Objective To prepare a novel ultrasound contrast agent , targeted phase-shift lipid nanoparticles mediated by tumor homing and penetrating peptide tLyP-1 ,and to evaluate its characteristics . Methods The nanoparticles were prepared by filming-rehydration and acoustic-vibration methods .The morphology ,distribution ,particle size and zeta potential were detected . After heating and irradiating of low intensity focused ultrasound ( LIFU) ,the phase-shift characteristic and the enhancement effect in vitro were observed . The tumor homing and cell-penetrating properties of the nanoparticles were examined by confocal laser scanning microscopy and flow cytometry . The cytotoxicity of the nanoparticles was evaluated by CCK 8 assay . Results The size and distribution of nanoparticles were uniformed . The size and zeta potential of nanoparticles were ( 399 .50 ± 29 .98) nm and ( 3 .28 ± 1 .72) mV ,respectively . When the nanoparticles were heated to a temperature of 45 ℃ or after irradiated by LIFU ,nanoparticles generated phase-shift and enhanced ultrasound imaging in vitro ( P < 0 .05 ) . The confocal laser scanning microscopy showed that nanoparticles mediated by tLyP-1 can targetedly aggregate to cell membrane of MDA-MB-231 and penetrate into the cell ,but not to HUVEC . The flow cytometry showed that intracellular fluorescence intensity of nanoparticles mediated by tLyP-1 in MDA-MB-231 group was higher than that in control groups ( P <0 .05) . The CCK8 assay indicated that different concentrations of nanoparticles had no significant effects on cell activity ( P > 0 .05 ) . Conclusions A novel ultrasound contrast agent , targeted phase-shift lipid nanoparticles mediated by tumor homing and penetrating peptide tLyP-1 ,is prepared successfully . It can target to MDA-MB-231 cell and penetrate into the cell in vitro ,and enhance ultrasound imaging in vitro after LIFU irradiation ,which expected to become a novel tumor targeted ultrasound contrast agent and achieve ultrasound molecular imaging at the level of tumor cell .

Objective To evaluate the protective effect of propofol on liver in severely scalded rabbits.Methods Twenty healthy male New Zealand rabbits, aged 3-4 months, weighing 2.3-2.5 kg, were randomly divided into either scald group (group S, n =10) or propofol group (group P, n =10).Thirty percent of the total body surface was shaved chemically with 10％ sodium sulphate and then exposed to 98 ℃ water for 20 s to produce third degree thermal injury at the back and buttocks of anesthetized rats.In group P, propofol was injected at a dose of 1.5 mg/kg at 1 h after scald, followed by an infusion of 4 mg· kg-1 · h 1 for4 h.The equal volume of normal saline was given in groupS.Before scald (T1), at 1 h after scald (T2) , and at 6, 12 and 24 h after administration of propofol or normal saline (T3-5) , blood samples were taken from the internal jugular vein for determination of serum alanine aminotransferase (ALT) activity (by lactate dehydrogenase method), aspartate aminotransferase (AST) activity (by MDH), and tumor necrosis factor-alpha (TNF-α) concentrations (by enzyme linked immunosorbent assay).The rabbits were sacrificed at T5, and their livers were removed and cut into sections which were stained with haematoxylin and eosin and examined under microscope.Results The serum ALT and AST activities and TNF-α concentrations were significantly higher at T2-5 than at T1.Compared with the values at T2, the serum ALT and AST activities and TNF-α concentrations in group S and serum TNF-α concentrations in group P were significantly increased at T3-5, and no significant change was found in the serum ALT and AST activities at T3-5 in group P.Compared with group S, the serum ALT and AST activities and TNF-α concentrations were significantly decreased at T3 5, and the pathological changes were mitigated in group P.Conclusion Propofol provides protective effect on liver in severely scalded rabbits.

Objective To evaluate the feasibility and advantages of robot-assisted laparoscopic radical prostatectomy (RALRP) in treating high-risk prostate cancer.Methods From Mar.2010 to Dec.2014,69 men with high-risk prostate cancer (clinical stage ≥ T3a,serum PSA ≥ 20 μg/L or biopsy Gleason score ≥8) underwent surgical treatment at our center.RALRP was performed in 44 cases,with a mean age of (66.7 ± 8.6) yrs (range:50 ～ 82) and a mean baseline PSA of (23.1 ± 11.2) μg/L (range:3.6-48.8).Transperitoneal approach was adopted in all cases.Twenty-five patients were treated with ORP.The mean age was (64.3 ± 5.9) yrs (range:52-75) and baseline PSA was (21.7 ± 10.2) μg/L (range:5.7-41.3).Baseline clinical features,including age,initial PSA,biopsy Gleason score and clinical staging,were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups.Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly (158 ± 47)min for RALRP group and (152± 42)min for ORP group,respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were (328 ± 254) ml and (8.4 ± 3.1) days,both of which were significant lower than those in ORP group,(674 ± 302) ml and (14.4 ± 3.7) days.Two cases of urine leak and two of lymphatic leak occurred after RALRP,and a statistically insignificantly higher complication rate was observed for the ORP group,in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5％ and 24％,respectively.After the mean follow-up of 25 (RALRP) and 27 months (ORP),continence rate was significantly higher in the RARLP group (93.2％ vs.72.0％).PSA failure was observed in seven RALRP cases (15.9％) and four ORP cases (16.0％).Conclusion Compared with traditional ORP,RALRP shows significant advantages,including less blood loss,fewer complications,shorter length of stay,better postoperative continence and equivalent oncologic outcome when dealing with high-risk prostate cancer cases.Robot-assisted surgery is a safe and efficacious surgical modality in this setting.

Objective To investigate the methods of early identification and early intervention for newborn with life-threatening congenital heart disease.Methods Between January 2010 and December 2010,223 neonates with serious congenital cardiac malformations were hospitalized in PICU of Fuwai Hospi-tal.Results The most type of cardiac lesions was complete transposition of the great arteries,accounting for 59%(131 cases),and the second was total anomalous pulmonary venous connection,17%(39 cases).For the primary clinical symptoms,the most common were any cyanosis,dyspnea and cardiac murmur,accounting for 91 %(204 cases),56%(125 cases)and 53%(1 18 cases),respectively.Fifty-nine cases developed into critical conditions such as severe hypoxia,metabolic acidosis and heart failure and were sent to PICU for emergency rescue.Early intervention included maintaining ductus arteriosus open,correcting internal environ-ment disturbances,treatment of heart failure,and surgical treatment as soon as possible.Four cases died before operation and 10 cases were abandoned to continue care,which all died within 12 days after discharge.In 209 cases who received operation,9 cases died.The total operation mortality was 4.3%.Within 3 to 63 month following-up,the late death was in 2 cases,2 cases received two-stage corrective operation,and three for reop-eration.The others all were in normal cardiac function and growth.Conclusion Most of neonatal life-threat-ening congenital cardiac malformations were ductus dependent such as transposition of the great arteries and total anomalous pulmonary venous connection,which the baby needs immediate diagnosis and management for survival.Early recognition,appropriate preoperative management and operation as soon as possible are the key to rescue.

Objective To establish a method for quantitative detection of urine iodine by catalytic spectrophotometry using discrete chemical analyzer.Methods After digestion of urine samples,discrete chemical analyzer was used to control the reaction temperature and time,determine the iodine content,which replaced the urine iodine arsenic cerium catalytic spectrophotometry (standard method) after sample digestion in the testing process,and the linear range,detection limit,precision and accuracy of the method were tested.The method was used to detect the urine iodine and the results were compared with the standard method.Results The urinary iodine was in a linear range of 0-1 000 μg/L,correlation coefficient r =-0.999 7.The detection limit of the method was 4.5 μg/L.Precision:the relative standard deviation (RSD) of urine iodine samples with high,medium,and low concentrations were all ＜ 5％.Accuracy:the contents of urinary iodine in reference materials at high,medium,and low concentrations were within their respective given value ranges.No statistical significant was found in the urinary iodine content detected either by this method or the standard method (t =0.643 8,P ＞ 0.05).Conclusion Catalytic spectrophotometry using discrete chemical analyzer is succeessfully established,this method is simple,rapid,accurate and easy to operate.

Objective To investigate the natural evolution of postoperative distal adding-on in Lenke 1A and 2A adoles-cent idiopathic scoliosis(AIS)patients,and to explore the risk factors for the progression of distal adding-on.Methods From Ju-ly 2006 to July 2012,a total of 197 AIS patients with Lenke 1A or 2A curves underwent posterior selective thoracic instrumenta-tion and fusion surgery.Among which,44 patients(22.3%)with postoperative distal adding-on were recruited in this study.There were 39 female and 5 male,with an average age of(15.0±2.1)years.The mean Cobb angle of main thoracic curve was 49.3°±9.3°. The first postoperative radiograph indicating distal adding-on and the last follow-up radiograph were compared:make the measure-ment of the disc angle below lowest instrumented vertebra(LIV),and the distance between the vertebra below LIV(LIV+1)and cen-tral sacral vertical line(CSVL).Distal adding-on could be classified into progressive group and non-progressive group according to its natural evolution during follow-up.If the disc angle increased> 5°or the LIV+1-CSVL distance increased>5 mm,the pa-tients were assigned into progressive group; Otherwise, the patients were assigned into non-progressive group. Using Student T test, χ2test or Fisher exact test, the predicted risk factors for progression were screened for further Logistic regression. Results Among the 44 patients enrolled in the study,17 patients(38.6%)had progressive adding-on while 27 patients(61.4%)had non-progressive adding-on.The Risser sign was significantly lower in progressive group than non-progressive group(t=4.399,P<0.001). Besides,more patients had LIV proximal to substantially stable vertebra(SSV)in progressive group than non-progressive group (Fisher exact test value=18.142,P<0.001).The improvement of shoulder imbalance was significantly better in progressive group than non-progressive group(t=3.011, P=0.002). According to Logistic regression, the low Risser sign and LIV proximal to SSV were independent risk factors for progression of distal adding-on.Moreover,the self-image domain of SRS-22 Scores was remark-ably lower in progressive group than non-progressive group(t=2.321,P=0.014).Conclusion Distal adding-on could be classi-fied into progressive group(40%)and non-progressive group(60%)according to its natural evolution.The risk factor for its progres-sion included skeletal immaturity and LIV proximal to SSV.Moreover,the progression of distal adding-on might compensate for the shoulder imbalance during follow-up.

Objective To understand the factors related with child restraint system (CRS) use,and provide evidence for the development of appropriate intervention measures to promote the use of CRS for the protection of child passengers' safety.Methods Self-administrated questionnaire survey was conducted among 0-6 years old children' s parents who owned private cars selected through stratified cluster random sampling in Shanghai and Shenzhen to collect date about CRS use and related factors.Group discussion was conducted among some of the parents randomly selected to further understand the reasons for using or not using CRS.Results Of 7 528 parents surveyed,39.23 ％ (2 820/7 189) reported to have CRS and 17.14％(1 232/7 189) reported consistent use of CRS.Multivariate analysis indicated that young age of children,high level of education of parents,good family economic status,awareness of importance of children's safety were the positive factors for CRS use.The frequency and distance of children' car taking and the seatbelt use of drivers significantly influenced the CRS use.The main reasons for not purchasing CRS included limited car space (53.33％,2 329/4 367),low frequency of children car taking (48.55％,2 120/4 367),difficulty in installation (42.25％,1 845/4 367),high cost (38.58％,1 685/4 367),and unreliable quality (31.03％,1 355/4 367).The main reasons for not using CRS included children' s refusal (67.36％,293/435),short travel distance (53.79％,234/435),difficulty in installation or use (53.10％,231/435),limited car space (32.41％,141/435),and unnecessary (25.75％,112/435).Conclusions Parents have gaps and misunderstandings in using CRSs to protect child passengers safety.There are demands of technical guiding service in use of CRS.Integrated intervention measures should be implemented targeting at the identified barriers and needs in CRS use to promote child passenger safety,which include strengthening the propaganda and education,promoting the legislation and law enforcement,strengthening market supervision,establishing CRS related services site,exploring the rental market,etc.

Objective:To establish a method for determination of iodine in salt by arsenic-cerium catalytic spectrophotometry.Methods:The content of iodine in salt was detected by arsenic-cerium catalytic spectrophotometry with an automatic iodine analyzer. The standard curve linearity, detection limit, precision and accuracy of the method were evaluated. The iodine content of 20 edible salt samples was detected by the newly established method and direct titration, and the results were compared.Results:In the range of 0 - 150 μg/L standard curve, the correlation coefficient ( r) = - 0.999 9, and the detection limit was 1.4 mg/kg. The average iodine contents of iodine composition analysis standard materials GBW10006z and GBW10007z were 12.2 and 22.8 mg/kg ( n = 6), respectively, which were all within the given standard value ranges, and the relative standard deviations ( RSD) were 2.04% and 2.33%, respectively. Iodine composition analysis standard materials GBW10006b, GBW10007b, GBW10006v, GBW10007v, GBW10006z and GBW10007z measurement results (12.0, 24.6, 12.6, 22.8, 12.3, 23.2 mg/kg, n = 2) were all within the given standard value ranges, with good quality control. The iodine content of 20 edible salt samples was detected by arsenic-cerium catalytic spectrophotometry and direct titration, respectively, and the difference was not statistically significant ( t = 1.99, P = 0.060). Conclusion:Arsenic-cerium catalytic spectrophotometry has the characteristics of good linear relationship, low detection limit, good precision and high accuracy in determination of salt iodine content, which is suitable for popularization and application.

Purpose To investigate the diagnostic value of 18F-FDOPA PET/CT imaging and semi-quantitative analysis platform for the diagnosis of Parkinson's disease(PD).Materials and Methods There were 27 healthy controls and 56 clinically diagnosed PD patients,including 33 early PD(Hoehn-Yahr class Ⅰ-Ⅱ)and 23 advanced PD(Hoehn-Yahr class Ⅲ-Ⅳ),underwent 18F-FDOPA PET imaging in Nanjing First Hospital,Nanjing Medical University were consecutively enrolled from January 2018 to December 2019.The striatal to occipital ratio(SORs)in radioactivity was calculated by HERMES BRASS platform,thereby completing the semi-quantitative analysis of the brain based on regions of interest and observing the asymmetry of the striatal subregions in early-stage PD and late-stage PD patients.Using artificial intelligence techniques to perform principal component analysis on the SORs of the striatal subregions in PD group and healthy control group,the degree of data aggregation and the distinguishability between groups were observed.Results The SORs was significantly reduced in the whole caudate,anterior,posterior putamen and striatum of advanced PD patients(t=9.02-11.72,P<0.000 1).The area under the curve was 0.952,0.973,0.995 and 0.982,respectively.Compared with the healthy control group,the loss of striatal asymmetry index(mean)in each subregion of the striatum in early PD group was caudate(7.61±5.50)%,anterior putamen(11.43±8.97)%,posterior putamen(17.17±11.63)%,and whole striatum(10.65±7.46)%,respectively.The uptake of 18F-FDOPA in the striatum of PD patients was significantly reduced,and the most obvious loss of early PD patients was contralateral posterior putamen,with a decrease of 34%.Conclusion The platform semi-quantitative analysis of 18F-FDOPA PET/CT images provides objective semi-quantitative values for early diagnosis and differential diagnosis of PD.Asymmetry in the striatum,especially in the putamen,may be an important parameter for early diagnosis of PD..

Objective:To compare the cost-effectiveness of hospitalized Chinese patients undergoing nucleic acid screening strategies for hepatitis B and hepatitis C, immunological screening strategy, and no screening strategy under different willingness to pay (WTP). The results might aid to decision-making for the optimal strategy.Methods:In this study, nucleic acid screening, immunological screening and no screening were used as screening strategies, and China′s GDP in 2021 (80 976 yuan) was used as the threshold of WTP to construct a Markov model. After introducing parameters related to the diagnosis and treatment of hepatitis B and C in inpatients, a cohort population of 100 000 inpatients was simulated by TreeAge Pro 2021 software, the total cost, total health effects, incremental cost-effectiveness ratio and average cost-effectiveness ratio of different screening strategies were calculated, and cost-effectiveness analysis was conducted. Univariate and probabilistic sensitivity analysis were used to assess the impact of parameter uncertainty on the final results.Results:Compared with the non-screening strategy, the incremental total cost of the hepatitis B immunological screening strategy for cohort patients was 11 049 536 yuan, and the incremental cost-effectiveness ratio was 24 762 yuan/quality-adjusted life years (QALY), while the total incremental cost of nucleic acid screening was 19 208 059 yuan, and the incremental cost-effectiveness ratio was 29 873 yuan/QALY; the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 834 yuan/QALY. Compared with the non-screening strategy, the incremental cost-effectiveness ratio of hepatitis C immunological screening strategy was 5 731 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening strategy was 8 722 yuan/QALY, the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45 591 yuan/QALY. The results of probabilistic sensitivity analysis showed that when the cost of nucleic acid testing exceeded 214.53 yuan, it was not cost-effective to perform hepatitis B nucleic acid screening under the WTP as 1 fold GDP. When the cost of nucleic acid testing exceeded 132.18 yuan, it was not cost-effective to conduct hepatitis C screening under the WTP as 1 fold GDP.Conclusions:Nucleic acid screening strategy can achieve more cost-effectiveness and is worthy of vigorous promotion. Compared with no screening, both the nucleic acid and immunological screening strategies are cost-effective, and hepatitis nucleic acid screening is the optimal strategy for hospitalized patients.