Abstract:Compared to the commonly used second-generation sequencing (NGS), long-read sequencing (LRS) is capable of continuously reading millions of base pairs. This article reviews the recent progress in the applications of single-molecule real-time sequencing technologies, Oxford nanopore sequencing technologies and novel single-molecule LRS technologies. LRS technologies facilitate the detection of genomic variations, including structural variations, copy number changes, gene fusions, etc. Moreover, LRS technologies provide an effective tool for profiling transcriptome and epigenetic modification. LRS can also solve part of the technical bottleneck of the NGS and help to reveal the complexity of biological macromolecule in health and disease conditions, which may provide a new theoretical basis for better understanding the mechanisms of carcinogenesis and malignant progression, subsequently leading to development of novel therapeutic strategies and drugs. Besides, this review outlines the potential advantages of the application of LRS in clinical practice of oncology.

Abstract:Objective To explore the effect of necroptosis inhibitor and polyethylene glycol with a molecular weight of 4 000 (PEG-4000) on the adhesion and deposition of calcium oxalate monohydrate (COM) on the surface of transformed C3H mouse kidney 1 (TCMK-1) cells. Methods TCMK-1 cells were separately treated with 400 or 800 μg/mL COM or pretreated with receptor-interacting serine/threonine-protein kinase (RIPK) 3 inhibitor GSK-872 before 400 or 800 μg/mL COM treatment. After incubation at 37 ℃ for 12 h, the crystal adhesion of TCMK-1 cells was observed under the phase inverted microscope. The cell proliferation activity was detected by cell counting kit 8 (CCK-8) method, the cell oxidative stress level was detected by 2’,7’-dichlorodihydrofluorescein diacetate (DCFH-DA) probe method, the expression of necroptosis-related proteins RIPK1, RIPK3, and phospho-mixed lineage kinase domain-like protein (p-MLKL) was detected by Western blotting, and the crystal adhesion of TCMK-1 cells was detected by inductively coupled plasma emission spectroscopy (ICP). TCMK-1 cells were divided into 3 groups and separately treated with 800 μg/mL COM, PEG-4000 solution followed by 800 μg/mL COM, or 800 μg/mL COM followed by PEG-4000 solution. After incubation at 37 ℃ for 12 h, the crystal adhesion of TCMK-1 cells was observed under the phase inverted microscope. The cell proliferation activity was detected by CCK-8 method, the oxidative stress level was detected by DCFH-DA probe method, and the surface crystal adhesion was detected by ICP method. Results At 400 μg/mL of COM, compared with the COM treated group, the GSK-872 pretreatment group showed a decrease in TCMK-1 cell crystal adhesion, an increase in cell proliferation activity (P＜0.05), and a decrease in oxidative stress level (P＜0.05). At 800 μg/mL of COM, the crystal adhesion of TCMK-1 cells in the GSK-872 pretreated group had no significant changes compared with the COM treated group, while the cell proliferation activity was increased (P＜0.05), the oxidative stress level was decreased (P＜0.05), and the expression of RIPK3 and p-MLKL was decreased (both P＜0.05). Compared with the COM treated group, the crystal adhesion of TCMK-1 cells in the PEG-4000 pretreated group was significantly decreased, with enhanced cell proliferation activity and decreased oxidative stress level (all P＜ 0.05). There were no significant changes in crystal adhesion, cell proliferation activity or oxidative stress levels between the PEG-4000 post-added group and the COM treated group (all P＞0.05). Conclusion Inhibition of necroptosis by GSK-872 can reduce the adhesion deposition of COM in cells to a certain extent, but the crystals can aggregate on the cell surface to form amorphous precipitates under high crystal load. The pre-application with PEG-4000 in the culture medium can maintain the suspension stability of COM micrograins in suspension, with less accumulation, adhesion, deposition of crystals and less oxidative stress damage of cells. Addition of PEG-4000 to TCMK-1 cells exposed to COM could not reverse the crystal adhesion, aggregation or deposition.

Abstract:Objective To construct a culture system of human gallbladder organoids, successfully culture them in vitro and identify their characteristics. Methods Human gallbladder epithelial cells were isolated and embedded in matrix glue using a 3-dimensional culture system for 3-dimensional culture. The area, perimeter and morphology were observed during the growth of gallbladder organoids and the form factor was calculated. The expression of the stemness markers (CD133 and leucine rich repeat containing G protein coupled receptor 5 ［LGR5］) and the bile duct epithelial cell markers (hepatocyte nuclear factor 1β ［HNF1β］, epithelial cell adhesion molecule ［EpCAM］, cytokeratin 7, cytokeratin 19, sex determining region Y box 9 ［SOX9］) of gallbladder organoids was detected by immunofluorescence staining. After adding small molecules CHIR-99021 and blebbistatin into the growth medium, 5-bromodeoxyuridinc (BrdU) incorporation assay was used to detect the proliferation characteristics of organoids. Results During the in vitro culture process of gallbladder organoids, the cell area was gradually increased, and there was a significant difference between the area on day 7 and day 1 (P＜0.01). The form factor was increased from 0.80 (0.75, 0.84) on day 1 to 0.83 (0.81, 0.85) on day 7 (P＜0.01), indicating that the organoids grew stably in vitro and tended to form a perfect circle. Immunofluorescence staining showed that the bile duct epithelial cell markers were expressed in organoids. After adding small molecules CHIR-99021 and blebbistatin into the medium, BrdU detection showed that the proliferation of the organoids was increased (P＜0.01). Conclusion Human gallbladder organoids with proliferative ability can be successfully cultured in vitro, and it has the characteristics of bile duct epithelial cells and can be used for the research and modeling of biliary diseases.

Abstract:Objective To investigate whether adoptive transfer of regulatory T cells (Treg cells) overexpressing Pellino-1 (Peli1) can repair the ovarian function of mice with autoimmune premature ovarian insufficiency (POI) and regulate its immune function. Methods The autoimmune POI mouse model was constructed using zona pellucida 3 peptide (pZP3), and the lentiviral vector overexpressing Peli1 (LV-Peli1) was constructed. Then LV-Peli1 was transfected into Treg cells, and finally the Treg cells overexpressing Peli1 were adoptively transferred into the model mice. The POI model mice were randomly divided into 4 groups (5 in each group), namely, LV-Peli1-POI group (Treg cells overexpressing Peli1 were adoptively transferred to POI mice), LV-POI group (Treg cells transfected with empty-vector lentivirus were adoptively transferred to POI mice), Treg-POI group (Treg cells without any treatment were adoptively transferred to POI mice) and POI model group (an equal volume of phosphate-buffered saline was injected into POI mice via the tail vein). Hematoxylin-eosin staining was used to observe the ovarian structures and follicle counts at various stages of mice in each group. Immunohistochemical staining was used to detect the levels of proliferation protein Ki-67 and CD3^＋ T lymphocytes in ovarian tissue, and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay was used to detect the apoptosis of granulosa cells in ovarian. Enzyme-linked immunosorbent assay was used to detect the expression levels of serum ovarian hormones follicle-stimulating hormone (FSH), estradial (E₂), and cellular immune factors interleukin 10 (IL-10) and transforming growth factor β (TGF-β) in mice in each group, so as to explore the effect of Peli1 overexpression on autoimmune POI. Results Compared with the LV-POI group, Treg-POI group and POI model group, the numbers of primordial follicles, primary follicles, secondary follicles and mature follicles were significantly increased, the expression of Ki-67 was significantly increased, the apoptosis of ovarian granulosa cells was significantly reduced, the expression level of FSH was decreased, and the expression level of E₂ was significanly increased in the LV-Peli1-POI group (P＜0.05, P＜0.01). The level of CD3^＋ T lymphocytes in the LV-Peli1-POI group was significantly decreased, and the expression levels of IL-10 and TGF-β were significantly increased (P＜0.05, P＜0.01). Conclusion Adoptive transfer of Treg cells overexpressing Peli1 can effectively promote the proliferation of POI ovarian granulosa cells of mice and inhibit their apoptosis. At the same time, it can improve the ovarian endocrine function and regulate immune function in POI mice, thereby producing a certain repairing effect on autoimmune POI.

Abstract:Objective To evaluate the in vitro anti-inflammatory activity of Jinyin Lidan capsule and study its anti-inflammatory spectrum-effect relation. Methods The lipopolysaccharide (LPS)-induced inflammation model of mouse mononuclear macrophages (RAW264.7 cells) was established, and the contents of nitric oxide (NO), tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in the supernatant of RAW264.7 cells were determined to evaluate the anti-inflammatory activity of Jinyin Lidan capsule. Different compatible samples of Jinyin Lidan capsules were prepared by uniform distribution design method, their fingerprints were established by high-performance liquid chromatography (HPLC), and their anti-inflammatory activity was determined. The inhibitory rates of NO, TNF-α and IL-6 in the supernatant were used as pharmacodynamic indexes, and the correlation between the anti-inflammatory spectrum and the common peak area was established by grey correlation analysis. Results The Jinyin Lidan capsule extract (0.25-1.00 mg/mL) reduced the secretion of NO, TNF-α and IL-6 in LPS-induced inflammatory RAW264.7 cells. Seven chromatographic peaks were identified by reference substance comparison, and they were neochlorogenic acid, chlorogenic acid, cryptochlorogenic acid, 1,3-dicaffeoylquinic acid, p-hydroxyacetophenone, naringin, and neohesperidin. The analysis results of anti-inflammatory spectrum-effect relation showed that 23 common peaks had a certain degree of anti-inflammatory contribution, and the correlation degree of peak 21 (naringin) and peak 23 (neohesperidin) with the 3 cellular inflammatory indicators (NO, TNF-α, and IL-6) was greater than 0.74. Conclusion The anti-inflammatory effect of Jinyin Lidan capsule is the result of the joint action of various components, and the results of our study can provide reference for the improvement of the substance basis and quality control of Jinyin Lidan capsule.

Abstract:Objective To verify the safety of a newly-developed helium-oxygen diving decompression table in a swine model and preliminarily explore a method for evaluating the safety of decompression profiles based on animal experimental results. Methods Simulated diving was performed in a purpose-built pressurized chamber for large animals. The diving profiles were verified every 6 m at regular operation depth and every 9 m at training and exceptional exposure depth by systematic stratified sampling according to the newly-developed helium-oxygen diving decompression table, and each profile was verified 4-6 times. The animal conditions during simulated diving and symptoms of decompression sickness (DCS) and bubbles flowing through the heart after depression were observed. Blood indicators related to endothelial injury, inflammatory response and oxidative stress levels were assessed. Results No symptoms of oxygen toxicity or DCS, or circulating bubbles were found in the animals exposed with all the 14 tested profiles. The inflammatory response indexes (interleukin 1β, tumor necrosis factor α), endothelial injury indexes (intercellular adhesion molecule 1, vascular cell adhesion molecule 1) and oxidative stress index (H₂O₂) were compared before simulated diving and immediately (0 h), 6 h and 24 h after decompression, and there were no significant differences (all P＞0.05). Conclusion As far as the swine model is concerned, the newly-developed helium-oxygen diving decompression table has excellent safety. More data are needed to verify the preliminary experimental method for evaluating the safety of diving decompression table.

Abstract:Objective To evaluate the microsurgical treatment of anterior clinoidal meningiomas (ACMs) and the early visual acuity recovery in ACM patients after surgery. Methods A retrospective review was performed on 64 patients with ACMs who were microsurgically treated in the Department of Neurosurgery, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jul. 2010 to Jul. 2020. There were 19 (29.7%) males and 45 (70.3%) females with an average age of (52.3±12.2) years. Thirty-two (50.0%) cases had large ACMs (diameter＞4.0 cm), 27 (42.2%) cases had medium ACMs (diameter 2.0-4.0 cm), 5 (7.8%) cases had small ACMs (diameter＜2.0 cm), and 46 (71.9%) cases involved important neural and vascular structures. All patients underwent tumor resection via the pterional approach (extended pterional approach) or orbitozygomatic approach. The extent of tumor resection was evaluated by Simpson classification, the complications were calculated, and the recovery of visual acuity was assessed within 1 week after surgery. Results Among the 64 patients, 49 cases were surgically treated with the pterional approach (extended pterional approach), and 15 cases were treated with the orbitozygomatic approach. Simpson Ⅰ-Ⅱ resection was achieved in 52 (81.2%, 52/64) cases, Ⅲ in 8 (12.5%, 8/64) and Ⅳ in 4 (6.2%, 4/64). For typeⅠACMs, all 21 tumors had a hard texture, and 13 (61.9%, 13/21) were Simpson Ⅰ-Ⅱ resection; for type Ⅱ ACMs, 33 tumors had a soft texture, 6 tumors had a hard texture, and 35 (89.7%, 35/39) were Simpson Ⅰ-Ⅱ resection; and for type Ⅲ ACMs, 4 tumors had a soft texture, and 4 (100.0%, 4/4) were all Simpson Ⅰ-Ⅱ resection. The complications of early oculomotor nerve injury occurred in 6 (9.4%, 6/64) cases after surgery, cerebrospinal fluid leakage occurred in 2 (3.1%, 2/64) cases and death occurred in 1 (1.6%, 1/64) case. Of the 56 patients with preoperative headache and dizziness, 40 (71.4%, 40/56) cases were improved within 1 week after surgery; of the 29 patients with decreased preoperative visual acuity, 12 (41.4%, 12/29) cases had improved visual acuity within 1 week after surgery. Conclusion For some ACM patients with decreased visual acuity, their visual acuity is improved in the early postoperative period. For the tumors with soft texture, the rate of complete resection (Simpson Ⅰ-Ⅱ resection) is high and neural function recovers well. For the tumors with hard texture, complete resection is very difficult and may cause severe neurological complications.

Abstract:Objective To investigate the clinical outcomes of direct anterior approach (DAA) total hip replacement when using surgical fixation device and how it differs from the conventional DAA total hip replacement. Methods Patients who planned to undergo total hip replacement through DAA at The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 1 to Jun. 30, 2022 were selected. Patients who underwent total hip replacement through DAA from Jan. 1 to Mar. 31 were included in the observation group. Patients who underwent total hip replacement through DAA from Apr. 1 to Jun. 30 were included in the control group. The patients in the observation group were fixed with surgical fixation device, while the patients in the control group were fixed with conventional surgical methods. The operation time, the number of cases required by the first assistant to complete the learning curve of operation draping, the assistant number, the acetabular prosthesis anteversion angle, the incidence of complications, visual analog scale (VAS) and Harris scores before and 6 weeks after surgery were analyzed in the 2 groups. Results A total of 110 cases were included. Forty-eight patients were assigned to the observation group, while the others were assigned to the control group. No significant differences were found in the general information and preoperative indicators of the 2 groups (all P＞0.05). Compared with the control group, the time taken for preoperative sterilizing or draping in the observation group was shorter (［15.3±2.1］ min vs ［21.4±4.3］ min, P＜0.05). The numbers of cases required for the first assistant to complete the learning curve in the observation group and control group were 4.7±0.6 and 7.3±1.2, respectively. Fewer surgical assistants were required in the observation group than in the control group (2 vs 3). The acetabular prosthesis anteversion angle in the observation group was smaller than that in the control group, but with no significant difference (18.4°±3.4° vs 21.3°±2.2°,P＞0.05). There were significant differences in VAS scores and Harris scores of the 2 groups before and 6 weeks after surgery (all P＜0.05), while there were no significant differences in VAS scores or Harris scores between the 2 groups (all P＞0.05). Conclusion A surgical fixation device for DAA total hip replacement can shorten the preoperative sterilizing and draping time, reduce the duration in operating room, and requires less assistants and training time, making it easier to know the acetabular prosthesis position during the operation.

Abstract:Objective To investigate the value of cardiovascular autonomic reflex test (CART) and heart rate variability (HRV) for the diagnosis of diabetic cardiac autonomic neuropathy (DCAN). Methods A total of 154 hospitalized patients with type 2 diabetes mellitus (T2DM) in Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine from Feb. to Dec. 2020 were enrolled. All patients underwent CART and 24-h Holter monitoring, and HRV indexes were analyzed. The differences in diagnostic value of DCAN between CART and HRV were analyzed. Results Among the 154 T2DM patients, 101 in the DCAN group and 53 in the non-DCAN group were diagnosed using CART. The incidence of DCAN was 65.58% (101/154). The differences in age, diabetes mellitus duration and incidence of diabetic peripheral neuropathy were statistically significant between DCAN and non-DCAN groups (allP＜0.05), while the differences in gender, hypertension, smoking or drinking habits, body mass index, waist-to-hip ratio, glycated albumin or brain natriuretic peptide were not statistically significant (all P＞0.05). There were significant differences in expiration/inspiration difference, 30/15 ratio, Valsalva test and blood pressure differences after postural change between the 2 groups (all P＜0.05). There were significant differences in HRV indexes (standard deviation of all normal N-N interval ［SDNN］, mean standard deviation of the normal N-N interval every 5 min ［SDANN］, root mean square of successive differences between adjacent N-N intervals ［RMSSD］, percentage of the number of pairs of adjacent N-N intervals differing by more than 50 ms ［pNN50］, total power ［TP］, very low frequency ［VLF］, low frequency ［LF］, and high frequency ［HF］) (all P＜0.05). The incidence of DCAN was 59.74% (92/154) according to the HRV indexes of 24-h Holter. The total coincidence rate was 61.68% between HRV and CART, and Kappa value was 0.184. The sensitivity and specificity of HRV in diagnosing DCAN were 66.34% and 52.83%, respectively. According to the CART score, T2DM patients were divided into 4 grades: non-, sub-clinical, confirmed and severe DCAN. The degree of DCAN was negatively correlated with SDNN, SDANN, RMSSD, pNN50, TP, VLF, LF, and HF (r＝－0.252, －0.234, －0.260, －0.219, －0.315, －0.280, －0.316 and－0.311, all P＜0.01). The correlation analysis of HRV indexes in the DCAN patients diagnosed by CART found that SDNN and SDANN had the strongest correlation (r＝0.977, P＜0.001), suggesting that sympathetic nerve damage was obvious; correlations between LF and VLF (r＝0.761, P＜0.001) and HF (r＝0.829, P＜0.001) were strong, suggesting that sympathetic and parasympathetic nerves were involved in cardiac autonomic damage. CART combined with HRV diagnosed 134 cases in the DCAN group and 20 cases in the non-DCAN group, and the incidence of DCAN was 87.01% (134/154). The sensitivity and specificity of CART combined with HRV in diagnosing DCAN were 100.00% and 37.74%, respectively. Conclusion CART combined with HRV has a higher detection rate in the diagnosis of DCAN. HRV analysis can be further performed on T2DM patients with low CART score at the early stage of DCAN to reduce the incidence of missed diagnosis.

Abstract:Objective To study the characteristics, potential categories and influencing factors of post-traumatic stress disorder (PTSD) symptoms in Chinese veterans based on variable-centered and person-centered settings. Methods Stratified sampling and convenient sampling methods were used. A total of 2 428 veterans from 12 cities of China were investigated through self-compiled general questionnaire and PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5). Variable-centered method was used to calculate the incidence and characteristics of PTSD symptoms, and person-centered method was used to classify the potential categories, and multiple logistic regression was used to analyze the influencing factors of each category. Results The positive rate of PTSD symptoms was 13.7% (333/2 428) in Chinese veterans. The risk factors were as follows: female (odds ratio ［OR］ ＝1.96, 95% confidence interval ［CI］ 1.21-3.20), 25-30 years old (OR＝3.08, 95% CI 1.01-9.36), divorce (OR＝2.64, 95% CI 1.19-5.89), suffering from serious illness (OR＝2.73, 95% CI 1.86-4.00), and serving in special military environment (OR＝1.56, 95% CI 1.13-2.16). PTSD symptoms of Chinese veterans were divided into 3 potential categories: mild symptom group, moderate symptom group, and severe symptom group. With the mild symptoms group as the reference, high per capita gross domestic product (OR＝3.15, 95% CI 1.25-7.93), suffering from serious illness (OR＝2.83, 95% CI 1.27-6.33) and awards during service (third class and above: OR＝6.30, 95% CI 1.51-26.31; commendation: OR＝4.83, 95% CI 1.30-17.93) were the risk factors of the moderate symptom group, while suffering from serious illness (OR＝8.08, 95% CI 1.66-39.43) and participation in war (OR＝15.03, 95% CI 1.41-159.82) were the risk factors of the severe symptom group. Conclusion Demographic variables are the main factors affecting the development of PTSD symptoms of Chinese veterans, and military stress events during service are the main factors influencing the severity.

Abstract:Patients with peritoneal metastasis from colorectal cancer have poor prognoses and are usually at advanced stage when first diagnosed. We have changed their treatment concepts for peritoneal metastasis of colorectal cancers from traditional palliative treatment to multidisciplinary treatments (including chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy). Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is introduced as a novel intraperitoneal administration approach to treat unresectable peritoneal metastasis from colorectal cancers. Compared with previous treatments, it has the advantages of minimal invasion, good safety, a homogeneous intraperitoneal distribution and enhanced tumour penetration. Owning to these advantages, PIPAC has been used in many countries around the world since its first application in humans in 2011. With increasingly improved technical models of PIPAC, several new treatment models were developed. The article reviews the history, technical criteria, complications, safety and prognosis of PIPAC treatment for peritoneal metastasis from colorectal cancers.

Abstract:Pancreatoduodenectomy is one of the largest surgeries in abdominal surgical field, with a high incidence of postoperative complications. Postoperative pancreatic fistula (POPF)-related hemorrhage is one of the most fatal and severe complications after pancreatoduodenectomy. The risk factors of POPF-related hemorrhage include pancreatic duct size, pancreatic texture, vascular pseudoaneurysm, pancreaticojejunostomy leak, choledochojejunostomy leak, and so on. The management and prevention are of great importance to POPF-related hemorrhage, and it is the goal that pancreatic surgeons are striving for. This review provides an overview of the risk factors, prevention and treatment strategies, and research progress of POPF-related hemorrhage after pancreatoduodenectomy.

Abstract:Diabetes mellitus (DM) is a metabolic disease that seriously threatens human health. In recent years, its prevalence has been increasing year by year worldwide. In order to reduce DM and its complications, early screening and diagnosis are particularly important. Glycosylated hemoglobin (HbA_1c) is an indicator of mean blood glucose concentration and plays an important role in blood glucose control and risk assessment of macrovascular and microvascular complications. HbA_1c was recognized by the World Health Organization as a diagnostic tool for DM in 2011. This paper introduces the history and research status of HbA_1c as a diagnosis indicator of DM, the value of HbA_1c in the screening and diagnosis of DM, and the influence of HbA_1c control on complications of DM.

Abstract:The incidence of vascular trauma is increasing in modern warfare, and tourniquets have become the most effective adjuncts to save lives of the wounded by preventing extremity or junctional hemorrhage at the stage of first-line treatment. Due to the complex environment of modern war, tourniquets should be of intelligence, integration, lightweight, miniaturization, reuse, well patient tolerance, strong stability, and low-cost. This review summarizes the research progress on tourniquets, including those recommended by the tactical combat casualty care guidelines, used by the Armed Forces of the Russian Federation and the Chinese People’s Liberation Army, and those currently not included in the guidelines but inspirational for research and development. We also list the advantages and disadvantages of those tourniquets, hoping to provide reference for the development of new tourniquets.

Abstract:Objective To establish a virtual reality technology-based segmented training system and apply it to the surgical training of robot-assisted laparoscopic pyeloplasty (RALP). Methods Virtual reality technology was used to conduct basic operation training and intensive training of suture-related skills for 3 urologists through a robotic simulation training system, and the changes in key indicators such as anastomosis time of the trained urologists were compared before and after the training. The RALP was divided into 4 segments: separating, cutting, anastomosis, and suturing. The trained surgeons participated in real surgical operations through the robotic system, first completing the learning curve in segments and then completing the whole RALP independently. Results After virtual reality training, the anastomotic time (［141.0±9.0］ s vs ［312.6±34.5］ s) and motion distance (［140.9±16.2］ cm vs ［323.1±50.6］ cm) were significantly shortened (both P＜0.01), and the times of both instrument collisions (1.6±0.6 vs 7.1±1.0) and instrument out of sight (0.8±0.5 vs 3.2±0.9) were significantly reduced (both P＜0.05). However, the times of missed target did not change significantly before and after training (P＞0.05). After 2 rounds of segmented training per person, trainees were able to conduct RALP independently. Their operation time was longer than that of senior surgeons (［149.0±36.0］ min vs ［117.0±10.0］ min), but the difference was not statistically significant (P＞0.05). In addition, there were no significant differences in perioperative indicators such as intraoperative blood loss, incidence of urine leakage, or postoperative hospital stay (all P＞0.05). Conclusion The virtual reality technology-based segmented training system can be successfully applied to the surgical training of RALP, and it can improve the operational skills of trainees on the premise of ensuring the safety and quality of the operation.

Abstract:Objective To explore the loneliness and its influencing factors in naval officers and soldiers. Methods With simple cluster sampling, the University of California at Los Angeles (UCLA) loneliness scale, perceived social support scale, interpersonal comprehensive diagnostic scale, self-esteem scale, general self-efficacy scale, general anxiety disorder scale 7, patient health questionnaire scale 9 and self-designed demography questionnaire were used to investigate the officers and soldiers in Apr. 2022. Correlations between general demographic variables and psychological variables were analyzed by Spearman correlation analysis and Pearson correlation analysis. Simple linear regression analysis and multiple linear regression analysis were used to explore the relationships between social support, interpersonal relationship, self-esteem, self-efficacy, anxiety, depression and loneliness. Results A total of 3 338 questionnaires were distributed and 3 105 valid questionnaires were collected, with an effective rate of 93.02%. Among the survey subjects, 3 032 (97.65%) were male and 73 (2.35%) were female, aged 18-55 (25.85±5.30) years old. The loneliness score of the officers and soldiers was 20-69 (34.04±9.79). There were significant differences in loneliness in different gender and age groups (bothP＜0.05), among which loneliness of the females was significantly higher than that of the males and loneliness of those aged 26-33 was significantly higher than that of those aged 18-25 (both P＜0.05). The loneliness of officers and soldiers was positively correlated with interpersonal relationship score and anxiety and depression levels (all P＜0.01), and was negatively correlated with perceived social support, self-esteem and self-efficacy (all P＜0.01). Interpersonal relationship score and anxiety and depression levels had significant positive predictive effects on loneliness (all P＜0.01), while the levels of perceived social support, self-esteem and self-efficacy had significant negative predictive effects on loneliness (all P＜0.01). Conclusion Social support, interpersonal relationship, self-esteem, self-efficacy, anxiety and depression have significant impacts on loneliness in naval officers and soldiers.

Abstract:Objective To investigate the incidence of femoroacetabular impingement syndrome (FAI) in recruits and analyze the related factors. Methods A total of 1 958 recruits were selected, and the recruits with hip joint and peripheral pain as the main symptoms were treated. Recruits with FAI were screened out based on the medical history, imaging examination and physical examination results. And the X-ray results were evaluated by the alpha angle and center-edge (CE) angle. Multivariate logistic regression was used to analyze the relationships between general data (gender, age, height, weight, body mass index ［BMI］, smoking history, and drinking history) and disease status. Results The incidence of FAI was 11.13% (218/1 958) among the recruits during training. The incidence of FAI in recruits was related to gender (P＝0.020), but not related to age, height, weight, BMI, smoking history or drinking history (all P＞0.05). Female soldiers have higher risk of FAI than male soldiers (odds ratio＝1.903，95% confidence interval 1.107-3.269). Male soldiers mainly showed cam-type, while female soldiers mainly showed pincer-type. Training subjects such as 3 000-m running and tactical movements involving highly frequent hip flexion movements were the main predisposing factors for the onset of FAI. Conclusion FAI has a high incidence among recruits. The incidence risk of females is higher than that of their male counterparts. Training programs including frequently excessive hip flexion are the main causative factors.

Abstract:Objective To evaluate the roles of serum lactate dehydrogenase (LDH), pleural effusion adenosine deaminase (ADA) and their ratio in diagnosing malignant pleural effusion (MPE). Methods A retrospective analysis of 195 hospitalized patients with exudative pleural effusion from Nov. 2019 to Aug. 2022 was conducted. The patients were divided into 2 groups: MPE group (n＝103) and benign pleural effusion (BPE) group (n＝92, including 59 cases with tuberculous pleural effusion and 33 cases with bacterial pleural effusion). LDH levels in the peripheral blood samples and ADA levels in the pleural effusion samples were measured and compared in all enrolled subjects, and serum LDH/pleural effusion ADA ratios were calculated. The diagnostic efficacy of serum LDH, pleural effusion ADA and their ratio for MPE was evaluated by receiver operating characteristic curves. Results Patients in the MPE group had higher serum LDH levels and serum LDH/pleural effusion ADA ratios than those in the BPE group (215.00 ［185.00, 269.00］ U/L vs 175.00 ［155.25, 207.75］ U/L, 29.17 ［21.57, 44.83］ vs 6.96［5.05, 11.48］; both P＜0.001). Pleural effusion ADA levels of patients in the MPE group were lower than those in the BPE group (8.00 ［6.00, 10.00］ U/L vs 26.50 ［14.00, 36.00］ U/L, P＜0.001). The combined test of serum LDH, pleural effusion ADA and their ratio had high sensitivity and positive predictive values, among which the sensitivity and positive predictive value of serum LDH combined with serum LDH/pleural effusion ADA ratio were the highest for the diagnosis of MPE, reaching 0.95 and 0.94, respectively. Conclusion Serum LDH, pleural effusion ADA and their ratio have high diagnostic efficacy for MPE. The combined test can maintain the sensitivity and increase the positive predictive value, and serum LDH combined with serum LDH/pleural effusion ADA ratio is the best, which can distinguish benign and malignant pleural effusion earlier and has reference value for clinical decision making.

Abstract:Objective To investigate the clinical manifestations, imaging characteristics, treatment and outcome of children with myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGADs), so as to improve the understanding of the disease. Methods Fourteen MOGAD children who were admitted to our department from Jan. 2018 to Dec. 2021 were retrospectively enrolled, and the general data, clinical manifestations, laboratory tests, imaging characteristics, as well as the treatment and outcome were collected and summarized for analysis. Results Of the 14 children with MOGAD, 6 were male and 8 were female, and the age of onset ranged from 2 to 12 years. Ten cases presented with acute disseminated encephalitis, 2 with neuromyelitis optica spectrum disorder, and 2 with optic neuritis; 3 cases combined with consciousness disorder, 5 with abnormal behaviors, and 6 with convulsive seizures. Magnetic resonance imaging suggested extensive involvement of abnormal signals, mainly involving the white matter, cerebellum, optic nerve and spinal cord. All children had positive peripheral blood myelin oligodendrocyte glycoprotein immunoglobulin G (titers of 1∶10 to 1∶1 000), and 3 cases were combined with positive cerebrospinal fluid anti-N-methyl-D-aspartate receptor antibodies. All patients were treated with high-dose methylprednisolone combined with gamma globulin in the acute phase, and 1 patient was treated with plasma exchange. At 0.5 to 2.0 years of follow-up, 9 cases had a monophasic course and recovered well; 5 cases had recurrent episodes and remitted after treatment with rituximab in 3 cases and cyclophosphamide in 2 cases. Conclusion The clinical manifestations of MOGAD in children are complex, and the imaging features are lack of specificity. In the acute phase, high-dose methylprednisolone combined with gamma globulin is effective, while some children have a multiphasic course of disease. Dynamic monitoring of myelin oligodendrocyte glycoprotein antibody level is helpful to early detection of patients with possible recurrence. Timely starting second-line drug treatment such as rituximab and cyclophosphamide can improve the prognosis.

Abstract:Objective To investigate the clinicopathologic features and differential diagnosis of atypical fibroxanthoma (AFX). Methods A total of 5 AFX cases were collected from Jan. 2016 to Dec. 2021 in The Second Affiliated Hospital of Nanchang University. The epidemiological characteristics, pathological morphology and immunohistochemical characteristics were analyzed retrospectively. Results Among the 5 AFX patients, there were 3 males and 2 females, with an average age of 58.6 years. AFX showed superficial skin nodules with a maximum diameter of 0.9-2.5 cm. Microscopically, the morphology of the tumor cells varied largely, mainly characterized by spindle cells and epithelioid cells, mixed with mononuclear and multinucleated tumor giant cells, and mitotic images were easy to see. Among them, 1 case contained pigment, 1 case combined with basal cell carcinoma, and 1 case had many inflammatory cells. Immunohistochemical markers showed that AFX mainly expressed vimentin and CD10; cytokeratin, epithelial membrane antigen and CD68 were expressed in some cases; and Ki-67 proliferation index was high in all patients. Local resection of skin mass was performed in all the 5 cases, and postoperative radiotherapy was performed in only 1 case. There were no local recurrence or metastasis during follow-up until May 2022. Conclusion AFX is rare in clinic and can easily be confused with malignant tumors under microscope. Immunohistochemistry indexes including CD10 are helpful for its diagnosis and differential diagnosis.

Abstract:Objective To evaluate the clinical effect of the treatment of bony mallet finger with steel wire binding through bone tunnel of the distal phalanx. Methods From Aug. 2019 to Jul. 2022, 32 patients with bony mallet fingers who were admitted to the hand and foot micro repair and reconstruction ward of The First Affiliated Hospital of Anhui Medical University were selected and divided into 2 groups according to the different treatment methods. The observation group (15 cases) used the steel wire binding method through bone tunnel, and the control group (17 cases) used the micro bone anchor method. The operation time, treatment cost, wound healing and complications were recorded. The Crawford criteria was used to evaluate the postoperative functional recovery. Results All 32 patients successfully completed the operation. The operation time in the observation group was significantly shorter than that in the control group (［57.5±18.1］ min vs ［69.6±15.3］ min, P＜0.05), and the treatment cost was significantly lower than that in the control group (［6 936.25±639.78］ yuan vs［11 021.62±459.73］ yuan, P＜0.05). The patients were followed up for 3 to 24 months, with an average of (15.9±7.0) months. According to the Crawford criteria the excellent and good rate was 100.0% (15/15) in the observation group and 82.4% (14/17) in the control group 3 months after surgery, with no statistical significance (P＞0.05). In the observation group, all patients healed at the first stage without wound infection, skin necrosis, displacement of fracture blocks, joint deformities or other complications. In the control group, there were 3 cases with poor postoperative incision recovery (including 2 cases with suture reaction), 1 case with fracture malunion, and 1 case with deck deformity. Conclusion The treatment of bony mallet finger with steel wire binding through bone tunnel is an ideal method with simple operation and satisfactory functional recovery of the distal interphalangeal joint.

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