Objective To investigate the correlation between bronchial provocation tests and the onset of the disease.Methods One hundred and seven patients who hospitalized in General Hospital of China Aviation from 2013-2014 were selected as our subjects.They all were with unexplained symptoms such as cough and asthma suppress.All the patients were performed bronchial provocation tests.In accordance with the onset time,patients were divided into acute (＜ 3 weeks),subacute (3-8 weeks) and chronic (＞ 8 weeks) groups.The positive rates of bronchial provocation test of three groups were compared.Results Of all 107 patients,36 patients were positive and 71 were negative in terms of bronchial provocation test.The cases with acute,subacute and chronic disease history were 16,36 and 55 respectively.The positive rate of bronchial provocation tests in different onset were 56.3％ (9/16),36.1％ (13/36),23.6％ (13/55) respectively,and there was statistics significant difference(x2 =6.275,P ＜ 0.05).The positive rate of bronchial provocation tests in acute group was higher than that in chronic group (x2 =6.165,P ＜ 0.05).There was positive correlation between the positive rate of bronchial provocation tests and the onset,and the correlation coefficient Pearson was 0.239 (P ＜0.05).Conclusion There is a correlation between the positive rate of bronchial provocation tests and the onset.We should strengthen the monitoring in patients with acute onset and follow-up.

Objective To explore the value of image fusion guided contrast-enhanced ultrasonography (CEUS) in detecting liver nodules with abnormal blood supply missed by ultrasonography (US) and CEUS.Methods In 35 patients with HBV cirrhosis,forty-two liver nodules with abnormal blood supply which were missed by US and CEUS but detected by contrast-enhanced CT/MRI were analyzed retrospectively.Image fusion guided CEUS was performed after ultrasound and contrast enhanced CT/MRI images were fused.The fusion time,technical success rate,nodule detection rate and diagnosis accuracy rate were analyzed.Results Image fusion was underwent successfully in all 35 patients,the technical success rate was 100％.Average fusion time was (4.1-± 1.8)min(1-17 min).Forty liver nodules with abnormal blood supply were detected by image fusion guided CEUS,and the detection rate was 95.2％ (40/42).One nodule located at the top of right liver was missed because of the influence of lung gas,the other one was invisible due to its deep position.The diagnosis accuracy rate of image fusion guided CEUS was 97.5 ％ (39/40),and two nodules misdiagnosed by contrast-enhanced CT were diagnosed correctly by image fusion guided CEUS.Conclusions Image fusion guided CEUS had a high detection rate and diagnosis accuracy rate for liver nodules with abnormal blood supply missed by US and CEUS.It can improve the clinical diagnosis and guide interventional procedures.

Metal or semi-metal elements have numerous physiological and biochemical properties and have correlations with the process of occurrence and development of Zheng and Chinese herbal medicine pharmacodynamics mechanism. This article will expound the current situation of traditional Chinese medicine (TCM) research based on metal elements from the researches of Zheng, medicine theory, pharmacodynamic mechanism, prescription principles, medicine concocted theory and medicine quality control in TCM. In addition to putting forward the shortages of current researches, we also introduce metallomics, the member of Omics in systems biology to offer a new idea for modernization of TCM based on metal elements.

ObjectivesTo examine the validity of high-frequency Doppler ultrasound in identifying knees synovitis in patients with rheumatoid arthritis(RA).MethodsNinety-five consecutive patients with active RA were examined withhigh-frequency Doppler ultrasound to examine synovitis signals in knees.Synovial tissue samples of 51 patients were obtained by closed needle biopsy from knees after ultrasound examination.Serial synovial tissue sections were stained with H&E and immunohistochemical staining,and the histopathological synovitis scores were evaluated.The relationship among clinical, histopathological and ultrasound synovitis indexes was analyzed by Spearman's rank order correlation test and receiver operating characteristic curve analysis.ResultsAmong 95 RA patients,the median thickness of synovial membrane in ultrasound was 2.8 mm,the median depth of effusion was 2.7 mm; Doppler signals of synovial blood flow were detected in 82％(78/95 ) of patients and the median semiquantitive grading of synovial blood flow was 1.0.The thickness of synovial membrane and synovial blood flow at Doppler ultrasound correlated positively with histological synovitis score,hyperplasia of the lining layer,and inflammatory infiltration in sublining area (the thickness of synovial membrane:r=0.438,0.424,0.368,respectively; synovial blood flow:r=0.357,0.377,0.347,respectively; all P＜0.05).Although there was no significant difference in clinical synovitis indexes between patients with histologically low-grade and high-grade synovitis,the thickness of synovial membrane and synovial blood flow in ultrasound in patients with histologically high-grade synovitis was significantly higher than those with low-grade synovitis(P=0.001,0.036,respectively).When the thickness of synovial membrane in ultrasound was ≥ 3.9 mm,the specificity of diagnosing the high-grade synovitis was 96.7％ and the sensitivity was 61.9％.ConclusionSynovitis signals at high-frequency Doppler ultrasound correlate with histopathological synovitis,and it might be helpful in evaluating the severity of histopathological synovitis.

Preoperative diagnosis of biliary obstruction mainly depends on imaging examination.Percutaneous transhepatic cholangiography (PTC) is a common method in detecting biliary obstruction.PTC combined with computed tomography (CT) could enhance the diagnostic rate.From April 2009 to April 2011,8 patients with biliary obstruction were admitted to the Shenzhen Hospital of Peking University.Contrast solution (30 ml of iodine solution at a concentration of 1.5％ -2.0％)was injected through a PTC tube,and then CT scan was performed.An iohexol contrast solution at a concentration of 300 mgl/ml was injected at a dosage of 1.5 ml/kg and at 3-5 ml/s,then the arterial phase,venous phase and delayed phase were scanned.The original data were uploaded to Vitrea 2 workstation for multiplane reconstruction,maximum intensity projection and volume rendering.The procedure was successfully performed on all patients,and the position of the biliary obstruction was identified in 7 patients.Five patients were diagnosed as with hilar cholangiocarcinoma,1 with sclerosing cholangitis and 2 with adenoma of the distal common bile duct.The patients' symptoms were alleviated after percutaneous transhepatic biliary drainage.

Objective To determine the incidence and risk factors of acute kidney injury (AKI) in respiratory failure patients.Method Clinical data of 235 patients diagnosed as respiratory failure admitted in respiratory division and internal medicine intensive care unit in Renji Hospital from January 2006 to December 2008 were analyzed retrospectively.Patients'demographics,clinical data and laboratory examinations before and after respiratory failure were collected.The incidence,clinical risk factors and hospital mortality of AKI in the respiratory failure patients were analyzed.Multivariate Logistic regression analysis was used to investigate the independent risk factors of AKI in these patients.Results Of the total 235 patients,the average age was (70.05±12.85) years old,the ratio of male to female was 1.90:1.Seventy-seven patients developed AKI and the incidence was 32.8％.The incidence of AKI in those with hypertension (44.4％ vs 26.6％,P＜0.01) or chronic kidney disease(66.7％ vs 31.3％,P＜0.01) was significantly higher.The incidence of AKI in patients with mechanical ventilation was much higher than those without mechanical ventilation(44.8％ vs 13.3％,P＜0.01).The incidence of multi-organ system failure (33.8％ vs 5.7％,P＜0.01),the failure of weaning from mechanical ventilation(69.2％vs 32.5％,P＜0.01) and the mortality (51.9％ vs 13.3％,P＜0.01) in AK1 patients were higher than those without AKI.Multivariate Logistic regression analysis showed that age (OR=1.668),anemia (OR=0.980),baseline serum creatinine (OR=1.071) and mechanical ventilation (OR=3.222) were independent risk factors of AKI.Conclusions Incidence and mortality of AKI are quite high in respiratory failure patients.Age,baseline serum creatinine,anemia and mechanical ventilation are independent risk factors of AKI.

Objective:To explore the application of endoscopic narrow-band imaging(NBI) in the early diagnosis of throat malignant tumors.Methods:From January 2014 to December 2019, 512 patients with suspected benign or malignant diseases of the throat in the First People's Hospital of Wenling were selected, and all patients were performed white light endoscopy and NBI endoscopy.The biopsies were taken for pathological examination.The histopathological results were seemed as gold standard for diagnosis.Results:NBI endoscopy was superior to white light endoscope in terms of microvascular morphology and lesion outline(χ 2=457.497, 293.209, all P<0.05). The diagnostic coincidence rate, sensitivity and negative coincidence rate of NBI endoscope for malignant tumors were higher than those of white light endoscope(χ 2=10.131, 6.197, 4.084, all P<0.05). The sensitivity of NBI endoscope type Ⅰ-Ⅱ in the diagnosis of benign lesions was 90.65%, and the specificity was 96.88%.The sensitivity and specificity of NBI endoscope type Ⅲ-Ⅳ in the diagnosis of mild-moderate dysplasia were 80.99% and 97.52%, respectively.The sensitivity and specificity of NBI endoscopy type Va in the diagnosis of severe atypical hyperplasia were 15.18% and 98.54%, respectively.The sensitivity and specificity of NBI endoscope Va-c in the diagnosis of invasive cancer were 93.24% and 96.93%, respectively. Conclusion:Compared with white light endoscope, NBI endoscope can more clearly show the outline of lesions and submucosal blood vessels, and can more accurately diagnose malignant tumors in the throat, especially can more recognized the pre-cancerous lesions and early malignant tumors.It has important clinical application value in early diagnosis of malignant tumor in the throat.

Objective To explore the value of the Physiology and Surgical Severity Score(POSSUM)scoring system in predicting postoperative complications in elderly patients with thoracic surgery,and to ana-lyze its correlation with Clavien-Dindo classification.Methods The data of 182 elderly patients who under-went thoracic surgery in this hospital from October 2019 to March 2023 were retrospectively analyzed.They were divided into the complication group and the non-complication group according to whether there were complications after surgery.The baseline data and POSSUM score of the two groups were analyzed,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of POSSUM for post-operative complications in elderly patients.POSSUM of patients with different Clavien-Dindo classification was compared,and the correlation between POSSUM and Clavien-Dindo classification analyzed.Results The incidence of pulmonary infection was the highest in the complication group,followed by hypoproteinemia.POSSUM in the complication group was higher than that in non-complication group before operation,and the difference was statistically significant(P＜0.05).The ROC curve showed that the area under curve(AUC)value of POSSUM was 0.829;In the complication group,according to Clavien-Dindo classification,there were 5 cases of grade Ⅰ,47 cases of grade Ⅱ,8 cases of grade Ⅱ Ⅲ,7 cases of grade Ⅳ and 8 cases of grade V,the difference was statistically significant(P＜0.05).The correlation analysis showed that POSSUM score was positively correlated with Clavien-Dindo classification(r＞0.513,P＜0.05).Conclusion The POSSUM scoring system has a high value in predicting postoperative complications in elderly patients with thoracic surgery.

Objective: To study the epidemiological characteristics of tsutsugamushi disease, and to confirm the existence of the disease's epidemic foci in Taizhou. Methods: From 2013 to 2014, Dongxing town hospital and Xingqiao town hospital were selected as specimen collection sites in Jingjiang city. Blood samples (5 ml) were collected from 40 patients with acute tsutsugamushi disease. A total of 59 rodents were captured with cage night method in the survey sites at 5, 7, 9, 10, and 11 months in 2013, from which, the spleen, liver, and kidney specimens were selected. Chigger mites were captured by small blackboard method and from the ears of the captured rodents. A total of 226 small blackboards were laid, 27 mites were captured, and the samples were grounded into suspension. Nested-polymerase chain reaction and cell and tissue culture techniques were used to test the specimen from the probable patients, host animals and chigger mites. Results: Among the 40 acute tsutsugamushi disease blood samples, 29 were found to meet the test requirements, 17 were positive for orientia tsutsugamushi nucleic acid with 59% of the positive rate, and 1 stran orientia tsutsugamushi was isolated. 59 rats were captured and the density of mice was 5.5%. Among them, there were 26 Mus musculus (2.4%), 18 Rattus flavipectus (1.7%) and 15 Smelly shrew (density 1.4%). 1 Smelly shrew was tested positive for orientia tsutsugamushi nucleic acid, and the negative results were found in the other rodent specimens. 27 Chigge mites were collected by small blackboard method and the density of mites was 0.12 for each blackboard, among which 3 larvae and 24 nymphs were found. 33 Chigger mites were collected from the ears of 3 Smelly shrew, and the density of the mite was 11 per mouse. All the captured Chigger mites were identified as Leptotrombidium scutellare and 1 group of specimens of Chigger mites from the external environment were positive for orientia tsutsugamushi nucleic acid. Conclusion There was a high density of mice in the epidemic area from May to November and the species of the chigger mites were Chigger mites in Taizhou. The nucleic acid of the oriental tsutsugamushi was detected in the patients with acute scrub typhus, rodents and vectors. According to the above-mentioned results, it was considered that the scrub typhus epidemic area of Taizhou city has the natural foci of scrub typhus.

OBJECTIVETo investigate the role of microRNA-34a (miR-34a) in regulating the cell cycles of bladder cancer cell line J82 and explore the underlying mechanism.

METHODSJ82 cells were transfected with a miR-34a mimic or an inhibitor to induce miR-34a overexpression or silencing. The RNA level of miR-34a in the transfected cells was detected by real-time PCR, and CD44 expressions at the mRNA and protein levels were detected by real-time PCR and Western blotting. Luciferase reporter assay was used to detect the activation of 3'UTR of CD44, and flow cytometry was performed to analyze the cell cycle changes.

RESULTSThe expression level of miR-34a was significantly increased and CD44 expression significantly lowered in cells transfected with miR-34a mimic; miR-34a inhibitor transfection caused reverse effects on miR-34a and CD44 expressions. MiR-34a mimics downregulated while miR-34a inhibitor enhanced the activation of 3'UTR of CD44 with corresponding changes in the expressions of some cell cycle-related proteins. MiR-34a mimics and miR-34a inhibitor induced opposite changes in J82 cell cycle, which were partly reversed by CD44.

CONCLUSIONMiRNA-34a regulates cell cycles by targeting CD44 in human bladder carcinoma cell line J82.

Cell Cycle ; Cell Line, Tumor ; Down-Regulation ; Humans ; Hyaluronan Receptors ; metabolism ; MicroRNAs ; metabolism ; RNA, Messenger ; Real-Time Polymerase Chain Reaction ; Transfection ; Urinary Bladder Neoplasms ; pathology