Abstract:Objective To explore the regulation of p38 mitogen-activated protein kinase (MAPK) pathway by West Nile virus (WNV) in human neuroblastoma SH-SY5Y cells and the contributions of p38 MAPK to WNV replication as well as stress and inflammatory response related molecule expression. Methods Total and phosphorylated p38 MAPK levels were analyzed in SH-SY5Y cells incubated with WNV for short (5, 15, 30 and 60 min) and long (12, 24, 48 and 60 h) durations by Western blotting. Dynamic changes of CCAAT/enhancer-binding protein homologous protein (CHOP), interleukin 6 (IL-6), activating transcription factor 6α (ATF6α) and interferon-stimulated gene 15 (ISG15) mRNA expression in WNV infected cells were detected by qRT-PCR. In response to WNV infection, WNV RNA level and CHOP, IL-6, ATF6α and ISG15 mRNA levels were assessed in SH-SY5Y cells transfected with p38 MAPK siRNA. Results Incubation with WNV for short durations enhanced p38 MAPK phosphorylation compared to the untreated control. The p38 MAPK signaling pathway was activated at 12 h and 24 h in WNV-infected SH-SY5Y cells, but down-regulated at 48 h and 60 h. WNV infection led to increased mRNA expression of CHOP, IL-6 and ISG15 and reduced ATF6α mRNA. In comparison with control siRNA transfection, the levels of WNV RNA (P<0.05) and ATF6α mRNA (P<0.01) were increased and CHOP mRNA level was decreased (P<0.05) in WNV-infected SH-SY5Y cells with the p38 MAPK siRNA transfection. Conclusion The p38 MAPK pathway is activated during early stage of WNV infection and such activation may negatively regulate WNV replication. WNV-induced stress response molecules CHOP and ATF6α and proinflammatory cytokine IL-6 production by SH-SY5Y cells are coupled with the regulation of p38 MAPK pathway.

Abstract:Objective To screen the different mutated somatic genes between primary ovarian cancer and metastatic ovarian carcinoma using the whole exon sequencing data of catalogue of somatic mutations in cancer (COSMIC) database, and to analyze their function and signal pathway. Methods The whole exon sequencing data of all tumors were downloaded from the COSMIC database, and the whole exon sequencing data of all ovarian cancer were extracted. In the R 3.5.3 environment, mutation rate of each mutated gene in the primary and metastatic ovarian carcinoma samples were performed. The χ² test or Fisher's exact probability method was used to identify the mutated gene groups which had statistically significant difference in mutation rate. The mutated gene groups were further analyzed for gene ontology (GO) function and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment. Results We found a total of 520 somatic mutations with statistically significant differences in mutation rate between primary ovarian cancer and metastatic ovarian carcinoma tissues, such as transmembrane protease serine 13 (TMPRSS13), Golgi brefeldin A resistance factor 1 (GBF1), Fos-like antigen 2 (FOSL2), mastermind-like 3 (MAML3), etc. Enriched GO function included presynapse organization, dendrite development, cell-cell adhesion via plasma membrane adhesion molecules, and actin binding, and so on. KEGG pathway included regulation of actin cytoskeleton, tricarboxylic acid carrier, and the like. Conclusion It can provide clues for revealing the metastasis regulation mechanism of ovarian cancer by exploring different mutated gene group between primary ovarian cancer and metastatic ovarian carcinoma and its related functional pathways. The significant mutated gene group may be used as biomarkers for the diagnosis and treatment of ovarian metastatic cancer.

Abstract:Objective To explore the application value of artificial intelligence (AI) automatic detection system in preoperative ultrasonic diagnosis of thyroid nodules. Methods Totally 98 patients with 137 thyroid nodules admitted to the General Surgery Department of Changzheng Hospital of Naval Medical University (Second Military Medical University) from April 2019 to July 2019 were enrolled in this study. Pathological data and ultrasonic diagnosis results were retrospectively analyzed. All patients underwent conventional ultrasonography and AI automatic detection before surgery. The diagnoses for benign and malignant thyroid nodules were compared between conventional ultrasonography and AI automatic detection system, which were based on the postoperative pathology. The sensitivity, specificity and accuracy of the two examination methods were calculated, and Kappa coefficient was performed to measure the consistency between the two methods and postoperative pathological diagnosis. Results The sensitivity, specificity and accuracy of conventional ultrasonography in diagnosis of benign and malignant thyroid nodules were respectively 93.75% (90/96), 80.49% (33/41) and 89.78% (123/137), and those of AI automatic detection were 89.58% (86/96), 68.29% (28/41) and 83.21% (114/137). There was substantial coefficience between conventional ultrasonography and pathological diagnosis results (Kappa=0.75, P<0.001), and that was fair coefficience between AI automatic detection system and pathological diagnosis results (Kappa=0.59, P<0.001). Conclusion The sensitivity and accuracy of AI automatic detection system are slightly lower than but close to those of conventional ultrasonography in differentiating benign from malignant thyroid nodules. AI automatic detection system can be used as an effective supplement to assist conventional ultrasonography for preoperative assessment of thyroid nodules.

Abstract:Objective To investigate the changes of tissue structure in the ablation area after microwave ablation of thyroid nodules and to identify the appropriate time for pathological evaluation of the ablation area. Methods From January 2017 to December 2018, a total of 69 core-needle biopsy tissue samples from the ablation area of thyroid nodules in 60 patients were investigated histologically using H-E and immunohistochemical staining. The samples were taken after microwave ablation at different stages and from different areas. Cellular morphology and tissue structure as well as thyroid transcription factor 1 (TTF1) in the tissues from the central zone and marginal zone of ablation area were observed immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. Results Successful biopsies were achieved in 69, 12, 19, 25 and 13 ablation areas immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. There was no necrosis but only coagulated degeneration in both the central zone and marginal zone of the 69 (100.00%) ablation areas immediately after microwave ablation. At 1 month after microwave ablation, 9 (75.00%) samples of central zone and 9 (75.00%) samples of marginal zone showed complete necrosis. At 3 months, 16 (84.21%) samples of central zone and 15 (78.95%) samples of marginal zone showed complete necrosis. At 6 and 12 months, all (100.00%) samples of central zone and marginal zone became necrotic completely. Conclusion The histopathologic feature of thyroid nodules after microwave ablation varies with time. There is only coagulated degeneration in the freshly ablated thyroid tissue, and no necrosis is found. Necrosis occurs and progresses to the whole ablation area in all patients. It suggests that the reliable therapeutic effect of microwave ablation on thyroid nodules is due to complete necrocytosis. Necrosis occurs in all the ablation area at 6 months after microwave ablation, indicating the 6^th month is an appropriate time for pathological evaluation of the ablation area.

Abstract:Objective To measure the carotid viscoelasticity using ultrasound shear wave dispersion (USWD), and to explore the correlation between the viscoelasticity and hemodynamics. Methods Forty-five volunteers without history of cardiovascular and cerebrovascular events were recruited and divided into elder group (≥ 50 years old, n=23) and younger group (<50 years old, n=22) according to the median age. The common carotid arteries were detected by USWD, and SWE_R (elastic index) and SWD_R (viscous index) were obtained. Hemodynamic parameters, including velocity time integral (VTI), peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MFV), were measured using Doppler ultrasound. Correlations between SWE_R, SWD_R and hemodynamic parameters were analyzed using Pearson analysis. Results The SWE_R, SWD_R, VTI, PSV, EDV and MFV in the elder group were significantly lower than those in the younger group (P<0.05, P<0.01). The SWE_R was positively correlated with VTI, PSV, EDV and MFV (r=0.354, 0.400, 0.467 and 0.310;P<0.01, P<0.05). The SWD_R was negatively correlated with VTI and PSV (r=-0.481 and -0.522, both P<0.01), but positively correlated with MFV (r=0.352, P<0.01). Conclusion USWD may identify the change of carotid viscoelasticity, and the change of viscoelasticity is related to hemodynamics.

Abstract:Objective To explore the application and efficacy of 3D printing technology of computed tomography 3D reconstruction and computer-assisted design in sacral neuromodulation. Methods This is a randomized, controlled, prospective study. From March 2017 to March 2018, 15 candidates for sacral neuromodulation were randomized into traditional puncture group (n=10) and 3D printing group (n=5). X-ray guided electrode placement was used in the traditional puncture group, and 3D printing navigation template puncture was applied in the 3D printing group. The clinical efficacy of the two groups was evaluated. Puncture time, needle insertion times, intraoperative adjustment and testing time, and postoperative complications (such as wound bleeding, wound infection, wound dehiscence, electrode breakage, displacement or prolapse) were assessed. Results There were no significant differences in gender, age, sacral neural foramen size, sacrococcygeal deformity, or disease type between the two groups (all P>0.05). Compared with those in the traditional puncture group, the puncture time, needle insertion times, intraoperative adjustment and testing time were significantly decreased in the 3D printing group ([9.10±2.73] min vs[26.20±5.67] min, 3.20±0.84 vs 5.30±1.30,[20.80±3.27] min vs[27.60±4.63] min; t=6.301, 3.255, 2.916; all P<0.05). Complications such as wound infection, wound bleeding, wound dehiscence, electrode breakage, displacement or prolapse, or pain of stimulator, were not found after operation. Conclusion Compared with traditional method, computer-assisted 3D printing technology is safe in sacral neuromodulation. It can reduce the needle insertion times, shorten the puncture time, and improve the efficiency of intraoperative adjustment and testing.

Abstract:Objective To summarize the clinical experiences for diagnosis and treatment of collecting duct renal cell carcinoma (CDRCC) and to analyze its prognosis. Methods A total of 21 CDRCC patients selected from 6 950 patients with renal cell carcinoma admitted to Changhai Hospital, Changzheng Hospital and Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University (Second Military Medical University) were enrolled in this retrospective study. CDRCC was confirmed by pathological examination. Clinical data, pathological data, imaging data, surgical conditions, postoperative adjuvant treatment and follow-up information of the 21 patients were analyzed. Results The proportion of CDRCC patients was 0.3% (21/6 950). There were 18 males and 3 females, with an average age of (55±13) years. The main symptoms were hematuria and flank pain. Computed tomography showed that the size of the kidney involved was enlarged, the outline of the mass was not smooth, and the boundary of the mass was not clear. After enhancement, the mass was heterogeneously enhanced. The maximum diameter of tumor ranged from 2.4 cm to 8.5 cm, with an average of (5.6±1.7) cm. Lymph node metastases were observed in 5 patients and distant metastasis in 6 patients. TNM clinical stage:8 cases in stage Ⅰ, 2 cases in stage Ⅱ, 5 cases in stage Ⅲ and 6 cases in stage Ⅳ. Twenty patients received surgical treatment, but one did not because of poor general condition. The pathological features of the tumors were grey-white or grey-yellow in section, infiltrating growth, irregular glandular tubular and papillary tissues, some of which had hobnail appearance, interstitial fibrous tissue proliferation and inflammatory cell infiltration. Immunohistochemical staining showed that very low molecular cytokeratin (CAM5.2), tumor-associated epithelial membrane antigen (EMA), paired box gene 8 (PAX8), and cytokeratin 7 (CK7) were positive, while carbonic anhydrase Ⅸ (CAⅨ), proto-oncogene tyrosine-protein kinase kit (C-kit), GATA binding protein 3 (GATA3), neutral endopeptidase (CD10), transformation-related protein 63 (P63), and cytokeratin 20 (CK20) were negative. Sixteen patients were followed up for (33.6±28.9) months on average (range, 4 to 87 months). The median survival time was 39.1 months. One-, two-and five-year survival rate was 71.5%, 57.2%, and 44.5%, respectively. The average survival time of 12 dead patients was (32.2±27.5) months. Conclusion CDRCC is a rare subtype of renal cell carcinoma with short course, rapid progression, high degree of malignancy and poor prognosis. Pathological examination is the golden standard for the diagnosis and surgery is the main treatment at present. Chemotherapy and targeted therapy can be used as adjuvant therapy. Early diagnosis and treatment are the key to a favorable prognosis.

Abstract:Objective To analyze the genetic evolution and hemagglutinin (HA) gene mutation sites of influenza B virus in Chengdu. Methods Influenza virus was isolated from patient's throat swab samples using Madin-Darby canine kidney (MDCK) cells in vitro. The HA gene of influenza B virus was obtained by PCR and was sequenced. The phylogenetic tree was constructed and mutation sites were analyzed by online comparison with NCBI database and MEGA 6.06 software. Results One strain of influenza B virus was isolated by MDCK cells, and 1 755 bp full-length HA gene was obtained by PCR amplification using the nucleic acids of the throat swab and the isolated strain as templates. The obtained sequence was submitted to the GenBank database, and the gene accession number was MH236281. By online alignment and phylogenetic tree construction, the virus infected in this case was confirmed to be Yamagata type B influenza virus. There were 57 HA point mutation bases as compared with Influenza B/Yamagata/16/88 (GenBank No. M36105). There were 20 mutated bases in HA as compared with the World Health Organization (WHO)-recommended vaccine strain Influenza B/Utah/08/2014 (GenBank No. KU592766). HA1 amino acid mutation site was further analyzed. Compared with the epidemic strains in Sichuan in recent years, HA1 amino acid sites have undergone varying degrees of mutations, of which there were only 4 point mutations compared with Wenjiang/2010 isolate (GenBank No. KP461138). Compared with the WHO-recommended vaccine strain Influenza B/Utah/08/2014, two amino acid sites mutated (L176Q and M255V), but the mutation was not located in the antigenic determinant region of HA1. Among them, site 176 was a new mutation. The amino acid was leucine (L) at site 176 of HA1 epidemic strains in Sichuan, Influenza B/Yamagata/16/88, and the WHO-recommended vaccine strain Influenza B/Utah/08/2014, whereas the amino acid was glutamine (Q) in the influenza B strain isolated in this study. Conclusion Mutations have occurred in the HA gene of influenza B virus infected in Chengdu during 2017-2018, while these mutations have not yet caused antigenic changes.

Abstract:Objective To explore the surface-enhanced Raman spectroscopy (SERS) difference of key female fertility indicators, estradiol (E2), anti-Müllerian hormone (AMH) and antral follicle count (AFC) in serum samples of healthy and infertile women, and the possibility of their application in preliminary screening of clinical female fertility. Methods A total of 236 serum samples of healthy and infertile women of childbearing age were collected from Reproductive Medical Center of the First Affiliated Hospital with Nanjing Medical University. The ages of all subjects ranged from 22 to 49 years old, with an average age of (30.8±5.1) years old. The samples were divided into high E2 value group (>5 000 pmol/L, 78 cases) and low E2 value group (<500 pmol/L, 86 cases), high AMH value group (≥ 1.1 ng/mL, 33 cases) and low AMH value group (<1.1 ng/mL, 30 cases), high AFC value group (>14, 68 cases) and low AFC value group (<7, 34 cases). Serum SERS analysis was established and Raman spectra of each group were detected. Orthogonal partial least squares discriminant analysis (OPLS-DA), receiver operating characteristic (ROC) curve and permutation test were used to analyze the signals. Results The Raman spectrum morphology of serum samples was similar between high and low E2 value groups, high and low AMH value groups, and high and low AFC value groups, but the spectral peak intensity of the three indicators was different between the high and low value groups. In the OPLS-DA model, there was an obvious clustering trend in E2, AMH and AFC between the high and low value groups, and the areas under ROC curve were 0.996 and 0.996, 0.995 and 0.995, and 1 and 1 in high and low E2 value groups, high and low AMH value groups, and high and low AFC value groups, respectively. Conclusion SERS has a potential to be used in the primary screening of female fertility. Serum SERS profile as an auxiliary method for early diagnosis of infertility is worthy of further study.

Abstract:Paroxysmal sympathetic hyperactivity (PSH) has a profound impact on the prognosis of patients suffering from brain injury, but the research on pathogenesis in relation to PSH is limited. In this paper, the etiologies of PSH, including traumatic brain injury, hypoxic brain injury, cerebrovascular-related brain injury, craniocerebral infection, anti-N-methyl-D-aspartate receptor encephalitis, and a number of rare etiological factors were reviewed. The epilepsy hypothesis, disconnection hypothesis and new-presented neuroendocrine hypothesis about the pathogenesis of PSH were introduced, so as to provide reference for further research on PSH.

Abstract:Prostate cancer is one of the male malignancies with the highest incidence rate in the world, which seriously endangers the physical and mental health of elderly men. Early diagnosis and treatment are critical for the formulation of treatment strategies and the prognosis of prostate cancer. At present, its diagnosis mainly depends on digital rectal examination, serum prostate-specific antigen and transrectal ultrasound guided biopsy. However, the diagnostic efficiency of these methods is very low. In recent years, with the introduction of functional magnetic resonance imaging, multi-parameter magnetic resonance imaging (mpMRI) is currently recognized as the most effective imaging method for diagnosing prostate cancer. Besides the differential diagnosis of prostate diseases, it could further predict the pathological score of prostate cancer and guide the subsequent targeted biopsy and local treatment. Accurate diagnosis of prostate cancer and subsequent individualized treatment are of great significance. The current status of mpMRI in the diagnosis of prostate cancer is reviewed in this paper.

Abstract:The information-based war has brought unprecedented challenges to the existing support ability of mobile medical service units in military hospitals, and combat readiness training is particularly important for improving its support ability. Combat readiness training is the main way to improve its support ability, a powerful means to improve the level of standardized management, a powerful lever to promote the development of medical equipment, a practical source to promote the theoretical innovation of medical service, a platform to test the design of medical service programs, and an inevitable measure to cultivate the spirit of combat. The above six aspects were analyzed in this paper to effectively solve the bottleneck of combat readiness training, so as to further strengthen the combat readiness training of mobile medical service units in military hospitals under the condition of information war, and improve the effect and level of combat readiness training.

Abstract:Objective To design a portable teleoperated rescue device for persons who fell into the sea. Methods The function analysis of rescue device and the design of target properties were performed using the quality function deployment method by summarizing the advantages of existing marine rescuers, marine environment and airborne characteristics. The optimal triangle rescuer was selected from six conceptual design schemes. The simulated analysis of surface pressure distribution was carried out with STAR-CCM⁺ software. The deformation, stress and strain energy were analyzed with ANSYS Workbench software. The reliability analysis was performed with failure mode and effect analysis (FMEA). Results The triangle rescue device met the requirements of STAR-CCM⁺ analysis and ANSYS Workbench analysis, and achieved low energy consumption and good agility. The possible causes of failure in reliability analysis were dealt with accordingly. Conclusion The design of portable teleoperated marine rescue device has the characteristics of portability, strong maneuverability and high safety. It can provide great help for maritime rescue and has certain military, social and economic values.

Abstract:Objective To investigate the mediation effects of coping style on the relationship between mental resilience and negative emotions among military personnel. Methods A questionnaire survey was performed in 358 military officers and soldiers using Connor-Davidson resilience scale, simplified coping style questionnaire and depression anxiety and stress scale. Structural equation model was built to analyze the relationship between variables. Results A total of 344 valid questionnaires were collected, and effective response rate was 96.09%. All the subjects were male with a mean age of (23.24±4.73) years old. Pairwise correlations between mental resilience, positive coping style, negative coping style and negative emotions were all significant (all P<0.01). Mental resilience explained 21.2% of the total variation of negative emotions (P<0.01), and coping style explained 7% of the variation. Mental resilience could indirectly affect negative emotions through positive coping style and negative coping style (χ²=35.744, df=17, χ²/df=2.103, goodness of fit index[GFI]=0.975, adjusted goodness of fit index[AGFI]=0.948, root mean square error of approximation[RMSEA]=0.057). The mediation effect of coping style accounted for 27.03% of the overall effect (positive coping style for 75.43% and negative coping style for 24.00%). Conclusion Coping style plays multiple mediating roles between mental resilience and negative emotions in military personnel, especially with the positive coping style contributing a large proportion. Therefore, it is necessary to focus on training positive coping style in military personnel with low mental resilience, so as to effectively reduce the level of negative emotions of military personnel and improve operational efficiency.

Abstract:Objective To explore the protective effect of hydrogen (H₂) inhalation through respiratory tract on monoarthritis (MA) rats. Methods Forty male SD rats were randomly divided into 5 groups:MA group, MA+H₂ 0-14 d group, MA+H₂ 0-3 d group, MA+H₂ 4-14 d group, and sham+H₂ 0-14 d group (n=8). Complete Freund's adjuvant (CFA) was injected into the left ankle joint of rats to construct MA model. The rats in the MA group did not inhale H₂, and the rats in other four groups inhaled 65% H₂ 1.5 h per day on the day of modeling and 1-14 days after modeling, 1.5 h per day on the day of modeling and 1-3 days after modeling, 1.5 h per day on the 4^th-14^th day after modeling, and 1.5 h per day on the day of sham operation and 1-14 days after modeling, respectively. Paw withdrawal threshold (PWT) was detected by von Frey method 0, 1, 3, 5, 7, 10, and 14 d after modeling. Another 15 rats were randomly divided into 5 groups and there were 3 rats in each group. Lumbar enlargement tissues were taken from the spinal cord of the inflammatory side on the 10th day after modeling or sham operation. The contents of superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) were detected. Results In the MA group, the posterior paw PWT of the inflammatory side was lower than that of the healthy side on the first day after modeling, reached the lowest on the 3th day and remained stable until the 14^th day (P<0.01). The PWT of the inflammatory side of the hind claw of rats in the MA+H₂ 0-14 d group and the MA+H₂ 0-3 d group was higher than that in the MA group (P<0.05, P<0.01). The PWT of the inflammatory side in the MA+H₂ 4-14 d group was not significantly different from that in the MA group (P>0.05). The levels of SOD and CAT in the spinal cord of the inflammatory side in the MA+H₂ 0-14 d group were higher than those in the MA group (all P<0.05), while MDA level was lower than that in the MA group (P<0.05). Compared with MA group, there was no significant difference in the SOD, CAT or MDA level in the MA+H₂ 0-3 d group and MA+H₂ 4-14 d group (all P>0.05). Conclusion Inhalation of 65% H₂ via the respiratory tract at the initial stage of MA rat modeling can alleviate mechanical hyperalgesia and oxidative stress. Pre-administration of H₂ can inhibit the formation of mechanical hyperalgesia in MA.

Abstract:Objective To observe the effectiveness of catheter-based renal sympathetic denervation (RDN) for reducing blood pressure in patients with resistant hypertension using a 5 F microtube-irrigated ablation catheter. Methods Thirty patients with resistant hypertension received RDN between January 2013 and December 2015. They were randomly divided into two groups:general ablation catheter group and microtube-irrigated ablation catheter group, with 15 cases in each group. 5 F temperature-controlled catheter was used in the general ablation catheter group. 5 F microtube-irrigated ablation catheter (microtubes at the head) was used in the microtube-irrigated ablation catheter group. Cold saline was irrigated for mapping and ablation. All patients were followed up for 9 months. Clinic blood pressure, 24 h ambulatory blood pressure, biochemical tests and cardiac function were measured at baseline and during follow-up. Results RDN was successfully performed in all patients. At the 9-month follow-up, the decrease of 24 h ambulatory systolic blood pressure (SBP) in the microtube-irrigated ablation catheter group was more obvious than that in the general ablation catheter group ([34.67±13.02] mmHg vs[17.00±16.74] mmHg, P<0.01; 1 mmHg=0.133 kPa). The 24 h ambulatory diastolic blood pressure (DBP) in the microtube-irrigated ablation catheter group was significantly lower than that in the general ablation catheter group ([81.20±7.15] mmHg vs (87.60±8.17) mmHg, P<0.05). There was a decreased trend in the use of antihypertensive drugs in the microtube-irrigated ablation catheter group as compared with the general ablation catheter group, particularly in the use of diuretics (P<0.05). During the operation, the microtube-irrigated ablation catheter group had a significantly lower catheter temperature (P<0.001), greater energy (P<0.05), and greater decrease in impedance than the general ablation catheter group (P<0.05). No syncope or amaurosis caused by hypotension, or deterioration of renal function occurred in either group. Conclusion 5 F microtube-irrigated ablation catheter is a safe and effective device during renal artery ablation. It has more advantages than general ablation catheter in reducing SBP and diuretic use in the treatment of resistant hypertension.

Abstract:Objective To investigate the effect of different organ metastases on clinical prognosis in patients with small cell lung cancer (SCLC). Methods A total of 10 347 SCLC patients with distant metastases (M1) obtained from the surveillance, epidemiology, and end results (SEER) database between 2010 and 2013 were enrolled in this study. The median duration of follow-up was 4 months and the median age was 67 years. According to metastatic sites, the patients were divided into six groups:bone metastasis group, brain metastasis group, liver metastasis group, lung metastasis group, none group (no metastasis found in the bone, brain, liver or lung) and multi-organ metastasis (MOM) group (2 or more organ metastases found in the bone, brain, liver or lung). The effects of different organ metastases on clinical prognosis in SCLC patients were analyzed. Results MOM was the most common pathway of metastasis, accounting for 32.8% (3 396/10 347), followed by liver metastasis (19.0%, 1 971/10 347), brain metastasis (12.1%, 1 251/10 347) and bone metastasis (10.0%, 1 033/10 347). The mortality rates associated with bone, brain, liver and lung metastases and MOM were 77.2% (797/1 033), 74.1% (927/1 251), 82.4% (1 625/1 971), 73.4% (504/687), and 81.6% (2 770/3 396), respectively. Compared with the none group, the MOM and liver metastasis groups had higher hazard ratio (HR) (95% confidence interval[CI] of 1.80 (1.66-1.96) and 1.69 (1.54-1.85), respectively, followed by bone and brain metastasis groups with HR (95% CI) of 1.24 (1.12-1.39) and 1.28 (1.16-1.42) (all P<0.001). Lung metastasis group had a lowest HR (95% CI) of 1.07 (0.95-1.21) (P=0.27). Conclusion MOM and liver metastases are associated with the worst prognosis and the highest mortality in SCLC patients, followed by bone, brain and lung metastases. Therefore, for the SCLC patients with distant metastasis, different treatments should be carried out according to involved organs, and treatment should be strengthened in patients with liver metastasis and MOM.

Abstract:Objective: To explore the clinical application of appropriate examination technology in precision laboratory diagnosis by testing whether there were intestinal fluid and intestinal contents in abdominal drainage fluid. Methods: Integrated common, simple, rapid and effective testing items to carry out precision laboratory diagnosis. First, the abdominal drainage liquid was mixed well and observed its appearance, then the specimen was centrifuged and separated the supernatant to detect the concentration of amylase and bile acid. The sediment was either taken for direct microscopic examination or prepared as dry slices for Gram dyeing. Finally, we draw a conclusion about whether there were intestinal contents based on the following results and other laboratory results.Results: Routine examination and morphology of the abdominal drainage fluid: the appearance was brown and turbid,Protein qualitative examination: positive (+++), cell lysis fragments was observed and thus the number of cells could not be counted. Microscopic results: Cells were lysed, a large number of bacteria and a small number of cocci were observed. Besides, there were also bilirubin crystals and lipid droplets. Biochemistry results: Amylase 1120U/L, bile acid 25μmol/L. Both the content of amylase and bile acid were 5 times to the patient’s own serum level respectively. Sediment results：The plant cells and plant fibers were found. Conclusion: The detection of plant cells, plant fibers in the wet sediment of drainage fluid is the basis for morphological diagnosis of intestinal contents in the drainage fluid.The results of amylase and bile acid in the drainage fluid were five times higher than those in the patient's own serum control, which was the basis for biochemical diagnosis of intestinal fluid. Therefore, the abdominal drainage fluid could be distinguished from intestinal fluid and intestinal contents by the above multi-parameter appropriate examination technology and results analysis.

Abstract:Object：To evaluated the surgical skill and safy of laparoscopic heminephrectomy in patients with duplex kidneys. Methods: From 2015 to 2018, five unilateral laparoscopic heminephrectomy were performed by single surgeon in our center. All patients were diagnosed as duplex kidney by enhanced CTU.Patients' characteristics, surgical skills, operative time, and blood loss, intestinal recovery time, length of hospital stay were all collected retrospectively. Results: All five patients were successful completed. Mean operative time was 152±32.7min（110-200min），intestinal recovery time was 2±1.1 days（1-3 day）. Mean hospital stay was 7±1.1day（5-8 days）. On mean follow-up of 6-32 months, B ultrasonography and renal function indicated that the residual kidney was normal. Conclusion: The technique of laparoscopic heminephrectomy with duplex kidneys is safe and reliable. Seperation of renal hilum vessels is the key to protect the renal function. The key to prevent the recurrence of urinary cysts is complete removal of pelvic mucosa.

Abstract:Objective Discussion on the application value of a cooling module of paraffin section in pathological section.Methods Random selection of 100 paraffin blocks, the pathology technicians first roughed 100 wax pieces and then set them aside. The 100 pieces of wax were respectively sliced up and cooled with ice block made by themselves, frozen table and cooling module. The sections were successively divided into group A, group B and group C, and dyed according to the same program. The scores of the three indexes, such as thickness uniformity, no wrinkles and no crack, were evaluated by a 10-point scale, respectively.The three groups were compared with each other. The differences between the 3 groups of slices in timeliness（carry on 10 tests）and capital input were also analyzed. Results ①There were statistically significant differences in the scores of thickness uniformity, no wrinkles and no crack index(P＜0.01) between group A and group B. There was significant difference in the score of no wrinkle index(P＜0.01) while there were no significant difference in the scores of thickness uniformity or no crack index (P＞0.05)between group A and C.There were statistically significant differences in the scores of thickness uniformity, no wrinkles and no crack index(P＜0.01) between group B and group C. ② Group A slices took 65.30±1.44 minutes, group B slices took 79.80±1.95 minutes, and group C slices took 62.50±2.17 minutes. The difference between group A and B was statistically significant(t=5.977，P＜0.01). The difference between group B and C was statistically significant(t=5.930，P＜0.01). There was no statistical difference between group A and C (t=1.007,P＞0.05).③The cost of group B in six years was about 7000 yuan.The cost of group A that the ice made by themselves in six years was about 3500 yuan for a refrigerator, a stainless steel plate, and water. The cost of paraffin section cooling module of group C was the same as that of group A, less than that of group B. Conclusion In the process of pathological routine paraffin section, the cooling module of paraffin section was used to slice the wax block after cooling, which had the advantages of good slice quality, high efficiency, simple operation and so on, which was worthy of recommendation.

Abstract: