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 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 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 effect of Bairui granule and Deacetylated Ligustrazin injection on plasma BNP and FABP levels in children with heart failure and pneumonia.Methods 60 children of heart failure and pneumonia who received therapy from July 2014 to June 2016 in our hospital were randomly divided into two groups, the observation group and the control group, 30 cases in each group.children in the observation group were treated with sodium phosphate creatine, and the control group was treated with 2-linolenic acid,the clinical outcomes, clinical signs, BNF, FABP, LVEF and LVEDP were compared between the two groups.Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05); The heart rate, respiratory rate and blood oxygen saturation of the two groups were significantly improved compared with those before treatment ( P<0.05 ) , the heart rate and respiratory rate of the observation group were lower than those of the control group, the oxygen saturation was higher than that of the control group (P<0.05).After treatment, the BNF and FABP indexes of the two groups were lower (P<0.05), and the BNF and FABP indexes in the observation group were lower than those in the control group (P<0.05); The LVEF of the observation group was higher than that of the control group, the LVEDP index was lower than that of the control group, the difference was statistically significant (P<0.05).Conclusion Bairui granule and Deacetylated Ligustrazin injection in the treatment of heart failure with pneumonia has a good effect in the process, which will help reduce the BNP index in children, recovery of children's body function.

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 establish a prediction model of herpangina epidemic trend based on Baidu index and hand, foot and mouth disease, so as to provide insights into analyses of communicable disease epidemics with limited or missing surveillance data. Methods: The incidence of hand, foot and mouth disease in Zhejiang Province during the period from the first week of 2015 through the 39th week of 2021 was retrieved from the China Information System for Disease Control and Prevention, and the Baidu index of hand, foot and mouth disease and herpangina was collected via the Baidu search engine during the same period. The correlation between the Baidu index and time series of hand, foot and mouth disease was examined using wavelet analysis. In addition, a random forest training model was created based on the Baidu index and incidence of hand, foot and mouth disease, and the fitting effectiveness was evaluated using the mean percentage error, while the Baidu index of herpangina was included in the model to predict the epidemic trend of herpangina during the study period. Results: The Baidu index of herpangina and hand, foot and mouth disease, and the Baidu index and incidence of hand, foot and mouth disease all appeared two peaks at the 26th and 52th week. The phase difference was less than 0.1 week between the Baidu index and time series of hand, foot and mouth disease, and the mean percentage error of the training model was 13.07%, with high concordance between the predicted number and actual report number of cases with hand, foot and mouth disease. The numbers of herpangina cases were predicted to be 28 822, 27 341, 28 422, 51 782, 52 457 and 5 691 from 2015 to 2020, and there were totally 48 702 herpangina cases reported until the 39th week of 2021. Like hand, foot and mouth disease, the incidence of herpangina peaked between May and July. Conclusion The random forest training model based on the Baidu index and incidence of hand, foot and mouth disease is feasible to predict the epidemic trend of herpangina.