Objective To study the value of spiral CT in diagnosing renal cell carcinoma(RCC) and to evaluate the correlation of CT findings with histopathologie features in RCC. Methods 279 cases with RCC proven by surgery and pathology underwent plain and contrast-enhanced CT examinations. The clinic characteristics and CT findings were analyzed statistically and compared with surgical results. Results 90.32% lesions showed medium or obvious enhancement on contrast-enhanced CT,with the exception of granule cells for enhanced uniform, the other cell type of RCC showed heterogeneous enhancement. 32.26% of tumors was of more or less short-burres (χ~2 = 38.2,P<0.01) ,and the there was significant relationship between pathological signs of short burr and the renal capsule involved by tumors. CT qualitative diagnostic rate was 91.40%. CT staging and pathologic staging were of the correla-tive coefficient of 0. 84, while there was not obviously correlation between CT classification of RCC and cancer cell types(P>0.05). Conclusion Spiral CT can better show characteristics of RCC, that can improve the diagnostic accuracy and staging aility for RCC.

To study the effect of Tibetan medicine Zuotai on the activity, protein and mRNA expression of CYP1A2 and NAT2, three different doses (1.2, 3.8 and 12 mg x kg(-1)) of Zuotai were administrated orally to rats once a day or once daily for twelve days, separately. Rats were administrated orally caffeine (CF) on the second day after Zuotai administration, and the urine concentration of CF metabolite 5-acetylamino-6-formylamino-3-methyl-uracil (AFMU), 1-methyluric acid (1U), 1-methylxanthine (1X), 1, 7-dimethylxanthine (17U) at 5 h after study drug administration was determined by RP-HPLC. The activity of CYP1A2 and NAT2 was evaluated by the ratio of metabolites (AFMU+1X+1U)/17U and the ratio of AFMU/(AFMU+1X+1U), respectively. The protein and mRNA expression of CYP1A2 and NAT2 were determined by ELISA and RT-PCR method, respectively. After single administration of Zuotai 3.8 mg x kg(-1) and repeated administration of Zuotai 3.8 and 12 mg x kg(-1), the activity of CYP1A2 and NAT2 decreased significantly compared with control group and there was no significant difference between other dose group and control group. The protein expression of CYP1A2 was significant lower than that in control group after repeated administration of Zuotai 12 mg x kg(-1), and the mRNA expression of CYP1A2 decreased significantly compared with that of control group after single administration of Zuotai 3.8 mg x kg(-1) and repeated admistration of Zuotai 12 mg x kg(-1), separately. The protein expression of NAT2 decreased significantly compared with that of control group after single and repeated administration of Zuotai 3.8 mg x kg(-1), respectively, and the mRNA expression of CYP1A2 decreased significantly compared with control group after single administration of Zuotai 3.8 mg x kg(-1). This study found that Tibetan medicine Zuotai had significant effect on the activity, protein and mRNA expression of CYP1A2 and NAT2.

Objective:To explore the effects of problem-solving therapy on breastfeeding self-efficacy and psychological status among primiparas, to provide basis for improving the breastfeeding of primipara.Methods:A total of 102 primiparas were divided into experimental group and control group by random number table method, each group contained 51 cases. Finally, 47 cases in the experimental group and 49 cases in the control group completed the study. The control group received routine nursing, while primiparas in the experimental group carried out problem-solving therapy. Before and after 6-week intervention, the effects was assessed by Breastfeeding Self-Efficacy Scale (BSES), Edinburgh Postnatal Depression Scale (EPDS) and General Well-being Schedule (GWB), respectively.Results:After intervention, the scores of primapara feedig cognition, feeding feeling, feeding skills and BSES total scores were (21.13±2.97) points, (65.47±6.63) points, (31.94±2.59) points, (118.53±8.47) points in the experimental group, significantly higher than (19.43±3.28) points, (61.76±5.20) points, (30.53±2.01) points, (111.71±6.11) points in the control group ( t values were 2.658-4.507, P<0.01); the scores of EPDS were (6.04±1.49) points in the experimental group, significantly lower than (6.92±2.08) points in the control group; the scores of life satisfaction and interest, depression and pleasure, energy, relaxation and tension in General Well-Being (GWB) and total scores were (7.51±1.71) points, (20.19±2.47) points, (21.68±2.32) points, (17.06±2.74) points, (90.45±4.96) points in the experimental group, significanlty higher than (6.41±1.82) points, (18.71±2.98) points, (20.57±1.87) points, (15.78±1.79) points, (84.61±5.26) points in the control group, the difference was statistically significant ( t values were 2.380-5.587, P<0.05 or 0.01). Conclusion:Problem-solving therapy can improve breastfeeding self-efficacy and alleviate postnatal depression as well as enhance subjective well-being of primipara women.

Objective To evaluate circulating tumor cells (CTC) in prognosis prediction of gastric cancer.Method Peripheral blood samples were obtained from 65 patients with gastric cancer and 20 normal volunteers.CTC were detected by using CellSearch(R) CTC Detecting System.Postoperative progress-free survival (PFIS) and overall survival (OS) were evaluated against CTC status and clinicopathological factors.Result CTC were positive in 35 out of 65 (53％) patients compared to 1 out of 20 (5％) healthy controls,P ＜ 0.05.CTC were not statistically corelated with patients' age,sex and lymph node status or distal metastasis,vascular invasion and tumor markers (all P ＞ 0.05).CTC positive patients had poorer OS (P ＜ 0.05) and PFS (P ＜ 0.05) compared with those with negative CTC.Conclusion Positive CTC in gastric cancer patients predict poor prognosis after radical gastrectomy.

The epidemic of coronavirus disease 2019 (COVID-19) puts higher demands on critical care medicine. Lots of studies have been conducted to solve COVID-19-related problems. Therefore, we reviewed the annual progress for COVID-19-related issues including antivirals threapies, respiratory support and immunomodulatory therapies and other critical issues, including the effect of antibiotic on mitochondrial damage and its relationship with sepsis, the goal and direction of antimicrobial de-escalation, drug prophylaxis of constipation, bleeding in gastrointestinal disorders and management of critical illness in the informalization era and so on. We hope to provide reference for clinical and scientific research work of the intensivists.

Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected.After preoperative assessment using computed tomography(CT) angiography,13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancrcatic tail.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up situations.Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT),thrombosis of splenic vein,lesions residual or recurrence up to November 2017.Measurement data were represented as average (range).Results (1) Intra-and post-operative recovery situations:13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail,without conversion to open surgery,including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen.Operation time was 42-93 minutes,with an average of 61 minutes;volume of intraoperative blood loss was 30-260 mL,with an average of 92 mL;postoperative gastrointestinal function recovery time was 22-47 hours,with an average of 34 hours;postoperative drainage tube removal time was 3.0-6.0 days,with an average of 4.2 days.The postoperative pathological examination of 13 patients:7,2,2,1 and 1 patients were respectively confirmed with splenic cysts,splenic hemangiomas,vascular hemangiomas,splenic hamartoma and splenic lymphangioma.Of 13 patients,1 was complicated with splenic recess effusion and fever,and was improved with B ultrasound-guided percutaneous catheter drainage.Duration of hospital stay of 13 patients was 7.0-16.0 days,with an average of 9.6 days.(2) Follow-up situations:13 patients were followed up for 1.0-19.5 months,with a median time of 8.5 months.During the follow-up,PLT level of 13 patients was normal.Color Doppler ultrasound examination showed no venous embolism,and CT angiography showed good vascular perfusion.There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients.Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective,and it can precisely dissect splenic hilum,preserve blood supply and function of the remnant spleen,and reduce surgical injury.

Objective:To compare the clinical value of stent assisted intestinal bypass and temporary loop ileostomy in laparoscopic low anterior resection of rectal cancer.Method:In this retrospective analysis, 57 patients undergoing laparoscopic low anterior resection for rectal cancer in the First Affiliated Hospital of Ningbo University from Jan 2020 to Jan 2022 were divided into intestinal bypass group (36 cases) and loop ileostomy group (21 cases).Result:There were no significant differences in postoperative GI function recovery and postoperative complication rate between the two groups (all P>0.05). The levels of albumin, prealbumin and hemoglobin in the intestinal bypass group were better than those in the ileostomy group when evaluated on 3rd months after operation [(40.5±2.3) g/L vs. (38.1±2.6)g/L、(26.4±2.7)mg/dl vs. (24.5±2.0)mg/dl、(137.6±5.9) g/L vs. (134.0±7.0) g/L, t=3.605、2.743、2.085, all P<0.05]. Hospital expenses of the intestinal bypass group was lower [(571 000±7 500) yuan vs. (69 300±9 100) yuan, t=-5.477, P<0.05]. Conclusion:Compared with traditional ileostomy, the stent assisted intestinal bypass reduces trauma with lower expenses and improves patients' status after laparoscopic low anterior resection for rectal cancer.

Objective: To explore the feasibility and clinical efficacy of serosal muscular layers incision and submucosal layers exfoliation technique in laparoscopic surgery for gastric gastrointestinal stromal tumors(GIST). Methods: 28 patients with gastric GIST underwent serosal muscular layers incision and submucosal layers exfoliation technique under laparoscopic surgery. Patients′clinicopathologic characteristics, operative outcomes, postoperative complications, and follow up results were analyzed retrospectively. Results: Surgery was successfully completed in all patients, and no one was converted to open surgery.The average operation time was (66±15) min, and the intra operative blood loss was (16±10) ml, the time of passage of gas by anus after operation was (20±10)h, the time starting liquid diet was(2.5±1.6)d, and the length of postoperative hospital stay was (7±3)d. One patient had delayed gastric emptying, one had incisional infection. All the specimen had complete pseudocapsule and negative margin. pathology was all gastric GIST. After a median 22 months followed up, no recurrence or metastasis were found. Conclusion Serosal muscular layers incision and submucosal layers exfoliation under laparoscopic surgery is a safe and feasible procedure for treating gastric GIST.

IgA nephropathy is recognized as the most common primary glomerular disease， with up to 20%-40% of patients developing end-stage kidney disease within 20 years of onset. The deposition of IgA1-containing immune complexes targeting glycosylation defects in the mesangial region and the subsequent inflammation caused by T lymphocyte activation are considered as the main causes of IgA nephropathy， and innate immunity is also involved in the pathogenesis. Nucleotide-binding oligomerization domain （NOD）-like receptor protein 3 （NLRP3） is a newly discovered pattern recognition receptor expressed in renal intrinsic cells such as renal tubular epithelial cells， mesangial cells， and podocytes. Activated by external stimuli， NLRP3 can form NLRP3 inflammasomes with apoptosis-associated speck-like protein containing a caspase recruitment domain （ASC）. The NLRP3 inflammasome can activate cysteine aspartate-specific protease-1 （Caspase-1）， causing the maturation and release of interleukin-18 （IL-18） and interleukin-1β （IL-1β） involved in inflammation. Increasing evidence has suggested that NLRP3 inflammasomes are involved in the pathogenesis and progression of IgA nephropathy and associated with the damage of renal intrinsic cells such as podocytes， mesangial cells， endothelial cells， and renal tubular epithelial cells. Chinese medicine can regulate inflammatory cytokines and their signaling pathways by acting on NLRP3 inflammasomes and related molecules， exerting therapeutic effects on IgA nephropathy. This article introduces the role of NLRP3 inflammasomes in IgA nephropathy and reviews the clinical and experimental research progress of Chinese medicine intervention in IgA nephropathy via NLRP3 inflammasomes， aiming to provide a reference for further research and application of Chinese medicine intervention in the NLRP3 inflammasome as a new therapeutic target.