Abstract:Endometriosis (EM) is an estrogen-dependent neuroinflammatory disease, which leads to chronic pelvic pain, ovarian cysts and infertility seriously affecting women's quality of life. Traditional Chinese medicine (TCM) believes that blood stasis is the core pathogenesis of EM, with complex syndrome types and diverse treatment plans, but lack of norms and standards. Modern medicine believes that uncontrollable inflammation and adhesion are the pathological processes of EM, but there is a lack of sensitive non-invasive diagnostic markers and ideal treatment methods. EM is a chronic disease, which needs long-term management. Clinical diagnosis should be emphasized in the process of diagnosis and treatment of EM to avoid diagnosis delay. At the same time, attentions should be paid to the standardized treatment of TCM, with early intervention and early use, so as to actively improve the status and clinical utilization rate of TCM in the treatment of EM.

Abstract:Objective To evaluate the demographic distribution and clinical comorbidities of kidney stone patients and explore the related factors, so as to provide evidence for clinical prevention and treatment. Methods A retrospective analysis was conducted in 10 140 patients who were diagnosed with kidney stones in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) between Jan. 2017 and Dec. 2020. The patients were divided into unilateral kidney stone group (unilateral group) and bilateral kidney stone group (bilateral group). The age, sex distribution, laboratory examination, and common clinical comorbidities were compared between the 2 groups. Logistic regression was used to explore the related factors that may affect the formation of bilateral kidney stones. Results The mean age of the 10 140 patients was (57.75±13.30) years old, with 276 cases (2.7%) ≤ 30 years old, 6 647 cases (65.6%) 31-64 years old, and 3 217 cases (31.7%) ≥ 65 years old. There were 7 021 males (69.3%) and 3 119 females (30.7%), with a male to female ratio of 2.25:1. The most common clinical complications of the patients in this study included hypertension (3 285 cases, 32.4%), tumor (2 775 cases, 27.4%), hyperuricemia (2 007 cases, 19.8%), diabetes mellitus (1 526 cases, 15.0%), coronary heart disease (1 072 cases,10.6%), and cerebrovascular disease (473 cases, 4.7%). Totally 8 171 patients (80.6%) were in the unilateral group and 1 969 patients (19.4%) in the bilateral group. The age of bilateral group was younger than that of unilateral group, the proportion of male was higher than that of unilateral group, the levels of serum creatinine, uric acid and urine pH were higher than those of unilateral group, the level of high density lipoprotein-cholesterol was lower than that of unilateral group, the proportions of patients with hypertension and hyperuricemia were higher than those of unilateral group, and the proportions of patients with tumor and coronary heart disease were lower than those of unilateral group (all P<0.05). There were no significant differences in body mass index, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein-cholesterol or the proportion of patients with diabetes or cerebrovascular diseases between the 2 groups (all P>0.05). The results of logistic regression analysis showed that gender (male) and hyperuricemia might be important risk factors for the formation of bilateral kidney stones; however, more patients combined with tumors were seen in the unilateral group (all P<0.05). Conclusion Kidney stones are more common in middle-aged men, and metabolic syndrome-related diseases play an important role in the development of kidney stones, so it is necessary to strengthen the early prevention of these diseases. The incidence of tumor combination is high in patients with kidney stones, suggesting an association between the 2 conditions. In addition, male sex and hyperuricemia are more closely related to the formation of bilateral kidney stones.

Abstract:Objective To analyze the differential expression levels of plasma microRNAs (miRNAs) in prostate cancer patients, and to investigate the potential of combined plasma miRNA detection in the diagnosis of prostate cancer. Methods The Gene Expression Omnibus database was used to screen out the differentially expressed miRNAs in prostate cancer plasma or serum, and 3 miRNAs with the highest weights were screened out by using nearest centroid classifier for area under curve optimization (NCC-AUC) method. A total of 45 plasma samples from patients with prostate cancer (prostate cancer group), 40 from patients with chronic prostatitis (prostatitis group) and 42 from healthy physical examination participants (healthy control group) were collected from Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. The expression levels of candidate plasma miRNAs were verified by quantitative polymerase chain reaction. The diagnostic value of candidate miRNAs and combined miRNAs for prostate cancer was analyzed by receiver operating characteristic (ROC) curve. Results A total of 26 differentially expressed miRNAs related to prostate cancer were obtained by bioinformatics analysis, and 3 miRNAs (miRNA-21-5p, miRNA-5189-5p, and miRNA-6780a-5p) with the highest weights in NCC-AUC mode were included for the clinical validation stage. Clinical verification results showed that the expression level of plasma miRNA-21-5p was increased successively in the healthy control group, prostatitis group and prostate cancer group, and the differences between the 3 groups were statistically significant (P<0.01). The expression level of plasma miRNA-5189-5p in the prostatitis group was significantly lower than that in the prostate cancer group and healthy control group (both P<0.01). The expression level of plasma miRNA-6780a-5p in the prostate cancer group was significantly higher than that in the prostatitis group and healthy control group (both P<0.01). ROC curve showed that both plasma miRNA-21-5p and miRNA-6780a-5p had excellent diagnostic potential for prostate cancer (both P<0.001); the values of area under curve (AUC) were 0.695 and 0.787, sensitivities were 95.6% and 64.4%, and specificities were 41.5% and 81.7%, respectively. The combination of miRNA-21-5p and miRNA-6780a-5p could improve the diagnostic efficiency, with an AUC of 0.830, a sensitivity of 82.2%, and a specificity of 74.4%. Conclusion Plasma miRNA-21-5p and miRNA-6780a-5p are both potential diagnostic markers for prostate cancer, and the combined detection of both can improve the diagnostic efficacy.

Abstract:Objective To summarize the experience of hemostatic gauze packing in the treatment of uncontrollable massive hemorrhage during hepatectomy. Methods The clinical data of 120 patients who underwent complicated hepatectomy with hemostatic gauze packing in The Third Affiliated Hospital of Naval Medical University (Second Military Medical University) from Nov. 2011 to May 2021 were retrospectively analyzed, and the in-hospital mortality was calculated. The patients were divided into non-death group and death group according to the occurrence of in-hospital death. The differences of blood routine, coagulation function, liver function and other indexes were compared between the 2 groups before and after operation. Multivariate logistic regression model was used to analyze the influencing factors of in-hospital death. Results Only 10 patients died in hospital, with a mortality of 8.33%. Patients were divided into non-death group (n=110) and death group (n=10). The albumin, red blood cells, hemoglobin, platelets, and γ-glutamyl transpeptidase of the patients in the death group were lower than those in the non-death group on the 1^st day after operation, and the creatinine, international normalized ratio (INR), prothrombin time (PT) and activated partial thromboplastin time (APTT) were higher than those in the non-death group on the 1^st day after operation (all P<0.05). Multivariate logistic regression analysis showed that the patient's age, PT and APTT on the 1^st day after operation were independent influencing factors for in-hospital death. Conclusion Hemostatic gauze packing has a significant effect for the treatment of massive hepatic hemorrhage during hepatectomy, and the operation technique is simple. It is a practical and effective method of hemostasis and is worthy of clinical promotion.

Abstract:Objective To conduct a comprehensive analysis on the reproductive toxicity of sodium-glucose co-transporter 2 (SGLT2) inhibitors and to uncover the potential signals based on the US Food and Drug Administration Adverse Event Reporting System (FAERS), hoping to provide references for rational clinical drug use. Methods We selected the data from the first quarter of 2013 to the second quarter of 2021 in FAERS to conduct disproportionality analysis. Two approaches, based on statistical shrinkage transform, reported odds ratio (ROR) and information component (IC), were used to evaluate the correlation between SGLT2 inhibitors and reproductive adverse events (AEs). Based on the important medical event (IME) list, we screened the IMEs of reproduction. The definition of AEs and IMEs relied on the preferred terms by the Medical Dictionary for Regulatory Activities (MedDRA) version 24.0. The clinical characteristics of patients, prognosis, signal detection results and time to onset (TTO) for specified AEs were analyzed. Results A total of 2 700 records of reproductive AEs were associated with SGLT2 inhibitors, with "primary suspect" and "secondary suspect" used as filters. In general, males were more prone to reproductive AEs, with a much higher proportion than females (57.59%[1 555/2 700]vs 35.70%[964/2 700]). Monotherapy (IC₀₂₅:1.40; ROR₀₂₅:2.65) was associated with a higher strength of reproductive AEs than the combination (IC₀₂₅:1.21; ROR₀₂₅:2.37). In monotherapy, a total of 56 signals were detected, with 8 strong signals and 13 IMEs. The common reproductive AEs included Fournier's gangrene, genital infection fungal, and balanoposthitis. There were 10 IMEs which were not mentioned in the instructions, including male external genital cellulitis, breast cancer, and penile cancer. Conclusion In addition to the known reproductive AEs, there remain other important reproductive signals of SGLT2 inhibitors. The reproductive toxicity varies among SGLT2 inhibitors, and clinicians should be reminded to fully consider the risk-benefit balance and prioritize IMEs for surveillance.

Abstract:Objective To explore the role of the E-mental health service platform "mood thermometer" in the recognition, diagnosis and treatment of depression disorders in community setting. Methods Mood thermometer application (App) is an online autonomous screening and auxiliary diagnosis system. A total of 700 outpatients from 2 community health service centers in Hongkou District of Shanghai were evaluated with the self-designed questionnaire, patient health questionnaire-9 (PHQ) and the mini-international neuropsychiatric interview (MINI), which had been set in the App for detection of depression disorder. Subsequent offline diagnosis and treatment of the patients were followed up 3 months later. Results The recognition rate of depressive symptoms was 14.86% (104/700) as detected by PHQ-9, and the detection rate of depressive disorder was 7.86% (55/700) as detected by MINI. Among the 55 patients with depression, 46 had unipolar depression, 8 had bipolar depression, and 1 had dysthymia. Of the 46 patients with unipolar depression, 8 were previously diagnosed, and 1 of the 8 patients with bipolar depression was previously diagnosed with depression, with a clinical diagnosis rate of 1.29% (9/700). The detection rate of MINI for depressive disorder was 6.57% higher than the clinical diagnosis rate. The treatment rate of patients with depression disorder was 16.36% (9/55) at baseline and increased by 10.91% (6/55) 3 months later, with the diagnosis and treatment rate increased to 27.27% (15/55). Conclusion The E-mental health platform in the community screening and diagnosis evaluation can not only improve the detection rate of depression disorder, but also promote the subsequent actual clinical diagnosis and treatment rate. E-mental health assessment should be integrated in the primary health care services to promote early diagnosis and effective treatment of depression disorder.

Abstract:Objective To study the differences in contrast vision of subjects with different visions under different simulated flight luminous environments, so as to provide experimental basis for flight safety. Methods Twenty-four subjects were recruited and divided into 1.0/1.0, 0.8/0.8, 0.6/0.6 and 0.4/0.4 (decimal vision) groups by measuring binocular vision, with 6 subjects in each group. Each subject was tested for 100%, 80%, 60%, 40%, 20% and 10% contrast visions in simulated luminous environments of sunlight, facing light, backlight, twilight and on-cloud light. Using a 3-factor design analysis of variance with 2 repeated measurement factors, we compared the effects of different luminous environments on the contrast vision of people with different visions. Results There were interactions among the 3 factors (luminous environment, vision, and contrast) (P<0.05). A further 2-factor interaction test showed that there were interactions between luminous environment and vision and between contrast and vision (both P<0.01), but there was no interaction between luminous environment and contrast (P>0.05). At the same contrast, compared with the sunlight environment, the contrast vision of twilight and on-cloud light was decreased in each vision group (all P<0.05). For 80%, 60% and 40% contrast, the contrast visions of the 0.6/0.6 and 0.4/0.4 groups in the facing light environment were lower than those in the sunlight environment (all P<0.05). For the contrast of 20% and 10%, the contrast vision of each vision group in the facing light environment was worse than that in the sunlight environment (all P<0.05). Compared with the 1.0/1.0 group for the same contrast, the contrast visions of the 0.6/0.6 and 0.4/0.4 groups were decreased in the 5 simulated luminous environments (all P<0.05). For 20% and 10% contrast, the contrast visions of the 0.8/0.8 group were lower than those of the 1.0/1.0 group in sunlight, facing light, twilight and on-cloud light (all P<0.05). For the same light environment and contrast, the contrast vision of the 0.4/0.4 group was worse than those of the other vision groups (all P<0.05). Conclusion The effects of the luminous environment, contrast and vision on contrast visual acuity interact with each other. When myopic flight personnel observe low-contrast targets in unfavorable luminous environments (such as facing light, on-cloud light, and twilight), their contrast vision is severely decreased, posing a potential threat to flight safety. Attention should be paid to the contrast vision examination of myopic flight personnel.

Abstract:Objective To observe the protective effect of rutin on a rat model of decompression sickness (DCS). Methods Eighty rats were randomly divided into normal control group (n=12), DCS group (n=34), and rutin+DCS group (n=34). An air-pressurized simulated diving method was used to establish a rat DCS model. The incidence and onset time of DCS, pathological changes of spinal cord and lung tissues, content of inflammation factors and oxidative stress index in spinal cord tissues, lung wet/dry ratio and protein content in alveolar lavage fluid were compared among the 3 groups to evaluate the effect of rutin on DCS injury in rats. Results The incidence of DCS in DCS group was 47.06% (16/34), the incidence of DCS in rutin+DCS group (26.47%, 9/34) was decreased compared with DCS group, but with no statistical difference (P=0.078). The DCS onset time in rutin+DCS group was (9.53±1.88) min, which was significantly delayed compared with DCS group ([6.27±2.64]min) (P<0.05). Compared with normal control group, the contents of tumor necrosis factor α, interleukin 1β and malondialdehyde in spinal cord tissues, the protein content in alveolar lavage fluid, and lung wet/dry ratio in DCS group were significantly increased (all P<0.05); and compared with DCS group, the above indexes were decreased in rutin+DCS group (all P<0.05). Rutin treatment also alleviated the pathological changes of lung tissues in DCS model rats. Conclusion Rutin treatment can improve DCS injuries in rats, and has a good protective effect on model rats.

Abstract:Objective To explore the effect of long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1) expression on the proliferation and pathology of osteosarcoma implanted subcutaneously in nude mice. Methods The osteosarcoma U2OS cell line with stable low expression of MALAT-1 was constructed by lentivirus infection, and the expression of MALAT-1 was verified by quantitative real-time polymerase chain reaction (qPCR). Twelve male nude mice aged 4-6 weeks were randomly divided into experimental group and control group. Osteosarcoma U2OS cells with stable low expression of MALAT-1 were implanted subcutaneously in the experimental group, while osteosarcoma U2OS cells infected by empty lentivirus were implanted subcutaneously in the control group. The volumes of subcutaneous osteosarcoma were measured and recorded on the 3^rd, 6^th, 9^th, 12^th, 15^th, 18^th and 21^st days after implantation. On the 21^st day after tumor transplantation, the nude mice were sacrificed. The osteosarcoma was taken out completely and weighed. The microscopic morphology of the osteosarcoma tissue was observed with hematoxylin-eosin (H-E) staining, and the expression levels of proliferacting cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry. Results Compared with the control group, the tumors in the experimental group grew slower and had smaller volume and weight on the 21^st day after implantation (both P<0.01). H-E staining showed that there was increased matrix composition and decreased cell density in the tumors of the experimental group. Immunohistochemistry showed that PCNA expression was decreased in the tumors of the experimental group (P<0.05). In the experimental group, the median integral optical density (IOD) of PCNA positive staining was 8 531.03, and the expression rate of positive cells was 29.3% (1 758/6 000). In the control group, the median IOD was 27 548.23, and the positive cell expression rate was 56.5% (3 392/6 000). There was no significant difference in the expression of VEGF between the experimental group and the control group (P>0.05). In the experimental group, the IOD of VEGF positive staining was 18 179.490±18 299.433, and the expression rate of positive cells was 51.0% (3 063/6 000). In the control group, the IOD was 15 850.632±9 341.063, and the positive cell expression rate was 50.0% (3 001/6 000). Conclusion Inhibiting the expression of MALAT-1 in osteosarcoma can slow down tumor growth, reduce tumor invasiveness, and promote tumor cell necrosis in solid tumors.

Abstract:Objective To study the effects of Dangshen Yuanzhi powder microemulsion on apoptosis of hippocampal neurons in mice with cortical dementia induced by D-galactose and sodium nitrite based on the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signal pathway. Methods Sixty ICR mice were randomly divided into 6 groups:normal group, model group, biocompatible microemulsion group, piracetam group, low-dose group of Dangshen Yuanzhi powder microemulsion, and high-dose group of Dangshen Yuanzhi powder microemulsion, with 10 mice in each group. Except for the normal group, the other 5 groups were intraperitoneally injected with D-galactose (120 mg/kg) and sodium nitrite (54 mg/kg) to establish mouse models of cortical dementia. Distilled water, biocompatible microemulsion (10 mL/kg), piracetam (0.63 g/kg), low- and high-doses of Dangshen Yuanzhi powder microemulsion (equivalent to 8.58 g/kg and 17.16 g/kg of raw medicine) were given by gavage, once a day for 6 weeks. Memory ability was examined by Morris water maze test, pathomorphological changes were observed by hematoxylin-eosin staining, the changes of Nissl bodies of neurons in the hippocampal cortex were observed by Nissl staining, the expression of PI3K, Akt and mTOR in the hippocampal cortex was observed by immunohistochemistry, and the expression of doublecortin (DCX) and the growth of newborn neurons in hippocampal cortex were observed by immunofluorescence. Results Compared with the model group, the learning and memory ability of mice with cortical dementia was significantly improved in the low- and high-dose groups of Dangshen Yuanzhi powder microemulsion, the pathological morphology of the hippocampal cortex was obviously improved, the neurons were round and dense, the contents of Nissl bodies of neurons were abundant, the expression of PI3K, Akt and mTOR was significantly decreased, the expression of DCX was significantly increased, the distribution of newborn neurons was dense, and extended synapse was increased. Conclusion Low- and high-doses of Dangshen Yuanzhi powder microemulsion can induce autophagy by inhibiting PI3K/Akt/mTOR signaling pathway, reduce neuronal damage, induce neuronal regeneration, and improve learning and memory ability in mice with cortical dementia induced by D-galactose and sodium nitrite. Considering efficacy and toxicity, low-dose (the clinical equivalent dose) of Dangshen Yuanzhi powder microemulsion should be selected.

Abstract:Objective To investigate the effect of Huanglian Huazhuo capsule on diabetic macrovascular disease by regulating peroxisome proliferator-activated receptor γ (PPARγ)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akte) pathway based on histone acetyltransferase (HAT)/histone deacetylase (HDAC) balance. Methods Forty apolipoprotein E (ApoE) gene deleted mice were randomly divided into model group, atorvastatin group, Huanglian Huazhuo capsule group, and atorvastatin+Huanglian Huazhuo capsule group, with 10 in each group. Ten wild-type C57 mice were included in the blank group. The mice in the atorvastatin group were gavaged with atorvastatin at a dose of 10 mg/kg, the mice in the Huanglian Huazhuo capsule group were gavaged with Huanglian Huazhuo capsule aqueous solution at a dose of 0.675 g/kg, the mice in the atorvastatin+Huanglian Huazhuo group were gavaged with atorvastatin at a dose of 10 mg/kg and Huanglian Huazhuo capsule aqueous solution at a dose of 0.675 g/kg, and the mice in the blank group and model group were gavaged with normal saline at the same dose, once daily for 8 weeks. Mouse thoracic aortic smooth muscle cells were collected and divided into blank group, human oxidized low density lipoprotein (ox-LDL) group, ox-LDL+PPARγ silent group, and ox-LDL+PPARγ overexpression group. The blank group was cultured with blank serum, and the other 3 groups were treated with 100 μg/mL ox-LDL, and co-cultured with serum containing 200 μg/mL Huanglian Huazhuo capsule. The ox-LDL+PPARγ silent group was transfected with PPARγ small interfering RNA, and ox-LDL+PPARγ overexpression group was transfected with PPARγ plasmid. Automatic biochemical analyzer was used to detect the blood glucose and blood lipid levels of mice, hematoxylin-eosin staining was used to observe the pathological morphology of mice thoracic aorta, flow cytometry was used to detect the apoptosis rate of smooth muscle cells, and Western blotting and quantitative ploymerase chain reaction were used to detect the protein and mRNA expression of HAT1, HDAC1, PPARγ, PI3K and Akt. Results Compared with the model group, the contents of postprandial blood glucose (PBG), total cholesterol (TC), triglyceride (TG) and low density lipoprotein-cholesterol (LDL-C) of mice in the atorvastatin group, Huanglian Huazhuo capsule group and atorvastatin+Huanglian Huazhuo capsule group were significantly decreased, while the contents of high density lipoprotein-cholesterol (HDL-C) were significantly increased (all P<0.05). Compared with the model group, the inner wall disorder was improved in the atorvastatin group and Huanglian Huazhuo capsule group, and a small number of foam cells were observed. The inner wall of thoracic aorta had the most significant improvement in the atorvastatin+Huanglian Huazhuo capsule group. The apoptosis rate of smooth muscle cells in the ox-LDL+PPARγ silent group was significantly lower than those in the ox-LDL group and ox-LDL+PPARγ overexpression group (both P<0.05). Compared with the ox-LDL group, the expression of HAT1 protein and mRNA in smooth muscle cells of the ox-LDL+PPARγ silent group was significantly increased, while the expression of HDAC1, PPARγ, PI3K and Akt protein and mRNA was significantly decreased (all P<0.05). Compared with the ox-LDL+PPARγ silent group, the expression of HAT1 protein and mRNA in smooth muscle cells of ox-LDL+PPARγ overexpression group was significantly decreased, while the expression of HDAC1, PPARγ, PI3K, Akt protein and mRNA was significantly increased (all P<0.05). Conclusion Huanglian Huazhuo capsule can improve the expression of HDAC1 and the activation of PPARγ/PI3K/Akt pathway by inhibiting the expression of HAT, inhibit the metabolic disorder of mice with diabetic macrovascular disease, increase the apoptosis of smooth muscle cells, and reduce the formation of arterial plaque, displaying a protective role.

Abstract:Primary liver cancer is one of the most common malignant tumors in China, with high incidence and mortality, and the main pathological type is hepatocellular carcinoma (HCC). Most patients with HCC are already at the advanced stages at the first diagnosis, with the 5-year survival rate being less than 16%. Early detection and early diagnosis of liver cancer can help improve the prognosis of patients. Blood testing is commonly used to screen patients with high risks of liver cancer because it is minimally invasive, objective, economical, repeatable and easy to monitored. This article summarized 3 types of reported indicators for blood screening of liver cancer:biomarkers that could be directly detected in the serum, biomarkers in the cargoes transferred by extracellular vesicles, and biomarkers in circulating tumor cells. The advantages and limitations of each category were discussed. We also provided perspectives for the promising strategies of blood testing for HCC screening and diagnosis in future.

Abstract:The liver is an important organ that helps to maintain metabolism and detoxification function in the human body. Orthotropic liver transplantation (OLT) is recognized as the first therapeutic option for patients with end-stage liver disease or liver failure caused by acute or chronic liver failure or genetic defect. Hepatocyte transplantation, however, gradually emerges as a possible strategy to overcome the limitations of OLT, especially the lack of organ donors. To date, the feasibility of hepatocyte transplantation has been confirmed in various animal models, and clinical observations have demonstrated encouraging results in promoting liver regeneration or reducing liver fibrosis by autologous cell transplantation. This paper reviews the main clinical indications of hepatocyte transplantation, and focuses on obstacles and breakthroughs in new cell sources and transplantation technique in order to boost related research in this field, leading to wider application in clinic and providing fundamental solutions for the shortage of donor organs.

Abstract:In recent years, digital twin as an emerging artificial intelligence technology has provided greater potential prospects for precision medicine. Digital twin can build virtual entities by using comprehensive data information of entities, and improve the accuracy of classification and prediction models through the dynamic connection between entities and virtual entities. At present, the application of digital twin in precision medicine not only includes the treatment of specialized diseases, but also includes the health management of entire life cycle of all population. However, most applications are at the stage of technical model design and the validation of single-center data, and greater potential value need to be developed. This paper summarizes the research progress and challenges of digital twin application in precision medicine, so as to provide directions for overcoming the technical bottleneck, expanding the application field, accelerating the implementation of application, and strengthening laws and regulations.

Abstract:The damage caused by combat is complex and extensive, and the deep organs and tissue are usually implicated. Some of these wounded patients have hemorrhagic shock and are in critical condition. The damage control surgery is necessary, while the anesthesia management is challenging. This article introduces the anesthesia methods and anesthetics for damage control surgery of combat wounds, focuses on airway management (including airway evaluation, difficult airway management, as well as measures for suspected cervical spine injury and inhalation injury), and discusses the difficulties such as permissive hypotension, transfusion and lethal triad, which provides a reference for guiding the implementation of anesthesia and improving the treatment for damage control surgery in combat field.

Abstract:Objective To analyze the epidemiological characteristics and risk factors of kidney stones and crystals in warship officers and soldiers. Methods The original data of the physical examination report of officers and soldiers of a warship force in 2021 were collected, including general information, physical examination results, ultrasound, blood and urine test results, etc. In the meantime, the training environment and living habits were investigated. Then, the prevalence and risk factors of kidney stones and crystals of officers and soldiers were analyzed. Results Among the 1 315 officers and soldiers, the total prevalence of kidney stones and crystals was 6.92% (91/1 315). The prevalence of kidney stones and crystals increased with age, length of military service and length of on board (all P<0.01). Among the patients with kidney stones/crystals, 32.97% (30/91) were overweight, which was significantly higher than those without kidney stones/crystals (17.04%[204/1 197], P<0.01). The proportion of water intake more than 2 000 mL/d and the proportion of drinking milk in the kidney stone/crystal group were lower than those in the non-kidney stone/crystal group (20.45%[18/88] vs 30.24%[362/1 197], 82.95%[73/88] vs 90.64%[1 085/1 197], both P<0.05). There were no significant differences in the training environment, water source, beverages intake, serum uric acid level or urine osmotic pressure between the 2 groups (all P>0.05). Multivariate logistic regression analysis showed that older age and overweight were the independent risk factors for kidney stones/crystals in warship officers and soldiers, while water and milk intake were the protective factors (all P<0.05). Conclusion The prevalence of kidney stones and crystals in warship officers and soldiers is relatively high, which is related to older age, overweight and less water and milk intake.

Abstract:Objective To investigate the sleep quality, positive mental health and their relationship in naval officers and soldiers during late long-time escort. Methods A total of 154 escort officers and soldiers were selected from a naval fleet by random cluster sampling method. The Pittsburgh sleep quality index (PSQI) and mental health continuum short form (MHC-SF) for adult were used for questionnaire survey on the 180th day of the long-distance navigation. Results A total of 152 valid questionnaires were collected. On the 180th day of the long-distance navigation, the total score of PSQI (7.16±3.47) was significantly higher than the military norm (5.41±3.09, P<0.01), and 46.71% (71/152) of the officers and soldiers suffered from poor sleep quality (the total score of PSQI>7). The total score of MHC-SF was 3.57±0.99, the score of social well-being dimension was 3.59±1.07, and the score of psychological well-being dimension was 3.71±1.06, which were all significantly higher than the national norm (3.24±1.00, 3.14±1.20, 3.44±1.10, all P<0.01). The total score of PSQI of escort officers and soldiers was negatively correlated with the total score of MHC-SF and the scores of emotional well-being, social well-being and psychological well-being dimensions of MHC-SF (r=-0.34, -0.40, -0.32, -0.28, all P<0.01). Conclusion During the late long-time escort, nearly half of the escort officers and soldiers have sleep problems, while the overall positive mental health is well and the sense of well-being is high. Sleep problems adversely affect the positive mental health of officers and soldiers.

Abstract:Objective To compare the difference of sleep quality between naval coast servicemen and servicemen stationed on island. Methods A random sample of 440 naval coast servicemen and 439 servicemen stationed on island was surveyed for sleep quality using self-designed demographic questionnaire and Pittsburgh sleep quality index (PSQI). Results A total of 421 valid questionnaires were collected from coast servicemen, with an effective rate of 95.7%; 424 valid questionnaires were collected from servicemen stationed on island, with an effective rate of 96.6%. After propensity score matching, there were significant differences in sleep duration, sleep efficiency, sleep disorders and PSQI total scores between 319 coast servicemen and 319 servicemen stationed on island (all P<0.05). After controlling for general demographic factors (gender, age, and marital status), it was found that the higher the education level was, the worse the sleep quality was (β=0.123, P<0.01), and servicemen stationed on island had worse sleep quality than coast servicemen (β=-0.095, P<0.05). Conclusion Sleep quality of servicemen stationed on island is worse than that of coast servicemen. Sleep hygiene education should be enhanced for military personnel in special positions to improve their sleep quality.

Abstract:Objective To explore the optimal concentration of ropivacaine in forearm surgery by ultrasound-guided 3-point injection of supraclavicular brachial plexus block. Methods A total of 64 patients with selective forearm surgery were enrolled, and all were anesthetized by the same anesthesiologist using ultrasound-guided supraclavicular brachial plexus block. The local anesthetic was 30 mL of ropivacaine, and 10 mL of ropivacaine was injected into the medial, upper and lateral sides of the supraclavicular brachial plexus by 3-point injection method, with the initial concentration of 0.50%. After anesthesia within 30 min, the blocked effect of 5 nerves (radial nerve, median nerve, ulnar nerve, lateral antebrachial cutaneous nerve, and medial cutaneous nerve) of the forearm was assessed. By sequential increase and decrease method, if all 5 nerves were completely blocked, the next case would reduce the concentration of ropivacaine by 0.05%. If one nerve block was incomplete or ineffective, the next case would increase ropivacaine concentration by 0.05%. The median effective concentration (EC₅₀) of ropivacaine was calculated by logistic analysis statistics. Results Sixty-four patients with forearm surgery underwent ultrasound-guided supraclavicular brachial plexus block. The basic vital indicators were maintained in the normal range before and after nerve block. The block anesthesia was effective in 34 cases and ineffective in 30 cases. The EC₅₀ of ropivacaine was 0.518% (95% confidence interval 0.496%-0.547%). Horner syndrome occurred in 2 patients, and no patients had complications such as pneumothorax, local anesthetic poisoning, vascular injury or dyspnea. Conclusion With 3-point injection method, the ropivacaine dose is 30 mL, and its optimal concentration is 0.518% in ultrasound-guided supraclavicular brachial plexus block.

Abstract:Objective To reclassify intramuscular hemangioma patients with the International Society for the Study of Vascular Anomalies (ISSVA) criteria, and compare the clinicopathological differences between different types. Methods Intramuscular hemangioma cases diagnosed using the World Health Organization (WHO) classification of soft tissue and bone tumors were collected from Oct. 2013 to May 2021 in The First Affiliated Hospital of Xinjiang Medical University and re-classified as hemangioma or vascular malformations with the ISSVA criteria. The clinicopathological characteristics were compared between the 2 groups. Results A total of 40 intramuscular vascular cases diagnosed using the WHO criteria were enrolled, including 4 hemangioma cases and 36 vascular malformation cases reclassified by the ISSVA criteria. The hemangioma cases were mainly female (1 male and 3 females) and were mainly in the head and neck region (4 cases all in the face). The patients with vascular malformations were mainly venous malformations (22 venous malformations, 1 arteriovenous malformation, and 13 mixed vascular malformations). The lesions were more commonly seen in the extremities, especially in the lower limbs (19 in the lower limbs, 10 in the upper limbs, 4 in the trunk, and 3 in the face). The pathological morphology of hemangioma was characterized by vascular proliferation with lobed distribution under the microscope, in which vascular endothelial cells were plump and mitosis could be seen. While the microscopic morphological features were correlated with the specific subtype of vascular malformations, venous malformations were characterized by thin-walled and dilated veins, occasionally accompanied by thrombosis and phleboliths. The thickness of blood vessels varied for arteriovenous malformations, with fibers and smooth muscles proliferating into surrounding stroma. For lymphatic malformations, the diameters of lymphatics differed and foci of lymphocytic cells could be seen in the stroma. There was no recurrence in hemangioma patients, and the recurrence rate was 22.2% (8/36) for vascular malformation cases during the follow-up from 9 months to 8 years. Conclusion It is suggested to reclassify intramuscular hemangiomas with the ISSVA criteria. The new classification (hemangioma and vascular malformation) has significant differences in lesion location, prognosis and pathological morphology.

Abstract:Objective To observe the effect of Siteng Fang on the count of circulating tumor cells (CTCs) in patients with gastric cancer, and to explore the modern cell biological mechanism of its detoxification effect. Methods From Sep. 2020 to Sep. 2021, 60 patients of stageⅠ-Ⅱ gastric cancer after radical surgery with clear pathological diagnosis in Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine were randomly divided into Siteng Fang group and control group according to the random number table method, with 30 cases in each group. The Siteng Fang group was treated by Siteng Fang+conventional treatment with traditional Chinese and Western medicine, and the control group was treated by conventional treatment with traditional Chinese and Western medicine. Peripheral blood was collected from both groups, and CTCs were isolated and enriched by immunomagnetic bead negative enrichment technique, combined with fluorescence in situ hybridization to detect and count CTCs, and CTCs ≥ 1/3.2 mL was defined as positive. Results The positive rate of CTC detection was 81.67% (49/60), including 90.00% (27/30) in the control group and 73.33% (22/30) in the Siteng Fang group. Siteng Fang reduced the CTC counts in patients after radical surgery of early gastric cancer (P<0.01). Conclusion Siteng Fang can reduce the number of CTCs in patients after radical surgery of gastric cancer, suggesting that Siteng Fang may have anti-metastasis effect on gastric cancer by inhibiting CTCs.