Objective To compare the clinical efficacy of natural orifice specimen extraction surgery (NOSES) combined with enhanced recovery after surgery (ERAS) and conventional laparoscopic surgery in treatment of rectal cancer patients. Methods A hundred patients with rectal cancer in the Department of Colorectal and Anal Surgery, the 940th Hospital of Joint Logistics Support Force of PLA were selected as the research objects from January 2019 to December 2021, including 49 cases treated with NOSES combined with ERAS were set as the observation group, and 51 cases treated with conventional laparoscopic surgery of rectal cancer were set as the control group. Postoperative C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), white blood cell count (WBC), percentage of neutrophil (NEUT), K⁺ concentration, postoperative peristalsis recovery time, first time out-of-bed activity, first liquid feeding time, removal time of urinary, and drainage tubes, hospital stay and intraoperative blood loss, number of lymph node detection, positive margin rate, incidence of complications, and pain score were compared between the two groups. Results The observation group showed significant lower postoperative CRP, PCT, IL-6 levels when compared with control group(P<0.05), while no significant difference in K⁺ concentration between the two groups (P>0.05). The recovery time of intestinal peristalsis, the time of the first out-of-bed activity, the first liquid feeding time, the time of removal of the urinary tube and the drainage tube, and the number of days of hospitalization in observation group were all superior to the control group (P<0.05). The observation group with the duration of surgery was longer than the control group, and the difference was statistically significant (P<0.05). There were no significant differences in intraoperative bleeding, number of lymph nodes detected and positive rate of resection margins between the two groups (P>0.05). There was no significant difference in the incidence of complications between the two groups (4.1% vs. 7.8%, P>0.05). The observation group showed significant lower pain scores than control group on the 1st, 2nd and 3rd day after surgery (P<0.05). Conclusions NOSES combined with ERAS in treatment of rectal cancer patients is safe and feasible, can narrow the surgical incision, alleviate stress response and postoperative pain, improve postoperative efficacy and reduce the occurrence of complications, so is worthy of promotion and application.

Objective To evaluate the application value of hydrogel in image guided radiotherapy (IGRT) for prostate cancer (PCa). Methods Eighty PCa patients in the First Affiliated Hospital of Hebei North University from October 2022 to February 2023 were collected. The patients were divided into experiment group injected with hydrogel (n=33) and control group without hydrogel (n=47) by central random system allocation. The acute and advanced radiation proctitis (RP) incidence rate of the two groups were compared. Patients in experimental group were divided into RP group (n=5) and non-RP group (n=28). The independent risk factors leading to RP were analyzed by using logistic regression for PCa patients. Results In experiment group, 12.1% (4/33) of the patients developed acute grade Ⅰ RP, and 3.0% (1/33) developed advanced grade Ⅰ RP. In control group, 31.9% (15/47) of the patients developed acute grade Ⅰ RP, and 12.8% (6/47) developed acute grade Ⅱ RP; 19.1% (9/47) of patients developed advanced grade Ⅰ RP, 4.3% (2/47) developed advanced grade Ⅱ RP, and 2.1% (1/47) developed advanced grade Ⅲ RP. The incidence of acute and advanced RP in experiment group was lower than that in control group (P<0.05). The application of hydrogel effectively reduced rectal toxicity. Age, rectal volume, V₇₀ and V₇₈ were independent risk factors for the incidence of RP in PCa patients (P<0.05). The characteristics of hydrogel injection were not related to the incidence of RP for PCa patients. Conclusions Hydrogel can effectively reduce the rectal toxicity for PCa patients in IGRT and has little impact on the overall treatment. Hydrogel has certain clinical application and promotion value.

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system (CNS) by a single-center analysis. Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020. Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6%), Mycobacterium tuberculosis 249(20.0%), other bacteria 150(12.0%), fungi 68(5.5%), parasites 18(1.4%), Treponema pallidum 18(1.4%) and rickettsia 1(0.1%). The number of cases increased by 177 cases (33.1%) in the latter 10 years compared to the previous 10 years (P<0.05). No significant difference in seasonal distribution pattern of data between disease types (P>0.05). Male to female ratio is 1.87︰1, mostly under 60 years of age.Viruses are more likely to infect students, most often at university/college level and above, farmers are overrepresented among bacteria and Mycobacterium tuberculosis, and more infections of Treponema pallidum in workers. CNS infectious diseases are characterized by fever, headache and signs of meningeal irritation, with the adductor nerve being the more commonly involved cranial nerve. Matagenomic next-generation sequencing improves clinical diagnostic capabilities. The median hospital days for CNS infectious diseases are 18.00(11.00, 27.00) and median hospital costs are ¥29,500(¥16,000, ¥59,200). The mortality rate from CNS infectious diseases is 1.6%. Conclusions The incidence of CNS infectious diseases is increasing last ten years, with complex clinical presentation, severe symptoms and poor prognosis. Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

Objective To investigate the association between body mass index (BMI), sex hormone and single nucleotide polymorphisms (SNPs) of follicle-stimulating hormone receptor (FSHR) gene rs2268361 and rs2349415 and its correlation with the risk of polycystic ovary syndrome (PCOS). Methods Peripheral blood was collected from 213 PCOS patients and 207 healthy controls, attending the Department of Reproductive Medicine at the First Hospital of Shanxi Medical University, and 32 follicular fluids were randomly collected from each of the PCOS and control groups from March to August 2021. Calculation of BMI of the PCOS and control groups; The levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), testosterone (T), progesterone (P) and prolactin (PRL) in peripheral blood of the two groups were detected by immunochemiluminescence method. Polymerase chain reaction (PCR) and high-resolution melting curve (HRM) were used to analyze the polymorphisms of rs2268361 and rs2349415 in FSHR of the two groups. Quantitative real-time PCR was used to detect the expression of FSHR gene mRNA in peripheral blood and ovarian granulosa cells. Results There was a strong positive correlation between LH and LH/FSH(r=0.88, P<0.05); The levels of BMI, E₂, LH, LH/FSH and T in PCOS group were significantly higher than those in control group(P<0.05); FSH level was significantly lower than that of control group (P<0.001). HRM analysis showed the frequencies of CC, CT and TT genotypes at rs2349415 were 55.9%, 34.3% and 9.8% in PCOS group and 68.6%, 23.2% and 8.2% in control group, respectively. The frequencies of C and T alleles were 73.0% and 27.0% in PCOS group and 80.2% and 19.8% in control group, respectively. There were significant differences in genotype frequencies and allele frequencies between the two groups (P<0.05); The expression level of FSHR mRNA was higher in ovarian granulosa cells in PCOS group than in control group (P=0.004), the expression level of FSHR mRNA in rs2349415 TT genotype was higher than that in CC (P=0.002) and CT (P=0.035) genotype. Conclusion High levels of BMI, LH, E₂ and T allele of rs2349415 increased the risk of PCOS.

Objective To analyze the relationship between MyD88L265P and CD79B mutations in tumor tissue and the prognosis of primary central nervous system lymphoma (PCNSL). Methods 18 PCNSL patients with normal immune function (no history of HIV infection and immunosuppressants administration) who were diagnosed by craniotomy or stereotaxic biopsy in the Second Hospital of Lanzhou University from August 2018 to November 2020 were retrospectively analyzed. Real-time quantitative PCR and first-generation sequencing techniques were respectively used to detect MyD88L265P and CD79B mutations in tumor tissues of 18 PCNSL patients. Univariate analysis and Cox regression multivariate analysis were performed for indicators that may be associated with first progression-free survival (PFS) and overall survival in PCNSL. Results The mutation rate of MyD88L265P was 38.9%, the mutation rate of CD79B was 33.3%, and the co-mutation rate of MyD88L265P/CD79B was 27.8% in PCNSL tissue of 18 patients. Univariate analysis showed that the PCNSL patients with multiple lesions, deep involvement of lesions, and tissue CD79B mutation had a statistically significant shorter time of PFS (P<0.05). Multivariate analysis showed that deep lesion involvement(HR=0.135, 95%CI 0.023-0.799, P<0.05) and CD79B mutation (HR=0.149, 95%CI 0.028-0.800, P<0.05) in PCNSL tissue were independent prognostic factors for PCNSL patients. Conclusion The frequency of MyD88L265P and CD79B mutations was high in tumor tissues of 18 PCNSL patients, and these two gene mutations may be associated with poor prognosis of PCNSL, especially CD79B mutation.

Objective To investigate the effect of antinuclear antibodies (ANAs) on hormone response in patients with autoimmune hepatitis (AIH)-primary biliary cholangitis (PBC) overlap syndrome (AIH-PBC OS) and AIH-only within half a year. Methods A retrospective analysis of 77 patients with autoimmune liver disease (AILD) admitted to First Clinical Medical College of Lanzhou University from January 2018 to December 2021, all of whom were confirmed by liver biopsy and receiving glucocorticoid treatment. Among them, 46 patients were in AIH-PBC OS group and 31 were in AIH-only group. The general clinical characteristics, liver puncture-related indexes, autoantibodies and immunoglobulin indexes of patients in each group at the time of diagnosis were collected and compared, and the biochemical and immunoglobulin indexes of patients at the time of hormone use and at the time of review within 6 months were also collected, and the hormone response within 6 months was evaluated according to the levels of glutamic transaminase (AST), glutamic alanine transaminase (ALT) and immunoglobulin G (IgG), and the effect of ANAs on hormone response outcomes in both groups over a six-month period was analyzed. Multifactorial ordered logistic analysis was performed to evaluate the effect of ANAs on hormone response between two groups. Results There was no statistically significant difference in the percentage of AIH-PBC OS and AIH-only patients among both ANAs-positive and -negative AILD patients (55.6% vs. 44.4% and 65.6% vs. 34.4%, P>0.05). Among 46 patients with AIH-PBC OS, there were 25 in ANAs-positive group and 21 in ANAs-negative group. The rate of complete hormone response within 6 months was lower than that of ANAs-negative group (44.0% vs. 76.2%), while the rate of hormone non-response was higher than that of ANAs-negative group (20.0% vs. 0), and the difference was statistically significant (P<0.05). There were 20 cases of ANAs-positive and 11 cases of ANAs-negative in the 31 AIH-only patients. There was no statistically significant difference in the results of hormone response within 6 months between the two groups (P>0.05). Multifactorial ordered logistic analysis showed that AIH-PBC OS patients were more likely to have a higher likelihood of 6-month hormone non-response rate in ANAs-positive patients, and the difference was statistically different (P<0.05). And there was no significant effect of ANAs type on hormone response outcome in AIH-only patients (P>0.05). Conclusion AIH-PBC OS ANAs-positive patients have a poor hormone response within half a year. In AIH-only patients, ANAs have no significant effect on hormone response results.

Objective To investigate the value of magnetic resonance imaging (MRI) T₂-mapping in evaluating the activity of Graves ophthalmopathy (GO). Methods A total of 64 patients with GO in the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from July 2019 to January 2021 were collected. Simple random grouping was performed by computer, with 49 cases as observation subjects, and 15 patients for diagnostic test. According to clinical activity score (CAS), 49 GO patients were divided into active group (CAS ≥3 points, 48 eyes) and inactive group (CAS <3 points, 50 eyes). Normal control group (NC group) included 31 patients (62 eyes). All subjects underwent 3.0T orbital MRI T₂-mapping. Measuring the T₂ relaxation time (T₂RT) of superior rectus, inferior rectus, medial rectus, and lateral rectus on five layers behind the eyeball on T₂-mapping coronal images, and select the maximum value of T₂RT in the five layers for each extraocular muscle to represent the T₂RT of this extraocular muscle. Finally, select the maximum T₂RT values of the four extraocular muscles, expressed as extraocular muscle maximum T₂RT. Compare the differences of the above 5 indicators (superior rectus T₂RT, inferior rectus T₂RT, medial rectus T₂RT, lateral rectus T₂RT, extraocular muscle maximum T₂RT) between active group, inactive group and NC group. ROC curve was used to analyze the diagnostic value of the above 5 indicators for GO activity assessment, and the diagnostic threshold was obtained. Then, another 15 GO patients were performed for diagnostic tests evaluation to determine the indicators of high diagnostic efficacy and the threshold of diagnostic activity. Results The T₂RT of all extraocular muscles in active group were significantly higher than those in inactive group and NC group, the difference was statistically significant (P<0.001). The threshold value of the five indicators were obtained by ROC curve analysis. The maximum T₂RT cut-off values of superior rectus muscle, inferior rectus muscle, medial rectus muscle, lateral rectus muscle and extraocular muscles for judging activity were 80.200 ms, 97.045 ms, 94.355 ms, 85.750 ms and 101.385 ms respectively. Another 15 GO patients were performed for diagnostic tests, the indexes with relatively high sensitivity, specificity, positive predictive value and negative predictive value were inferior rectus T₂RT and extraocular muscle maximum T₂RT, the cut-off values of GO activity were 97.045 ms and 101.385 ms, respectively; the sensitivity were 91.7% and 93.8%, respectively; the specificity all were 80.0%. Conclusions MRI T₂-mapping sequence has a good value in assessment of GO activity. The inferior rectus T₂RT and extraocular muscle maximum T₂RT can be choosed to evaluate the activity of GO.

Objective To explore the efficacy and safety of ticagrelor de-escalation and nicorandil therapy in elderly patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods A total of 300 elderly patients with ACS were selected from the Sixth and Seventh Medical Center of Chinese PLA General Hospital and Beijing Chaoyang Integrative Medicine Emergency Rescue and First Aid Hospital from November 2016 to June 2019, including 153 males and 147 females, aged>65 years old. All the patients received PCI, and all had double antiplatelet therapy (DAPT) scores ≥2 and a new DAPT (PRECISE-DAPT) score of ≥25. All patients were divided into two groups by random number table method before operation: ticagrelor group(n=146, ticagrelor 180 mg load dose followed by PCI, and ticagrelor 90 mg bid after surgery) and ticagrelor de-escalation + nicorandil group (n=154, ticagrelor 180 mg load dose followed by PCI, ticagrelor 90 mg bid+nicorandil 5 mg tid after surgery, changed to ticagrelor 60 mg bid+ nicorandil 5 mg tid 6 months later). Follow-up was 12 months. The composite end points of cardiovascular death, myocardial infarction and stroke, the composite end points of mild hemorrhage, minor hemorrhage, other major hemorrhage and major fatal/life-threatening hemorrhage as defined by the PLATO study, and the composite end points of cardiovascular death, myocardial infarction, stroke and bleeding within 12 months in the two groups were observed. Results The comparison of general baseline data between the two groups showed no statistically significant difference (P>0.05). There was also no significant difference in the composite end points of cardiovascular death, myocardial infarction and stroke between the two groups (P>0.05). The cumulative incidence of bleeding events in ticagrelor de-escalation + nicorandil group was significantly lower than that in ticagrelor group (P<0.05), while the composite end points of cardiovascular death, myocardial infarction, stroke and bleeding were also significantly lower than those in tecagrelor group (P<0.05). Conclusion In elderly patients with ACS, the treatment of ticagrelor de-escalation + nicorandil after PCI may not increase the incidence of ischemic events such as cardiovascular death, myocardial infarction or stroke, and it may reduce the incidence of hemorrhagic events.

Objective To observe the effects of amyloid-β (Aβ) receptor PirB on mouse astrocyte proliferation and reactive astrogliosis in vitro. Methods Mouse primary astrocytes were cultured, and divided into control group, Aβ group, Aβ+0.2 μmol/L PEP group, Aβ+0.4 μmol/L PEP group, Aβ+Fluspirilene group, Aβ+GFP-LV group, and Aβ+mPirB-LV group. The mouse astrocytes were treated with soluble PirB extracellular peptide PEP or PirB inhibitor Fluspirilene, respectively, to inhibit endogenous PirB receptor, or overexpressed PirB gene via lentivirus transfection and then treated with Aβ_1-42 oligomers. The proliferation of astrocytes was observed by RTCA and EdU methods, and the mRNA expression levels of S-100 calcium-binding protein B (S-100β), Vimentin, Nestin and amyloid precursor protein (APP) associated with reactive astrogliosis of astrocytes were observed by real-time PCR, and the expression level of glial fibrillary acid protein (GFAP) was detected by Western-blotting. Results The results of RTCA monitoring showed that normalized cell index (NCI) values of each group decreased sharply after treatment, and then increased gradually and tended to be stable. The results of EdU staining showed that the proliferative activity of astrocytes was significantly enhanced in the Aβ group (P<0.05) compared with control group; Compared with Aβ group, cell proliferation activity in Aβ+0.2 μmol/L PEP group, Aβ+0.4 μmol/L PEP group and Aβ+Fluspirilene group were significantly decreased (P<0.01 or P<0.001). The results of real-time PCR showed that compared with control group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ group were significantly increased (P<0.05); Compared with Aβ group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ+0.4 μmol/L PEP group were significantly decreased (P<0.01); Compared with Aβ+GFP-LV group, mRNA expressions of GFAP, S-100β, Vimentin, Nestin, APP and PirB in Aβ+mPirB-LV group were significantly increased(P<0.05). The results of Western blotting showed that compared with control group, the expression of GFAP in Aβ group was significantly increased (P<0.05); Compared with Aβ group, the expression of GFAP in Aβ+0.4 μmol/L PEP group was significantly decreased (P<0.05). Conclusions PirB is an upstream molecule which could regulate astrocyte proliferation and reactive astrogliosis, and inhibiting PirB receptor in astrocytes may be a potential treatment for Alzheimer's disease.

Objective To investigate the effect and mechanism of pomalidomide (POM) on airway inflammation and mucus hypersecretion in rats with chronic obstructive pulmonary disease (COPD). Methods Thirty-six SD rats were randomly divided into control group, model group and POM group, with 12 in each group, half male and half female. The COPD model was established by smoke exposure combined with Klebsiella pneumoniae infection in model group and POM group. The rats in POM group were treated with POM (0.5 mg/kg, once a day for 1 week). The lung function, lung tissue pathology, the proportion of inflammatory cells in bronchoalveolar lavage fluid (BALF) and the levels of serum inflammatory factors tumor necrosis factor-α (TNF‑α), interleukin (IL)‑1β, IL-6 and IL‑13 were observed and detected in each group. AB-PAS staining and immunohistochemistry were used to analyze the proliferation of goblet cells and the secretion of mucin (MUC) 5AC and MUC5B in airway epithelium of rats. The expression levels of TNF‑α receptor 1 (TNFR1), IκB kinase (IKK), phosphorylated IKK (p-IKK) and P65 protein in lung tissue were detected by Western blotting. Results Compared with control group, model group showed significant decreased of tidal volume (TV), minute ventilation (MV), forced expiratory vital capacity (FVC), 0.1s forced expiratory volume (FEV0.1) and 0.3 s forced expiratory volume (FEV0.3) (P<0.05), increased of the mean linear intercept (MLI) of the alveoli (P<0.01), decreased of the mean alveolar number (MAN) (P<0.01), increased of the proportion of neutrophils and lymphocytes in BALF sediment (P<0.05), and decreased of the proportion of macrophages in BALF sediment (P<0.01);increased of the levels of serum inflammatory factors TNF-α, IL-1β, IL-13 and IL-6 (P<0.05), the proportion of goblet cells in airway epithelium (P<0.01), the secretion of MUC5AC and MUC5B in lung tissue (P<0.01), the content of TNFR1 and the ratio of p-IKK / IKK (P<0.01), the content of P65 in nucleus (P<0.01); and decreased of the content of P65 in cytoplasm (P<0.05). Compared with model group, after one week of POM treatment, POM group showed significant improved of the TV, MV, FVC, FEV0.1, FEV0.3, MLI and MAN of rats (P<0.05); decreased of the proportion of neutrophils and lymphocytes in BALF (P<0.05); increased of the proportion of macrophages (P<0.01); decreased of the levels of serum TNF-α, IL-1β, IL-6 and IL-13 (P<0.05), the proportion of goblet cells in airway (P<0.01), the secretion of MUC5AC and MUC5B (P<0.01), and the expression of TNFR1, P-IKK and P65 (nucleus) (P<0.05); and increased of the level of P65 (cytoplasm) (P<0.01). Conclusions POM can improve airway inflammation and mucus hypersecretion in COPD rats, which may be achieved by inhibiting TNF-α/NF-κB signaling pathway.