Objective To study the computed tomograhpy (CT) features of non-tuberculous mycobacteria (NTM) and multidrug-resistant pulmonary tuberculosis (MDR-TB), and to improve the differential diagnosis of the disease. Methods The CT imaging data of 67 patients diagnosed with NTM pulmonary disease (NTM lung disease group) and 103 patients with MDR-TB (MDR-TB group) were selected from January 2010 to December 2015 in our hospital. The imaging findings and differences in lesion location were compared between two groups. Results Lesions of NTM lung disease occurred in the posterior segment of the posterior and posterior lumbar dorsal (Ⅰarea), clustered lobular central nodules, accompanied by bronchiectasis and subpleural thin wall empty, rare bronchial foci. MDR-TB lesions occurred in the middle lobe of the right lung and the upper lobe of the left lung (Ⅱarea). The upper lung of the lungs were patch, nodules and caseous lesions, with thick wall and chronic lung inflammation, showing thick wall empty, pulmonary consolidation, atelectasis, calcification (lung), hilar mediastinal lymph node calcification, lung volume reduction, pleural thickening and pleural effusion. Conclusion Chest CT images are similar in NTM lung disease and MDR-TB, but there are differences. The detailed analysis of image features can provide a basis for clinical differential diagnosis.

Objective To study the radiation-induced mitochondrial damage and energy metabolic alteration in pancreatic exocrine cells,and to explore underlying mechanism.Methods Rat pancreatic exocrine cells (AR42 J) were divided into control group and experimental group irradiated with 6 Gy of X-rays.Mitochondrial membrane potential was detected at 24,48,72 and 96 h,the lactic acid and ATP production were detected at 24 h and 48 h,and reactive oxygen species (ROS) were detected at 24 h after irradiation.The expressions of energy metabolism related factors of HIF-1α,LDHA and PDH were detected by Western blot.The animal experiments were conducted to confirm the changes.According to random number table,eight rats were randomly divided into two groups with 4 rats in each.The irradiated group was exposed to 12 Gy of X-rays,while the control group sham-irradiated.Results Compared with the nonirradiated control group,the mitochondrial membrane potential (△Ψm) of the experimental group was progressively decreased at 24-96 h after irradiation (t =5.438-17.687,P＜0.05).The ATP content in the experimental group decreased at 24 h and 48 h (q=17.300,8.328,P＜0.05),the lactic acid increased (q =21.790,16.250,P＜0.05),and the ROS level increased (t =7.935,P＜0.05).The expressions of HIF-1α and LDHA were significantly increased,but PDH was reduced after radiation.Silencing HIF-1α by siRNA eliminated radiation-induced energy metabolic alteration.These changes were confirmed with animal experiments by locally irradiating rats.Conclusions The expression of HIF-1α is upregulated by irradiation,which leads to the change of energy metabolism as the enhancement of glycolysis pathway and the inhibition of aerobic oxidation of mitochondria in pancreatic exocrine cells.

This study was aimed to reveal characteristics of functions, main indications and applications of Chinese patent medicines in order to provide references for development of new Chinese patent medicines for antitussive ef-fect. Chinese patent medicines recorded in the Pharmacopoeia of the People's Republic of China and the New Na-tional Chinese Patent Medicines were taken as research subjects. Chinese patent medicines classified in the function and indication with key words of cough-relieving, cough-suppressing, cough and chronic cough were col-lected. Analysis was made on the prescription characteristics, such as functions, main indications and applications. The results showed that there were 684 Chinese patent medicines and 462 terms, which were used for a total of 1533 times. The frequently-used terms are antitussive effect with expectorant, antitussive effect, expectorant, heat-clearing and exterior-releasing, antiasthmatic, wind-expelling and antipyretic, antitussive effect with antiasthmatic, purging lung heat, relieving exterior syndrome and moistening the lungs. All 684 Chinese patent medicines were used 48 ma-jor treatments for a total of 1107 times. The main indications include acute and chronic trachitis / bronchitis, exoge-nous wind-heat type of common cold, exogenous wind-cold type of common cold, cough with abundance of phlegm due to phlegm-heat obstructing the lung, acute upper respiratory tract infection, asthma, acute and chronic pharyngi-tis, lung heat cough, and etc. All 684 Chinese patent medicines used a total of 537 kinds of herbs and chemical medicines, including 441 kinds of herbal medicine, 36 kinds of animal medicine, 25 kinds of mineral medicine and 35 kinds of chemical medicine. The top ten herbs in terms of using frequency are Glycyrrhizae radix et rhizoma, Platycodonis radix, Armeniacae semen amarum, Menthae haplocalycis herba, Citri reticulatae pericarpium, Ephedrae herba, Scutellariae radix, Perilla frutescens (L.) Britt, Pinelliae rhizoma, Fritillariae cirrhosae bulbus. Among them, 1/4 of Chinese patent medicines used extract. Five kinds of food or fruits were also used, which were orange, fresh gin-ger, pear, watermelon and dried mushroom. It was concluded that Chinese patent medicines for antitussive effect can be adopted in the treatment of various kinds of diseases, especially for the treatment of cough(heat cough in partic-ular), abundance of phlegm, asthma, pharyngitis, laryngitis, and etc. The treatment methods of clearing heat, dis-pelling wind and relieving exterior syndrome played an important role in the realization of antitussive effect. However, the expression of functions and main indications is far from standardized and clear. Drugs commonly used are herbal medicine plus animal medicine, mineral medicine and chemical medicine as well as food and fruit. The discovery of preparations with certain clinical curative effect from ethnomedicine and the using of their extracts as a major ingre-dient are one important way to develop new Chinese patent medicines with antitussive effect.

Objective:To explore the value of serum activin A (ACT-A) level in early identification of moderate and severe acute pancreatitis (AP).Methods:A prospective case control study was conducted. A total of 120 patients with AP admitted to department of hepatobiliary surgery of Affiliated Nanhua Hospital of Hengyang Medical College of University of South China between October 2020 and April 2022 were recruited. According to the revised Atlanta classification, all patients were classified into mild AP group and moderate-to-severe AP group. The blood samples within 24 hours of onset were drawn, and the serum ACT-A and C-reactive protein (CRP) levels were detected by enzyme-linked immunosorbent assay (ELISA). The Ranson score and the modified CT severity index (MCTSI) were performed. Pearson correlation method was used to analyze the correlation of various parameters. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of ACT-A and CRP for moderate-to-severe AP.Results:A total of 120 patients with AP were enrolled, including 83 patients with mild AP and 37 patients with moderate-to-severe AP. Serum ACT-A and CRP levels within 24 hours of onset in the moderate-to-severe AP group were significantly higher than those in the mild AP group [ACT-A (ng/L): 140.4±37.7 vs. 53.9±30.5, lg CRP: 1.42±0.91 vs. 0.77±0.70, both P < 0.01], and the Ranson score and MCTSI score were also significantly higher than those in the mild AP group (Ranson score: 5.3±1.3 vs. 1.8±1.6, MCTSI score: 5.5±1.0 vs. 2.7±1.2, both P < 0.01). Correlation analysis showed that the serum ACT-A level was positively correlated with serum CRP level, Ranson score and MCTSI score ( R2 value was 0.272, 0.841, 0.616, respectively, all P < 0.05). ROC curve analysis showed that the serum ACT-A, CRP and Ranson score had predictive value for moderate-to-severe AP. The area under the ROC curve (AUC) was 0.948 [95% confidence interval (95% CI) was 0.909-0.986], 0.711 (95% CI was 0.606-0.815), 0.946 (95% CI was 0.910-0.982), respectively. When serum ACT-A > 112.6 ng/L, the sensitivity and specificity of predicting moderate-to-severe AP were 78.38% and 96.39%, respectively, which was better than serum CRP with sensitivity and specificity of 72.92% and 66.27%, respectively, and the specificity was better than Ranson score (71.08%). Conclusion:ACT-A can be detected in the early stage of AP, and it is positively correlated with the disease severity, which can early identify moderate-to-severe AP.

Objective To analyze clinical outcome of high grade squamous intraepithelial lesion (HSIL) within 24 months after loop electrosurgical excision procedure (LEEP),and to explore risk factors of recurrent cervical HSIL,the risk of progress into cervical cancer and methods of follow-up.Methods This retrospective study was carried out on 1 005 patients who underwent LEEP,diagnosing with HSIL after LEEP from January 2011 to December 2013 at Obstetrics and Gynecology Hospital Affiliated to Fudan University to confer the difference between non-recurrent group and recurrent group 24 months after the LEEP conization.Patients were followed with ThinPrep cytologic test (TCT),high risk HPV (HR-HPV) test,colposcopy guided biopsy.Results A total of 1 005 cases were enrolled in this study with HSIL in the LEEP specimen,no residual HSIL in the 6-month follow up,and have follow up records in 24 months after LEEP.HSIL recurred in 5 cases,microinvasive carcinoma in 1 case,low grade squamous intraepithelial lesion (LSIL) in 17 cases at 12 months follow-up.HSIL recurred in 8 cases,LSIL in 11 cases,adenocarcinoma in situ in 1 case,and invasive cervical carcinoma in 1 case in Ⅰ b1 stage at 24 months after LEEP.The recurrence rate was 1.3％ (13/1 005),and the progression rate was 0.3％ (3/1 005).There was no significant difference in age,length,circumference and width of LEEP between recurrent and non-recurrent patients (P ＞ 0.05).The recurrence rate was highest in the endocervical positive margin group with 3/16,which was higher than ectocervical positive margin and negative margin (P＜0.01,P=0.040,respectively).The recurrence rate of endocervical positive margin group and fibrous interstitial positive margin group showed no significant difference (P=0.320).There was no significant difference between ectocervical positive margin and negative margin [2.8％ (2/72) vs 0.7％ (6/882),P=0.117].Postoperative cytological examination combined with HR-HPV detection has a high sensitive and high negative predictor value of HSIL recurrence with both 100.0％.Multivariate logistic regression analysis showed that positive endocervical positive margin,abnormal follow-up cytological examination and positive HR-HPV after LEEP were independent factors affecting recurrence of HSIL patients after LEEP (P＜0.05).Conclusions Age,length,circumference and width of LEEP have no effect on recurrence within 24 months after HSIL.The high risk factors for HSIL recurrence within 24 months after LEEP in HSIL patients include:positive HPV,abnormal cytology,and positive endocervical positive margin.Colposcopy biopsy and endocervical curettage have important role in diagnosing HSIL recurrence and progression.

Objective To analyze clinical outcome of high-grade squamous intraepithelial lesion (HSIL) half a year after loop electrosurgical excision procedure (LEEP) and explore the high risk factor of residual cervical HSIL.Methods The retrospective study was carried out on 1 502 patients who underwent LEEP,with HSIL in the LEEP histopathology from January 2011 to December 2013 at Obstetrics and Gynecology Hospital of Fudan University to confer the difference between residual group and non-residual group after 6 months of the leep conization.Patients were followed with ThinPrep cytologic test (TCT),high risk HPV (HR-HPV) test,colposcopy guided biopsy (CBD) and endocervical curettage (ECC).The high risks of residual cervical HSIL was analyzed.Results Among 1 502 cases,48 (3.20％,48/1 502) cases suffered HSIL residual disease.Forty cases were diagnosed by CBD,4 cases were diagnosed by ECC.The other 4 cases were both positive in CBD and ECC.Residul rate were different among different age groups.The residual rate was higher in the age ≥50 years old compared to the age below 50 [9.70％ (16/165),2.39％ (32/1 337);x2=25.33,P＜0.01].For post-LEEP specimens,both circumference (2.5,2.8 cm;Z=-3.17,P＜0.01) and width [0.6,0.6 cm;Z=-2.88,P＜0.01) were less in HSIL lesion residual group than those in non-residual group,though length showed no obvious difference [1.5,1.5 cm;Z=-1.55,P＞0.05).The residual rate of leep positive margin was obviously higher than that in the negative margin group [6.77％ (18/266) vs 2.43％(30/1 236);x2=13.30,P＜0.01].Different positive margin had diverse residual rate,as positive endocervical margin was 16.07％ (9/56),positive margin undetermined was 7.29％ (7/96) and positive ectocervical margin was 3.33％ (4/120).Both positive endocervical margin and positive margin undetermined had a higher residual rate than residual rate (x2=26.99,P＜0.01;x2=4.24,P＜0.05).Abnormal cytology showed higher residual rate than the non-residual with significant difference [6.00％ (6/100) vs 1.29％ (14/1 083),x2=9.50,P＜0.01].In terms of the post-LEEP HR-HPV test follow-up,HR-HPV positive's residual rate was higher than that in the negative group [2.91％ (6/206) vs 0.96％ (7/727)],while there was no statistical significance (x2=3.10,P＞0.05).Multivariate logistic analysis showed that abnormal cytology in 6 month's follow-up post-LEEP conization was an independent risk factor on residual lesion (OR=3.75,P＜0.05).Conclusions Patient with age ≥50 years old and positive endocervical margin are high risk factors for the residual HSIL lesion after LEEP conization,especially for abnormal cytology during follow up is independent risk factor for residual lesion.Colposcopy directed biopsy and (or) ECC still play an indispendsable role in finding the HSIL residual lesion.