[Summary] The experience of diagnosis and treatment in a case of hypothyroidism with severe ascites and extremely elevated blood CA125 levle was summarized,the mechanism for severe ascites and extremely elevated blood CA125 were discussed,and the diagnosis clues and the main points of differential diagnosis were proposed.

Objective To investigate the expression of long chain non-coding(lnc) RNA LOC285194 in breast cancer tissue and paracancerous tissue and its clinical significance.Methods Forty-two samples of paraffin embedded breast cancer tissue and 16 samples of paraffin embedded paracancerous tissue were selected.The expression of lncRNA LOC285194 in these tissue were detected by using quantitative real-time polymerase chain reaction(PCR).Then its correlation with clinicopathological features was analyzed.Results The expression level of lncRNA LOC285194 in breast cancer tissue was significantly lower that in the paracancerous tissue (P＜0.01);the level of lncRNA LOC285194 in human epidermal growth factor receptor-2(HER2)overexpression tissues was up-regulated compared with HER2 negative breast cancer tissue(P =0.013),there was a positive correlation between them(r=0.385,P=0.012).Conclusion lncRNA LOC285194 may play the role of cancer suppressor gene and may be involved in the generation of breast cancer by HER2 association,which may become a target gene of breast cancer treatment.

Objective To evaluate the efficacy and safety of trimebutine combined with mosapride on functional dyspepsia. Methods Patients with functional dyspepsia were randomly divided into three clinical groups. Group A (n=116) received 0.2 g trimebutine after meal,group the drug combination B (n=116) received 5 mg mosapride before meal,and the drug combination group (n=115) received 0. 2 g trimebutine after meal plus 5 mg mosapride before meal. All medications were taken orally three times daily for 4 weeks. Improvement in clinical symptoms and adverse reactions in each group were evaluated at the end of study. Results A total of 339 patients among 347 enrollees completed the treatment and follow-up. The clinical efficacy on postprandial fullness, early satiation, epigastric pain, epigastric burning, upper abdominal bloating and nausea were 88. 4%,76. 9%,72. 9%,61. 8%,86. 7% and 81. 7%,respectively in the drug combination group after 4-week treatment,which were superior to those in group A or B (P<0. 05) except for epigastric burning. The total effective rate of the drug combination group was 78. 8%,significantly higher than the other two groups (P<0. 05). The total incidence of side effects in the drug combination group was 1. 8%,similar to that of group A and B (1. 8% and 0. 9%,respectively, P =0. 776). Conclusion Trimebutine combined with mosapride is safe and effective for improving symptoms in functional dyspepsia.

Objective To analyze the blood screening results after adjustment of critical value 40 to 50 U/L and to observe the effect of reducing blood scrap rate and to discuss the correlation between ALT and HBV,HCV infection.Methods We screened 2656 blood donors (ALT >40 U/L)by serological and nucleic acid amplification testing(NAT)in Qingdao blood center from 2013 to 2014,and conducted the correlation analysis by chi square test.Results 1 771 cases (66.68%)were ALT 40-50 U/L,including 6 cases of HBsAg ELISA (+),2 cases NAT (+),4 cases NAT(-).In the 8 cases of anti-HCV ELISA (+)samples,4 cases NAT (+),3 cases NAT (-),1 case with positive TP without NAT result.In 885 blood donors with ALT>50 U/L,5 cases were HBsAg-reactive,7 cases were anti-HCV-reactive,and 873 cases were negative.Related statistics showed that there was no signifi-cant difference between ALT and HBV infection (P <0.05),but significant difference was found between ALT and HCV infection (P >0.05).Conclusion The proportion of blood donors with ALT 40-50 U/L is much higher than that with ALT >50 U/L do-nors.Adjustment of the critical value greatly reduces blood scrap rate.Elevated ALT is associated with the infection of HBV but not with HCV.

0.05),but there was significant difference between group A and group C,the rate of hypoglycemia of group A was less than group C(P

Objective To investigate the association of urinary albumin-to-creatinine ratio (UACR) and the diameter of retinal vessel in population with essential hypertension in Fujian coastal area.Methods Central retinal artery and vein equivalents (CRAE and CRVE) were measured from the avoiding mydriatic digitized photographs and semi-automatic fundus analysis software,as well as albumin and urine creatinine.Results There were significant differences in CRAE levels among the normal control group,normoalbuminuria with essential hypertension group and microalbuminuria with essential hypertension group [(135.68 ± 10.10) μm,(129.79 ± 10.48) μm,(125.29 ± 11.17) μm,all P values ＜0.01].The CRAE levels were significantly negative correlated with UACR (r =-0.29,P ＜ 0.01).Linear regression analysis showed CRAE was associated with UACR in the patients with hypertension(β =-5.0,P ＜ 0.01).Logistic regression analysis showed,systolic blood pressure (β =1.08,P =0.02) was risk factor for CRAE abnormality.The CRAE abnormality was increased in turn in the normal control group,normoalbuminuria with the essential hypertension group and microalbuminuria with essential hypertension group (P ＜ 0.01).Conclusion The reduction of central retinal artery diameter are associated with the hypertensive renal damage.UACR and CRAE could be used to evaluate the microvascular lesions and be used as an indicator to assess the target organs damage in essential hypertension patients.

Objective To summarize the CT imaging features of peritoneal metastasis of gastric cancer (GC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 78 GC patients with peritoneal metastasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to September 2016 were collected.All the patients underwent plain and enhanced scans of CT,and imaging data were converted to the multiplanar reformation (MPR) and maximum intensity projection (MIP).Observation indicators:(1) CT imaging features of primary lesion of GC;(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis;(3) CT imaging features of lymph nodes and other abdominal organ metastasis;(4) treatment and follow-up.Patients selected treatment plan according to results of laboratory and imaging examinations and patient's will.Follow-up using outpatient examination,telephone interview and correspondence was performed to detect the treatment method and patients' prognosis up to December 2016.The survival time was from post-treatment to death or end of follow-up.Measurement data with skewed distribution were described as M (range).Results (1) CT imaging features of primary lesion of GC:primary tumor location of 78 patients:tumor located in the antrum,leather bottle stomach,gastric cardia,lesser curvature,gastric antrum and body and greater curvature were detected in 40,11,9,9,5 and 4 patients,respectively.All the 78 patients were in T4 stage,including 43 with T4a stage and 35 with T4b stage.(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis:of 78 patients,57 were found with peritoneal metastasis by CT examinations before chemotherapy,15 with peritoneal metastasis by exploratory laparotomy or open surgery and 6 with peritoneal metastasis by follow-up CT re-examinations after gastrectomy.Seventy-two patients were diagnosed as GC with peritoneal metastasis by CT scans,and final diagnosis,missed diagnosis and overdiagnosis were detected in 78,9 and 3 patients,respectively.The precision,sensitivity,specificity,positive and negative predictive values of CT diagnosis were respectively 98.7％,88.5％,99.6％,95.8％ and 98.9％.Location and manifestation of 78 GC with peritoneal metastasis patients:① Peritoneal effusions:71 patients were accompanied with peritoneal effusions,including 21 with the slight peritoneal effusions and 50 with moderate and massive peritoneal effusions.② Greater omentum thickening:greater omnentum of 59 patients showed sheet,flocculent and nodular thickening,with a mass and cake-like change.③ Peritoneal thickening:54 patients had peritoneal thickening,with the main of nodulelike and thick lines-like thickening;thickening occurred mainly in around the liver,peritoneal cavity and pelvic floor;11 patients were found with obvious left anterior renal fascia thickening.④ Mesenteric thickening:46 patients were found with mesenteric thickening and edema,showing increased fat density with multi-node shadow.⑤ Lesser omentum and hepatogastric ligament:18 patients were found with increased fat density of lesser omental bursa,showing striped and nodular shadow.⑥ Transverse mesocolon:increased local fat density with striped-and nodular-like changes were seen in 15 patients after coronal and sagittal planes reconstruction,including 5 with local wall thickening of transverse colon.⑦ Ovary:8 patients had ovarian metastases,including 6 with bilateral metastases and 2 with unilateral metastasis;diameter of metastatic tumor was 3-12 cm.⑧ Intestinal canal:6 patients had local intestinal wall thickening,including 3 in small intestine and 3 in transverse colon,thickening tissues were mainly located in the mesentery,showing obvious intestinal wall enhancement.⑨ Liver capsule node:2 patients showed multi-node abnormal enhanced lesions under liver capsule.(3) CT imaging features of lymph nodes and other abdominal organ metastasis:78 patients were accompanied with lymph nodes enlargement,including 41 in N2 stage and 37 in N3 stage;liver metastases were detected in 13 patients;5 had adrenal metastases,including 3 with bilateral metastases and 2 with unilateral metastasis;4 had lower GC invading the pancreatic head and body;2 had upper GC invading the liver and spleen;1 had leather bottle stomach invading the pancreatic head and neck,and inducing to obstruction of biliary tract.(4) Treatment and follow-up:of 78 patients,62 underwent systemic chemotherapy,6 underwent systemic chemotherapy and intraperitoneal hyperthermic perfusion chemotherapy,5 underwent systemic chemotherapy and local radiotherapy and 5 underwent palliative operations due to gastrointestinal tract obstruction or bleeding.Of 78 patients,69 were followed up for 15 months (range,3-21 months),and 9 lost to follow-up.The median survival time of 69 follow-up patients was 12 months (range,3-19 months).Conclusions CT imaging features of peritoneal metastasis of GC show specific sites of metastasis and performance.Combining with CT axial images and images of coronal and sagittal planes reconstruction,adjusting appropriate window width and level would be benefit to observe primary lesions of GC and peritoneal metastasis.

Objective:To retrieve, screen, evaluate and synthesize evidence related to the management of pregnant women during pregnancy after cervical cerclage to provide a basis for clinical practice.Methods:According to the "6S" evidence resource pyramid model, the system searched of all evidence on the management of pregnant women after cervical cerclage in databases suchas UpTo Date, BMJ Best Clinical Practice, International Guidelines Network, American Guidelines Network, World Health Organization website, Yimaitong, Metz Medical website, Clinical Guidelines website, American College of Obstetricians and Gynaecologists, Royal College of Obstetricians and Gynaecologists of the United Kingdom, Canadian College of Obstetricians and Gynaecologists, French College of Obstetricians and Gynaecologists, European Association of Perinatal Medicine, Cochrane Library, the Joanna Briggs Institute (JBI), the Centre for Evidence-Based Health Care Database, PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database, including best dicision practices, guidelines, expert consensus, evidence summary, systematic reviews, Meta-analysis. The search time limit was the establishment of the database to March 1, 2023, and the evidence was extracted and summarized according to the theme after the two researchers independently evaluate the quality of the literature.Results:A total of 8 studies were selected, including 2 expert consensuses, 2 systematic reviews and 4 guidelines. Through literature reading, evidence extraction and classification, 23 pieces of best evidence were summarized from seven aspects: systematic management, activity management, medication management, health behavior management, pregnancy supervision, supervision of the timing of cerclage removal and supervision of psychological state.Conclusions:The best evidence quality and autuority of pregnancy management for pregnamt women after cervical cerclage surgery summarized in the study are high. It was recommended to strengthen the management of pregnant women during pregnancy after cervical cerclage, dynamically and continuously assess the pregnancy status of pregnant women, and prudently selected evidence to improve the prenatal examination process, ensure the safety of mothers and babies, and reduce the occurrence of complications. Overall, effective management of pregnant women during pregnancy after cervical cerclage required a combination of many factors to ensure the health and safety of the mother and baby.

The medicinal history of Zanthoxyli Radix is long,and it is recorded in the Shen Nong Ben Cao Jing under the name of Manjiao.Modern pharmacological research has proven that Zanthoxyli Radix has anti-tumor,antibacterial,antioxidant,and hemostatic effects.This article reviewed the pharmacological effects of Zanthoxyli Radix based on its functional indications.Based on the basic requirements of TCM quality markers(Q-markers),this article predicted and analyzed the Q-markers of Zanthoxyli Radix from the perspectives of plant phylogeny and chemical component specificity,chemical component and pharmacological correlation,and chemical component testability.It is proposed to select alkaloids,flavonoids,and lignans as the Q-markers for the general classification of Zanthoxyli Radix.The candidate components for Q-marker were identified,including chloramphenicol,white croaker alkaloid,magnolian alkaloid,taro alkaloid,vanillin,hesperidin,L-sesamin and L-asarone,providing a reference for further research on the quality standards of Zanthoxyli Radix.

Objective:To observe the changes of skeletal muscle indexes in elderly patients with type 2 diabetes complicated with sarcopenia treated with sitagliptin and acarbose.Methods:A total of 60 patients over 60 years old with type 2 diabetes complicated with sarcopenia in Dalian Municipal Central Hospital from January 2019 to January 2020 were selected and divided into two groups by random number table method.One group received sitagliptin and metformin,and the other group received acarbose and metformin. The changes of skeletal muscle indexes, glucagon-like peptides-1 (GLP-1), insulin resistance index (HOMA-IR) and inflammatory indexes were compared between the two groups at baseline and 36 weeks after treatment.Results:After treatment, the skeletal muscle index (SMI) of sitagliptin group was increased (5.94 ± 1.52 vs. 5.99 ± 1.52), and the difference was statistically significant ( P<0.05). Muscle strength and SMI decreased in acarbosse group (18.75 ± 4.64 vs. 17.72 ± 4.44, 6.09 ± 1.74 vs. 6.00 ± 1.71), with statistical significance ( P<0.05). GLP-1 increased in sitagliptin group, 0 min: (10.65 ± 1.68) pmol/L vs. (12.41 ± 1.88) pmol/L; 60 min: (22.79 ± 2.85) pmol/L vs. (25.51 ± 2.79) pmol/L; 120 min: (24.26 ± 2.94) pmol/L vs. (29.49 ± 2.91) pmol/L; 180 min: (11.68 ± 1.84) pmol/L vs. (12.88 ± 1.83) pmol/L. There were significant differences ( P<0.05). HOMA-IR and CRP decreased: 4.73 ± 3.04 vs. 3.16 ± 2.41, (2.39 ± 0.50) mg/L vs. (2.33 ± 0.43) mg/L, and the differences were statistically significant ( P<0.05). HOMA-IR in acarbose group decreased after treatment (5.80 ± 3.94 vs. 4.00 ± 1.63), and the difference was statistically significant ( P<0.05). Comparison between the two groups after treatment, the decreased value of muscle strength in sitagliptin group was less than that in acarbose group, and the difference was statistically significant ( P<0.05). GLP-1 and overall GLP-1 area under the curve in sitagliptin group were higher than those in acarbose group (67.64 ± 6.81 vs. 58.98 ± 6.72), with statistical significance ( P<0.05). HOMA-IR and CRP in sitagliptin group were lower than those in acarborose group: 3.16 ± 2.42 vs. 4.00 ± 1.63, (2.33 ± 0.43) mg/L vs. (2.41 ± 0.70) mg/L, with statistical significances ( P<0.05). Conclusions:Sitagliptin therapy improves muscle mass and protects muscle strength in elderly patients with type 2 diabetes mellitus and sarcopenia.