The proliferation of Patu8988 cells pre-treated with metformin for 72h was measured by CCK-8 assay.Cell cycle was analyzed by flow cytometry.The expression of related genes was detected by RT-PCR.Metformin suppressed the proliferation of Patu8988 cells in a dose-dependent manner( r=0.994,P＜0.05 ).The proportion of cells at G0/G1 stage was increased while that of G2/M stage decreased (P＜0.05 ).The expressions of MMP-3,cyclinD1,p53 were down regulated and that of Bax was up regulated.The results show that metformin may inhibit the proliferation of Patu8988 cells,via blocking the cell cycle and affecting the expression of related genes.

Objective To investigate the feasibility of low-dose CT perfusion imaging(CTPI)examination combined with iterative model reconstruction (IMR) in the brain.Methods 80 patients with clinical suspicion of acute cerebral infarction underwent the cerebral CTPI were enrolled in this study.30 normal hemispheres on group A [35 cases,80 kV,150 mAs, filtered back projection(FBP)] and group B(45 cases,80 kV,30 mAs, IMR) were selected to evaluate respectively.The pictures' subjective scores, effective radiation dose (ED),CT value,SD,signal to noise ratio(SNR), contrast to noise ratio(CNR) and the perfusion parameters of the grey matter (GM) and white matter(WM) in each hemisphere of the middle cerebral artery(MCA) territory were respectively compared at ASPECTS level 2 for the two groups.Results The ED were 2.52,0.50 mSv for group A,B.There were no statistical significances in the perfusion parameters,CT value, SD, CNR of the ROIs of the GM and WM,the SNR of the ROIs of the GM and the pictures' subjective scores between group A, B (P>0.05).There was statistical significance in the SNR of the ROIs of the WM between group A,B (P<0.05).Conclusion IMR combined with 30 mAs of the CTPI can reduce the radiation dose apparently while maintain the stability of the image quality and perfusion parameters.

Objective To analyze the clinical characteristics and endoscopic findings in the elderly cirrhotic patients with variceal bleeding.Method In this study,181 cirrhotic patients with variceal bleeding cltnically and endoscopically diagnosed from May 2011 to May 2016 were divided into ≥60 years of age group (58 cases) and control group (＜ 60 years of age,123 cases).Clinical data and endoscopic findings were compared retrospectively.Results The cirrhosis caused by virus and alcohol (15/58,62/123) was less in elderly group,but autoimmune disease and non-alcoholic fatty liver disease was more common (14/58,12/58)(x2 =7.452,P =0.004).The incidence rate of hypertension and coronary artery disease was higher in elderly group (20/58,7/58,x2 =6.124,12.764,P =0.012,0.001).However,there was no difference in the incidence rate of diabetes between the two groups (P ＜ 0.05).Gastric varices bleeding was higher in the elderly group (x2 =3.965,P =0.049).The gastric varices located in cardia were more in the elderly group (37.93％,22/58) than control (34.96％,43/123),(x2 =4.124,P =0.044).The rate of EIS was higher in the elderly group and cyanoacrylate injection was less than control (x2 =3.621,P =0.046).Conclusions Compared with those of ＜ 60 years of age,the causes and endoscopic findings and treatment are different cirrhotic variceal bleeding in patients ≥60 years of age.

Objective To analyze the clinical characteristics and endoscopic findings in patients with cirrhosis and upper gastrointestinal variceal bleeding (UGIB) and to evaluate the risk factors of rebleeding after endoscopic therapy.Method Between May 2010 and May 2017,383 patients who diagnosed with cirrhosis and UGIB were enrolled.Results The incidence of rebleeding was 8.88％ (n =34).In the univariate analysis,advanced age (P =0.362,OR =0.662),male (P =0.036,OR =2.975),cause of cirrhosis (P =0.047,OR =2.512),Child-Pugh scores (P =0.026,OR =1.852),prothrombin time (P =0.017,OR =3.746),thrombocytopenia (P =0.445,OR =0.577),severe varices (P =0.314,OR =0.745),red color sign (P =0.016,OR =4.013),portal vein diameter (P =0.365,OR =1.026),portal thrombosis (P =0.027,OR =1.954) were risk factors for rebleeding following endoscopic therapy.In the non-condition multivariate logistic regression analysis,male (P =0.036,OR =2.975),autoimmune liver disease (P =0.047,OR =2.512),Child-Pugh scores (P =0.026,OR =1.852),prothrombin time (P =0.017 OR =3.746),red color sign (P =0.016,OR =4.013),portal thrombosis (P =0.027,OR =1.954) were independent risk factors for rebleeding following endoscopic therapy.Conclusions Esophagogastric variceal rebleeding is common after a successful initial endoscopic therapy.Independent risk factors for rebleeding are male,autoimmune liver disease,elevated Child-Pugh scores,prolonged thrombin time,portal vein thrombosis and red color sign.

Objective:To automatically segment four body components at the T4 thoracic veertebra plane on chest CT in the newly diagnosed multiple myeloma(MM)patients by deep learning model,and to discuss the correlation between the four body components and the prognosis of the MM patients.Methods:The retrospective analysis was conducted on the clinical data of the MM patients diagnosed in our hospital from January 2017 to December 2021.The clinical informations such as age,gender,weight,height,and body mass index(BMI)of the patients were collected.The laboratory data of the patients were collected,including serum levels of lactate dehydrogenase(LDH),calcium(Ca),creatinine(Scr),albumin(Alb),hemoglobin(Hb),β2-microglobulin(β2-MG),and serum free light chains.The chest CT images of 79 regularly evaluated MM patients detected by deep learning model were divide into four body components:pectoralis major,pectoralis minor,subcutaneous fat,and mediastinal fat.Image J software was used to detect the areas of the four body components at the T4 thoracic vertebra plane,and their correlation with the prognosis of the MM patients was analyzed by Kaplan-Meier survival analysis.Results:The univariate analysis results showed that the area of subcutaneous fat,serum Ca levels,Scr levels,and International Staging System(ISS)stage were related to the overall survival(OS)of the MM patients(HR=2.260,95％CI:1.116-4.578,P=0.024;HR=2.088,95％CI:1.007-4.327,P=0.048;HR=2.209,95％CI:1.105-4.414,P=0.025;HR=1.730,95％CI:1.040-2.879,P=0.035).The multivariate analysis results showed that the area of subcutaneous fat among the four body components was an independent risk factor affecting the prognosis of the MM patients(95％CI:1.228-5.782,P=0.013).The Log-Rank test results showed that compared with high subcutaneous fat area group,the OS of the patients in low subcutaneous fat area group was decreased(P=0.018).There was no significant difference in OS of the patients with different genders between high subcutaneous fat area group and low subcutaneous fat area group(P＞0.05).In the patients without hematopoietic stem cell transplantation,compared with high subcutaneous fat area group,the OS of the patients in low subcutaneous fat area group was decreased(P=0.037).Conclusion:Among the four body components at the T4 thoracic vertebra plane,the area of subcutaneous fat is related to the OS of the MM patients and it is an independent risk factor for the prognosis of the MM patients,while the areas of mediastinal fat,pectoralis major,and pectoralis minor have no predictive value for the prognosis of the MM patients.

Driven by demand and policy guidance, the construction of Internet hospitals is on a fast track mode in China. To address such a situation, the state requires that before Internet hospitals are admitted, the provincial health authorities should establish an Internet medical service supervision platform to interconnect with the Internet hospital information platform for real-time supervision. This study discussed and introduced the Internet medical service supervision platform in Henan province, covering its system architecture, functions, regulatory indicators and operation mode. The platform is officially in operation and has completed docking with 7 medical institutions. It can implement entire process supervision with a total of 186 indicators in five categories in Henan, providing a reference for the construction of Internet medical service supervision platforms in other provinces.

Objective:To study the efficacy and influencing factors of ursodeoxycholic acid (UDCA) in the treatment of cholesterol gallstone, so as to provide reference for the treatment of cholesterol gallstone by internal medicine.Methods:From March 1, 2017 to March 31, 2018, at outpatient department of gastroenterology of 9 Beijing medical centers including Peking University People′s Hospital, the Sixth Medical Center of PLA General Hospital, Beijing Huaxin Hospital, PLA Rocket Force Characteristic Medical Center, Peking University Aerospace Center Hospital, Beijing Youan Hospital of Capital Medical University and Beijing Tiantan Hospital of Capital Medical University, Beijing Tongren Hospital of Capital Medical University, and Beijing Shijitan Hospital of Capital Medical University, the data of patients with cholesterol gallstone treated by UDCA were collected. The inclusion criteria were that the largest diameter of stone was ≤10 mm and the stone was not detected under X-ray. The treatment plan was taking UDCA orally for 6 months at a dose of 10 mg·kg -1·d -1. The basic information of patients, the ultrasound examination results before treatment and 6 months after treatment, and scores of biliary abdominal pain and dyspepsia symptom were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of the efficacy in gallstrone dissolution by UDCA, and Wilcoxon signed rank test was used for statistical analysis. Results:A total of 215 patients were enrolled. The complete dissolution rate of gallstone was 19.5% (42/215) and partial dissolution rate was 50.7% (109/215), and the total effective rate was 70.2% (151/215). The complete dissolution rate of sandy stone was significantly higher than that of lumped stones (37.0%(17/46) vs. 14.8%(25/169); OR=3.377, 95% confidence interval (95% CI) 1.621 to 7.035, P=0.001). In lumped stones, the complete dissolution rate of the stones with diameter ≤5 mm was significantly higher than that of the stones with diameter >5 mm (37.5%(9/24) vs. 11.0%(16/145); OR=4.837, 95% CI 1.823 to 12.839, P=0.002). The complete dissolution rate of patients with higher body mass index ( OR=0.872, 95% CI 0.764 to 0.995, P=0.043) and longer disease course ( OR=0.942, 95% CI 0.912 to 0.973, P<0.001) was low. The results of multivariate logistic analysis indicated that long disease course of gallstone ( OR=0.940, 95% CI 0.908 to 0.974, P=0.001), rough gallbladder wall ( OR=0.438, 95% CI 0.200 to 0.962, P=0.040) and lumped stone ( OR=0.236, 95% CI 0.101 to 0.550, P=0.001) were independent risk factors of influencing the efficacy of stone dissolution by UDCA. As for lumped stones, the independent risk factors included long disease course of gallstone ( OR=0.926, 95% CI 0.877 to 0.978, P=0.006) and stone diameter >5 mm ( OR=0.142, 95% CI 0.043 to 0.470, P=0.001). After 6 months of UDCA treatment, score of biliary abdominal pain decreased from 0 (0 to 6) to 0 (0 to 0) and the score of dyspepsia symptom decreased from 1 (0 to 2) to 0 (0 to 0), and the differences between before treatment and after treatment were statistically significant ( Z=-8.50, and -9.13, both P<0.001). Conclusions:UDCA has a certain efficacy in cholesterol gallstone dissolution and can ease biliary abdominal pain and dyspepsia symptom. Long disease course of gallstone, rough gallbladder wall and stone diameter >5 mm are independent risk factors of poor efficacy in gallstone dissolution by UDCA.

Objective To investigate the effect of miR-217 on gefitinib resistance in non-small cell lung cancer(NSCLC),and to explore the downstream target genes and related pathways.Methods qRT-PCR was used to detect the expression of miR-217 in human lung normal epithelial cell lines BEAS-2B,NSCLC cell lines A549,HCC827,PC9,NCI-H1975 and gefitinib resistant strain PC9/GR.PC9/GR cells were selected and the cells of control group,NC-mimic group,miR-217 mimic group,miR-217 mimic+si-NC group,and miR-217 mimic+si-FOXO3 group were constructed using liposome transfection technique.CCK8 and clonal formation assay were used to detect changes in cell proliferation capacity,flow cytometry was used to detect changes in cell apoptosis capacity,and western blot was used to detect protein expression related to PI3K/AKT signaling pathway.The Targetscan bioinformatics website predicted the downstream target genes of miR-217,and the correlation between miR-217 and the target gene FOXO3 was detected by dual luciferase assay.Results Compared with BEAS-2B cells,the expression of miR-217 in A549,HCC827,PC9 and NCI-H1975 cells was significantly decreased(P＜0.05).With the increase of gefitinib concentration,the expression of miR-217 gene in PC9 cells was gradually decreased(P＜0.05),and the expression of miR-217 in PC9/GR cells was lower than that in PC9(P＜0.05).Compared with the control group and NC-mimic group,the cell proliferation capacity of miR-217 mimic group was significantly decreased(P＜0.05),the number of apoptosis was increased(P＜0.05),and the expression levels of p-PI3K and p-AKT were decreased(P＜0.05).Dual luciferase reporter gene assay proved that FOXO3 is the target of miR-217.Compared with miR-217 mimic group and miR-217 mimic+si-NC group,the cell drug resistance of miR-217 mimic+si-FOXO3 group was increased(P＜0.05),the proliferation ability was significantly increased(P＜0.05),and the number of apoptosis was decreased(P＜0.05).The expression levels of P-PI3K and P-AKT were increased(P＜0.05).Conclusion Overexpression of miR-217 reversed the resistance of PC9/GR to gefitinib in NSCLC cells and inhibited the proliferation and accelerated apoptosis of PC9/GR cells,which may be related to the regulation of PI3K/AKT signaling pathway by targeting FOXO3.

Background The effects of meteorological factors and air pollutants on ischemic heart disease (IHD) hospitalizations in Urumqi have not been fully understood. Objective To investigate the effects of meteorological conditions (temperature, relative humidity) and common air pollutants [fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), ozone (O₃), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO)] on the daily hospitalization volume of IHD, and to provide a scientific basis for the development of targeted prevention and management strategies. Methods Basic information of 90622 IHD hospitalized patients in Urumqi City was collected from January 1, 2014 to December 31, 2022, and daily air pollutant concentration data and meteorological data were collected during the same period. The meteorological data included daily mean temperature, daily maximum temperature, daily minimum temperature, and daily mean relative humidity, and the common air pollutants included PM_2.5, PM₁₀, daily maximum 8-h average concentration of O₃ (O₃_8 h), SO₂, NO₂, and CO. Descriptive statistical analyses (mean, standard deviation, and quartiles) were performed on the collected data. A distribution lag nonlinear model (DLNM) based on time-stratified case-crossover design was established to estimate the lagged effects (RR) as well as the cumulative lagged effects (RR_cum) of daily mean temperature, relative humidity, and different air pollutants on the number of IHD admissions, stratified by gender and age (<60 and ≥60 years). Subsequently, a generalized additive model (GAM) was used to explore the effects of cold waves (≤ P₅ of the daily minimum temperature and lasting ≥3 d) versus heat waves (≥ P₉₅ of the daily maximum temperature and lasting ≥3 d) on IHD hospitalizations and the potential interactions between temperature and the more influential air pollutants [particulate matter (PM) and O₃_8 h] on IHD hospitalizations. Results The maximum number of IHD hospitalizations in a single day in Urumqi from January 1, 2014 to December 31, 2022 was 100, and the average daily number of hospitalized IHD patients was 27. Daily mean temperature, relative humidity, and air pollutants had different nonlinear relationships and hysteresis with IHD hospitalizations. Extremely low temperatures (<P₁: −18 °C) showed the greatest risk to admission for the total IHD population at a cumulative lag of 31 d (lag0-31) (RR_cum=2.092, 95%CI: 1.261,3.471). Female [lag0-31, RR_cum and 95%CI: 3.416 (2.296,5.082)] and people ≥60 years old [lag0-31, RR_cum and 95%CI: 2.356 (1.681,3.303)] were more sensitive to extremely low temperatures. The risk of IHD hospitalization was greatest on lag20 for cold waves (RR=1.242, 95%CI: 1.053, 1.465), and no lagged effect of heat waves on the number of IHD hospitalizations was found. There was a positive interaction (SI >1, P<0.001) between temperature, PM, and O₃_8 h on the risk of IHD hospitalization, especially for low temperature-high PM and O₃_8 h. Conclusion Both low temperature and high pollutant concentrations associate with an increase in IHD hospitalizations with lagged effects in Urumqi from 2014 to 2022, while cold waves associate with a higher risk of IHD admissions. Females and people aged 60 years and older are at high risk.

OBJECTIVE： To evaluate the economics of the full coverage policy for hypoglycemic essential medicines in Taizhou city， and to provide reference for improving medicine accessibility and essential medicine system in China. METHODS： The electronic health records and financial input data of diabetic patients were extracted from different districts and counties of Taizhou city during 2009-2016. In cohort study design， taking the implementation time of each district and county’s policies as the breakpoint， the data recorded annually were processed as annual data， forming the cohort data for 1 year before （baseline year） and 3 years after the implementation of the policies. According to the choice of free medicines after the implementation of the policy， they were divided into policy group and control group. Propensity score matching was used to balance the differences between two groups to get the final sample， and then the economics of the policy was evaluated with the methods of difference-in-differences. The cost and benefit of implementation policy were calculated. RESULTS： Totally 14 744 people of each group were got by propensity score matching. The mean annual financial expenses on free medicine per capita were 263.8 yuan. Compared with baseline year， mean annual medicine expenses per capita reduced by the policy were 649.2 yuan， and mean annual hospitalization expenses per capita were 624.7 yuan. Thus the input-output ratio of the policy was 1 ∶ 4.8. CONCLUSIONS： The implementation of the policy is beneficial to reduce the cost burden of patients and economical. It can be popularized and sustained through scientific design combined with relevant policies.