Objective To explore the application efficacy and safety of oblique ultrasound-guided techniques in PICC puncture,in order to provide guidance and references for clinical application.Methods Through convenient sampling,654 patients from a tertiary A hospital in Zhejiang Province from March to December 2022 were selected as the study subjects.The random numbers were generated through Excel table functions and they were randomly grouped into 3 groups:A,B,and C.The ultrasound short axis method,long axis method,and oblique axis method were employed to guide PICC puncture catheterization,respectively.The success rate of PICC puncture,the number of subcutaneous adjustments of the puncture needle,puncture time,and the occurrence of puncture complications(such as hematoma,puncture of the posterior wall of blood vessels,accidental injury to arteries,and accidental injury to nerves)were recorded during the catheterization process in 3 groups.Results A total of 654 patients completed the study,including 215 in group A,219 in group B,and 220 in group C.The success rate of first-time puncture in the group C(86.36％)was higher than that in group A(73.95％)and group B(63.93％),and there was a statistically significant difference among 3 groups(P＜0.001).The subcutaneous adjustment frequency of the puncture needle was 1(1,1)in group C,1(1,2)in group A,and 1(1,2)in group B.The difference between 3 groups was statistically significant(P＜0.001);the puncture time of group C was shorter than that of group A and group B,and the difference was statistically significant(P＜0.001).There was a statistically significant difference in the puncture time between 3 groups(P＜0.017);the pairwise comparison of the number of subcutaneous needle adjustments and the success rate of a puncture between 3 groups showed that there was a statistical difference between group C and group A,and between group C and group B(P＜0.017),while there was no statistical difference between group A and group B(P＞0.017).There was statistical significance(P＜0.05)among 3 groups in terms of complications such as accidental nerve injury and puncture of the contralateral vascular wall by puncture needle,but there was no statistical significance in terms of accidental arterial injury and hematoma occurrence among 3 groups.Conclusion Compared with the short axis approach and the long axis approach,the ultrasound oblique axis approach guided PICC puncture has statistical differences in the success rate of a puncture and the incidence of puncture complications,etc.It is recommended to use the ultrasound oblique axis approach during PICC puncture.

Objective To explore the value of artificial intelligence(AI)in the diagnosis of pulmonary nodules in terms of consistency and efficiency compared with two radiologists(physician 1 is a chief physician and physician 2 is a deputy chief physician)in the diagnosis of benign and malignant pulmonary nodules using computed tomography(CT).Methods Retrospective analysis of 201 patients with pulmonary nodules confirmed by surgery pathology at Hangzhou Municipal Hospital affiliated to Zhejiang Chinese Medical University from January 2021 to October 2022,including a total of 229 pulmonary nodules,of which 74 were benign and 155 were malignant.The consistency of AI diagnosis with two radiologists was evaluated by weighted Kappa test,and the diagnostic performance of AI with the two radiologists was evaluated by the receiver operating characteristic curve(ROC).Results In the diagnosis of the benign and malignant nature of partial solid nodules,ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules,the consistency between AI and physician 2 was higher than that between AI and physician 1.Additionally,the area under the curve(AUC)of physician 2 was higher than that of AI and physician 1 with statistically significant differences between the AUCs of ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules(P<0.05).In the diagnosis of the benign and malignant nature of partial solid nodules and ground-glass nodules,the AUC of physician 1 was higher than that of AI,but there was no statistically significant difference between the two(P>0.05).In the diagnosis of the benign and malignant nature of solid nodules and partial ground-glass and solid plus ground-glass nodules,the AUC of AI was higher than that of physician 1 with statistically significant differences between the two(P<0.05).In the diagnosis of the benign and malignant nature of ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules,AI's sensitivity(97%,92%,and 94%)was higher than that of physician 1(58%,89%,and 72%)and physician 2(83%,84%,and 85%).Conclusion AI has a certain diagnostic efficacy in the diagnosis of pulmonary nodules malignancy.The overall diagnostic efficacy of the AI system used in this study is between that of physician 1 and physician 2,but its sensitivity is higher than that of the latter two.

Objective To investigate the predictive value of preoperative bi-parametric MRI radiomics for the International Society of Urological Pathology(ISUP)grading of prostate cancer(PCa).Methods One hundred and sixty-five patients with PCa confirmed by pathology were analyzed retrospectively.According to the ISUP grading system,PCa patients were divided into five subgroups:G1 group(Gleason score=6),G2 group(Gleason score=3+4),G3 group(Gleason score=4+3),G4 group(Gleason score=8)and G5 group(Gleason score=9 or 10).A total of 3 948 radiomics features were extracted from T2WI,diffusion weighted imaging(DWI),and apparent diffusion coefficient(ADC)images of each patient.Patients were classified into two categories based on Gleason score≥4+3 or ≤3+4.A radiomics signature(Rad-score)was constructed after reduction of dimension by the minimum redundancy maximum relevance(mRMR)and the least absolute shrinkage and selection operator(LASSO).The Spearman rank correlation test was used to evaluate the correlation between Rad-score and ISUP grading groups.The Kruskal-Wallis test was used to compare the difference of Rad-score among the five groups.Results Eleven most valuable features were selected as the Rad-score after reducing the dimension by mRMR and LASSO algorithm.Moderate correlation existed between Rad-score and ISUP grading(r=0.53,P＜0.05).There were significant differences in Rad-score between G1 and G2 groups and G3,G4 and G5 groups(P＜0.05),no significant difference existed between the remained two groups(P＞0.05).The area under the curve(AUC)of receiver operating characteristic(ROC)curve for Rad-score were 0.827,0.762,0.563,0.657,0.698 for G1,G2,G3,G4 and G5 groups,respectively.Conclusion The radiomics based on bi-parametric MRI can be used to predict grade 1,2 PCa patients in the ISUP grading system.

Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.

Objective:To investigate the correlation between three-dimensional histogram analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and Gleason score(GS)in prostate cancer(Pca)from two hospital, and its diagnostic efficacy for discriminating low-grade from high-grade Pca.Methods:A total of 102 pathologically confirmed Pca patients in the First Affiliated Hospital of Zhejiang Chinese Medical University and Hangzhou Traditional Chinese Medical Hospital(TCM Hospital)Affiliated to Zhejiang Chinese Medical University from January 2017 to October 2020 were retrospectively analyzed.The quantitative parameters of Pca, including transport constant(K trans), rate constant(K ep), percent volume of the extravascular extracellular space(V e)and fraction of the Intraplasmic contrast volume(V p), were obtained by manually layer by layer delineating of interested regions of all lesions on the original DCE-MRI imaging.Then the three-dimensional histogram analysis of the above parameters were performed to obtain the minimum, maximum, median, mean, area, 10 thpercentile, 25 thpercentile, 75 thpercentile and 90 thpercentile.The correlations between quantitative parameters and GS, and diagnostic efficiencies were analyzed. Results:102 Pca patients were divided into low-grade prostate cancer group(GS≤3+ 4)(n=44)and high-grade Pca group(GS≥4+ 3)(n=58). There were no statistically significant differences in age and location of lesions between the two groups( P>0.05), but there were statistically significant differences in Gleason score, PSA level and lesion diameter between the two groups( U=0.000, 730.000, 711.000, all P<0.05). The median, mean, 10 thpercentile, 25 thpercentile, 75 thpercentile, 90 thpercentile derived from K trans, and K ep(median, mean, 10%, 25%, 75%, 90%)together with maximum of K transand mean for V e were positively correlated with GS( r=0.405 to 0.583, P<0.05), in which mean of K transhad the highest positive correlation( r=0.583, P=0.000). The histogram parameters derived from V pwere negatively correlated with GS( r=-0.301 to 0.341, P<0.05). The area under ROC of 75th percentile derived from K transwas the highest(0.832). When the cut-off value of 75 thpercentile derived from K transwas ≥0.680/min, its Youden index, sensitivity, and specificity were 0.594, 0.776, 0.818, respectively. Conclusions:The three-dimensional histogram of DCE-MRI quantitative parameters has correlation with GS in Pca patients, can be used to discriminate low-grade from high-grade Pca.

ObjectiveTo investigate the therapeutic effect of Gexia Zhuyutang on rats with endometriosis （EMT） with Qi stagnation and blood stasis syndrome and its mechanism. MethodSix female unpregnant healthy SD rats of SPF grade were randomly selected as a blank group. The rest were treated with the compound factor method to induce EMT with Qi stagnation and blood stasis syndrome in rats. After successful modeling， 30 rats from 36 rats were randomly divided into a model group， a medroxyprogesterone （0.416 mg·kg^-1） group， and low， medium， and high-dose Gexia Zhuyutang groups （4.063， 8.125， 16.25 g·kg^-1）， with 6 rats in each group. Each group was given corresponding drugs， once a day for 4 consecutive weeks. The effect of Gexia Zhuyutang on rats with EMT was observed by the pathological changes and the volume of ectopic foci. The endometrial tissues of each group were taken for hematoxylin-eosin （HE） staining to observe histopathological changes. Enzyme-linked immunosorbent assay （ELISA） was used to determine the content of interleukin （IL）-10 and IL-6 in the serum supernatant of each group. Immunohistochemistry （IHC） was used to determine the protein expressions of nuclear factor kappa B （NF-κB）， matrix metalloproteinase-9 （MMP-9）， vascular endothelial growth factor （VEGF）， and Bcl-2 related X protein （Bax） in the tissues of rats in each group. Real-time fluorescence quantitative reverse transcription polymerase chain reaction （Real-time PCR） was used to determine the mRNA expressions of NF-κB， MMP-9， VEGF， and Bax. ResultAfter treatment， the volume of ectopic foci in the low， medium， and high-dose Gexia Zhuyutang groups and the medroxyprogesterone group was significantly reduced. The pathological observation under the microscope showed that the endometrial structure of rats in the sham-operated group and the blank group was intact， glands and mesenchymal cells grew well， glandular epithelial cells were arranged tightly and neatly， the cytoplasm was abundant and highly columnar， the interstitial cells were evenly distributed， and the blood vessels were abundant and spindle-shaped. Compared with the blank group and the sham-operated group， the model group was dominated by columnar epithelium and cubic epithelium. In the model group， ectopic endometrial epithelial cells were short columnar， some were pseudo-lamellar， the cell morphology was incomplete， the number of interstitial cells and glands was reduced， some glands were round， and degenerative dysplasia was formed. Compared with the blank group， the serum content of IL-10 in the model group was decreased （P<0.05）， and the content of IL-6 was increased （P<0.05）. The model group increased the protein expressions of NF-κB， VEGF， and MMP-9 （P<0.05） and decreased the protein expression of Bax in eutopic and ectopic endometrial tissues. Compared with the model group， the serum content of IL-10 in the medium and high-dose Gexia Zhuyutang groups was increased （P<0.05）， and the content of IL-6 was decreased （P<0.05）. The protein expressions of NF-κB， VEGF， and MMP-9 in eutopic and ectopic endometrial tissues of rats in the low， medium， and high-dose Gexia Zhuyutang were decreased （P<0.05）， and the protein expression of Bax was increased （P<0.05）. Compared with the ectopic endometrium of the model group， the mRNA expressions of NF-κB， MMP-9， and VEGF in the ectopic endometrium of the medium and high-dose Gexia Zhuyutang groups were decreased （P<0.05）， and the mRNA expression of Bax was increased （P<0.05）. ConclusionGexia Zhuyutang has the effect of inhibiting the invasion of ectopic foci in rats with EMT with Qi stagnation and blood stasis syndrome， and its mechanism may be related to the intervention of immunosuppression mediated by overactivation of the NF-κB signaling pathway， the improvement of the inflammatory response， and the blocking of microvascular regeneration function.

Objective To investigate the expression of ENO3 gene in hepatocellular carcinoma and its effect on the sensitivity of hepatocellular carcinoma cell lines to OXA, and to explore the possible mechanism. Methods qRT-PCR and immunohistochemical analysis were used to detect the expression of ENO3 in 48 pairs of hepatocellular carcinoma tissues and normal liver tissues.Overexpression plasmid was constructed and transfected into MHCC97H and HepG2 cells.The experiments were divided into empty group (Vector group), ENO3 overexpression group (ENO3 group), empty+OXA group (Vector+OXA group) and ENO3 overexpression+OXA group (ENO3+OXA group).The proliferation ability of MHCC97H and HepG2 cells were detected by CCK-8 assay and cell colony formation assay.The apoptosis rate was determined by flow cytometry assay.Protein expressions of Bcl-2, Bax and Caspase-3 were detected by Western blot assay. Results The expression of ENO3 was significantly decreased in hepatocellular carcinoma tissues, compared with normal liver tissues adjacent to the carcinoma.The expression of ENO3 gene in the ENO3 overexpression group was significantly higher than that in the empty group.Compared with the Vector+OXA group, cell viability was decreased, apoptosis rate was increased, Bcl-2 protein expression was decreased, Bax and Caspase-3 protein expression were increased in the ENO3+OXA group. Conclusion The expression of ENO3 is down-regulated in hepatocellular carcinoma tissues, and the overexpression of ENO3 can enhance the sensitivity of hepatocellular carcinoma cell lines to oxaliplatin by promoting cell apoptosis.

Acute respiratory distress syndrome (ARDS) is characterized by the severe inflammation and destruction of the lung air-blood barrier, leading to irreversible and substantial respiratory function damage. Patients with coronavirus disease 2019 (COVID-19) have been encountered with a high risk of ARDS, underscoring the urgency for exploiting effective therapy. However, proper medications for ARDS are still lacking due to poor pharmacokinetics, non-specific side effects, inability to surmount pulmonary barrier, and inadequate management of heterogeneity. The increased lung permeability in the pathological environment of ARDS may contribute to nanoparticle-mediated passive targeting delivery. Nanomedicine has demonstrated unique advantages in solving the dilemma of ARDS drug therapy, which can address the shortcomings and limitations of traditional anti-inflammatory or antioxidant drug treatment. Through passive, active, or physicochemical targeting, nanocarriers can interact with lung epithelium/endothelium and inflammatory cells to reverse abnormal changes and restore homeostasis of the pulmonary environment, thereby showing good therapeutic activity and reduced toxicity. This article reviews the latest applications of nanomedicine in pre-clinical ARDS therapy, highlights the strategies for targeted treatment of lung inflammation, presents the innovative drug delivery systems, and provides inspiration for strengthening the therapeutic effect of nanomedicine-based treatment.

Objective: To compare different specimen types of lung adenocarcinoma in the detection of epidermal growth factor receptor (EGFR) gene and to correlate EGFR mutations with patient clinical features. Methods: One hundred lung adenocarcinoma cases were collected from June to December in 2015, at the First Affiliated Hospital of Xinjiang Medical University.Of the 100 lung adenocarcinoma samples, 43 were male and 57 were female. The age was from 40 to 88 years old, and the average age was 66 years. One hundred lung adenocarcinoma cases were divided equally into two groups. Mutation analysis of EGFR gene by real-time PCR was performed using biopsied tissue and paired blood samples in one group (n=50) and using pleural effusion and paired blood samples in the other group (n=50). Results: The mutation rate of EGFR gene in biopsy samples was 54% (27/50) , higher than that of blood samples (46%, 23/50), but without statistical differences (χ²=0.640, P=0.424). In contrast, mutation rate of EGFR gene in pleural effusion samples (42%, 21/50) was higher than that of blood samples (34%, 17/50), but without statistical differences(χ²=0.679, P=0.409). Two patients had EGFR mutation detected in paired blood samples but not in the corresponding biopsy samples, and four patients had EGFR mutation detected in pleural effusion samples but not in their paired blood samples. The mean progression-free survival of patients with detectable EGFR mutation were 9.5 months (tissue samples), 8.6 months (pleural effusion) and 8.5 months (blood). However, there was no statistical difference. Conclusions Blood samples may be used to assess EGFR mutations for patients with lung adenocarcinoma. However, further studies are needed to improve the sensitivity and accuracy in the detection of EGFR mutations using blood samples.

Objective:To investigate the expression of PIK3CA and PTEN in PI3K/Akt/Mtor signaling pathway and its correlation with clinicopathological parameters in invasive B-cell lymphoma.Methods:A total of 235 invasive B-cell lymphoma cases enrolled in First Affliated Hospital of Xinjiang Medical University from January 2008 to December 2012,without any pre-operative treatment,were collected;those included 205 cases of diffuse large B-cell lymphoma(DLBCL),27 cases of Burkitt lymphoma(BL),and the remaining three cases were somewhere between DLBCL and BL,but could not be classified clearly.The expression of PIK3CA and PTEN genes was detected by fluo-rescence in situ hybridization.The relationship between PIK3CA and PTEN genes was analyzed statistically and extended to clinicopathological parameters and prognosis.Results:The positive rate of PIK3CA amplification in invasive B-cell lymphoma was 12.3%(29/235),and the positive rate of clinical stageⅠ-Ⅱ(8.6%,12/139)was much lower than that ofⅢ-Ⅳ(17.7%,17/96),with the difference being statistically significant (P=0.038).The deletion rate of PTEN in invasive B cell lymphoma was 13.6%(32/235),which was not correlated with other clinicopathological features.PIK3CA amplification was negatively correlated with PTEN deletion(P=0.046),and neither was found to be significantly associated with survival.Conclusions:PIK3CA amplification and PTEN deletion play a role in the development of invasive B-cell lymphoma,and the former is associated with late stage of the disease.