Objective To investigate the effect of rivaroxaban on HIF-α, P-selectin and TNF-αin patients with lower extremity venous thrombosis.Methods 41 cases from May 2014 to February 2015 were selected and randomly divided into two groups, 21 cases in the control group were treated by routine treatment, 20 cases in the experiment group were treated on the base of the control group with ivaroxaban.Serum HIF-α, P-selectin and TNF-αwere detected before and after the treatment.ResuIts Compared with the control group, the clinical effect were higher ( P<0.05 ) , the adverse reactions occur rate was no difference (P>0.05).HIF-α, P-selectin and TNF-αwere lower(P<0.05),HIF-αwas positively correlated with TNF-α(r =-0.468,P<0.05), and was not correlated with P-selectin, P-selectin was not associated with TNF-α.ConcIusion Rivaroxaban can effectively improve the lower limb venous thrombosis in patients with clinical symptoms, reduce serum HIF-α, P-selectin and TNF-αexpression, has better clinical curative effect, for clinical treatment of lower limb venous thrombosis has important significance.

Objective To systematically evaluate the relationship between stroke location and post-stroke depression (PSD) in first-ever stroke patients.Methods The studies on the relationship between stroke location and PSD published from January 1980 to March 2016 were retrieved from databases,including Chinese science and technology journal full-text database (VIP),China journal full-text database (CNKI),Wanfan database,PubMed,ISI Web of Science,Ovid database and Elsevier Science Direct.RevMan5.3 software was adopted for data consolidation and analysis.Results A total of 14 studies,including 1 952 cases of patients were included.The meta analysis indicated that no direct relationship was found between stroke location and PSD in first-ever stroke patients [random effects model,95 ％CI(0.89,1.43),P＜0.01].The results of subgroup analysis indicated that the PSD was associated with the right hemisphere lesion when the Hamilton Depression Scale (HAMD) was adopted for assessment [fixed effects model,95 ％ CI(1.21,1.76),P＜0.01],while the relationships were not found in the subgroup analysis of time course after stroke and the aphasia occurrence.Conclusion Stroke location may be not directly associated with PSD,further studies are needed to ascertain the relationship between stroke location and PSD.

Objective To revise the Symptom Distress Scale for postoperative patients with pituitary tumor and to test its reliability and validity. Methods On the base of previous qualitative interview and literature review, Delphi consultation was performed to identify items of the Symptom Distress Scale for postoperative patients with pituitary tumor. By convenience sampling method, totally 191 patients from four first-class ternary hospitals in Jiangsu province were investigated effectively by this scale. Results A scale of 4 factors and 16 items was identified by expert interviews, item analysis, exploratory factor analysis and the four factors could explain 69.812%of the variance. The Cronbachαcoefficient of the scale was 0.920, the content validity index was 0.915, and the interrater reliability was 0.860. Conclusions Symptom Distress Scale for postoperative patients with pituitary tumor has good reliability and validity to assess the symptom distress of pituitary tumor patients after operation.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective To study the value of Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in older inpatients.Methods A total of 163 older patients who were treated with wide-spectrum antibiotics at least three days during January 2014 to December 2015 were randomly divided into control and study group.In study group, 81 patients were administrated with oral Saccharomyces boulardii 500 mg twice a day for 21 days.The control group was of no intervention.Morbidity rate of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, frequency and duration of diarrhea were recorded.Results The incidence of antibiotic-associated diarrhea in study group was significantly lower than that in control group [14.8%(12/81) vs 28.0%(23/82), P<0.05],whereas no difference was seen in the incidence of Clostridium difficile-associated diarrhea [3.7%(3/81) vs 4.9%(4/82), P>0.05] in two groups.The frequency and duration of diarrhea in the study group were significantly lower and shorter than those in control group[(4.3±1.7) times/day vs (6.9±2.0) times/day;(3.0±1.1) days vs (5.7±1.8) days, both P<0.01].Conclusion Saccharomyces boulardii may reduce the incidence of antibiotic-associated diarrhea therefore improving the symptom of diarrhea in older inpatients.

Objective To investigate the status and influencing factors of cooperation of doctors and nurses in the nutritional support of critically ill patients, and provide the basis for future improve the physician-nurse collaboration in the nutritional support. Methods Doctors and nurses who from ICU in Soochow were investigated by the Nurse-Physician Collaboration Scale (NPCS). Results The doctors′score of physician-nurse collaboration in the nutritional support of critically ill patients was 87.42 ±15.73, which was significantly higher than 80.97 ± 13.80 the nurses′(t=3.279, P= 0.001).In addition, under the item 1, 3, 5 in the dimension one as well as the total items in the dimensions two and three, the doctors′score was similarly higher than the nurses, and the differences are also statistically significant (Z=-3.894--1.964, all P<0.01 or 0.05). Technical titles, educational level and age was significantly related to the cooperative level between doctors and nurses respectively (χ2=11.037, P=0.012;F=3.488, P=0.037; F=3.499, P=0.016). Conclusions Doctors have higher levels of perceived collaboration than nurses in the nutritional support of critically ill patients, while both require further improvement. We should highlight the physician-nurse collaboration in feeding critically ill patients, and should improve the nutrition quality through standardized process management and active team cooperation.

Objective Based on the diagnostic technique of electric meridian detection, to observe the clinical efficacy of acupuncture in treating angioneurotic headache.Method Totally 106 patients with angioneurotic headache were randomized into a treatment group and a control group, 53 cases in each group. The treatment group received acupuncture based on the electric meridian detection, while the control group received medication treatment. The hemorheology indexes [plasma viscosity (PV), erythrocyte sedimentation rate (ESR)] and McGill Pain Questionnaire (MPQ) [Pain Rating Index (PRI), Visual Analogue Scale (VAS), and Present Pain Intensity (PPI)] were observed before and after intervention, and the clinical efficacies were compared. Result The total effective rate was 88.7% in the treatment group versus 71.7% in the control group, and the between-group difference was statistically significant (P<0.05). After intervention, the hemorheology indexes and MPQ scores were significantly changed in both groups (P<0.01,P<0.05).Conclusion Acupuncture based on electric meridian detection is an effective method in treating angioneurotic headache.

Objective:Flotillin-2(FLOT2)is a prototypical oncogenic and a potential target for cancer therapy.However,strategies for targeting FLOT2 remain undefined.Post-translational modifications are crucial for regulating protein stability,function,and localization.Understanding the mechanisms and roles of post-translational modifications is key to developing targeted therapies.This study aims to investigate the regulation and function of lysine acetylation of FLOT2 in nasopharyngeal carcinoma,providing new insights for targeting FLOT2 in cancer intervention. Methods:The PhosphoSitePlus database was used to analyze the lysine acetylation sites of FLOT2,and a lysine acetylation site mutation of FLOT2[FLOT2(K211R)]was constructed.Nasopharyngeal carcinoma cells were treated with histone deacetylase(HDAC)inhibitor trichostatin A(TSA)and Sirt family deacetylase inhibitor nicotinamide(NAM).TSA-treated human embryonic kidney(HEK)-293T were transfected with FLOT2 mutant plasmids.Co-immunoprecipitation(Co-IP)was used to detect total acetylation levels of FLOT2 and the effects of specific lysine(K)site mutations on FLOT2 acetylation.Western blotting was used to detect FLOT2/FLAG-FLOT2 protein expression in TSA-treated nasopharyngeal carcinoma cells transfected with FLOT mutant plasmids,and real-time reverse transcription PCR(real-time RT-PCR)was used to detect FLOT2 mRNA expression.Nasopharyngeal carcinoma cells were treated with TSA combined with MG132 or chloroquine(CQ)to analyze FLOT2 protein expression.Cycloheximide(CHX)was used to treat HEK-293T cells transfected with FLAG-FLOT2(WT)or FLAG-FLOT2(K211R)plasmids to assess protein degradation rates.The BioGrid database was used to identify potential interactions between FLOT2 and HDAC6,which were validated by Co-IP.HEK-293T cells were co-transfected with FLAG-FLOT2(WT)/FLAG-FLOT2(K211R)and Vector/HDAC6 plasmids,and grouped into FLAG-FLOT2(WT)+Vector,FLAG-FLOT2(WT)+HDAC6,FLAG-FLOT2(K211R)+Vector,and FLAG-FLOT2(K211R)+HDAC6 to analyze the impact of K211R mutation on total lysine acetylation levels.In 6-0B cells,overexpression of FLOT2(WT)and FLOT2(K211R)was performed,and the biological functions of FLOT2 acetylation site mutants were assessed using cell counting kit-8(CCK-8),colony formation,and Transwell invasion assays. Results:The PhosphoSitePlus database indicated that FLOT2 has an acetylation modification at the K211 site.Co-IP confirmed significant acetylation of FLOT2,with TSA significantly increasing overall FLOT2 acetylation levels,while NAM had no effect.Mutation at the K211 site significantly reduced overall FLOT2 acetylation,unaffected by TSA.TSA decreased FLOT2 protein expression in nasopharyngeal carcinoma cells without affecting FLOT2 mRNA levels or FLOT2(K211R)protein expression in transfected cells.The degradation rate of FLOT2(K211R)protein was significantly slower than that of FLOT2(WT).The proteasome inhibitor MG132 prevented TSA-induced FLOT2 degradation,while the lysosome inhibitor CQ did not.BioGrid data suggested a potential interaction between FLOT2 and HDAC6,confirmed by Co-IP.Knockdown of HDAC6 in nasopharyngeal carcinoma cells significantly increased FLOT2 acetylation;co-transfection of HDAC6 and FLAG-FLOT2(WT)significantly decreased total lysine acetylation levels,whereas co-transfection of HDAC6 and FLAG-FLOT2(K211R)had no effect.Knockdown of HDAC6 significantly reduced FLOT2 protein levels without affecting mRNA levels.MG132 prevented HDAC6-knockdown-induced FLOT2 degradation.Knockdown of HDAC6 significantly accelerated FLOT2 degradation.Nasopharyngeal carcinoma cells transfected with FLOT2(K211R)showed significantly higher proliferation and invasion than those transfected with FLOT2(WT). Conclusion:The K211 site of FLOT2 undergoes acetylation modification,and HDAC6 mediates deacetylation at this site,inhibiting proteasomal degradation of FLOT2 and maintaining its stability and tumor-promoting function in nasopharyngeal carcinoma.

Objective:To investigate the characteristics of atelectasis and its relationship with the degree of diaphragm inhibition in elderly patients with artificial pneumoperitoneum under general anesthesia.Methods:Patients of both sexes, aged 20-80 yr, of American society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 20-29 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=20 each) according to age: young and middle-aged group and elderly group.Total intravenous anesthesia was applied and intraoperative pressure of artificial pneumoperitoneum was set at 10 mmHg.Before anesthesia, at 5 min of mechanical ventilation, at 5 min of artificial pneumoperitoneum, at 20 min of artificial pneumoperitoneum, at 5 min after the end of artificial pneumoperitoneum and at 15 min after extubation, diaphragmatic excursion (DE) was measured at the right diaphragm point using M-mode ultrasound.The minimal DE was recorded and the maximum degree of diaphragm inhibition was calculated.B-mode was used to assess the lung ultrasound images at the upper bedside lung ultrasound in emergency (BLUE) point, the lower BLUE point and the diaphragm point, and the cumulative scores before anesthesia and perioperative maximum cumulative scores of lung ultrasound score (LUS) were recorded. Results:Compared with the young and middle-aged group, the maximum cumulative scores of LUS were significantly increased, the degree of DE before anesthesia, the perioperative maximum degree of diaphragm inhibition were increased ( P<0.05), and no significant change was found in LUS cumulative scores in elderly group ( P>0.05). Conclusion:The degree of atelectasis is more serious in the elderly patients with artificial pneumoperitoneum under general anesthesia, and the mechamism may be related to the increased degree of diaphragm inhibition.

Irritable bowel syndrome is a common functional gastrointestinal disorder, among which diarrhea-type irritable bowel syndrome (IBS-D) is the main type in China, which is seriously affecting the quality of life for patients. The pathogenesis of IBS-D is still unclear. It has been found that Intestinal flora disorder is an important pathogenesis of IBS-D. There is a close relationship between intestinal flora and IBS-D TCM syndrome types, and there are differences in intestinal flora of different TCM syndrome types of IBS-D. However, TCM syndrome types are a complex and multi-factor combination. Therefore, based on the TCM theory of nature and location of disease, this article proposed the following conclusions through analyzing previous studies on intestinal flora of different TCM syndromes of IBS-D, including that the intestinal flora of different TCM syndromes have different characteristics and there are differences in the functions of flora, deficiency and excess of disease are associated with the diversity and abundance of intestinal flora, cold and heat of disease are related to the proportion of beneficial bacteria and opportunistic pathogens, and the characteristics of intestinal flora are the microcosmic manifestation of the disease position of TCM. In addition, this article also proposed the application of fecal bacteria transplantation based on the theory of nature and location of disease. Based on this theory, the study on intestinal flora of IBS-D can provide help for objectification of TCM syndrome types, and also provide TCM research ideas for revealing the pathogenesis of IBS-D.