Objective To observe the change of early postoperative cognition in the elderly under low central venous pressure (LCVP) after lobe resection to investigate the safety and feasibility of LCVP in Geriatrics.Methods A total of 45 ASA class Ⅰ ～ Ⅱ old patients (60 ～ 75 y)with elective liver resection were divided into L group and C group.In the LCVP group (L group),CVP was maintained below 5 cmH2O during liver resection until the lobe was done.The patients in the control group (C group) received standard care (The CVP was controlled between 6 cmH2O to 12 cmH2O).To compare the anesthesia recovery after surgery,all patients were tested with a battery of neuropsychologic assessment of cognitive function preoperatively and on the 7th day postoperatively.Results During liver resection,the MAP [(75.8 ±7.9)mmHg] and CVP [(3.1 ±0.4)cmH2O] of experimental group were lower than the control group [MAP (92.3 ± 10.6)mmHg,CVP(9.3 ± 1.4)cmH2O].The difference was statistically significant (t' =20.08,P ＜0.05,t =5.89,P ＜0.01) ;There was no statistically significant difference in postoperative recovery of spontaneous breathing,respiratory,eye opening time,extubation time and leave the operating room time between two groups[(18.1 ±6.7)min,(25.4±8.3)min,(31.9±11.7)min,(42.8±17.8)minvs (15.3 ± 7.0)min,(22.6 ±9.4)min,(30.2 ± 10.8) min,(45.4 ± 13.6) min,P ＞ 0.05].The incidence of POCD was 30.0％ in the experimental group and 27.3％ in the control group.The difference was no statistical significance between two groups(P ＞0.05).Conclusious There was no significant influence of low central venous pressure on anesthesia recovery time and early postoperative cognition in the elderly under hepatic resections.

Objective To evaluate the relationship between vascular endothelial growth factor (VEGF) and extracellular signal-regulated kinase (ERK) signaling pathway in spinal dorsal horns of rats with neuropathic pain.Methods Twenty male Sprague-Dawley rats,aged 2 months,weighing 160-320 g,were randomly divided into 4 groups (n =5 each):sham operation group (group S); chronic constrictive injury (CCI) group; normal saline group (NS group); VEGF antibody group.Neuropathic pain was induced by CCI.The animals were anesthetized with intraperitoneal 10％ chloral hydrate 350 mg/kg.The left sciatic nerve was exposed and 4 ligatures were placed on the sciatic nerve at 1 mm intervals.In group S,the left sciatic nerve was only exposed but not ligated.In VEGF antibody group,VEGF antibody 0.3μg/15 μl was injected intrathecally every 2 days for 4 times starting from 2 h after CCI,while the equal volume of normal saline was injected in NS group.Paw withdrawal threshold to von Frey filament stimulation (PWMT) and paw withdrawal latency to nociceptive thermal stimulation (PWTL) were measured at 1 day before CCI (T1),and 1,3,5 and 7 days after CCI (T2-5).The rats were sacrificed after PWMT and PWTL were measured and the L4-6 segments of the spinal cord were removed for determination of phosphorylated ERK (p-ERK) expression in spinal dorsal horns by immunohistochemistry and Western blot.Results Compared with group S,PWMT and PWTL were significantly decreased at T2-5,and the p-ERK expression in spinal dorsal horns was up-regulated in CCI and VEGF antibody groups (P ＜ 0.05).Compared with CCI group,PWMT and PWTL were significantly increased at T3-5,and the p-ERK expression in spinal dorsal horns was down-regualted in VEGF antibody group (P ＜ 0.05).Conclusion VEGF in the spinal dorsal horn is involved in the development and maintenance of neuropathic pain in rats through activating ERK signaling pathway.

Objective To investigates the diagnostic value of combined detection serum CCL18, CXCL1 antigen, C1D, TM4SF1, FXR1, TIZ IgG autoantibody by suspension array for ovarian cancer. Methods Suspension array was used to detect CCL18, CXCL1 antigen, C1D, TM4SF1, FXR1, TIZ IgG autoantibody in 120 cases of healthy women, 204 cases of patients with benign pelvic tumors, 119 cases of pelvic malignant tumor patients, and 40 cases with breast cancer, lung cancer oroliver cancer, respectively. Constructed diagnosis model of combined detection six biomarkers for diagnosis of ovarian malignant tumor. Constructed diagnosis model of combined detection autoantibodies to diagnose epithelial ovarian cancer. Analysed the value of detecting six biomarkers for diagnosis of ovarian malignant tumor and detecting autoantibodies for diagnosis of epithelial ovarian cancer. Analysed diagnostic value of detecting six biomarkers to diagnose stageⅠandⅡepithelial ovarian cancer. Compared diagnostic value of detecting six biomarkers in diagnosis of tissue types and pathologic grading with that of CA125. Results Model of combined detecting six biomarkers to diagnose ovarian malignant tumor was logit(P)=-11.151+0.008×C1D+0.011 × TM4SF1+0.011 × TIZ-0.008 × FXR1+0.021 × CCL18+0.200 × CXCL1. Model of combined detection autoantibodies to diagnose epithelial ovarian cancer was logit(P)=-5.137+0.013 × C1D+0.014 × TM4SF1+0.060 × TIZ-0.060 × FXR1. Sensitivity and specificity of detecting six biomarker to diagnose ovarian malignant tumor was 90.6% and 98.7%. Sensitivity and specificity of detecting autoantibodies to diagnose epithelial ovarian cancer was 75.8%and 96.7%. Combined detection for six biomarkers to diagnose serous and mucinous ovarian cancer was statistically no better than those of CA125 (P=0.196 and P=0.602, respectively);there was significantly difference in diagnosis of ovarian cancer (P=0.023), and there was no significantly difference in diagnosis of different pathological grading (P=0.089 and P=0.169, respectively). Conclusions Constructing diagnosis model of combined detection six biomarker to diagnose ovarian malignant tumor and constructed diagnosis model of combined detectionautoantibodies to diagnose epithelial ovarian cancer. Combined detection six biomarkers to diagnose serous and mucinous ovarian tumors is better than that of CA125.

ObjectiveTo investigate the correlation between interferon regulatory factor 5 (IRF5) ,vitamin D receptor (VDR ) ,beta-defensin 1 (DEFB1 ) ,Toll-like receptor 4 (TLR4 ) gene polymorphismand Crohn′s disease (CD) in Chinese Han population .MethodsFrom January 2007 to May 2011 ,thedata and serum samples of 158 CD patients and 246 healthy controls were collected .The genotype of 14tag single-nucleotide polymorphisms (SNP) of IRF5 ,VDR ,DEFB1 and TLR4 were detected .Chi-squaretest was performed for rate comparison between CD group and healthy control group . Multifactordimensionality reduction (MDR) was used to analyze the combined effects of above candidate genes and therelation with susceptibility of CD .ResultsAccording to allele or genotype correlation analysis ,there wasno correlation between IRF5 ,VDR ,DEFB1 ,TLR4 and susceptibility of CD (all P> 0 .05) .The resultsof haplotype correlation analysis indicated that the frequency of GTACC haplotype in IRF5 of CD groupand healthy control group was 0 .046 and 0 .089 ,respectively ,the difference was statistically significant (χ2 = 5 .223 ,P= 0 .022 3) .The results of genotype and clinical type analysis indicated that the genotypesof rs2978880 of DEFB1 in CD patients were C/C ,C/T ,T/T ,the frequency of patients with surgery was0 .235 ,0 .603 and 0 .162 ,respectively ,and the frequency of patients without surgery was 0 .482 ,0 .388and 0 .129 ,respectively .The risk of intestinal surgery in patients with C /C genotype was lower (χ2 =10 .065 ,P= 0 .006 ) .The results of MDR analysis indicated that no interactions were detected betweenabove genes and susceptibility of CD (all P > 0 .05) .ConclusionsThe GTACC haplotype in IRF5 wascorrelated with the susceptibility of CD ,and the C/C genotype of rs2978880 of DEFB1 was correlatedwith CD clinical phenotype in Chinese Han population .

Objective To evaluate the clinical reliability and feasibility of computerized endoscopic balloon manometry in vitro and in vivo, in measurement of pressure of esophageal varices. Methods Computerized endoscopic balloon manometry was used to measure the pressure of variceal model with different diameter (3 mm, 6 mm and 8 mm) and intraluminal pressures (ranging from 8 to 36 mm Hg), and the findings were compared with actual pressures. The technique was also applied in 23 patients with liver cirrhosis and esophageal varices, and its correlation with hepatic venous pressure gradient and other factors related with varices bleeding. Results The study in vitro showed that the measured intraluminal pressure was correlated significantly with the actual value ( r ≥ 0. 993, P ＜ 0. 001 ) without obvious measurement bias(95% CI = -0.13 cm H2O to 0. 33 cm H2O). The measurement in 23 patients were success with little variation coefficient (r≥0. 998) between repeated procedures. Regression analysis showed a good correlation between variceal pressure and hepatic venous pressure gradient (r=0. 858, P ＜ 0. 001 ). A higher variceal pressure was strongly associated with presence of previous bleeding episodes, vascular diameter and presence of red color signs, but did not correlate with the parameter of Child-Pugh classification ( t = 0. 31, P =0. 76). Conclusion Computerized endoscopic balloon manometry is reliable and feasible to examine esophageal variceal pressure, and is very likely to be a valuable clinical index for variceal bleeding.

The physiological reconstruction of bone is strictly dependent on bone resorption. Bone resorption is believed to be a complicated molecular reaction process that occurs in the microcircumstance of bone tissue. A lot of enzymes and factors take part in this process, yet there are not enough data with reference to the activation of osteoclast, resorption of bone matrix, regulation of bone resorption. In this paper we review the importance of matrix metalloproteinases (MMPs) in transfer of osteoclast and degradation of bone matrix, and the function of receptor activator of NF-kappaB-ligand (RANKL) and osteoprotegerin (OPG) in regulation of bone resorption.
Bone Resorption ; Humans ; Matrix Metalloproteinases ; metabolism ; Osteoclasts ; physiology ; Osteoprotegerin ; physiology ; RANK Ligand ; physiology

Objective: To summarize the gene mutation of early onset epileptic spasm with unknown reason. Method: In this prospective study, data of patients with early onset epileptic spasm with unknown reason were collected from neurological department of Children's Hospital of Fudan University between March 2016 and December 2016. Patients with known disorders such as infection, metabolic, structural, immunological problems and known genetic mutations were excluded. Patients with genetic disease that can be diagnosed by clinical manifestations and phenotypic characteristics were also excluded. Genetic research methods included nervous system panel containing 1 427 epilepsy genes, whole exome sequencing (WES), analysis of copy number variation (CNV) and karyotype analysis of chromosome. The basic information, phenotypes, genetic results and the antiepileptic treatment of patients were analyzed. Result: Nine of the 17 cases with early onset epileptic spasm were boys and eight were girls. Patients' age at first seizure onset ranged from 1 day after birth to 8 months (median age of 3 months). The first hospital visit age ranged from 1 month to 2 years (median age of 4.5 months). The time of following-up ranged from 8 months to 3 years and 10 months. All the 17 patients had early onset epileptic spasm. Video electroencephalogram was used to monitor the spasm seizure. Five patients had Ohtahara syndrome, 10 had West syndrome, two had unclear classification. In 17 cases, 10 of them had detected pathogenic genes. Nine cases had point mutations, involving SCN2A, ARX, UNC80, KCNQ2, and GABRB3. Except one case of mutations in GABRB3 gene have been reported, all the other cases had new mutations. One patient had deletion mutation in CDKL5 gene. One CNV case had 6q 22.31 5.5MB repeats. Ten cases out of 17 were using 2-3 antiepileptic drugs (AEDs) and the drugs had no effect. Seven cases used adrenocorticotropic hormone (ACTH) and prednisone besides AEDs (a total course for 8 weeks). Among them, five cases had no effect and two cases were seizure free recently. A case with GABRB3 (C.905A>G) had seizure controlled for 3 mouths. A case with ARX (C.700G>A) had seizure controlled for 6 mouths. Conclusion The early onset epileptic spasm with unknown reason is highly related to genetic disorders. A variety of genetic mutations, especially new mutations were found. Genetic heterogeneity of epileptic spasm is obvious.

This is an experimental study in the realm of physiology inquiring about the effect of pulsatile fluid flow shear stress on the proliferation, differentiation and functions of osteoblasts;the objective is to validate the important effect of fluid flow shear stress on the mechanics adaptability of bone tissue. The osteoblasts derived from Wistar rat's calvaria were exposed to fluid shear stress 5, 10, 20 and 30 mN/cm2 for 3, 6, 9, 12, 24, 36h respectively in the flow chamber. The ability of proliferation, alkaline phosphatase (ALP) activity and extracellular calcium secretion of osteoblasts were assessed. The results showed that fluid flow shear stress at 5, and 10 mN/cm2 increased the proliferation, but at 20 and 30 N/cm2, the shear stress inhibited the proliferation. The shear stress at 5, 10, 20 mN/cm2 increased the ALP activity and extracellular calcium secretion of osteoblasts, and advanced the time of the peak value of ALP activity during the experiment period, but the shear stress at 30 mN/cm2 decreased ALP activity. So osteoblasts responded rapidly to shear stress; the proliferation, differentiation and mineralization of cells were regulated in the presence of some shear stress; and such regulation exhibited a pattern of dependence on the mN/cm2 level of shear stress.
Alkaline Phosphatase ; metabolism ; Animals ; Cell Proliferation ; Cells, Cultured ; Mechanotransduction, Cellular ; physiology ; Osteoblasts ; cytology ; enzymology ; Pulsatile Flow ; Rats ; Rats, Wistar ; Shear Strength ; Skull ; cytology ; Stress, Mechanical

Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.

Taking the Department of Obstetrics and Gynecology as an example, this paper expounds a series of practices of online education, in the process from pre-course training, platform selection, curriculum design, to student evaluation, etc. From that, we can provide a reference for carrying out online teaching in response to the epidemic for clinical medical colleges which have not been exposed to the online course. Furthermore, it is a new attempt to explore a way to make a change of the traditional teaching method and deepen the reform of clinical teaching in our hospital after the epidemic, not only in professional medical education, but also in the popularization of medical knowledge.