ELISA technique was employed to determne the concentration of mannose binding lectin (MBL),plasminogen activator inhibitor-1 (PAI 1),and high sensitive ()eactive protein (hs-CRP).hs CRP level m patients with subclinical atherosclerosis was significantly higher (P ＜ 0.01),MBL level was of no significant difference (P＞0.05) ; PAI-1 was significantly higher (P＜0.01) only m those with metabolic syndrome(MS).Taking no account of subclinical atherosclerosis,MBL of diabetic patients with MS was significantly lower while hs-CRP and PNI 1 were signific amlv higher (P ＜ 0.01).Inflammatory faetors MBL,hs-CRP,and PAI-1 involved in the -ube linical atherosclerosis development in the type 2 diabetic patients with MS.

Objective To evaluate the ultrasonic feature and clinical significance of persistent left superior vena cava(PLSVC)in fetal life.Methods Fetal echocardiography was performed in 3368 fetuses.Thirty-one fetuses of PLSVC were confirmed.Results The dilated coronary sinus was observed in 30 of 31 fetuses.Congenital heart defects were presented in 14 of these cases,and extracardiac anomalies were presented in 6 fetuses.Both congenital heart defects and extracardiac anomalies were observed in 4 fetuses.Conclusions PLSVC is always associated with congenital heart defects.The prognosis Of affected fetuses largely depends on whether or not the PLSVC is associated with a congenital heart defect.Prenatal diagnosis of PLSVC can help US plan perinatal counseling and ameliorate the postnatal course.

Objective To assess the reproducibility of vascularization measurement in cervical carcinoma using transvaginal three-dimensional power Doppler angiography (3D-PDA) with virtualorgan computer-aided analysis ( VOCAL), and compare the reproducibility of two different contour mode (manual and automatic mode) of VOCAL. Methods Eighty patients with cervical carcinoma were examined by observer 1 using transvaginal 3D-PDA. The two acquired volume datasets were analyzed using manual and sphere automatic contour mode of the VOCAL imaging program for assessing carcinoma vascularization index( VI), flow index(FI), and vascularization flow index(VFI). Forty patients of them were examined randomly by observer 2 by the same method. Reproducibility of vascularity measurement was assessed by calculating intraclass (intra-CC) and interclass (inter-CC) , limits of agreement, 95% confidence interval definition. The contribution of various factors (examiner, measurement, contour mode and patient) to intrasubject variance was estimated using different analysis of variance models (ANOVA). Results For intraobserver,manual contour mode was more valid than sphere automatic contour mode for each observer (0. 92～0. 99 vs 0. 75～0. 94) ,and it also had smaller standard deviation,narrower limit of agreement range, 95% confidence interval and higher intra-cc than those of sphere automatic contour mode. Interobserver agreement of manual contour vascular measurements was similar to the intraobserver agreement for manual contour vascular measurements ( 0. 89 ～ 0. 97 vs 0. 92 ～ 0. 99 ) , but interobserver agreement for sphere automatic contour vascular measurements dramatically reduced (0. 52～0. 72). Conclusions Manual contour mode for 3D-PDA vascular measurement has better reproduciblity than sphere automatic contour mode, especially useful for irregular shape tissue.

Objective: To assess the outcomes and toxic effects of 5-day actinomycin D (Act-D) salvage therapy and to explore the predictors of Act-D resistance in patients with low-risk gestational trophoblastic neoplasia (GTN)who failed 5-day methotrexate (MTX) chemotherapy. Methods: This retrospective study analyzed patients with low-risk GTN administered Act-D salvage therapy after failing MTX chemotherapy at Women's Hospital, School of Medicine Zhejiang University between January 2000 and December 2015. The clinical parameters of these patients were collected and analyzed. Results: The final analysis included 89 cases. Of these, 73 cases (82.02%) responded to salvage Act-D. The remaining 16 resistant cases were switched to etoposide, MTX, Act-D/ cyclophosphamide, and vincristine chemotherapy and achieved complete remission. Serum human chorionic gonadotrophin levels before Act-D salvage therapy (hCG Act-D )in the Act-Dresistant cases were significantly higher than those in the Act-D responders (median 605 vs.103 IU/L, p=0.009). However, the range of hCGAct-D values in Act-D responders was wider than that in Act-D-resistant cases (5.76–16,664 IU/L vs. 11.43–6,732 IU/L). Thus, assigning a general cut-off value was difficult considering the individual setting. Except for 2 cases requiring other salvage regimens due to Act-D toxicity, 97.80% of cases (89/91) tolerated the toxicity. During at least 1-year follow-up, the survival rate was 100.00% and no case developed recurrence. Conclusion Based on the good therapeutic effect and tolerable toxicity, we recommend Act-D salvage therapy for all patients with low-risk GTN who fail primary MTX chemotherapy.The higher serum hCG levels before Act-D salvage therapy may be associated with resistance to this treatment.

Objective:To investigate the etiologies and clinical characteristics of bilateral adrenal lesions.Methods:The clinical data of 143 patients with bilateral adrenal lesions hospitalized in the First Affiliated Hospital of Chongqing Medical University from Jan. 2013 to Mar. 2018 were collected and analyzed.Results:140 patients were retained for final analysis. 79 were men, and 61 were women. The age was (51.53±13.93) years. Regarding the etiologies, there were primary aldosteronism ( n=44, 31.43%) , Cushing’s syndrome ( n=27, 19.29%) , non-functional lesions ( n=23, 16.43%) , adrenal tuberculosis ( n=17, 12.14%) , pheochromocytoma ( n=11, 7.86%) , congenital adrenal hyperplasia ( n=5, 3.57%) , adrenal metastases ( n=5, 3.57%) , and adrenal lymphoma ( n=4, 2.86) . These patients were classified into the following groups according to the mass size: ≤2 cm, 2-4 cm and ≥4 cm. The highest proportion of primary aldosteronism (62.79%) , Cushing’s syndrome (46.15%) and pheochromocytoma (31.25%) was observed in the ≤2 cm, 2-4 cm and ≥4 cm groups, respectively. The mass sizes of primary aldosteronism, Cushing’s syndrome and pheochromocytoma were compared, with pheochromocytoma the largest, followed by Cushing’s syndrome, non-functional lesion, and primary aldosteronism. Conclusions:For patients with bilateral adrenal lesions in our hospital, primary aldosteronism and Cushing’s syndrome are more common than non-functional lesion. Mass size is of great value in the diagnosis of endocrinological etiology, as well as distinguishing malignant tumors from the benign ones. The imaging phenotype is helpful to determine tumor types.

OBJECTIVE: To investigate the effect of benzo(α)pyrene on the ATPase activity and content of Ca²⁺ in the hippocampus of neonatal SD rats. METHODS: Sixty male and 60 female 4-days-old neonatal SD rats were randomly divided into 5 groups (n=24): a blank control group, a vehicle control group (peanut oil), 3 benzo(α)pyrene groups (0.02, 0.2 and 2 mg/kg, respectively). SD rats were given benzo(α)pyrene (dissolved in peanut oil) by gavage daily from postnatal day 4 (PND4) to PND20. The nerve reflex, the condition of neuro-muscle development and motion function were examined in the period of treatment. The colorimetric technique was used to detect the activity of Ca²⁺-ATPase and Ca²⁺-Mg²⁺-ATPase in hippocampus after the treatment. The concentration of Ca²⁺ of synapse in the hippocampus of rats was detected by fluorescent labeling. RESULTS: The results from the behavior tests showed that duration of surface reflex latency in rats with medium dose of benzo(α)pyrene was longer compared with that in the control group in PND12. The duration of surface reflex latency in rats with high dose of benzo(α) pyrene is longer in PND 14 and PND 16 compared with that in the control group (P<0.05). Compared with the rats in the control group, the activities of Ca²⁺-Mg²⁺-ATPase and Ca²⁺-ATPase in hippocampus in rats with high dose benzo(α) pyrene were significantly decreased, and the degree in the decrease of Ca²⁺-ATPase activity was dose-dependent (P<0.05). The contents of Ca²⁺ in the hippocampus in rats with medium or high dose of benzo(α) pyrene were significantly increased compared with that in the control group (P<0.05), which showed a dose-dependent manner (P<0.05). CONCLUSION Benzo(α)pyrene exposure led to the decrease in ATPase activity as well as Ca²⁺ overload of the synapse in the hippocampal tissue, which in turn results in the nerve damage of newborn SD rats.
Animals ; Benzo(a)pyrene ; toxicity ; Ca(2+) Mg(2+)-ATPase ; metabolism ; Calcium ; metabolism ; Calcium-Transporting ATPases ; metabolism ; Female ; Hippocampus ; enzymology ; Male ; Rats ; Rats, Sprague-Dawley

Objective To evaluate etoposide,methotrexate and dactinomycin (EMA)/ cyclophosphamide and vincristine (CO) regimen for treatment of ultra high-risk gestational trophoblastic neoplasia (GTN).Methods A total of twenty-four ultra high-risk patients who had International Federation of Gynecology and Obstetrics (FIGO) prognostic scores greater or equal to 12 with liver,brain,or extensive metastases did poorly when treated with primary chemotherapy admitted in Women's Hospital,School of Medicine,Zhejiang University from January 2001 to December 2015.All of the patients were treated by EMA/CO regimen and followed up to death or December 2017.The clinical data of patients were analyzed retrospectively and the efficacy and toxicity of EMA/CO were evaluated.Results All of the cases with ultra high-risk GTN had FIGO prognostic scores ≥12 (ranged 12-18,median 13.0).Twenty patients (83％,20/24) received EMA/CO regimen as primary treatment and 4 patients (17％,4/24) had a history of failed chemotherapy.Seven patients (29％,7/24) had metastasis of liver or brain and 17 patients (71％,20/24)had no metastasis of liver and brain.Twenty-four patients received totally 167 courses of EMA/CO regimen (average 7.0 courses).Sixteen patients achieved complete remission and 8 patients showed drug-resistant.The complete remission rate was 67％ (16/24) and the resistance rate was 33％ (8/24).Of the 16 patients who got complete remission,6 cases were treated with EMA/CO regimen alone,and 10 cases were treated by chemotherapy combined with surgery.For the 8 patients who showed drug-resistant to EMA/CO,5 cases of them received EMA/etoposide and cisplatin (EP) regimen and 3 cases got remission,1 case received methotrexate,dactinomycin and cyclophosphamide (MAC) regimen and got remission,2 cases gave up treatment because of economic factors.The side effects of EMA/CO mainly included Ⅲ-Ⅳ degree neutropenia,anemia and alopecia.The incidence of Ⅲ-Ⅳ degree neutropenia during the treatment of EMA/CO was 21.6％ (36/167),the incidence of anemia was 96.4％ (161/167),and the incidence of alopecia was 60.5％ (101/167).In these 24 ultra high-risk GTN patients,4 patients died during follow-up.In the 20 patients who got complete remission,no recurrence or secondary tumor by chemotherapy were occurred.Conclusion EMA/CO is an effective regimen with manageable toxicity for patients with ultra high-risk GTN.

OBJECTIVE: To investigate the effect of low-frequency pulsed electromagnetic fields (PEMF) on the maturation and mineralization of rat cranial osteoblasts and its relation to IGF-1R/NO signaling pathway. METHODS: The rat osteoblasts were isolated and cultured and randomly divided into blank control group, PEMF group, GSK group (IGF-1R blocker) and PEMF+GSK group. The cells were treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. After 3 d of PEMF treatment, the expressions of protein kinase (AKT), inducible nitric oxide synthase (iNOS) and cGMP-dependent protein kinase (PKG) were detected by Western blotting; on 6 d of PEMF treatment alkaline phosphatase (ALP) activity was determined; on 12 d of PEMF treatment the calcification nodule formation was demonstrated by Alizarin red staining. RESULTS: NO level was significantly increased in rat osteoblasts treated with 50 Hz 0.6 mT PEMF for 1.5 h/d. Western blot analysis showed that the expressions of AKT, iNOS and PKG protein in PEMF group were higher than those in the control group (all <0.01); the ALP activity was increased(<0.05), and the PEMF group had the largest area of Alizarin red staining (<0.01). The expressions of AKT, iNOS and PKG protein in GSK group were lower than those in the control group; the ALP activity was decreased (<0.05), and the GSK group had the least area of Alizarin red staining (<0.01). The expressions of AKT, iNOS, PKG protein, the ALP activity and the area of Alizarin red staining in PEMF+GSK group were between PEMF group and GSK group. CONCLUSIONS PEMF may enhance the maturation and mineralization of rat cranial osteoblasts through IGF-1R/NO signaling pathway.
Animals ; Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Electromagnetic Fields ; Nitric Oxide ; metabolism ; Osteoblasts ; radiation effects ; Rats ; Receptor, IGF Type 1 ; metabolism ; Signal Transduction ; radiation effects

OBJECTIVE To study the protective effect of saikosaponin b2(SSb2)on corticosterone(CORT)induced PC12 cell injury and its mechanism.METHODS ① PC12 cells were divided into the cell control group(24 h of culture with RPMI-1640 medium),CORT group(24 h of culture with CORT 100-800 μmol·L-1)and SSb2 group(24 h of culture with SSb2 1.5625,3.125,6.25,12.5,25,50 and 100 μmol·L-1).MTT assay was used to detect the cell survival rate.②PC12 cells were divided into the cell control group(24 h of culture with RPMI 1640 medium),model group(24 h of culture with CORT 400 μmol·L-1),and model+SSb2 group(3 h pretreatment with SSb2 1.5625,3.125,6.25,12.5 and 25 μmol·L-1,removal of the supernatant before cells were co-incubated with CORT 400 μmol·L-1 and corresponding concentrations of SSb2 for 24 h).MTT assay was used to detect the cell survival rate while micro-plate assay was used to detect the lactate dehydrogenase(LDH)leakage rate of PC12 cells.③PC12 cells were divided into the cell control group,model group and model+SSb2 12.5 μmol·L-1 group.AnnexinV-FITC/PI flow cytometry assay was used to detect PC12 cell apoptosis,ultra-perfor-mance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS)cell metabonomics was used to detect metabolic profile changes and colorimetric assay was employed to detect the glutamic acid content and glutaminase activity in PC12 cells.RESULTS Compared with the cell control group,the cell viability decreased to(55±6)%(P<0.01)when the concentration of CORT was 400 μmol·L-1.When the concentration of SSb2 was higher than 50 μmol·L-1,there was significant toxicity to PC12 cells(P<0.01).②Compared with the cell control group,the cell survival rate was signif-icantly decreased(P<0.01),while the release rate of LDH was significantly increased(P<0.01)in the model group.Compared with the model group,the cell survival rate significantly increased(P<0.05,P<0.01),while the LDH release rate significantly decreased(P<0.01)in the model+SSb2 group.③ Com-pared with the cell control group,cell apoptosis was significantly increased in the model group(P<0.05).Compared with the model group,cell apoptosis was significantly decreased(P<0.05)in the model+ SSb2 group.Metabolomics results show that SSb2 significantly back-regulated nine differential metabo-lites of glutamate,creatine,N-acetylaspartate,L-tyrosine,citric acid,L-isoleucine,lactic acid,glutamine and choline.Further network analysis of the key metabolites regulated by SSb2 yielded five major metabolic pathways:D-glutamine and D-glutamate metabolism,phenylalanine,tyrosine and tryptophan biosynthesis,alanine,aspartate and glutamate metabolism,tyrosine metabolism and arginine biosynthesis.Compared with the cell control group,the content of glutamate and activity of glutaminase were significantly decreased in the model group(P<0.01).Compared with the model group,the content of glutamate(P<0.01)and activity of glutaminase(P<0.05)were significantly increased in the model+SSb2 group.CONCLUSION SSb2 has a neuroprotective effect on CORT-injured PC12 cells,and the mechanism of which is related to inhibition of apoptosis and regulation of metabolic disorders.

The application of artificial intelligence （AI） in medical diagnosis and treatment is becoming increasingly widespread， providing doctors and patients with more high-quality， efficient and personalized medical services. However， it also raised a series of ethical issues such as data security， algorithm transparency， responsibility definition， fairness and justice， doctor-patient relationships， and other aspects. Based on the combing of existing research results， this paper analyzed the research status of medical ethics in the application of AI in diagnosis and treatment， as well as expected that future medical ethics research can further explore the ethical issues of AI technology in medical treatment in greater depth， thus ensuring the rational application of AI in the medical field and maximizing the protection of patients’ rights and interests.