Objective To explore the effect of tetramethylpyrazine (TMP) on serum cytokines and cardiac function in patients with sepsis myocardial injury.Methods Fifty patients with sepsis myocardial injury were admitted in Hangzhou First People's Hospital from June 2015 to September 2016,and according to the computer generated random number,they were divided into conventional treatment group and TMP treatment group,25 cases in each group.The patients in the conventional treatment group were treated with antimicrobial agents,vasoactive drugs,fluid resuscitation and organ function support,etc.;TMP treatment group was treated with traditional Chinese medicine (TCM) TMP on the basis of routine treatment.TMP 120 mg was added to 250 mL normal saline (NS) for intravenous drip once a day for a therapeutic course of 10 days.Plasma N-terminal pro-B type natriuretic peptidec (NT-proBNP) and serum tmnor necrosis factor-oα (TNF-α) levels were measured before treatment and on 1,5 and 10 days after treatment.Left ventricular internal systolic dimension (LVIDs),fractional shortening (FS) and left ventricular ejection fraction (LVEF) were measured by cardiac ultrasound,3 cardiac cycles were measured and the average results were taken.The intensive care unit (ICU) hospital stay and mortality were calculated in the two groups.Results The levels of NT-proBNP and TNF-α in the two groups after treatment were lower than those before treatment,the differences in the levels were statistically significant between those before treatment and 5 days after treatment in the conventional treatment group [NT-proBNP (ng/L):334.25 ± 36.46 vs.577.72 ± 60.34,TNF-α (ng/L):388.48 ± 43.38 vs.507.74-± 31.63,both P ＜ 0.05],and in TMP treatment group,the levels from 1 day after treatment compared with those before treatment,there were statistical significant differences [NT-proBNP (ng/L):387.44 ± 36.39 vs.571.67-± 56.34,TNF-α(ng/L):403.79 ± 23.20 vs.505.82 ± 31.31,both P ＜ 0.05];the degrees of decrease in TMP treatment group were more obvious than those in conventional treatment group (all P ＜ 0.01).After treatment in the two groups,the LVIDs was decreased gradually,FS and LVEF were increased gradually,reaching the lowest or highest level on 10 days after treatment,and the changes of TMP treatment group were more significant than those in the conventional treatment group,LVIDs and LVEF of the two groups showed statistically significant differences on 5 days after treatment [LVIDs (mm):43.23 ± 5.57vs.48.21 ± 2.29,LVEF:0.47 ± 0.02 vs.0.41 ± 0.02,both P ＜ 0.05],FS on 1 day after treatment showed a statistically significant difference [FS:(23.92 ± 1.81)％ vs.(22.84 ± 1.79)％,P ＜ 0.05].The ICU stay in the TMP group was shorter than that in the conventional treatment group (days:13.16 ± 2.67 vs.16.48-± 3.08,P ＜ 0.05),and the mortality was lower than that of conventional treatment group [20％ (5/25) vs.36％ (9/25)],the difference being not statistically significant (P ＞ 0.05).Conclusions In septic myocardial injury,TNF-α plays an important role;after TMP treatment in patients with myocardial injury caused by viral myocarditis,the serum TNF-α level is decreased showing it has antagonizing TNF-α activity,thus it has protective effect on sepsis myocarditis,improves heart function and the disease prognosis.

Objective To study the correlation of HBV infection pretransplantation and posttrans-plantation and HCMV recurrence after liver transplantation (LT). Methods We reviewed historical patient medical records of LT patients in recent two years in our hospital. All the patients were divided into HBV in-fection group and a control group based on a peripheral blood HB antigen assay before LT. The HBV infec-tion group was divided into HBV reactive infection group and HBV non-relapse group. HCMV antigen pp~65 was detected by immunohistochemical methods. HB antigens and antibodies were detected by time-resolved fluorescence immunoassay, and liver enzyme levels were detected by conventional methods. Results Com-paring two groups of patients, pp65-positive rates of LT patients with HBV infection and control group pa-tients were 84.3% and 57.9% respectively (P=0.024). While in HBV recurrence infection group and non-recurrence infection group, the incidences of HCMV recurrence were 90.9% and 83.3% (P=0.843). The changes in the liver transaminases level in both groups have no statistical significance (P>0.05). Conclusion Pretransplantation HBV infection may increase the incidence of HCMV recurrence. Posttrans-plantation HBV reactive infection, however, may not increase the incidence of HCMV reactive infection. Meanwhile, compare with either HBV infection or HCMV infection alone, co-infection may not serious in liv-er enzymes levels.

Described in the paper is the reform made at public hospitals in Zhejiang province,with analysis of its problems and causes. Based on such,the authors proposed the following actions:to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people.

Objective To investigate JC virus(JCV) infection in kidney transplant recipients and its influence on graft function and also initially explore JCV infection factors. Methods A total of 49 kidney transplant recipients and 24 health examination persons were enrolled in our study, JCV DNA was measured using nested qualitative polymerase chain reaction assays of urine, while CMV DNA was measured by common qualitative polymerase chain reaction assays of urine. JCV infection factors, such as age, male, immunosuppressive therapy, cytomegalovirus(CMV) infection were analyzed by Binary Logistic Regression, and glomerular filtration rate(GFR) was selected as a index of kidney function and the difference of GFR between JCV-infected and non-infected patients was compared using t test. Results JCV was detected in 42.9% of kidney transplant patients and 4.2% health examination persons. CMV infection and Pred + MMF + CsA triple immunosuppressive regimen were found to be the risk factors of JCV infection. No difference of GFR was observed between JCV infected and non-infected patients (86.470 ± 29.990 and 84.060 ± 33. 729 for each; t =0. 259, P =0.797). Conclusion JCV is frequently detected in kidney transplant recipients. CMV infection and using of Pred + MMF + CsA triple immunosuppressive regimen can significantly increase the risk of JCV infection. While, graft function was not influenced by JCV infection in kidney transplant patients.

Objective To explore the application value of Supportan in elderly bedridden patients with enteral nutrition (EN) support. Methods Forty cases of elderly bedridden patients admitted to the Department of Intensive Care Unit (ICU) of Hangzhou First People's Hospital from January 2015 to January 2016 were enrolled, Supportan was injected through an indwelling naso-intestinal tube on the basis of routine treatment, and the changes of blood biochemical parameters of EN [serum albumin (Alb), pre-albumin (PA), total lymphocyte count (LYM)] and immune indexes (IgG, IgM, IgA) were monitored before and after EN treatment. Results Ten days after EN treatment, the serum Alb, PA, LYM, IgG, IgM were significantly higher than those before treatment, the differences being statistically significant [Alb (g/L): 30.29±1.65 vs. 28.31±1.72, PA (g/L): 0.25±0.05 vs. 0.23±0.02, LYM (×109): 1.69±0.28 vs. 1.47±0.32, IgG (g/L): 11.54±0.96 vs. 10.69±0.70, IgM (g/L): 1.21±0.19 vs. 0.95±0.13, all P < 0.05]; 20 days after EN treatment, above indexes were increased more significantly compared with those 10 days after EN treatment [Alb (g/L): 34.16±2.41 vs. 30.29±1.65, PA (g/L): 0.28±0.03 vs. 0.25±0.05, LYM (×109/L): 1.96±0.31 vs. 1.69±0.28, IgG (g/L): 14.56±0.77 vs. 11.54±0.96, IgM (g/L): 1.56±0.18 vs. 1.21±0.19, all P < 0.05], 10 days, 20 days after EN treatment, IgA shown a tendency increased, there was no statistical significant difference compared with that before treatment (g/L: 2.63±0.33, 2.67±0.11 vs. 2.61±0.27, both P > 0.05). Conclusion Supportan has important clinical significance in improving the nutritional status and immune function of elderly bedridden patients.

Acute respiratory distress syndrome(ARDS)is a highly fatal syndrome in the intensive care unit(ICU),with a mortality rate of up to 40%.Early identification and treatment of ARDS are essential to improve the prognosis.Machine learning,the core of artificial intelligence and data science,is a set of computer tools designed to acquire new knowledge from existing data,which can assist medical staff in making clinical decisions.In recent years,machine learning has been increasingly used in the clinical diagnosis,precision treatment,and prognosis assessment of ARDS,which is expected to generate new ideas for diagnosing and treating ARDS.This article summarizes the application of machine learning in the clinical diagnosis of ARDS,classification of ARDS,treatment of ARDS,prognosis evaluation of ARDS,and the shortcomings of machine learning in the application of ARDS to explore the research progress of machine learning in diagnosing and treating ARDS and provide directions for further research.

Objective To investigate the value of endoscopic carbon nanoparticles labeling technique assisted in situ resection after neoadjuvant chemoradiotherapy(nCRT)for middle and low locally advanced rectal cancer(LARC).Methods From January 2020 to January 2023,46 cases of middle or low LARC were selected for endoscopic injection of carbon nanoparticles suspension to label the lower edge of the tumor before nCRT,and laparoscopic anterior resection of the rectum was performed after nCRT.The main observations were the visualization of carbon nanoparticles marker during the operation,the length of each area(primary tumor area,tumor regression scar,distal resection margin,and regression area of lower edge of tumor)of surgical specimens and the positive rate of distal resection margins.Results The median interval between injection of carbon nanoparticles suspension and surgery was 105(77-182)d in the46 cases.Carbon nanoparticles remnants were observed on the rectal mucosal surface in all the patients after nCRT by endoscopy.During laparoscopic anterior rectal resection surgeries,carbon nanoparticles marker exposure on the surface of the rectal intrinsic fascia observed in 41 cases(89.1%),of which38 cases were judged as good exposure(the width of marker area≤1.5 cm,which assisted the operator accurately determining the distal surgical margins)and 3 cases were judged as inferior exposure(a larger range of black staining whereas in situ resection of the tumor still achievable).In another 5 cases,the carbon nanoparticles marker could not be observed and were judged as exposure failure.Intraoperative cryopathology showed that all distal resection margins were negative.Measurement of 30 surgical specimens with identifiable primary tumor area showed that the length of resected intestinal canal was 17.9(10.1-25.7)cm,the diameter of primary tumor area was(4.3±0.8)cm,the diameter of scar after tumor regression was 2.5(0.8-4.8)cm,and the length of regression of tumor lower margin was 1.0(0-2.9)cm.The length of distal resection margins in middle rectal cancer(n =17)was3.4(1.5-4.3)cm and in low rectal cancer(n =13)was1.6(0.5-2.8)cm.Conclusion Application of carbon nanoparticles labeling technology before nCRT for rectal cancer can effectively mark the lower margin of the primary tumor in a long time and assist surgeons to precisely remove the primary tumor area.

Objective To investigate the impact of anti-reflux modified duodenal exclusion surgery on glucose metabolism in rats with type 2 diabetes mellitus (T2DM), and to elucidate the role of the duodenum in maintaining glucose homeostasis. MethodsForty male Sprague-Dawley rats aged 5 weeks were fed a high-fat diet and induced with T2DM using low-dose streptozotocin. Thirty-six rats that met the T2DM model criteria were randomly divided into three groups: the simple duodenal exclusion surgery group (DE group), the anti-reflux modified duodenal exclusion group (MDE group), and the sham operation group (SO group), with 12 rats in each group. Gastroenterography was performed 4 weeks after surgery, and the body weight, fasting blood glucose levels, and serum glucagon-like peptide-1 (GLP-1) concentrations were measured before surgery and at 1, 2, 4, and 8 weeks post-surgery. Eight weeks post-surgery, the rats were euthanized, and a 1 cm segment of the biliopancreatic loop was collected from each group for pathological sectioning and HE staining to observe the intestinal mucosal villus length under an optical microscope. Results Gastroenterography showed that there was significant reflux of the contrast agent into the duodenal lumen in the DE group, while no reflux was observed in the MDE group. At one week post-surgery, the body weights of rats in all three groups significantly decreased compared to before surgery (P<0.05), and then the body weights of all groups increased over time, with no significant differences between the groups (P>0.05). Compared with the SO group, the fasting blood glucose levels in the MDE and DE groups significantly decreased at all time points post-surgery (P<0.05), while GLP-1 concentrations significantly increased (P<0.05). The fasting blood glucose levels in the MDE group were lower than those in the DE group at all time points post-surgery (P<0.05), but there were no significant differences in serum GLP-1 concentrations between the MDE and DE groups (P>0.05). Regarding intestinal mucosal morphology, the villus lengths of the biliopancreatic loops in the MDE group were significantly shorter than those in the DE and SO groups (P<0.05). Conclusion Anti-reflux modified duodenal exclusion surgery effectively improves glucose metabolism in T2DM rats by preventing the reflux of chyme into the diverted duodenum, thereby enhancing its hypoglycemic effect.