who underwent physical examinations at different health management centers between 2009 and 2018 in China were included in the cross-sectional study. 7,475 participants who had multiple physical examinations and initially did not have left ventricular hypertrophy constituted a longitudinal cohort to analyze the association between lipid markers and the new-onset of left ventricular hypertrophy. Left ventricular hypertrophy was measured by echocardiography and defined as an end-diastolic thickness of the interventricular septum or left ventricle posterior wall > 11 mm. The Logistic regression model was used in the cross-sectional study. Cox model and Cox model with restricted cubic splines were used in the longitudinal cohort. Results In the cross-sectional study, for participants in the highest tertile of each lipid marker compared to the respective lowest, triglycerides [odds ratio (OR): 1.250, 95％CI: 1.060 to 1.474], HDL-cholesterol (OR: 0.780, 95％CI: 0.662 to 0.918), and lipoprotein(a) (OR: 1.311, 95％CI: 1.115 to 1.541) had an association with left ventricular hypertrophy. In the longitudinal cohort, for participants in the highest tertile of each lipid marker at the baseline compared to the respective lowest, triglycerides [hazard ratio (HR): 3.277, 95％CI: 1.720 to 6.244], HDL-cholesterol (HR: 0.516, 95％CI: 0.283 to 0.940), non-HDL-cholesterol (HR: 2.309, 95％CI: 1.296 to 4.112), apolipoprotein B (HR: 2.244, 95％CI: 1.251 to 4.032) showed an association with new-onset left ventricular hypertrophy. In the Cox model with forward stepwise selection, triglycerides were the only lipid markers entered into the final model. Conclusion Lipids levels, especially triglycerides, are associated with left ventricular hypertrophy. Controlling triglycerides level potentiate to be a strategy in harnessing cardiac remodeling but deserve to be further investigated.

Objective:To retrospectively analyze the clinical characteristics of elderly patients who received colonoscopy and to explore the clinical value of regular colonoscopy for the elderly.Methods:This was a retrospective cohort study.A total of 1 154 patients aged 75 years and over undergone colonoscopy in Guangdong General Hospital from January 2015 to March 2018 were enrolled and divided into three groups, including 605 cases aged 75-79 years, 527 cases aged 80-89 years and 22 cases aged 90 years and over.Detection rates of colorectal lesions by colonoscopy were recorded.The clinical value of annual colonoscopy on the detection of colorectal lesions in elderly patients 75 years and older were analyzed to assess the necessity for regular monitoring.Results:Overall, 569 cases(49.3%)underwent colonoscopy with sedation and 585 cases(50.7%)underwent colonoscopy without sedation.The total positive detection rate was 83.4%(962/1 154), and the main lesions were polyps(858 cases, 74.4%), including 605(52.4%)cases of adenomas.Among the three groups, gastrointestinal bleeding was the main cause for colonoscopy in the group aged 90 years and over, while abdominal discomfort, elevated immunological tumor markers and history of non-colon cancer were the main reasons for colonoscopy in the group aged 75-79 years( P<0.05). A total of 153 cases underwent annual colonoscopy.The detection rate of polyps and adenomas decreased in the second exam, but still higher than 40.0%. Conclusions:Colonoscopy is a safe and effective method for the elderly population aged 75 years and over.Polyps and adenomas are the most common lesions.Recurrence of polyps after colorectal cancer and polypectomy is common and it is necessary to receive colonoscopy regularly.

Objective: To evaluate the efficacy of green surgery pathway on senile hip fractures. Methods: The green surgery pathway was implement in senile (≥75 years) hip fracture cases in our department since March 2016. A historically controlled trial study was designed: 97 senile hip fracture patients admitted between March 2016 and March 2017 were included in the intervention group and 78 senile hip fracture patients admitted between March 2015 and March 2016 were included in the control group. The patients’ general information were recorded, including gender, age, type of fracture, internal medical conditions, surgery method, the American Association of Anesthesiologists classification of physical status (ASA) classification, et al. The hip function was evaluated by the Harris score system at one week,6 months and one year after surgery. The waiting time for operation, operation time, length of hospital stay, complications during hospitalization and hip Harris score were compared between the two groups. Results: For the baseline data between the two groups in terms of gender, age, fracture type, surgery method, ASA classification, and combined underlying disease, the differences were not statistically significant. The waiting time for operation of the green surgery pathway group (36.3±7.8 h) was significantly shorter than that in the control group (46.9±11.4 h, t=6.995, P=0.000). The operation time of the green surgery pathway group was 45.4±17.5 min, and that of the control group was 43.8±20.8 min, the differences were not statistically significant. The length of hospital stay in the green surgery pathway group (6.8±2.4 d) was significantly shorter than that in the control group (9.5±2.8 d), the difference was statistically significant (t=6.866, P=0.000). In the green surgery pathway group, one patient developed acute myocardial infarction at 15 h after surgery and died of invalid rescue. In the control group, one patient developed acute cerebral hemorrhage 3 d after surgery and died of invalid rescue. The incidence of pulmonary infection, urinary tract infection, and acne in the green surgery pathway group were lower than that in the control group, the differences were statistically significant (χ^2PI=5.081, P_PI=0.024; χ^2UI=6.841, P_UI=0.009; χ^2acne=11.768, P_cne=0.001). For the incidence of acute myocardial infarction, acute cerebrovascular accident, pulmonary embolism and deep vein thrombosis between the two groups, the differences were not statistically significant. The Harris score of hip in the green surgery pathway was higher than that in the control group (72.6±13.1 points vs 62.2±15.4 points, t=4.826, P=0.000) one week after the surgery, the difference was statistically significant. While the score was slightly higher than that of the control group in the half year (93.8±16.8 vs 90.5±14.7) and one year (94.1±18.3 vs 92.4±15.9) after surgery, but the differences were not statistically significant. The mortality rate of the green surgery pathway was slightly lower than that of the control group within one year after surgery (6.19% vs 8.97%), but the difference was not statistically significant. Conclusion The implementation of green surgery pathway can reduce the occurrence of complications in bed, promote the early hip rehabilitation, effectively shorten the hospitalization time. It is worth further promotion because of its social benefits and health economic benefits.

Objective We aimed to investigate the overexpression of succinic dehydrogenase (SDH) B and MIB-1 in patients with pheochromocytoma/paraganglioma(PHEO/PGLs) and its significance for predicting the clinical malignant behavior.Methods From August 2008 to April 2016,the clinical characteristics of 93 patients with PHEO/PGLs were analyzed retrospectively.There were 57 males and 36 females,with an average of 34 years,ranging 8-73 years old.There were 68 cases of adrenal pheochromocytoma and 25 cases of paraganglioma.There were 79 cases with hypertension and 14 cases of adrenal accidental tumors.Sixty-six cases with typical hyper-catecholamine secretion symptoms and 27 cases with non-functional PHEO/PGL.Benign PHEO/PGLs were 77 cases and malignant 16 cases.The tumor was located on the left side in 39 cases,on the right side in 32 cases and multiple lesions in 22 cases.The diameter of the PHEO/PGL tumor was (6.8 ± 2.7) cm.The 24 h urine catecholamine was measured before operation,which showed epinephrine was (42.6 ± 5.1) μg/24 h,norepinephrine was (167.5 ± 13.5) μg/24h and dopamine was (246.4 ± 71.2)μg/24h.Six cases wihtout hereditary diseases of urinary system were selected as normal control group.SDHB,SDHAF2,SDHC,SDHD,VHL and RET gene mutations were detected in all patients.Immunohistochemical panel has been performed to detect the expression of SDHB,MIB-1,EPAS1,VEGF-1 receptor (VEGF-1 R),and chromain A (CgA) in 93 specimens of PHEO/PGL tissue.The positive granular cytoplasm staining ＞ 50％ was strongly positive (+ + +),11％ to 50％ was moderately positive (+ +),1％ to 10％ was weak positive (+) and the negative was compared with the known positive internal reference,that is,there was less than 1％ or no stain completely.Results SDHB,SDHAF2,SDHC,SDHD,VHL and RET gene mutations in 27 cases (29.5％).Nine patients with SDHB gene mutation (9.7％).RET proto-oncogene mutations in 8 cases (8.6％).3 cases had VHL mutation (3.2％).Immunohistochemical staining showed that MIB-1 positive expression was found in 7 of 9 patients with SDHB gene mutation.Six cases in the control group were negative for gene detection and MIB-1,EPAS1,CgA and VEGF-1R immunohistochemical results.EPAS1 showed moderately positive in patients with PHEO/PGL and strong positive in patients with malignant PHEO/PGL.In 9 cases with SDHM mutation,EPAS1 was noticed positive in seven cases,which showed the relationship with CgA,MIB-1 and VEGF-1R.Conclusions The SDHB gene mutation is usually shown as a paraganglioma focus outside the adrenal gland.And 9.8％ of the paragangliomas were associated with a mutation of the SDHB gene with an increase in malignant risk.The SDHB mutation caused over-expression of MIB-1 and the positive expression of EPAS1 and VEGF-1R in PHEO/PGL tissues,which was associated with invasion and metastasis of malignant PHEO/PGL.

Objective To compare the safety and efficacy of the caudal block and Total Intravenous Anesthesia (TIVA) for transrectal ultrasound (TRUS) guided prostate biopsy.Methods 60 elderly patients with transrectal ultrasound guided transperineal prostate biopsy were randomized into Group A and Group B.Patients in Group A received ultrasound guided caudal block (0.33％ ropivacaine 15 ml) and patients in Group B received TIVA.In operation room (T1),immediately before operation (T2) and at the end of operation (T3),mean artery pressure (MAP),heart rate (HR),breathing rate (BR) and pulse oxygen saturation (SpO2) were recorded.The patients in two groups were rated the level of mini-mental state examination (MMES) at 2 h,8 h and 24 h after operation.Complications during the whole study period were also evaluated.Results The values of MAP,HR and BR of T1 in group B were significantly lower than those at T2 (P＜0.05),and were lower than those in the group A (P ＜0.05).The MMSE value in group A [2 h (25.66 ± 1.71) and 8 h (26.13 ± 1.52)] was significantly higher than that in group B [2 h (27.96 ± 1.71) and 8 h (29.01 ± 0.77)] at after operation (P ＜ 0.05).The rate of usage of ephedrine (13％) and assisted ventilation (20％) in group B was higher.No significant differences were detected in side effects between the two groups.Conclusions Caudal block provides better anesthesia than TIVA for TRUS guided prostate biopsy without an increase of side effects,and it may be safely used during ambulatory surgery.

Objective To investigate the value of diffusion weighted imaging combined with contrast-enhanced MRI(CE-MRI)in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods The AS patients diagnosed in Beijing Jishuitan Hospital were selected as the experimental group,and healthy volunteers were selected as the control group.The AS group was divided into the active group and the stable group according to the clinical diagnostic criteria.All subjects were examined with both MRI plain scan and CE-MRI of bilateral sacroiliac joints.ROIs were drawn in the lesion region and the ADC values and signal intensity enhancement rate(△SI)were recorded.△SI and ADC value among the active AS group,chronic group and control group was compared and analyzed.The clinical diagnostic criteria was regarded as the gold standard for the active AS group and the chronic group.The ROC curve was used to evaluate the value of ADC,△SI,ADC, and ADC combined with △SI can detect the efficiency of AS activity.Results Ninety-eight AS patients were enrolled in this study,including 63 cases in the active AS group,35 cases in the chronic AS group,and 23 cases in the control group.The ADC values of the active group,the chronic group and the control group were(1.35 ±0.17)×10-3mm2/s,(1.07±0.20)×10-3mm2/s,(0.36±0.14)×10-3mm2/s,respectively,and ΔSI values were (2.42±0.80)%,(1.28 ± 0.34)% and(0.74 ± 0.22)%.There were significant differences in ΔSI and ADC values among the three groups(F=216.559,56.522.P=0.000).When ADC values were used to assess the activity of AS,the area under the ROC curve was 0.809 and the optimal diagnostic threshold was 1.35×10-3 mm2/s,the sensitivity and specificity of AS activity were 57.1% and 94.3%.When ΔSI values were used,the area under the ROC curve was 0.837 and the sensitivity and specificity were 71.40% and 97.10% with the optimal diagnostic threshold of 1.79%.When ΔSI values were combined with the ADC values,the area was 0.963 and the sensitivity and specificity were 74.6% and 94.3%.Conclusion In assessment of the activity of AS,DWI combined with CE-MRI is most valuable.