ObjectiveTo study the distribution characters and linkage disequilibrium of vitamin D receptor(VDR) gene ApaI and BsmI polymorphism,and explore the genetic susceptibility of VDR and vitamin D deficiency rickets.MethodsVDR gene ApaI and BsmI polymorphisms were determined by PCRRFLP technology in 56 cases of rickets and 76 cases of normal children.The frequencies of the VDR genotype and allele were compared between the two groups.The software SHEsis was used to make linkage disequilibrium analysis.Results No significant difference was found in either the frequency distribution of VDR gene ApaI and BsmI polymorphism or allele of them between two groups; Two polymorphisms didn't show linkage disequilibrium and D' and r2 were 0.23 and 0.01,respectively.ConclusionsThe ApaI and BsmI polymorphism of VDR gene might be not associated with vitamin D deficiency rickets.Two polymorphisms didn't show linkage disequilibrium.

Objective To evaluate the guidance value of capsule endoscopy and clinical scoring system in risk stratification for acute upper gastrointestinal bleeding (AUGIB) .Methods 24 patients presenting to the emergency room with AUGIB ,were randomly divided into two groups (12 cases in each group) .Pre‐Endoscopic Blatchford and Rockall scores were calculated for all pa‐tients .All patients underwent endoscopy(EGD) within 24 hours .The timing of EGD was based on clinical scores in control group , and on VCE in observation group .Positive VCE was defined as red blood ,clot or coffee grounds .Mean Rockall and Blatchford scores for all 24 patients were compared to differentiate high‐and low‐risk patients .Rockall and Blatchford scores were also com‐pared with VCE findings .Results A total of 13 out of 24 patients had high‐risk stigmata on EGD ,with the mean Rockall and Blatchford scores of 3 and 13 respectively .Meanwhile ,the mean Rockall and Blatchford scores of the other 11 patients were 2 and 11 .There was no statistically significant difference between the Blatchford scores of the two groups(95% CI:5 .2‐1 .4 ;P=0 .23) . Also there was no statistically significant difference between the Rockall scores of the two groups(95% CI:2 .2‐0 .3;P=0 .12) .In the subgroup of 12 patients who underwent VCE ,9/12 had positive findings confirmed at EGD afterward ,compared with the other 3 patients with negative VCE and endoscopy .Conclusion Both the Rockall and the Blatchford scores are not accurate to predict the degree of risk in patients with AUGIB identified at EGD .However ,VCE is sensitive and specific enough to a better risk stratifica‐tion tool .

Aim To investigate metabolomic profiles of acute myocardial ischemia (AMI) in rat plasma and explore the intervention effects and its mechanism of leonurine using a metabolomics approach based on nuclear magnetic resonance (NMR).Methods The plasma metabolomic characteristics in rats of sham group,AMI model group,and leonurine-treated group were detected by 1H NMR,and the different metabolites between AMI group and sham group or leonurine-treated group were analyzed by pattern recognition and multivariate data analysis.Results Orthogonal partial least squares discriminant analysis (OPLS-DA) demonstrated that six metabolites related to AMI were screened out,including alanine,lysine,glycine,creatine,N-acetyl glycoprotein,and O-acetyl glycoprotein and all their levels were elevated in AMI group compared to sham group.Treatment of leonurine decreased the levels of alanine,lysine,and glycine,and increased the levels of choline,phosphocholine,and scyllo-inositol compared with the model group.Conclusions Leonurine can improve amino acid metabolism disorder under AMI conditions and enhance the function of choline and inositol pathway,which may explain its cardioprotective effect.The developed metabolomics approach in this study is a powerful tool for the investigation of the cardioprotective effect of leonurine and provide a new insight to understand its pharmacological mechanism.

Objective To investigate the difference of Theory of Mind (ToM) processing (especially in social-perceptual component and social-cognitive component) in male methamphetamine (METH) addicts, and test whether the deficits of ToM is correlated with their psychotic symptoms or not. Methods Thirty METH addicts with psychotic symptoms (METH-P group), 31 METH addicts with no psychotic symptoms (METH-NP group) and 41 healthy controls (control group) were recruited. Eyes Task and Faux pas Task were used to test the social-perceptual component and social-cognitive component in all participants. The psychotic symptoms of METH addicts were assessed using Brief Psychiatric Rating Scale (BPRS). Results Compared with control group, performance was poor in Eyes Task and Faux pas Questions in both METH-P group and METH-NP group (P＜0.05). Performance in Eyes Task was poorer in METH-P group than in METH-NP group (P＜0.05). There were no significant differences in performance in Faux pas Questions scores between METH-P group and METH-NP group (P＞0.05). Multivariate linear regression analysis demonstrated that BPRS positive symptom score were correlated with Eyes Task scores of METH addicts (β=-0.415, P=0.001). Conclusions METH addicts exhibit deficits in both ToM social-perceptual component and ToM social-cognitive component. METH-associated psychosis are related to the deficit in social-perceptual component of ToM.

Objective To study the expression,immunological effect and prognosis analysis of G2 and S phase-expressed protein 1(GTSE1)in hepatocellular carcinoma(HCC),and its potential action mechanism.Methods Using the data provided by the public da-tabases The Cancer Genome Atlas(TCGA),the Kaplan-Meier,Tumor Immune Estimation Resource(TIMER)and Gene Expression Profiling Interactive Analysis(GEPIA)databases were used to analyze the gene expression,immunological effect and prognosis of GTSE1,and the expression of GTSE1 in clinical samples was verified by immunohistochemical experiments.Gene Ontology(GO)and Kyoto Ency-clopedia of Genes and Genomes(KEGG)enrichment analysis of GTSE1-related differential genes was performed by R software.Results GTSE1 was significantly overexpressed in human cancer tissues,and was significantly associated with poor prognosis of liver cancer(P＜0.05).GTSE1 gene expression was significantly correlated with the abundance of infiltrating immune cells in HCC(P＜0.001).GTSE1-related differentially expressed genes were mainly enriched in gene modules such as nuclear division,organelle fission and ion channel activity.The signaling pathways involved mainly include neuroactive ligand-receptor interaction and cell cycle.Conclusion GTSE1 expression is significantly up-regulated in HCC and is significantly associated with poor prognosis,and plays an important role in immune cell infiltration,which can be used as a prognostic marker and immunotherapeutic target for HCC.

Objective:To explore the application value of CT measurement of renal depth correction, optimized acquisition and post-processing in the measurement of renal glomerular filtration rate (GFR) by Gates renal dynamic imaging.Methods:From January 2018 to November 2019, 157 patients (102 males, 55 females, age (51.4±14.5) years) including 118 in normal renal area group (adults with normal renal position and morphology, and excluding hydronephrosis, renal occupation, retroperitoneal mass and other factors affecting renal depth) and 39 in abnormal renal area group (19 of transplanted kidney, 11 of horseshoe kidney and 9 of ectopic kidney), were retrospectively enrolled in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The GFR was measured by renal dynamic imaging Gates method. For the normal renal area group, the renal depth was calculated by CT method, the traditional Tonnesen formula or the Li Qian formula. For the abnormal renal area group, the GFR was measured by optimized acquisition and post-processing method (GFR optimization), the traditional post-processing method (GFR tradition), or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula method (eGFR). The differences of the renal depth and corresponding GFR obtained by different methods were analyzed using one-way analysis of variance and the least significant difference (LSD) t test. The correlation was analyzed by Pearson correlation analysis, and the consistency was analyzed by Bland-Altman analysis. Results:In the normal renal area group, the left and right renal depth measured by CT were (7.40±1.43) and (7.51±1.37) cm. Tonnesen formula underestimated renal depth (left kidney: (6.03±0.82) cm, right kidney: (6.06±0.84) cm; F values: 64.145 and 68.567, both P<0.01), and the deviation increased with the increase of CT measured depth ( r values: 0.847 and 0.834, both P<0.01). The GFR measured by Tonnesen formula was (56.93±28.42) ml·min -1·1.73 m -2, and the difference was statistically significant compared with CT method ((73.43±36.56) ml·min -1·1.73 m -2; F=9.423, P<0.01). The renal left and right depth measured by Li Qian formula were (7.55±1.03) and (7.52±0.98) cm, and the total GFR was (73.65±34.50) ml·min -1·1.73 m -2 with no differences compared with CT method (all P>0.05). The GFR obtained by Li Qian formula had better correlation ( r=0.901, P<0.01) and consistency with CT method. In the abnormal renal area group, GFR optimization, GFR tradition and eGFR was (63.11±27.40), (48.40±25.45) and (59.89±32.24) ml·min -1·1.73 m -2, respectively, and the difference between GFR tradition and GFR optimization was statistically significant ( F=2.870, P=0.025). GFR optimization had better correlation ( r=0.941, P<0.01) and consistency with eGFR. Conclusions:Tonnesen formula underestimates the renal depth. Using CT to measure renal depth and perform depth correction can improve the accuracy of Gates method for GFR determination. For the special cases of transplanted kidney, horseshoe kidney, ectopic kidney and retroperitoneal mass, it is important to optimize acquisition scheme and post-processing method to obtain accurate GFR.

Objective:To evaluate the effects of different sphere volumes, target background ratio (T/B) and post-processing correction techniques on the quantitative results of 99Tc m SPECT/CT. Methods:Six spheres with different diameters (37, 28, 22, 17, 13, 10 mm) in National Electrical Manufacturers Association International Electrotechnical Commission (NEMA IEC) models were filled with a mixture of 0.54 MBq/ml 99Tc m and iodixanol. The mixture iodine content was about 0.3%(135 mg), which led to different T/B (32∶1, 16∶1, 8∶1, 4∶1) by changing the radioactivity concentration of the cylinder. Routine imaging was performed on different T/B phantoms which were scanned by SPECT/CT. The CT threshold method was used for the delineation of volume of interest (VOI). Then the same processing correction technique and ordered-subsets expectation maximization (OSEM) parameters were used to calculate the radioactivity concentrations of different spheres, and further compared with the true values, and the accuracies were calculated. Pearson correlation analysis was applied to evaluate the relationships between sphere volume, T/B and quantitative results. The sphere with T/B of 32∶1 and diameter of 37 mm were processed by 3 correction techniques (CT attenuation correction (CTAC)+ scatter correction (SC)+ resolution recovery (RR); CTAC+ SC; CTAC+ RR). One-way analysis of variance and the least significant difference t test were used to analyzed the effects of 3 correction techniques on the quantitative results and image contrasts. Results:There were significant relationships between the sphere volumes, T/B and the quantitative accuracy ( r values: 0.757, 0.409, both P<0.05). There were significant differences of 3 correction techniques on the quantitative results and image contrast ( F values: 139.665 and 38.905, both P<0.001). Among them, the quantitative error of CTAC+ SC+ RR was lower than that of CTAC+ SC ((9.63±8.82)% vs (38.89±2.17)%; P<0.001), and similar to that of CTAC+ RR ((8.70±6.64)%; P>0.05). The quantitative error of CTAC+ RR was lower than that of CTAC+ SC ( P<0.001). The image contrast of CTAC+ SC+ RR was higher than that of CTAC+ SC ((93.45±0.91)% vs (92.41±0.25)%; P<0.001) and the image contrast of CTAC+ SC was higher than that of CTAC+ RR ((91.37±0.87)%; P<0.001). Conclusions:The larger sphere volume and the higher T/B, the more quantitative accuracy. The volume has a more significant effect on quantitative accuracy than T/B. Choosing the appropriate correction technique is helpful to quantitative accuracy improvement. It is suggested to use CTAC+ SC+ RR in quantitative processing.

Objective:To construct a prediction model of pancreatic fistula after pancreaticoduodenectomy and explore its application value.Methods:The retrospective case-control study was conducted. The clinicopathological data of 285 patients with periampullary diseases who underwent pancreaticoduodenectomy in the the First Affiliated Hospital of Harbin Medical University from January 2015 to September 2018 were collected. There were 183 males and 102 females, aged (56±14)years, with a range from 12 to 84 years. According to the random numbers showed in the computer, patients were randomly divided into training dataset consisting of 214 patients and validation dataset consisting of 71 patients, with a ratio of 3∶1. The training dataset was used to construct prediction model, and the validation dataset was used to evaluate performance of prediction model. Observation indicators: (1) incidence of postoperative pancreatic fistula; (2) construction of prediction model of pancreatic fistula after pancreaticoduodenectomy; (3) validation of prediction model of pancreatic fistula after pancreaticoduodenectomy. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis and multivariate analysis were conducted using the Logistic regression model. The accuracy of prediction model was analyzed by drawing receiver operating characteristic curve and calculating area under curve (AUC). Results:(1) Incidence of postoperative pancreatic fistula: of 214 patients in the training dataset, 45 patients had postoperative pancreatic fistula, including 39 of grade B and 6 of grade C, respectively. (2) Construction of prediction model of pancreatic fistula after pancreaticoduodenectomy. Results of univariate analysis showed that body mass index(BMI), diameter of the main pancreatic duct on computed tomography (CT) scan, diameter of the main pancreatic duct by intraoperative exploration, pancreas texture, and level of amylase in ascites at the postoperative first day were related factors for pancreatic fistula after pancreaticoduodenectomy ( χ2=32.450, 15.789, 19.577, 4.559, Z=-7.962, P<0.05). Results of multivariate analysis showed that BMI>25 kg/m 2, diameter of the main pancreatic duct by intraoperative exploration <3 mm and level of amylase in ascites at the postoperative first day >2 651U/L were independent risk factors for pancreatic fistula after pancreaticoduodenectomy ( odds ratio=0.148, 4.286, 0.086, 95% confidence interval: 0.058-0.376, 1.736-10.580, 0.032-0.231, P<0.05). Based on results of multivariate analysis, a prediction model of pancreatic fistula after pancreaticoduodenectomy was built: the predicted value of pancreatic fistula=Exp[0.452-1.914(BMI)+ 1.455(diameter of the main pancreatic duct by intraoperative exploration)-2.451(level of amylase in ascites at the postoperative first day)]/1+ Exp[0.452-1.914(BMI)+ 1.455(diameter of the main pancreatic duct by intraoperative exploration)-2.451(level of amylase in ascites at the postoperative first day)]. The model had the AUC of 0.888 (95% confidence interval : 0.832-0.943, P<0.05). (3) Validation of prediction model of pancreatic fistula after pancreaticoduodenectomy: in the validation dataset, the prediction model of pancreatic fistula after pancreaticoduodenectomy had the AUC of 0.868 (95% confidence interval: 0.780-0.957, P<0.05). There was no significant difference in the AUC between the training dataset and validation dataset ( Z=0.514, P>0.05). Conclusions:BMI>25 kg/m 2, diameter of the main pancreatic duct by intraoperative exploration <3 mm and level of amylase in ascites at the postoperative first day >2 651 U/L are independent risk factors for pancreatic fistula after pancreaticoduodenectomy. Construction of a prediction model of pancreatic fistula after pancreaticoduo-denectomy can effectively predict the risks of postoperative pancreatic fistula.

Objective To explore the clinical value of uncinate process resection combined with portalsuperior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected.During the vascular reconstruction,uncinate process of the pancreas was first resected for reducing anastomotic tension,and then end-to-end anastomosis was done after portal-superior mesenteric vein resection.Observation indicators:(1) intraoperative situations;(2) postoperative recovery situations;(3) postoperative pathological examination situations;(4) follow-up and survival situations.Follow-up using outpatient examination and imaging examination was performed to detect patients' postoperative survival,tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The non-recurrence and non-metastasis survival curve,overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.Results (1) Intraoperative situations:11 patients received uncinate process resection of the pancreas,and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis.Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery,including 2 undergoing combined total gastrectomy due to gastric ischemia;2 patients underwent distal pancreatectomy;1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach.Operation time and volume of intraoperative blood loss of 11 patients were (5.8± 1.1) hours and 800 mL (range,200-2 500 mL).(2) Postoperative recovery situations:there was no grade C of pancreatic fistula of 11 patients.Four patients had grade B of pancreatic fistula,including 2 were cured by drainage-tube indwelling of pancreatic wound ＞ 3 weeks,1 was cured by continous washing due to pancreatic fistula combined with infection,and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever;1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment,and other 3 patients didn't occur postoperative complications.Of 5 patients diagnosed as biochemical fistula,1 had esophagus-jejunum anastomotic leakage,and 1 had changes of hepatic ischemia in S2,S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively,with long-term hepatatrophia in S2 and S3 segments.There was no postoperative death and reoperation in 11 patients.Duration of postoperative hospital stay of 11 patients was (22± 5) days.(3) Postoperative pathological examination results:tumors of 11 patients were located in neck and body of the pancreas,with a maximum diameter of (4.8± 1.7)cm.Among 11 patients,10 were confirmed with moderate-or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma.The length of portal-superior mesenteric vein resection of 11 patients was (2.6± 0.8) cm.Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein,and other 4 patients occurred inflammatory adhesion,without tumor infiltration.(4) Follow-up and survival situations:11 patients were followed up for 3.0-37.6 months,with a median time of 15.7 months.During the follow-up,8 patients died of tumor recurrence and /or metastasis,and 3 survived;the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range,3.0-37.6 months) and 24.6 months (range,3.0-37.6 months).One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination,anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death.Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula,and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction,meanwhile,it can also achieve end-to-end anastomosis after longer vein resection.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.