Objective To discuss the value of combining the physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)in severe acute pancreatitis(sAP).Methods 60 cases of SAP were divided into surgery group(n=15)and non-surgical group(n=45),Non-surgical group was vahde with APACHE Ⅱ score,the surgery group with POSSUM score,decided to continue conservative treatment or surgery treatment,Observation of two ways with the complications and death.Results The rates of compHcafions and death were(0.37±0.08)and(0.27±0.09)in Single-operation group(n=15)higher than(0.76±0.14)and(0.61±0.15)in surgical group(n=11)(t1=3.125,t2=3.211,P＜0.01);APACHEⅡ score of mortality in operation group and non-surgical group were no significant difference(x2=2.28,x2=1.98,P＞0.05);APACHE Ⅱ score were(10.12±6.27)in survival group(n=46)were lower than (25.75±7.90)in death group(n=14)(t=2.525,P＜0.05.Conclusion The score of dynamic APACHE Ⅱ has better effect to judge the timing of surgery,and the score of POSSUM has high value to predict post-operative complications and deaths occurred in patients with severe acute pancreatitis.

Objective T o investigate the expression of hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (H C N 4) and connexin43 (C x43) in the sinoatrial node of electric shock death. Meth-ods As experim ental group, 34 cases of electric shock death who had definite current m ark evidence were selected from pathology departm ent of X uzhou M edical C ollege from 2010 to 2013. As the control group, 20 cases of fatal severe craniocerebral injury in traffic accidents were chosen. T he expressions of H C N 4 and C x43 in the sinoatrial node were observed by im m unohistochem ical technology. Results H C N 4 positive cells expressed in the cell m em brane and cytoplasm of the sinoatrial node. C x43 positive cells expressed in the cell m em brane and cytoplasm of T cells and m yocardial cells. T he expression of H C N 4 was significantly higher than that of the control group (P<0.05) and the expression of C x43 was signifi-cantly lower than that of the control group (P<0.05). Conclusion T he changes of H C N 4 and C x43 ex-pressions in the sinoatrial node illustrate electric shock death m ight be related to the abnorm alities of cardiac electrophysiology and conduction.

Objective To observe the Th17 and regulatory T cells(Tr) equilibrium state as well as their changes of tuberculosis patients in six-month's anti-Tuberculosis treatment.Methods Select thirty-two tuberculosis patients received anti-Tuberculosis treatment while thirty-two healthy volunteers as controls.Flow cytometry was used to analyze Th17 and Tr cells in venous blood at the time of pre-therapy,3th,6th month.Results The ratio of Th17 cells in CD4 cells in tuberculosis patients and volunteers were (1.10±0.39)％,(2.50±1.03) ％,(3.90±1.34) ％,(4.50±1.52)％,respectively; the ratio of Tr cells were (9.17±3.26)％,(6.85±2.73)％,(5.46±1.69)％,(4.35±0.86)％,respectively.Conclusion Tuberculosis could make Th17 cells and Tr cells lost their balance,but the immune equilibrium state may gradually recover after anti-tuberculosis.The change of the amount of immune cells was likely to be the reference indexes to observe the progress of tuberculosis and the treatment effect of anti-tuberculosis.

Objective To study the correlation between female urination abnormalities and pelvic floor injury.Methods A total of 193 adult women with urination abnormalities from January 2015 to January 2017 were selected from Foshan Maternal and Child Hospital of Guangdong Province,including 84 cases of lower urinary tract symptoms (LUTS),71 cases of overactive bladder (OAB) and 38 cases of stress urinary incontinence (SUI).All patients aged 38-82 years (mean 51 ± 3.74) were enrolled according to their clinical symptoms.100 adult female patients without obvious symptoms such as abnormal urination were selected as the control group.Pelvic floor pain points were examined and scored in both groups.Results In the 193 cases,the number of pain points in LUTS,OAB and SUI were 1 093,983 and 415,respectively,a total of 2 491.The total pain scores of pain points were 7 163,6 480 and 2 583,with a total of 16 226 points.There were 100 cases in the control group with 527 pain points,and the total pain points were 1 377 points.According to the pelvic floor injury formula,the injury scores of the inspection group and the control group were calculated to be 3.59 vs 0.24 respectively,with statistically significant difference (P ＜ 0.01).The pelvic floor injury scores of LUTS group,OAB group and SUI group were 3.67,4.18 and 2.46 respectively,with statistically significant difference (P ＜ 0.01).Conclusions Overall,female urination abnormalities are significantly associated with pelvic floor injury,which are consistent with clinical observation.

Objective To investigate the relationship between pelvic floor pain and pelvic floor injury in female patients with lower urinary tract disease.Methods Transvaginal and rectal pelvic floor acupressure was used to perform pelvic floor pain point examination in women with lower urinary tract disease.The number of tender points and the pain point of tenderness were recorded.R~ults The positive rate of pelvic pain points was 61.5％ (3 507 checkpoints,2 156 checkpoints had tenderness);there was a difference in the degree of pain caused by pain points in different regions (H =159.144,P ＜0.01).There was no difference in pain level between the P3 area,P4 and P5 areas and P2 (adjust P =1),and the pain points of the other areas were statistically different from the pain level (adjust P ＜ 0.01).Conclusions The density of tender points and degree of pain in pain points in female pelvic floor are related to the pelvic floor injury.It is of clinical significance to evaluate the degree of pelvic floor injury by taking the pelvic floor pain point.

Objective:To observe the clinical efficacy of Heweishupiyin decoction in the treatment of functional dyspepsia (FD) in elderly patients with liver stagnation and spleen deficiency.Methods:A randomized controlled method was performed in this study, and 70 FD patients were selected from February 2018 to June 2019 in accordance with the inclusion criteria.The patients were divided into the observation group and the control group according to the random digital table method, with 35 cases in each group.The observation group was treated with Heweishupiyin decoction, the control group was given mosapride citrate tablets.The period of treatment was 4 weeks.The changes of total symptom scores, TCM syndrome evaluation, electrogastrogram (EGG) parameters, serum serotonin, and Hamilton depression scale (HAMD) scores before and after treatment were recorded.The statistical analysis was performed to evaluate the clinical efficacy of Heweishupiyin decoction.Results:After treatment, the overall symptom scores in both two groups were decreased.The overall symptom score of the observation group after treatment[(8.03±4.23)points] was lower than that of the control group[(10.36±4.67)points], and the difference was statistically significant( t=2.145, P<0.05). The overall efficacy of TCM symptoms of the observation group was 88.2% (30/35), which was significantly higher than 72.8% (24/35) of the control group ( Z=-2.473, P<0.05). After treatment, the EGG parameters of two groups had different degrees of increase, the main frequency of the observation group after meal[(3.39±0.34)cpm] was higher than that of the control group[(3.18±0.36)cpm], the difference was statistically significant( t=-2.202, P<0.05). The percentage of normal slow wave in the observation group[(68.91±4.79)%] was higher than that in the control group[(66.33±3.00)%], and the difference was statistically significant( t=-2.549, P<0.05). The reaction area of the observation group[(99.09±13.58)μV/s] was higher than that of the control group[(90.27±14.70)μV/s], and the difference was statistically significant( t=-2.390, P<0.05). After 4 weeks of treatment, the HAMD score of the observation group[(14.94±2.42)points] was lower than that of the control group[(16.94±4.29)points], and the difference was statistically significant( t=2.355, P<0.05). The serum level of serotonin after treatment in the observation group[(110.46±16.69)μmol/L] was higher than that in the control group[(99.04±19.86)μmol/L], the difference was statistically significant( t=-2.551, P<0.05). Conclusion:Heweishupiyin decoction is superior to mosapride citrate tablets in improving the overall symptomatic efficacy and TCM syndrome efficacy of FD patients with liver stagnation and spleen deficiency.Heweishupiyin not only can improve the depression state of FD in the elderly, but also has the effect of improving the gastric electrical rhythm disorder, which may be related to the regulation of serum serotonin levels.

Objective:To develop the problematic short video use scale for college students in the context of Chinese culture, and to test its reliability and validity.Methods:The questionnaire items were established based on bibliographic retrieval method, interviewing method and social investigation method.Totally 275 college students were selected as subjects for item analysis and exploratory analysis, and 642 college students were selected for confirmatory factor analysis, validity analysis and reliability analysis. One month later, 112 college students were retested and test-retest reliability data were collected. SPSS 26.0 and Mplus 8.3 softwares were used for correlation analysis, reliability and validity analysis of the questionnaires.Results:(1) The formal questionnaire contained three dimensions, 13 items in total, and the three dimensions were change of knowledge and behavior, physical discomfort and social viscosity. The internal consistency coefficients of three dimensions were 0.794, 0.820, and 0.716, respectively. The item load ranged from 0.577 to 0.805, and the variance contribution rate was 64.803%. (2) The confirmatory factor analysis results showed that χ2/ df=2.39, SRMR=0.038, RMSEA=0.047, CFI=0.970, TLI=0.963, indicated that the three-factor structure accords with the requirements of psychometrics. (3) The split-half reliability of the questionnaire was 0.885, Cronbach's α was 0.882, and the test-retest reliability after one month was 0.991. The internal consistency reliability of the total questionnaire and each dimension ranged 0.716-0.882. Conclusion:The problematic short video media use scale has good psychometric indicators and it benefits the studies of problematic short video use among Chinese college students.

Objective To evaluate efficacy and safety of acarbose compared with metformin as add-on therapy in patients with type 2 diabetes mellitus inadequately controlled with insulin. Methods This was a randomized, open-labeled, and parallel group study. Ninety-one type 2 diabetic patients ( HbA1C7.5%-11.0%) who were suboptimally controlled despite receiving twice daily injection of insulin (30-60 U/d for at least 8 weeks) were enrolled. They were randomly assigned 1 ∶ 1 ∶ 1 to continuation of insulin, insulin with acarbose (Ins+Aca), and insulin with metformin (Ins+Met) groups to insulin treatment. The levels of HbA1C, oral glucose tolerance test, blood lipids etc were measured at baseline and 12 weeks, and adverse events were recorded. Results The mean HbA1C levelsdecreasedfrom(7.9±0.4)%atbaselineto(7.0±0.3)%atweek12(P＜0.01)intheIns+Acagroupand(7.8 ±0.2)%to(7.0±0.3)%in the Ins+Met group(P＜0.01), while no significant change in HbA1Cin the insulin alone group. Adding acarbose to insulin resulted in similar reductions in HbA1Crelative to metformin (P＝0.431). The achievement rate of HbA1Cbelow 7.0%at week 12 was the same(both 70%) between the Ins+Aca group and the Ins+Met group. Insulin combined with acarbose in improving blood glucose fluctuation effect was more significant than that incombinationwithmetformin(P＜0.01),withstandarddeviation(SD)ofbloodglucose[(1.1±0.5vs2.7±0.6) mmol/L, P＜0.01], postprandial blood glucose fluctuations [(0.5 ± 0.7 vs 2.8 ± 0.4) mmol/L, P＜0.01], the maximumbloodglucosefluctuations[(2.8±0.7vs4.6±0.6)mmol/L,P＜0.01].Theweightlossoccurredinboththe Ins+AcaandtheIns+Metgroups[-(0.5±0.8vs1.0±0.4)kg].Therewasnosignificantchangesinbloodpressure and lipid profile. Hypoglycemic episodes were comparable in all groups. No serious adverse event was noted in any group. Conclusions Adding acarbose or metformin to insulin therapy could achieve improvements in glycemic control with similar reductions in HbA1Clevels and weight, when comparing with insulin treatment alone. Add-on acarbose to insulin therapy may exist more effectively on glucose fluctuation than that of add-on metformin, which may have important clinical implications in those patients with postprandial hyperglycemia, large blood glucose fluctuation, and intolerance to metformin.

Objective To investigate the effect of comprehensive rehabilitation exercise on the rehabilitation of upper limb function and quality of life in patients with breast cancer. Methods From January 2014 to December 2017,68 cases received breast cancer surgery in Hangzhou Red Cross Hospital were chosen in the research. The patients were randomly divided into observation group (34 cases) and control group (34 cases). All the patients were given routine rehabilitation training,and the observation group was given latissimus dorsi muscle strengthening exercise and simplified 24 Style Taijiquan exercise. The upper limb function rehabilitation and quality of life of the two groups were compared and analyzed. Results At 2 months after operation, the angle of extension, the angle of internal rotation and the adduction strength in the observation group were (39. 43 ± 5. 82)°,(150. 7 ± 10. 34)° and (145. 24 ± 10. 35) N,respectively,which in the control group were (33. 71 ± 5. 28)°,(134. 10 ± 39. 43)° and (119. 57 ± 9. 46)N,respectively,which were significantly improved compared with those before discharge (t=12. 041,3. 883, 11. 807,4. 906,21. 904,11. 617,all P<0. 05),which in the observation group were significantly higher than those in the control group (t=4. 244,6. 166,10. 674,all P<0. 05). The pain,ADL and ROM scores in the observation group at 2 months after operation were ( 13. 27 ± 4. 51 ) points, ( 16. 48 ± 4. 22 ) points and ( 31. 46 ± 5. 64 ) points,respectively,which in the control group were ( 10. 73 ± 4. 15 ) points, ( 12. 05 ± 4. 13 ) points and ( 26. 57 ± 5. 16)points,respectively,which were significantly higher than before discharge (t=5. 238,2. 503,10. 953,5. 531, 12. 872,9. 160,all P<0. 05),which in the observation group were significantly higher than those in the control group (t=2. 417,4. 375,3. 730,all P<0. 05). The WHOQOL-BREF scores in the observation group at 2 months after operation were (17. 24 ± 2. 81) points,(16. 74 ± 3. 18) points,(17. 45 ± 2. 56) points,(33. 48 ± 5. 15) points, (3. 97 ± 1. 05)points and (3. 87 ± 1. 18)points,respectively,which in the control group were (14. 21 ± 3. 08)pionts, (13.81 ±3.28)points,(13.45 ±2.83)points,(28.81 ±4.82)points,(3.26 ±1.16)points,(3.18 ±1.28)points, respectively,compared with those before discharge,the differences were statistically significant(t =9. 669,4. 965, 8. 327,4. 857,10. 522,4. 198,11. 487,7. 132,5. 572,2. 688,5. 178,2. 727,all P<0. 05),which in the observation group were significantly higher than those in the control group(t=4. 238,3. 740,6. 112,4. 638,2. 646,2. 311,all P<0. 05). Conclusion A positive comprehensive rehabilitation exercise for the patients with breast cancer is helpful to the recovery of the function of the upper limb and the improvement of the quality of life of the patients.

Objective:To establish the population pharmacokinetics model of mitiglinide given by oral route in Chinese healthy volunteers using nonlinear mixed effect model (NONMEM), investigate the pharmacokinetic characteristics of mitiglinide in Chinese healthy people to evaluate the factors that can influence the clinical pharmacokinetics of mitiglinide .Methods: Clinical data from 22 healthy volunteers were collected and the experiment was with single-dose administration.The volunteers were given 10 mg mitiglinide calcium orally and mitiglinide plasma concentration was determined by LC-MS/MS.The data was analyzed by the first order conditional estimation, and the influences of fixed effect factors such as demographic index and biochemical index were quantitatively evaluated . The population pharmacokinetics model of mitiglinide was established , and the result was verified by using the VPC and self-test meth-od.Results:The result showed that mitiglinide pharmacokinetics was fit single-compartment model .The inter-individual variability could be described by an exponential model .The typical values including central volume of distribution , clearance and absorption con-stant was 2.4 L· h-1(24％), 9.82 L(4％) and 6.46 h-1(14％), respectively.The clearance was influenced by creatinine clear-ance rate , and the absorption constant was influenced by ALT .Conclusion:The population pharmacokinetic parameters were mainly influenced by creatinine clearance rate and ALT .The established population pharmacokinetics model can explain the reasons for the in -dividual variation in the plasma concentration of mitiglinide , which can be used to guide the clinical administration of Chinese people .