Objective To evaluate the efficacy and safety of retrograde wire in chronic total occlusion with calcification.Methods 4 patients with chronic total occlusion with calcification were selected.3 RCA and 1 LAD as CTO target vessel.Side branches proximal to the occlusion waspresent in all patients,2 of 4 with extreme tortuosity,1 of 4 with ostial occlusion in LAD.At the support of 150cm Finecross microcatheter,all patients were treated with the retrograde technique,with 3 of 4 as primary strategy,1 of 4 as immediately after antegrade failure.Results Retrograde wire crossed the collaterals and successfully delivered distal to the occlusion in all patients.Epicardial collateral from LCX to RCA was accessed in 1 patient,and septal in 3 of 4 patients.Reverse CART technique was applied in 2 of 4 patients,and subsequent exteriorization of the retrograde wire via the antegrade guide was completed.Kissing of antegrade and retrograde microcatheters inside antegrade guide was completed and antegrade wire crossed the CTO lesion via retrograde microcatheter in 1 patient.Both retrograde and antegrade wires could not cross the CTO lesion in 1 patient with extreme tortuosity and severe calcification,and the RCA CTO lesion was not opened in this patient.Overall successful rate was 75％.Drug eluting stents were implanted in 3 successfully recanalized vessels.All patients had no complications during procedure and subsequent hospitalization.Conclusion The retrograde approach was used with high degree of success and safety in chronic total occlusion with calcification.

Objective:To observe the effect of triptolide on asthmatic mice IL-23, Th17 cells and their cytokine IL-17 expression,and to explore its effect on Th17 cell-mediated airway inflammation,and its mechanism of action,which provides targets for triptolide in treatment of asthma.Methods: 32 SPF level BALB/c mice were randomly divided into normal control group ( NC ) , asthmatic group ( A ) , triptolide group ( TA group ) and dexamethasone group ( DA group ) , n=8.Asthmatic group with ovalbumin sensitization and aluminum hydroxide;ovalbumin intranasal inhalation challernge.Mice of triptolide group and dexamethasone group were sensitized and challenged as asthmatic group, and the two groups were respectively given triptolide and dexamethasone by intraperitoneal injection 30 minutes before challenged.Mice of control group was sensitized and challenged by saline.The total number of white blood cells and the number of eosinophils of BALF were calculated by cell counter.IL-23 and IL-17 levels in BALF were measured by ELISA.Lung tissue were stained with hematoxyin and eosin(HE).IL-17 protein expression levels were detected by immu-nohistochemistry in lung tissue,and the mRNA expression levels of right lung tissue were detected by qRT-PCR.Th17 percentage of CD4+T lymphocytes were analyzed by flow cytometry.Results:Numbers of white blood cells( WBC) and eosinophils( Eos) of BALF, IL-23 and IL-17 levels of BALF,IL-17 protein and IL-17 mRNA expression in lung tissue,and Th17 cell frequencies in peripheral blood were all significantly increased in the asthmatic group compared to the control group(P<0.05),but reduced significantly in triptolide group and dexamethasone group compared to asthmatic group;there was no significant difference in the above mentioned indicators between in triptolide group and dexamethasone group ( P>0.05 ) .Conclusion: Triptolide can inhibit airway inflammation, which mechanism is possible by inhibiting IL-23/Th17(IL-17) inflammatory axis.

Objective: To investigate the willingness to receive a COVID-19 vaccination and its influencing factors among individuals that missed the second dose of the inactivated COVID-19 vaccine in Zhejiang Province, so as to provide the evidence for improving the strategy for COVID-19 vaccination. Methods: Individuals that did not receive the second dose of the inactivated COVID-19 vaccine after 56 days of getting the first dose (missed individuals) from March and May, 2021, were randomly sampled from Zhejiang Provincial SaaS Vaccination Information System. Their basic information, status of getting the inactivated COVID-19 vaccine and willingness to receive the second dose of the inactivated COVID-19 vaccine were collected through telephone interviews. The factors affecting the willingness to receive the second dose of the inactivated COVID-19 vaccine were identified among the missed individuals using a multivariable logistic regression model. Results: Totally 562 individuals were investigated, and there were 292 (51.96%) valid respondents. There were 54 actual missed individuals, with a mean age of (40.91±16.75) years, which included 39 men (72.22%) and 15 women (27.78%). Of all missed individuals, 23 had an educational level of junior high school and below (42.59%). The mean duration from the time of investigation to the time of getting the first dose of the inactivated COVID-19 vaccine was (137±28) days. A half of the missed individuals were willing to receive the second dose of the inactivated COVID-19 vaccine. Multivariable logistic regression analysis showed high willingness to receive the second dose of the inactivated COVID-19 vaccine among the missed individuals with requirements of vaccination in the workplace (OR=5.393, 95%CI: 1.112-26.152) and low willingness among the missed individuals that felt physical discomfort after receiving the first dose (OR=0.168, 95%CI: 0.035-0.806). Conclusions The willingness to receive the second dose of the inactivated COVID-19 vaccine was low among the missed individuals, and high willingness is seen among the missed individuals with requirements of vaccination in the workplace and without physical discomfort after receiving the first dose of the inactivated COVID-19 vaccine.

Objective To observe the curative effect of auricular point sticking on menstrual distending pains of breasts. Methods Sixty-two patients with hyperplasia of mammary glands were randomized evenly into experiment group and control group:the former were managed with auricular point sticking and the latter with oral administration of Xiaoyao Pills for three treatment courses, each menstrual cycle as a course.The two groups were compared in terms of menstrual distending pains of breasts.Results The experiment group was significantly better than the control group in terms relieves of pains as well as the curative effect after the trial (P<0.01 for both).Conclusions Auricular point sticking is effective in relieving the menstrual distending pains of breasts.It is simple for manipulation and thus worth clinical spreading.

Objective To investigate the effects of acarbose versus fenofibrate on insulin secretion and insulin resistance in the subjects with impaired glucose tolerance (IGT) and hypertriglyceridemia. Methods Eighty subjects were allocated to acarbose group (28 cases),fenofibrate group (30 cases),and control group (22 cases) without intervention for 3 months,and also divided into elderly (46 cases) and younger groups (34 cases). Fasting blood samples were collected for measuring fasting plasma glucose and lipid.Oral glucose tolerance test (OGTT) were carried out with measurement of plasma insulin and glucose before ad after treatment.Early insulin secretion indexes(△I30/△G30),insulin secretion indexes (HOMA -β) and insulin resistance indexes (HOMA-IR)were calculated. Results After 3-months of treatment,the lipid profile was evidently improved in fenofibrate group. Levels of triglyceride (TG) and total cholesterol (TC) were significantly reduced ( both P ＜ 0.01 ),△I30/△G30 was significantly increased (P ＜ 0.05) and HOMA-IR was decreased (P＜＜0.01).In acarbose group,levels of fasting plasma glucose (FPG),2hours postprandial plasma glucose (2 hPG) and HOMA-IR were reduced (all P＜0.01),△I30/△G30 and HOMA-β were enhanced (P＜0.01 or P＜0.05).No change of above indicators was found in the control group.Compared with fenofibrate group,acarbose group had higher △ I30/△G30 (P＜ 0.05),HOMA-β (P＜ 0.01 ) and lower HOMA-IR ( P ＜ 0.01 ).The improvement of △△I30/△G30 was correlated with the decreasing of plasma FPG,2 hPG and TG(r=0.5812,0.6327,0.3872,P＜0.01),while HOMA-1R was related with the decreasing of plasma 2 hPG,TG and TC(r=0.8126,0.4671,0.2895,P＜ 0.01). HOMA-IR,△I30/△G30 and HOMA-β were lower (P＜0.01) and acarbose improved insulin resistance better (P＜0.05) in the elderly than in the younger with type 2 diabetes. Conclusions Pancreatic β-cell function declines gradually with aging,acarbose may have advantage over fenofibrate in improving early insulin secretion and resistance which was more relieved by diminishing glucotoxity in comparison with lipotoxity.

Objective To investigate the relatio nship between the DNA methylation status of gluco-corticoid receptor (GR) gene promoter and mRNA expression level of GRα gene of peripheral blood mononuclear cells (PBMCs) in patients with systemic lupus erythematosus (SLE). Methods Fifteen new onset SLE patients and fifteen healthy controls were enrolled in this study. The DNA methylation status of GR gene promoter 1 of PBMCs was detected through bisulfite sequencing polymerase chain reaction (PCR). The mRNA expression of GRα, DNA methyltransferases, growth arrest and DNA damage-induced 45α (GADD45α) of PBMCs was detected using the quantitative real-time polymerase chain reaction method. T-test and χ2-test were used to detect the differences between the two groups, Pearson's correlation coefficient was used to analyze the linear correlation between two variables. Results Compared with healthy controls, the mRNA expression of GRα was signi-ficantly declined in SLE patients (10±5, 17±7, t=2.69, P<0.05), and the mRNA expression of DNMT1 and GADD45α was significantly elevated in SLE patients (t=3.11, P<0.05 and t=2.98, P<0.05). The overall mean methylation status of the 142 CpG islands of the four promoters was significantly elevated in SLE patients [(16±8)%vs (11±6)%, t=2.75, P<0.05]. The global methylation status of PBMCs in SLE patients was obviously lower than healthy controls (t=4.39, P<0.05). Conclusion Hypermethylation of GRα promoter may result in GRαgene low expression in PBMCs of patients with SLE.

Objective:To study the influence of triptolide on neutrophils asthmatic mice of WBC and EOS in bronchoalveolar lavage fluid.Methods:Using ovalbumin ( OVA) combined with lipopolysaccharide ( LPS) method to establish sensitized asthmatic mice,BALB/c mice were randomly divided into 32 neutrophilic asthma group ( NA group ) , neutrophil triptolide intervention group (TLN group),neutrophil dexamethasone group (DXN group) and normal control group (NC group),n=8,hemocytometer calculated for each group of mice bronchoalveolar lavage fluid ( BALF) of the total number of WBC and EOS;smears stained Switzerland View in-flammatory cell infiltration.Results: In bronchioalveolar lavage fluid, numbers and infiltrations of WBC and EOS were significantly decreased in the DXN,TLN group than those in the NA group(P<0.05);but were significantly higher than the NC group (P<0.05), the DXN group above parameters were significantly higher than the TLN group ( all P<0.05 ) .Conclusion: Triptolide can reduce the total number of BALF WBC and EOS,inhibit lung WBC,EOS infiltration,ease neutrophilic airway inflammation.

Objective To explore the effect of ultrasound guided percutaneous dilatation tracheotomy in critical ill patients.Methods From January 2016 to January 2018,95 critical ill patients who were treated in the People's Hospital of Quzhou were selected.According to the random number table method,they were divided into control group (n =47) and observation group (n =48).The patients in the control group were treated with traditional tracheotomy,and the patients in the observation group were treated with percutaneous dilatation tracheotomy under ultrasonic guidance.The operation condition of the two groups was observed,including operative bleeding volume,operative time,incision length,extubation time,incision healing time,hospitalization time and so on.The postoperative complications and mortality were recorded in the two groups.Results The operative bleeding volume,operative time,incision length and incision healing time in the observation group were (12.91 ± 1.36) mL,(10.05 ± 1.14) min,(1.46 ± 0.32) cm,(5.48 ±0.39)d,respectively,which were lower than those in the control group[(38.54 ± 3.47)mL,(27.43 ±2.29) min,(3.25 ± 0.68) cm,(7.64 ± 0.72) d],there were statistically significant differences between the two groups(t =40.098,39.616,13.888,15.381,P =0.000,0.000,0.000,0.000).The extubation time,hospitalization time in the observation group were (14.19 ± 1.14)d,(20.17 ± 1.85)d,respectively,which in the control group were (14.23 ± 1.17) d,(20.26 ± 1.89) d,respectively,there were no statistically significant differences between the two groups (t =0.142,0.198,P =0.886,0.843).The incidence rate of postoperative complications in the observation group was 6.25％,which was lower than 21.28％ in the control group,there was statistically significant difference between the two groups (x2 =9.515,P =0.002).The ICU mortality and hospitalization mortality in the observation group were 2.08％ and 4.17％,respectively,which in the control group were 10.64％ and 12.77％,respectively,there were no statistically significant differences between the two groups (x2 =2.937,2.277,P =0.087,0.131).Conclusion Ultrasound guided percutaneous dilatation tracheostomy can improve operation condition,reduce hospitalization time,and has less complications,low mortality,which has good clinical value in critical ill care.

Objective: To investigate the characteristics of public health emergencies and related information in schools of Zhejiang Province from 2012 to 2021, so as to provide insights into the management of public health risks in schools. Methods: The public health emergencies and related information in schools of Zhejiang Province during the period from 2012 to 2021 were retrieved from the Public Health Emergency Management Information System of Chinese Disease Prevention and Control Information System. The type, temporal distribution and regional distribution of the events and the type of schools were analyzed, and the trends in disease attack rates were evaluated. Results: A total of 1 284 public health emergencies and related information were reported in schools of Zhejiang Province from 2012 to 2021, accounting for 72.34% of all public health emergencies and related information, and a total of 40 562 cases were reported, accounting for 87.72% of all cases; no death was recorded. There were 1 276 infectious disease events reported, accounting for 99.38%, and norovirus enteritis (649 cases), varicella (281 cases), influenza (181 cases), hand, foot and mouth disease (94 cases) and mumps (22 cases) were predominant infectious diseases, accounting for 95.56% of all public health emergencies and related information in schools. The number of public health emergencies and related information in schools peaked during the period between March and June (361 events, 28.12% of all events) and the period between November and December each year from 2012 to 2021 (629 events, 48.99% of all events), and the events occurred across 11 cities of Zhejiang Province, with the largest number of events reported in Hangzhou City (507 events). In addition, there were 627, 328 and 242 events reported in primary schools, kindergartens, and middle schools, accounting for 93.22%, and the events predominantly occurred in city schools. Nevertheless, there were no significant changes in the trends for attack rates of norovirus enteritis, varicella, influenza and hand, foot and mouth disease and mumps in schools of Zhejiang Province from 2012 to 2021. Conclusions Norovirus enteritis, varicella, influenza, hand, foot and mouth disease and mumps were the predominant types of public health emergencies and related information in schools of Zhejiang Province from 2012 to 2021, and the largest number of events were reported in primary schools.

Objective: To analyze the epidemiological characteristics of overseas imported cases with coronavirus disease 2019 (COVID-19) in Zhejiang Province, so as to provide insights into containment of overseas imported COVID-19. Methods: The pertaining to overseas imported COVID-19 cases in Zhejiang Province during the period between January 1, 2020 and May 31, 2022 were captured from the Chinese Disease Prevention and Control Information System. The temporal, spatial and population distributions, the duration from entry to the first time of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test, and COVID-19 vaccination of overseas imported COVID-19 cases were analyzed using a descriptive epidemiological method. Results: A total of 1 535 overseas imported COVID-19 cases were reported in Zhejiang Province during the period between January 1, 2020 and May 31, 2022, including 596 confirmed cases and 939 asymptomatic infections, and all reported cases were imported from 102 countries and territories. Overseas imported COVID-19 cases were reported in each month during the period between March 2020 and May 2022 except May 2020, and the mean monthly number of reported overseas imported COVID-19 cases was 125 during the period between December 2021 and May 2022. Overseas imported COVID-19 cases were reported across 11 cities of Zhejiang Province, with the largest numbers reported in Hangzhou (978 cases) and Jiaxing cities (177 cases), and imported cases were reported in 76.09% of counties (districts) in Zhejiang Province. The overseas imported COVID-19 cases were predominantly identified among individuals with Chinese nationality (88.79%), at ages of 20 to 39 years (59.09%), and students (21.82%), workers (17.20%) and business servants (17.00%) were predominant occupations among the overseas imported COVID-19 cases. The median duration from entry to the first time of positive SARS-CoV-2 nucleic acid test was 3.98 (7.06) d during the period between January 1, 2020 and May 31, 2022, and was 3.23 (4.97) d during the period between December 1, 2021 and May 31, 2022, which was significantly shorter than that during the period between January 1, 2020 and November 30, 2021 (P<0.001). The proportion of normal and more severe types of COVID-19 was 15.69% among cases without COVID-19 vaccination, which was significantly higher than that (7.77%) among those receiving booster vaccination (χ2=5.345, P=0.021), but was not significantly different from that (12.65%) among those receiving full-dose vaccination (χ2=0.971, P=0.324). Conclusions Students with Chinese nationality, workers and business servants were predominant among overseas imported COVID-19 cases in Zhejiang Province until May 31, 2022. The duration from entry after December 1, 2021 to identification of overseas imported COVID-19 cases shortened, and booster COVID-19 vaccination facilitated the alleviation of severity of clinical symptoms. There is a long-term risk of overseas importation of COVID-19 in Zhejiang Province, and the containment of imported COVID-19 requires to be sustainably implemented among entry personnel.