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 investigate the efficacy of histone deacetylase (HDAC) inhibitor chidamide combined with the PD-1 inhibitor on CD8⁺ T cells anti-cancer function in OVA-expressing MC38 (MC38-OVA) colorectal-bearing mice. Methods Animal experiments: C57BL/6 tumor models were constructed by subcutaneously injecting MC38-OVA colorectal cancer cells into the back of mice. We randomized mice into control group, chidamide group, anti-PD-1 group and chidamide+anti-PD-1 group (20 each group). We monitored the tumor growth and animal survival rate of each group; we employed a flow-based method to detect the number and ratio of tumor-infiltrating CD8⁺ T cells, CD8⁺IFN-γ⁺ T cells, OVA antigen-specific CD8⁺ T cells, and the expression changes of regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC), and tumor-associated macrophages (TAM). Cell experiments: We used a flow-based method to detect the apoptosis of CD8⁺ T cells and MC38-OVA tumor cells after 0, 10, 25, 50, 100, or 200 nmol/L chidamide treatment. The proliferation of CD8⁺ T cells and MC38-OVA tumor cells treated with 0 and 100 nmol/L chidamide was detected by Ki-67 antibody labeling and cell counting. To evaluate CD8⁺ T cell killing ability, we treated CD8⁺ T cells with various conditions (control group, chidamide group, anti-PD-1 group and chidamide+anti-PD-1 group) followed by co-culture with MC38-OVA tumor cells, using the flow-based method. In the condition that CD8⁺ T cells treated with 0 and 100 nmol/L chidamide co-cultured with the same number of MC38-OVA tumor cells, the expression of CD107a was detected by flow cytometry. Results Compared with control group, the tumor growth was inhibited (P<0.05) while the survival rate was improved (P<0.01) in chidamide+anti-PD-1 group. The number of tumor-infiltrating CD8⁺ T cells was significantly higher in chidamide group, anti-PD-1 group and chidamide+anti-PD-1 group than that in control group (P<0.05). Nonetheless, the ratio and levels of CD8⁺IFN-γ⁺ and OVA antigen-specific CD8⁺ T cells were significantly higher in chidamide+anti-PD-1 group than those in other groups (P<0.05). The in vitro experiment results showed that chidamide could enhance the killing ability of CD8⁺ T cells and the expression of CD107a. Conclusion Chidamide combined with PD-1 inhibitor significantly enhanced the number and function of tumor-infiltrating CD8⁺ T cells and increased antigen-specific CD8⁺ T cells, which will provide a theoretical and experimental basis for the combination of chidamide in clinical solid tumor immunotherapy.

Corona virus disease 2019 (COVID-19) epidemic has been effectively controlled, but its related complications still cannot be ignored, especially the cardiovascular circulatory system is the active site of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE2) is a type Ⅰ transmembrane glycoprotein that is highly expressed in heart, kidney and testis. Spike protein of SARS-CoV-2 invades host cells by binding to the cell surface receptor ACE2. However, there are still many deficiencies in the clinical application of vaccines and drugs developed based on this target. As a molecular chaperone, cyclophilin A (CypA) promotes protein folding and T cell activation. CD147 is one of the most widely studied CypA receptors, and the interaction of CypA/CD147 plays an important role in the entry of SARS-CoV-2 into host cells. However, there are few reports on the invasion of SARS-CoV-2 into the cardiovascular system through the CypA/CD147 signaling pathway. Based on this, this article summarizes the previous research evidence and the research basis of the research group, and reviews the structure and function of CypA/CD147, the role of CypA/CD147 in cardiovascular disease, and the cardiovascular disease caused by SARS-CoV-2 targeting CypA/CD147 signal pathway, in order to provide reference for the diagnosis and treatment of the COVID-19 complicated with cardiovascular system diseases.

Non-puerperal mastitis (NPM) is a group of chronic inflammatory diseases with breast pain, lumps, abscesses and sinus tracts/fistulas as the main clinical manifestations, which is easily confused with breast cancer or other benign breast diseases. NPM always leads to a long treatment cycle and high recurrence rate, which may cause a large economic and psychological burden to patients. At present, the etiology and pathogenesis of NPM are still unclear, but it has a certain correlation with immune abnormality, bacterial infection, hormone disorder and other factors. Although several diagnostic methods available, the diagnosis of NPM relies on histopathological examination mainly. The treatment methods of the disease include observation and follow-up, pharmacotherapy, surgical treatment, etc., but there is still no unified standard for specific treatment timing and treatment selection. In view of the controversy over etiology and treatment selection of NPM, this paper comprehensively summarizes the latest research progress in disease characteristics, clinical diagnosis and treatment of NPM based on domestic and foreign literature, aiming to provide reference and inspiration for the selection of reasonable clinical diagnosis and treatment.

Premature ovarian insufficient (POI) is one of the important causes of infertility in woman of reproductive age. At present, the clinical treatment of POI is limited and the therapeutic effect is not ideal. Extracellular vesicles derived from stem cells have attracted the attention of many researchers at home and abroad as a new cell-free therapy. Many animal experiment study shows that a variety of extracellular vesicles from stem cells carry microRNAs, lncRNAs, lipids, proteins, and other bioactive substances, improve ovarian function, affect granulosa cell proliferation and apoptosis, promote ovarian angiogenesis, and reduce oxidative stress response, thus playing a therapeutic role on POI. This article will review the mechanisms of extracellular vesicles in treatment of POI, and provide evidence for the application of extracellular vesicles in clinical treatment of POI.

Objective To establish and validate the nomogram prediction model of degenerative lumbar disc disease in young and middle-aged people. Methods From January 2020 to March 2022, 232 young and middle-aged people who were examined with MRI of lumbar intervertebral disc and standard standing position lumbar anteroposterior and lateral X-ray films in Suzhou Ninth Hospital Affiliated to Soochow University were selected as the study subjects. Collecting the factors that may affect the occurrence of degenerative lumbar disc disease in young and middle-aged people, the people were divided into degenerative disease group (n=78) and non-degenerative disease group (n=154) according to the presence or absence of degenerative lumbar disc disease. Influencing factors were compared between the two groups, the independent influencing factors screened out by multifactor logistic regression, the nomograph model was constructed by R software, and the model verified. Results Among 232 young and middle-aged people included in this study, 78 (33.6%) had degenerative lumbar disc diseases. The results of multivariate logistic regression analysis showed that the increase of BMI, sedentariness, the increase of IL-1β level were the risk factors of degenerative lumbar disc disease in young and middle-aged people; the increase of pelvic incidence angle and the increase of miRNA-142-3p level were protective factors for degenerative lumbar disc disease in young and middle-aged people (P<0.05). The nomogram model was constructed according to the results of multifactor analysis. ROC results showed that AUC was 0.889 (95%CI 0.844-0.933, P<0.05), the average absolute error of internal validation was 0.017, the prediction curve was basically fitted with the standard curve, and the H-L goodness of fit test showed that the model was consistent (P>0.05). The decision curve shows that the clinical benefit rate is the highest when the model prediction probability threshold is 0.16-0.80. Conclusions Degenerative lumbar disc disease in young and middle-aged people is affected by such factors as BMI, sedentariness, and incidence angle of pelvis, and the nomogram model established based on this has high differentiation and accuracy of prediction.

Metabolism-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is one of the most popular chronic liver diseases in the world, and has become one of the main causes of liver cirrhosis, end-stage liver disease, and primary liver cancer. In recent years, the prevalence of MAFLD has gradually increased in China, the Asia Pacific region, and even globally, increasing the medical and socio-economic burden. The exploration of the epidemiology and risk factors of this disease at home and abroad has also gradually increased. Meanwhile, due to the scarcity of MAFLD treatment drugs, their drug treatment has become a hot issue that needs to be urgently addressed in clinical practice. In recent years, there has been an increase in the number of drugs entering the clinical trial stage. Based on this, the current epidemiological status, risk factors, diagnostic criteria, and treatment research progress of MAFLD have been reviewed in order to provide new ideas and directions for the clinical diagnosis, treatment, and scientific research of MAFLD.

Objectives To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection (TAAD). Methods A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University. According to the lowest postoperative PaO₂/FiO₂ ratio within 24 hours, the patients were classified into two groups: hypoxemia group (PaO₂/FiO₂ ≤200 mmHg) and non-hypoxemia group (PaO₂/FiO₂ >200 mmHg). The difference of preoperative oxygen index, duration of mechanical ventilation and mortality in hospital were analyzed between the two groups. The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character (ROC) curves. Results For TAAD patients, the incidence of postoperative hypoxemia was 45.9%. Compared to non-hypoxemia group, hypoxemia group exhibited longer duration of mechanical ventilation (P<0.001) and longer intensive care unit (ICU) length of stay (P<0.05). Moreover, patients with hypoxemia presented higher mortality during hospital (P=0.011). Multivariate regression analysis identified BMI as independent risk factor (OR=1.701, P<0.001) and preoperation PaO₂/FiO₂ ratio as protective factors for postoperative hypoxemia in patients with TAAD (OR=0.987, P=0.004). Area under the ROC curve of BMI was 0.848, the optimal cut-off point of BMI was 25.8 kg/m². Area under the ROC curve of pre-operation PaO₂/FiO₂ ratio was 0.808, the optimal cut-off point of preoperation PaO₂/FiO₂ ratio was 265 mmHg. Conclusions BMI higher than 25.8 kg/m² is an independent risk factor and preoperation PaO₂/FiO₂ ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD. Subjects with hypoxemia had longer duration of mechanical ventilation, ICU stay and higher mortality.

Heat stroke (HS) is a serious life-threatening disease caused by heat injury and characterized by a core body temperature >40 ℃ with central nervous system dysfunction and multi-organ failure. The main pathophysiological manifestations of HS are the thermal acute phase response and thermoregulatory imbalance. Proteins are particularly sensitive to heat, and the thermal environment can cause massive protein denaturation, resulting in the deposition of unfolded and misfolded proteins in the cytoplasm, causing cellular dysfunction and even death. The unfolded protein response (UPR), mainly divided into the endoplasmic reticulum UPR and the mitochondrial UPR, is an important physiological process that helps proteins to fold correctly or degrade irretrievably denatured proteins. This paper summarizes the regulatory mechanisms of UPR, the relationship between UPR and severe diseases, as well as the relationship between HS and UPR to provide new ideas for the treatment of HS.

Objective To investigate the possible mechanism of Xuebijing injection in regulating abnormal degradation of pulmonary vascular endothelial calyx to improve acute lung injury induced by severe heatstroke. Methods Forty-eight Wistar rats were randomly divided into control group, heatstroke group and Xuebijing group. Before heatstroke induction, rats in Xuebijing group were administrated with Xuebijing injection (2 ml/kg, 2 times/d) for 3 days. All rats were exposed to an environment with temperature of (40±2) ℃ and humidity of 65%±5% for 60 minutes to induce heatstroke. Two hours later, the lung wet/dry weight ratio was recorded; the concentration of proteins in BALF was measured; the pulmonary vascular permeability was measured by Evans blue (EB); HE staining was used to observe the pathological changes of lung tissue; the changes of hyaluronic acid (HA) on the surface of pulmonary vessels were observed by immunofluorescence; Western blotting was used to detect the expression of Syndecan-1, Glypican-1, VE-Cadherin, Occludin, VCAM-1 and E-selectin in lung tissues; Enzyme-linked immunosorbent assay (ELISA) was utilized to quantify the concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) in serum and heparanase (HPA) in lung tissue. Results Xuebijing could decrease the lung wet/dry weight ratio, reduce protein exudation and improve pulmonary vascular permeability (P<0.01); reduce the histological injury (P<0.01); reduce the degradation of HA, Syndecan-1 and Glypican-1 on the surface of pulmonary vessels (P<0.01); increase the expression of VE-Cadherin and Occludin (P<0.01); regulate the overexpression of VCAM-1 and E-selectin (P<0.01); down-regulate the expression of TNF-α, IL-6 and HPA (P<0.01). Conclusion Xuebijing injection decrease the expression of HPA, improve the disintegration of pulmonary vascular endothelial calyx, repair the integrity of pulmonary vessels, reduce the damage of cell connections, down-regulate the expression of adhesion molecules, inhibit the inflammatory reaction, relieving acute lung injury caused by severe heat stroke.