Objective:To explore the expression of IL-22 in the patients with rheumatoid arthritis,and to define the clinical sig-nificance of IL-22 cells for RA. Methods: A total of 50 RA patients, 15 OA patients and 15 healthy controls were enrolled. The proportion of Th22 cells in peripheral blood and synovial fluid( SF) of RA patients was detected by flow cytometry;the levels of IL-22 in serum and synovial fluid of RA patients were detected by ELISA. The clinical parameters of disease activity were assessed including ESR,RF,CRP,DAS28,anti CCP and the degree of bone erosions determined by X-rays. Pearson correlation analysis,t test and Kruskal-Wallis H test were used for statistical analysis. Results:The proportion of Th22 cells in RA patients was higher than that of OA patients (t=2. 290 ,P=0. 021) and healthy controls(t=2. 524,P=0. 015). IL-22 levels in RA patients were higher than that of OA patients (t=2. 560,P=0. 014) and healthy controls(t=2. 768,P=0. 009). IL-22 in the RF positive group were higher than that of RF negative group(t=2. 322,P=0. 035). IL-22 in the anti-CCP antibody positive group were higher than that of anti-CCP antibody negative group (t=2. 504,P=0. 015). The levels of IL-22 were correlated positively with ESR,RF,DAS28(r=0. 312,0. 314,0. 332,P<0. 05). The levels of IL-22 were increased gradually along with the aggravation of bone erosions. There were statistical significant difference among different X-ray stagings(H=9. 14,χ20.05(3)=7. 81,H> χ20.05(3),P<0. 05). Serum IL-22 levels in the RA patients with joint effusion were higher than that of without(t=2. 587,P=0. 012). The levels of IL-22 in SF were higher than that in serum(t=2. 668,P=0. 011),and had no correlation with the proportion of Th22 cells in SF. Conclusion: The expression of IL-22 in serum and joint effusion of RA patients increase. The level of IL-22 may be useful marker for assessment of disease activity and finding of bone erosions. Therapeutic targeting of IL-22 may be valuable for the intervention of RA.

The construction of harmonious doctor-patient relationship is an important project in social medicine .The influen-cing factors about doctor-patient relationship are analyzed from three aspects which are responsibility ethics , bottom-line ethics and clin-ic ethics.Based on the discussion , certain countermeasures are proposed to reconstruct harmonious doctor -patient relationship .

The hospital grade assessment is an effective approach to measure the comprehensive strength and the overall level of a hospital, and it is also an effective carrier which can promote the standardized management , improve the quality of connotation and accelerate the development of the hospital .This article aims to expound the effective and concrete methods for preparation in the hospi -tal grade assessment by introducing the practice and experience of Jinling Hospital in grade assessement .It also points out that:defi-ning the purpose of the assessment is the fundation , having a thorough grasp of the assessment criteria is the basis , having a compre-hensive knowledge of the hospital is the premise , establishing and implementing the plan strictly is the crux .All these might be helpful to promote the hospital grade assessment .

Objective:To evaluate the quality status of lithium carbonate tablets and lithium carbonate sustained-release tablets. Methods:The samples were examined in accordance with the statutory standard,and the exploratory studies were carried out. The results were statistically analyzed. Results:In accordance with the statutory standard,among 120 batches of samples, only one was unqualified in dissolution,and the others were qualified. The qualified rate was 99. 2% . Conclusion:The quality of the most products meets the current standard and the quality evaluation standard needs to be improved.

Objective To clone,express and characterize a tegument protein gene of Schistosoma japonicum(Sj29),and investigate the immune protection of the recombinant protein against S.japonicum in mice.Methods The gene coding for Sj29 protein was amplified by PCR,and the sequence was analyzed by bioinformatics tools.Partial fragment of Sj29 gene was subcloned into the prokaryotic expression vector pET28c(+).The recombinant plasmid was transformed into E.coli BL21(DE3) and induced the recombinant with IPTG.The recombinant protein(rSj29) was purified by His-binding-resin affinity chromatography and characterized by Western blotting.Three groups each with 10 BALB/c mice were immunized subcutaneously three times(two weeks interval) respectively with 100 ?l recombinant rSj29(0.1 mg/ml),adjuvant or PBS.At the 15th day after the final inoculation,each mouse was challenged by 40 ?2 cercariae of S.japonicum.At the 53th day after infection,the mice were sacrificed to obtain the number of adult worms,number of eggs in liver and feces.Serum samples were collected at pre-immunization and certain time after immuniza-tion,and were analyzed for IgG by ELISA.The localization of rSj29 in worms of different developmental stages was demonstrated by immunofluorescent technique.mRNA expression level of Sj29 gene in worms of different developmental stages and three groups after infection was detected by quantitative real-time PCR.Results A 576 bp Sj29 gene fragment was obtained.The recombinant protein rSj29 with Mr 22 900 was expressed in the form of inclusion body.The recombinant rSj29 can be recognized by sera of mice immunized with rSj29 and sera of infected mice.The number of adult worms(15.4?5.9),number of hepatic eggs(40 143.3?2 995.9) and number of fecal eggs(3 803.9?110.9) in re-combinant protein group were significantly higher than those of PBS control group(20?3.4,49 318.1?6 648.3,5 238.1? 303.5,respectively)(P

Objective:To investigate the value of the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS), real-time ultrasound elastography (RTE), and contrast-enhanced ultrasound (CEUS), individually and in combination, in the diagnosis of TBSRTC Ⅲ-Ⅴ thyroid nodules.Methods:A retrospective analysis was performed on 106 patients with TBSRTC Ⅲ-Ⅴ thyroid nodules who were pathologically diagnosed by fine needle aspiration cytology at Bao Ji People's Hospital between February 2022 and December 2023. All patients were assessed using ACR TI-RADS grading, RTE, and CEUS, with postoperative pathological diagnosis serving as the gold standard. The diagnostic effectiveness of ACR TI-RADS, RTE, and CEUS, individually and in combination, for TBSRTC Ⅲ-Ⅴ thyroid nodules was analyzed using the receiver operating characteristic (ROC) curve.Results:There were statistically significant differences in nodule size, blood supply, and proportion of TBSRTC Ⅲ-Ⅴ nodule between the two groups ( χ2 = 4.67, 42.56, 26.09, all P < 0.05), while there was no statistical significance in other general data (all P > 0.05). Of the 106 patients with TBSRTC Ⅲ-Ⅴ nodules, 69 patients were diagnosed with malignant nodules and 37 with benign nodules. The area under the curve (95% CI) of ACR-TIRADS, RTE, and CEUS in identifying malignant nodules were 0.860 [95% CI (0.779-0.920)], 0.712 [95% CI (0.616-0.796)], and 0.788 [95% CI (0.698-0.862)], respectively, with sensitivities of 85.51%, 66.67%, and 73.91%, respectively and specificities of 86.49%, 75.68%, and 83.78%, respectively. The Youden indices were 0.719, 0.423, and 0.577, respectively. Among the three diagnostic methods, ACR TI-RADS had the highest diagnostic efficiency, while RTE had the lowest. Pairwise comparisons in ROC analysis revealed statistically significant differences between ACR TI-RADS and RTE, ACR TI-RADS and CEUS, as well as RTE and CEUS ( Z = 4.22, 3.02, 2.78, all P < 0.05). The ACR TI-RADS + RTE + CEUS combination had the highest sensitivity, specificity, Youden index, and AUC (95% CI) values: 94.20%, 89.19%, 0.834, and 0.917 (95% CI: 0.847-0.962). The RTE + CEUS combination had the lowest values: 76.81%, 78.38%, 0.552, and 0.776 (95% CI: 0.685-0.851). The pairwise comparison results in the ROC curve revealed that significant differences were observed between ACR TI-RADS + RTE and RTE + CEUS, ACR TI-RADS + RTE and ACR TI-RADS + RTE + CEUS, ACR TI-RADS + CEUS and ACR TI-RADS + RTE + CEUS, RTE + CEUS and ACR TI-RADS + RTE + CEUS, and ACR TI-RADS + CEUS and RTE + CEUS ( Z = 3.13, 2.40, 2.16, 4.07, 3.32, all P < 0.05). However, there was no significant difference between ACR TI-RADS + RTE and ACR TI-RADS + CEUS in ROC analysis ( Z = 0.06, P > 0.05). Conclusion:The combined utilization of ACR TI-RADS, RTE, and CEUS offers enhanced information on thyroid nodules, encompassing malignant risk stratification, nodular elasticity, and contrast agent perfusion, thereby aiding in improving the diagnostic precision of TBSRTC Ⅲ-Ⅴ malignant nodules.

Objective:This study aims to determine the efficacy of chemotherapy and to identify potential chemotherapy agents for advanced primary duodenal carcinoma (PDC). Methods:Fifty-six patients with advanced PDC, who did and did not receive chemo-therapy, were involved in this study. Response rates (RR), disease control rates (DCR), progression-free survival (PFS), and overall sur-vival (OS) were analyzed. Results:The overall RR and DCR of 43 patients were 19.04%and 71.42%, respectively. The patients who re-ceived chemotherapy agents fluorourzcil and oxaliplatin exhibited higher RR compared with patients who received other chemotherapy combinations (35.29%vs. 7.69%, P=0.010 9). Palliative chemotherapy improved the OS of patients with advanced PDC compared with patients who did not receive chemotherapy (13.35 months vs. 5.65 months, HR=0.203, 95%CI:0.083 to 0.497, P=0.000 5). Compared with the use of other chemotherapy regimens, treatment with a fluorourzcil-based chemotherapy agent resulted in a longer PFS (5.08 months vs. 1.08 months, HR=0.004, 95%CI:0.000 to 0.315, P=0.013 2). Multivariate analysis indicated mucinous histology and lymph mode metastasis as factors predictive of poor prognosis in patients with advanced PDC. Conclusion:Palliative chemotherapy may im-prove the OS of patients with advanced PDC.

Objective:This retrospective study aims to determine the efficacy of chemotherapy and improve a salvage chemother-apy agent for metastatic colorectal cancer (MCRC) after failure of treatment with irinotecan and oxaliplatin. Methods:Between Janu-ary 2002 and March 2013, 37 patients with metastatic MCRC who had progressed after treatment with irinotecan and oxaliplatin were analyzed for their response rate (RR) and progression-free survival (PFS). Results:The overall RR of the 37 patients was 13.51%, with 5 cases of partial response (PR), 12 cases of disease stabilization (SD), and 20 cases of progression (PD). Compared with other chemo-therapy regimens, treatment with a pemetrexed-based chemotherapy agent had a higher RR (17.64%vs. 10.00%, P=0.64) without a lon-ger PFS (2.00 months vs. 1.63 months, HR=0.79, 95%, CI:0.35 to 1.78, P=0.58). Compared with other chemotherapy regimens, treat-ment with a raltirexed-based chemotherapy agent had a higher RR (16.67%vs. 12.00%, P=0.34) without a longer PFS (1.58 months vs. 1.90 months, HR=2.24, 95%, CI:0.98 to 5.12, P=0.06).Conclusion:In patients with MCRC after failure of treatment with irinotecan and oxaliplatin, a pemetrexed-based or raltirexed-based chemotherapy agent may beneficial during salvage treatment and is therefore worthy of further study.

Objective To compare the value of two-dimensional high-frequency ultrasound,a-coustic pulsed radiant force imaging(ARFI)-acoustic palpation tissue quantification(VTQ)technolo-gy,and strain elastography alone and their combination in diagnosis of benign and malignant thyroid micronodules.Methods A retrospective analysis was conducted in 99 patients(107 thyroid micro-solid nodules with diameters≤10.0 mm)who were treated at Baoji People's Hospital in Shaanxi Province from June 2021 to June 2023.All patients underwent two-dimensional high-frequency ultra-sound,ARFI-VTQ technology,and strain elastography to obtain ultrasound data scores and data.Using biopsy and surgical pathology as the diagnostic"gold standard",the diagnostic efficacy of the three ultrasound methods alone and their combination was compared for thyroid micro-nodules.Results A total of 62 patients(68 nodules)underwent fine-needle aspiration biopsy(FNAB),and 37 patients(39 nodules)underwent surgery.Among 107 thyroid micro-nodules,45 were diagnosed as malignant,and 62 as benign.Significant differences were observed between malignant micro-nodules and benign micro-nodules in terms of internal echo(isoechoic and hyperechoic echo,very hypoe-choic and hypoechoic echo),boundary,microcalcification,aspect ratio＞1,blood supply,and re-sistance index(RI)of the artery(P＜0.05).When the critical value of the C-TIRADS score for diagnosing thyroid micro-nodules using two-dimensional high-frequency ultrasound was ≥ 2 points(C-TIRADS 4b),the diagnostic sensitivity was 73.33％,specificity was 79.03％,and the area under the curve(AUC)was 0.762[95％CI,0.670 to 0.839].In ARFI-VTQ technology,the SWV values ranged from 0.52 to 7.55 m/s,with an average of(2.62±0.61)m/s.The mean SWV of malignant micro-nodules was(5.24±2.23)m/s,which was higher than(2.11±0.70)m/s of be-nign micro-nodules(t=10.258,P＜0.05).When the critical SWV value was 3.19 m/s,the di-agnostic sensitivity was 77.78％,specificity was 80.65％,and the AUC(95％CI)was 0.792(95％CI,0.703 to 0.865).In strain elastography,when the critical score was ≥3,the diagnostic sensitivity was 75.56％,specificity was 77.42％,and the AUC(95％CI)was 0.765(95％CI,0.673 to 0.841).Combined detection of the three methods showed that there were 44 positive mi-cro-nodules,63 negative micro-nodules,the diagnostic sensitivity was 93.33％,specificity was 96.77％,and the AUC(95％CI)was 0.951(95％CI,0.891 to 0.983).There was statistical sig-nificance in the diagnostic efficacy of combined application compared with that of 2D high-frequency ultrasonography,ARFI-VTQ technology and strain-elasticity imaging alone(Z=4.861,4.393,4.842,P＜0.05).Conclusion The combination of two-dimensional high-frequency ultrasound,ARFI-VTQ technology,and strain elastography can improve the diagnostic accuracy of benign and malignant thyroid micro-nodules.

Objective To compare the value of two-dimensional high-frequency ultrasound,a-coustic pulsed radiant force imaging(ARFI)-acoustic palpation tissue quantification(VTQ)technolo-gy,and strain elastography alone and their combination in diagnosis of benign and malignant thyroid micronodules.Methods A retrospective analysis was conducted in 99 patients(107 thyroid micro-solid nodules with diameters≤10.0 mm)who were treated at Baoji People's Hospital in Shaanxi Province from June 2021 to June 2023.All patients underwent two-dimensional high-frequency ultra-sound,ARFI-VTQ technology,and strain elastography to obtain ultrasound data scores and data.Using biopsy and surgical pathology as the diagnostic"gold standard",the diagnostic efficacy of the three ultrasound methods alone and their combination was compared for thyroid micro-nodules.Results A total of 62 patients(68 nodules)underwent fine-needle aspiration biopsy(FNAB),and 37 patients(39 nodules)underwent surgery.Among 107 thyroid micro-nodules,45 were diagnosed as malignant,and 62 as benign.Significant differences were observed between malignant micro-nodules and benign micro-nodules in terms of internal echo(isoechoic and hyperechoic echo,very hypoe-choic and hypoechoic echo),boundary,microcalcification,aspect ratio＞1,blood supply,and re-sistance index(RI)of the artery(P＜0.05).When the critical value of the C-TIRADS score for diagnosing thyroid micro-nodules using two-dimensional high-frequency ultrasound was ≥ 2 points(C-TIRADS 4b),the diagnostic sensitivity was 73.33％,specificity was 79.03％,and the area under the curve(AUC)was 0.762[95％CI,0.670 to 0.839].In ARFI-VTQ technology,the SWV values ranged from 0.52 to 7.55 m/s,with an average of(2.62±0.61)m/s.The mean SWV of malignant micro-nodules was(5.24±2.23)m/s,which was higher than(2.11±0.70)m/s of be-nign micro-nodules(t=10.258,P＜0.05).When the critical SWV value was 3.19 m/s,the di-agnostic sensitivity was 77.78％,specificity was 80.65％,and the AUC(95％CI)was 0.792(95％CI,0.703 to 0.865).In strain elastography,when the critical score was ≥3,the diagnostic sensitivity was 75.56％,specificity was 77.42％,and the AUC(95％CI)was 0.765(95％CI,0.673 to 0.841).Combined detection of the three methods showed that there were 44 positive mi-cro-nodules,63 negative micro-nodules,the diagnostic sensitivity was 93.33％,specificity was 96.77％,and the AUC(95％CI)was 0.951(95％CI,0.891 to 0.983).There was statistical sig-nificance in the diagnostic efficacy of combined application compared with that of 2D high-frequency ultrasonography,ARFI-VTQ technology and strain-elasticity imaging alone(Z=4.861,4.393,4.842,P＜0.05).Conclusion The combination of two-dimensional high-frequency ultrasound,ARFI-VTQ technology,and strain elastography can improve the diagnostic accuracy of benign and malignant thyroid micro-nodules.