Objective The aim of our study was to study the CT findings of cryptococcosis in immunocompetent children.Methods CT scan and clinical data of 21 immunocompetent children with proven pulmonary cryptococcosis were retrospectively collected and analyzed.Results The CT scans demonstrated 1 mm subpleural nodule in the lingula of left lung in 1 patient and multiple nodules in 20 patients.Of 20 patients with multiple nodules,peripheral or subpleural distribution was found in 12 patients,and diffuse distribution in 8 patients.Of 20 patients with multiple nodules,Nodules of ＜ 10 mm was found in 18 patients,＜3 mm in 14 patients,and ＞ 10 mm in 2 patients.Round nodular with smooth margin was detected in 15 of 20 patients with multiple nodules.Lymphadenopathy was found in 17 patients including 3 patients with mild contrast enhancement and 2 patients with circular enhancement.Extrapulmonary lesions distributing in liver,spleen,kidney,and the nervous system were found in 14 patients.In follow-up,1 patient died and 20 patients fully recovered.ConclusionsPulmonary multiple nodules with lymphadenopathy is the characteristic CT findings in immunocompetent children with pulmonary crytococcosis which is prone to involve multiple extra-pulmonary organs.

ObjectiveTo compare the effects between laparoscopic cholecystectomy (LC) +laparoscopic common bile duct exploration(LCBDE) and endoscopic sphincterotomy(EST) + laparoscopic cholecystectomy( LC ) for secondary choledocholithiasis.MethodsThe clinical data of patients with secondary choledocholithiasis receiving LC + LCBDE or EST + LC from January 2008 to December 2009 were retrospectively compared. Parameters included operation time, postoperative complication, length of stay,cost of hospitalization. All patients received follow up of 1 year. Enumeration data was analyzed by chisquare test and measurement data was analyzed by t test.ResultsIn this study 87 patients received LC +LCBDE,76 patients received EST + LC.Patients in LC + LCBDE group had shorter hospital stay, less hospital charges and less complications. There was not difference in the procedure success rate and stone remanent rate between the two groups.ConclusionsLC + LCBDE could be used as the first choice for patients with gallstones and secondary choledocholithiasis.

Objective To investigate and analyse the status and influential factors of palliative care knowledge of nursing undergraduates,then provide theoretical basis for palliative care education. Methods Using random sampling method, 400 nursing undergraduates were investigated by Palliative Care Quiz for Nursing (PCQN) and palliative care attitude questionnaire. Results 366 nursing undergraduates completed the survey whose scores were 8.363 ± 4.240, and 66.9%(244/366) of them had never heard of palliative care. Choosed right rate of PCQN was 41.13% (150/366). The scores of palliative care philosophy and principles 0.298±0.248, pain and symptom control and psychological scores 0.436 ± 0.235 and social and spiritual support scores 0.499 ± 0.318 had significant difference (F=38.866, P=0.000). The scores of palliative care attitude questionnaire were 36.756 ± 3.183, and the average score of all items were over 3. The palliative care attitude scores had significant difference in different grade (F=2.737, P=0.043). Conclusions Nursing undergraduates hold positive attitudes of palliative care, but the cognition degree were at a low level. To promote the development of palliative care, it should be strengthened publicity, education and training in this area. It is necessary to carry out palliative care education in nursing undergraduate students.

Objective To investigate the chest HRCT characteristics of pediatric perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) associated systemic vasculitis. Methods Retrospectively analysis of the clinical and HRCT data of 15 pediatric cases diagnosed as p-ANCA related pneumonia according to the classification and diagnostic criteria of Chapel Hill meeting of 1994 in our hospital were retrospectively analyzed. They were 13 girls and 2 boys. The age range was 1—17 years and the median was about 10 years old, In the 15 patients, 12 were diagnosed as primary MPA, 2 were secondary MPA, 1 was CSS. Two radiologists with 10 years of radiological experience read the CT imaging together. Results 1 of 12 primary MPA were found large opacities and ground glass shades in both sides of lung,especially the posterior parts on CT images with bilateral pleural effusion; 1 case had focal opacities in left lower lobe, around with thickened interlobular septa and pleural effusion; Another 1 case only had focal thickened interstitial in right middle lobe; The other 9 cases showed scattered or diffused ground glass opacity, with thickened pulmonary interstitial and (or) pleura. 1 of the 2 secondary MPA who had hemoptysis showed ground glass opacity on CT images with no thickened septal nodules or pleural effusion. The other one who had renal anomalies and no respiratory symptoms showed subpleural nodules with halo sign in right low lobe. The CSS showed diffused patchy ground glass opacity, consolidation of both lingular lobes, nodules of centri-and peri-lobular, thickened septa near the pleura, obviously thickened bronchial wall, slightly widened bronchial lumen and thickened pleura. Conclusion The classic imaging features of p-ANCA pneumonia on HRCT is the non-specific small pulmonary vessel hemorrhage.

Objective To study clinical characteristics and prognostic factors in primary systemic anaplastic large cell lymphoma (S-ALCL). Methods Clinical data of 56 S-ALCL were retrospectively analysed, who were diagnosed in Lymphoma Lab of Peking University Health Science Centre. Immunohistochemical staining for ALK-1 and bcl-2 were performed by standard SP method. Results The median age of patients is 17 years, and the ratio of sex was1.67:1 (male : female) in 56 cases of S-ALCL. Among of the 49 cases who were followed up, 32.65 % (16/49) of patients died, and all of them died within two years after diagnosis. The 3-year and 5-year overall survival were 64.28 %. 41 out of 56 cases (73.21 %) was positive for ALK-1 protein, while 10 cases out of 56 S-ALCL cases (17.86 %) positive for bcl-2. Clinical staging, extranodal sites of involvement or with extranodal sites of involvement and ALK were important prognostic factors with statistic significance by Long-rank test. Among of them, Clinical staging was the most independent prognostic factor by COX multivariate analysis. Conclusion S-ALCL was mostly seen in the young and middle-aged male patients. The death were most frequently occurred within two years after diagnosis. Most of the patients who have good responses to chemotherapy can get the complete remission and long-term survival. Clinical staging, extranodal sites of involvement or with extranodal sites of involvement and ALK were very important prognostic factors which can be used to predict the patients long term survival, and guide the treatment.

Objective:To investigate the effect of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in elderly patients.Methods:A total of 848 elderly patients(≥60 years)undergoing PCI in our department between Mar 2015 and Dec 2017 were enrolled in a prospective cohort.The CI-AKI was defined as the increase of serum creatinine ≥44.2 μmol/L within 48-72 h after using iodine contrast agent or more than 25 % higher than base level within 48-72 h after PCI.A receiver operating characteristic curve was used to analyze the optimal cut-off value of Cystatin C for predicting CI-AKI after PCI.Patients were divided into 2 groups based on the optimal cut-off value of Cystatin C: the high Cystatin C group(Cystatin C ≥1.3 mg/L, n=178)and the control group(Cystatin C<1.3 mg/L, n=670). The differences in the incidence of CI-AKI after PCI and major adverse cardiac events(MACE)at 1 year follow-up were compared between the two groups.The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results:Of 848 patients receiving PCI, the incidence of CI-AKI was 9.4%.The incidence of MACE at 1 year after PCI was higher in the high Cystatin C group than in the control group(15.7% vs.9.3%, χ2=6.524, P=0.011). Cox regression analysis confirmed that the high baseline level of Cystatin C was the most independent predictive factor for MACE at 1 year of follow-up( HR=16.244, P<0.001). Conclusions:The high baseline level of Cystatin C(≥1.3 mg/L)is an independent risk factor for CI-AKI and is also the most important predictor for the occurrence of long-term MACE in elderly patients undergoing PCI.

Objective: To investigate the knowledge, attitude, and practice on disposable plastic tableware and self reported gastrointestinal symptoms in college students. Methods: Stratified sampling method was applied in 338 students of a medical university during the 2020-2021 academic year. The study investigated knowledge, attitude and practice on disposable plastic tableware and self reported gastrointestinal symptoms among students. Results: There were 24.0% students were unaware of the specific material of plastic tableware, 82.0% students had no idea about the meaning of "plastic products logo". About 94.1% of the students thought that plastic tableware might contaminate food, and female students (97.1%) were more worried than male (86.3%) ( χ 2=14.32, P <0.05). The attitude towards the use of disposable tableware was not consistent with the cumulative use score of disposable plastic tableware ( F=1.31, P =0.25),students with high consumption had higher score of accumulative use of disposable plastic tableware ( F=8.32, P <0.01). About 18.3% of the students were prone to report gastrointestinal symptoms. The cumulative scores of disposable plastic tableware weekly using frequency in students who reported gastrointestinal symptoms(14.85±4.01) was still higher than that of no gastrointestinal symptoms group(13.78±3.50), regardless of the effect of takeout ordering frequency( F=4.53，P = 0.03 ). Conclusion College students have limited knowledge of disposable plastic products. However, the use of disposable plastic products may be associated with gastrointestinal diseases. It is suggested to active the propaganda and education, to reduce the use of disposable tableware, and enhance the awareness of health and environment.

Objective To investigate the effect and mechanism of Jiawei Ditan Decoction on cardiomyocyte ferroptosis in rats with chronic intermittent hypoxia based on the phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway.Methods Thirty 8-week-old male Sprague-Dawley rats were randomly divided into normal control,low-oxygen intervention,and Jiawei Ditan Decoction intervention groups using the random number table method,with 10 rats per group.The low-oxygen and Jiawei Ditan Decoction intervention groups were treated with intermittent hypoxia chamber for modeling,with 8 h of intervention daily.Gavage administration was performed before and after daily intervention.The intervention group received a dosage of 16.38 g/kg Jiawei Ditan Decoction,whereas the other two groups received normal saline.The experimental intervention period was 12 weeks.Hematoxylin and eosin staining was used to observe the morphology of myocardial tissue.Transmission electron microscope was used to observe the mitochondrial ultrastructure in cardiomyocytes.Biochemical detection was used to measure the Fe2+and malondialdehyde(MDA)content in myocardial tissue.Phosphorylated-phosphoinositide 3-kinase(p-PI3K),PI3K,phosphorylated-protein kinase B(p-Akt),Akt,solute carrier family 7 member 11(SLC7A11),glutathione peroxidase 4(GPX4),nuclear factor erythroid 2-related factor 2(Nrf2),and acyl-coenzyme A synthetase long-chain family member 4(ACSL4)protein expression in myocardial tissue were measured using western blotting.The rat cardiomyocyte cell line,H9c2,was cultured in high glucose Dulbecco's Modified Eagle Medium,and the ultra-high-performance liquid chromatography was used to detect drug components in Jiawei Ditan Decoction.The CCK-8 assay was used to detect the cell survival rate of cells treated with different concentrations of Jiawei Ditan Decoction.The cells were divided into the normoxic,erastin,and erastin+Jiawei Ditan Decoction intervention groups,and p-Akt and GPX4 protein expression was measured using western blotting.p-PI3K and GPX4 protein expression were detected in the normoxic,low-oxygen intervention 12 h,and low-oxygen intervention 12 h+740Y-P groups.The p-PI3K,PI3K,p-Akt,Akt,and GPX4 protein expression was detected in the normoxic,low-oxygen intervention 6 h,low-oxygen intervention 12 h,low-oxygen intervention 12 h+Jiawei Ditan Decoction low-dose,low-oxygen intervention 12 h+Jiawei Ditan Decoction medium-dose,and low-oxygen intervention 12 h+Jiawei Ditan Decoction high-dose groups(drug concentrations of 5,10,and 20 g/L,respectively).Results The myocardial cells in the low-oxygen intervention group were disordered and swollen and the mitochondrial arrangement of myocardial cells was disordered,with increased mitochondrial membrane density,ruptured cristae,and vacudar degeneration compared with those in the normal control group.The myocardial cells in the Jiawei Ditan Decoction intervention group were arranged neater,and the morphology of mitochondria was relatively regular than those in the low-oxygen intervention group,and no apparent swelling was observed.Compared with the normal control group,the low-oxygen intervention group showed an increase in the MDA and Fe2+content,a decrease in the p-PI3K/PI3K and p-Akt/Akt values,decreased SLC7A11,GPX4,and Nrf2 expression,and increased ACSL4 expression(P＜0.05).Compared with the low-oxygen intervention group,the Jiawei Ditan Decoction intervention group showed a decrease in MDA and Fe2+content,an increase in the p-PI3K/PI3K and p-Akt/Akt values,increased SLC7A11,GPX4,and Nrf2 expression,and decreased ACSL4 expression(P＜0.05).Jiawei Ditan Decoction contained DL-stachydrine,D-(+)-malicacid,adenosine,etc.The cell survival rate of the 10.00 g/L group increased(P＜0.05)compared to that of the Jiawei Ditan Decoction 0,1.25,2.50,5.00,and 20.00 g/L groups.Compared with the normoxic group,p-Akt and GPX4 expression decreased in the erastin group(P＜0.05);compared with the erastin group,the erastin+Jiawei Ditan Decoction intervention group showed increased p-Akt and GPX4 expression(P＜0.05).Compared with the normoxic group,p-PI3K and GPX4 expression decreased in the low-oxygen intervention 12 h group(P＜0.01);compared with the low-oxygen intervention 12 h group,the low-oxygen intervention 12 h+740Y-P group showed increased p-PI3K and GPX4 expression(P＜0.05).Compared with the normoxic group,GPX4 expression and the p-Akt/Akt and p-PI3K/PI3K were reduced in the low-oxygen intervention 6 and 12 h groups(P＜0.05);compared with the low-oxygen intervention 6 h and 12 h groups,the p-PI3K/PI3K and p-Akt/Akt values increased in the low-oxygen intervention 12 h+Jiawei Ditan Decoction low,medium,and high-dose groups(P＜0.05).GPX4 expression was also increased(P＜0.05).Conclusion Jiawei Ditan Decoction may improve cardiomyocyte ferroptosis in rats by regulating the PI3K/Akt signaling pathway,thereby playing a protective role against chronic intermittent hypoxia-induced cardiac injury in rats.

Objective To investigate the effect and mechanism of Jiawei Ditan Decoction on cardiomyocyte ferroptosis in rats with chronic intermittent hypoxia based on the phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway.Methods Thirty 8-week-old male Sprague-Dawley rats were randomly divided into normal control,low-oxygen intervention,and Jiawei Ditan Decoction intervention groups using the random number table method,with 10 rats per group.The low-oxygen and Jiawei Ditan Decoction intervention groups were treated with intermittent hypoxia chamber for modeling,with 8 h of intervention daily.Gavage administration was performed before and after daily intervention.The intervention group received a dosage of 16.38 g/kg Jiawei Ditan Decoction,whereas the other two groups received normal saline.The experimental intervention period was 12 weeks.Hematoxylin and eosin staining was used to observe the morphology of myocardial tissue.Transmission electron microscope was used to observe the mitochondrial ultrastructure in cardiomyocytes.Biochemical detection was used to measure the Fe2+and malondialdehyde(MDA)content in myocardial tissue.Phosphorylated-phosphoinositide 3-kinase(p-PI3K),PI3K,phosphorylated-protein kinase B(p-Akt),Akt,solute carrier family 7 member 11(SLC7A11),glutathione peroxidase 4(GPX4),nuclear factor erythroid 2-related factor 2(Nrf2),and acyl-coenzyme A synthetase long-chain family member 4(ACSL4)protein expression in myocardial tissue were measured using western blotting.The rat cardiomyocyte cell line,H9c2,was cultured in high glucose Dulbecco's Modified Eagle Medium,and the ultra-high-performance liquid chromatography was used to detect drug components in Jiawei Ditan Decoction.The CCK-8 assay was used to detect the cell survival rate of cells treated with different concentrations of Jiawei Ditan Decoction.The cells were divided into the normoxic,erastin,and erastin+Jiawei Ditan Decoction intervention groups,and p-Akt and GPX4 protein expression was measured using western blotting.p-PI3K and GPX4 protein expression were detected in the normoxic,low-oxygen intervention 12 h,and low-oxygen intervention 12 h+740Y-P groups.The p-PI3K,PI3K,p-Akt,Akt,and GPX4 protein expression was detected in the normoxic,low-oxygen intervention 6 h,low-oxygen intervention 12 h,low-oxygen intervention 12 h+Jiawei Ditan Decoction low-dose,low-oxygen intervention 12 h+Jiawei Ditan Decoction medium-dose,and low-oxygen intervention 12 h+Jiawei Ditan Decoction high-dose groups(drug concentrations of 5,10,and 20 g/L,respectively).Results The myocardial cells in the low-oxygen intervention group were disordered and swollen and the mitochondrial arrangement of myocardial cells was disordered,with increased mitochondrial membrane density,ruptured cristae,and vacudar degeneration compared with those in the normal control group.The myocardial cells in the Jiawei Ditan Decoction intervention group were arranged neater,and the morphology of mitochondria was relatively regular than those in the low-oxygen intervention group,and no apparent swelling was observed.Compared with the normal control group,the low-oxygen intervention group showed an increase in the MDA and Fe2+content,a decrease in the p-PI3K/PI3K and p-Akt/Akt values,decreased SLC7A11,GPX4,and Nrf2 expression,and increased ACSL4 expression(P＜0.05).Compared with the low-oxygen intervention group,the Jiawei Ditan Decoction intervention group showed a decrease in MDA and Fe2+content,an increase in the p-PI3K/PI3K and p-Akt/Akt values,increased SLC7A11,GPX4,and Nrf2 expression,and decreased ACSL4 expression(P＜0.05).Jiawei Ditan Decoction contained DL-stachydrine,D-(+)-malicacid,adenosine,etc.The cell survival rate of the 10.00 g/L group increased(P＜0.05)compared to that of the Jiawei Ditan Decoction 0,1.25,2.50,5.00,and 20.00 g/L groups.Compared with the normoxic group,p-Akt and GPX4 expression decreased in the erastin group(P＜0.05);compared with the erastin group,the erastin+Jiawei Ditan Decoction intervention group showed increased p-Akt and GPX4 expression(P＜0.05).Compared with the normoxic group,p-PI3K and GPX4 expression decreased in the low-oxygen intervention 12 h group(P＜0.01);compared with the low-oxygen intervention 12 h group,the low-oxygen intervention 12 h+740Y-P group showed increased p-PI3K and GPX4 expression(P＜0.05).Compared with the normoxic group,GPX4 expression and the p-Akt/Akt and p-PI3K/PI3K were reduced in the low-oxygen intervention 6 and 12 h groups(P＜0.05);compared with the low-oxygen intervention 6 h and 12 h groups,the p-PI3K/PI3K and p-Akt/Akt values increased in the low-oxygen intervention 12 h+Jiawei Ditan Decoction low,medium,and high-dose groups(P＜0.05).GPX4 expression was also increased(P＜0.05).Conclusion Jiawei Ditan Decoction may improve cardiomyocyte ferroptosis in rats by regulating the PI3K/Akt signaling pathway,thereby playing a protective role against chronic intermittent hypoxia-induced cardiac injury in rats.

Objective To investigate the effect and mechanism of Jiawei Ditan Decoction on cardiomyocyte ferroptosis in rats with chronic intermittent hypoxia based on the phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)signaling pathway.Methods Thirty 8-week-old male Sprague-Dawley rats were randomly divided into normal control,low-oxygen intervention,and Jiawei Ditan Decoction intervention groups using the random number table method,with 10 rats per group.The low-oxygen and Jiawei Ditan Decoction intervention groups were treated with intermittent hypoxia chamber for modeling,with 8 h of intervention daily.Gavage administration was performed before and after daily intervention.The intervention group received a dosage of 16.38 g/kg Jiawei Ditan Decoction,whereas the other two groups received normal saline.The experimental intervention period was 12 weeks.Hematoxylin and eosin staining was used to observe the morphology of myocardial tissue.Transmission electron microscope was used to observe the mitochondrial ultrastructure in cardiomyocytes.Biochemical detection was used to measure the Fe2+and malondialdehyde(MDA)content in myocardial tissue.Phosphorylated-phosphoinositide 3-kinase(p-PI3K),PI3K,phosphorylated-protein kinase B(p-Akt),Akt,solute carrier family 7 member 11(SLC7A11),glutathione peroxidase 4(GPX4),nuclear factor erythroid 2-related factor 2(Nrf2),and acyl-coenzyme A synthetase long-chain family member 4(ACSL4)protein expression in myocardial tissue were measured using western blotting.The rat cardiomyocyte cell line,H9c2,was cultured in high glucose Dulbecco's Modified Eagle Medium,and the ultra-high-performance liquid chromatography was used to detect drug components in Jiawei Ditan Decoction.The CCK-8 assay was used to detect the cell survival rate of cells treated with different concentrations of Jiawei Ditan Decoction.The cells were divided into the normoxic,erastin,and erastin+Jiawei Ditan Decoction intervention groups,and p-Akt and GPX4 protein expression was measured using western blotting.p-PI3K and GPX4 protein expression were detected in the normoxic,low-oxygen intervention 12 h,and low-oxygen intervention 12 h+740Y-P groups.The p-PI3K,PI3K,p-Akt,Akt,and GPX4 protein expression was detected in the normoxic,low-oxygen intervention 6 h,low-oxygen intervention 12 h,low-oxygen intervention 12 h+Jiawei Ditan Decoction low-dose,low-oxygen intervention 12 h+Jiawei Ditan Decoction medium-dose,and low-oxygen intervention 12 h+Jiawei Ditan Decoction high-dose groups(drug concentrations of 5,10,and 20 g/L,respectively).Results The myocardial cells in the low-oxygen intervention group were disordered and swollen and the mitochondrial arrangement of myocardial cells was disordered,with increased mitochondrial membrane density,ruptured cristae,and vacudar degeneration compared with those in the normal control group.The myocardial cells in the Jiawei Ditan Decoction intervention group were arranged neater,and the morphology of mitochondria was relatively regular than those in the low-oxygen intervention group,and no apparent swelling was observed.Compared with the normal control group,the low-oxygen intervention group showed an increase in the MDA and Fe2+content,a decrease in the p-PI3K/PI3K and p-Akt/Akt values,decreased SLC7A11,GPX4,and Nrf2 expression,and increased ACSL4 expression(P＜0.05).Compared with the low-oxygen intervention group,the Jiawei Ditan Decoction intervention group showed a decrease in MDA and Fe2+content,an increase in the p-PI3K/PI3K and p-Akt/Akt values,increased SLC7A11,GPX4,and Nrf2 expression,and decreased ACSL4 expression(P＜0.05).Jiawei Ditan Decoction contained DL-stachydrine,D-(+)-malicacid,adenosine,etc.The cell survival rate of the 10.00 g/L group increased(P＜0.05)compared to that of the Jiawei Ditan Decoction 0,1.25,2.50,5.00,and 20.00 g/L groups.Compared with the normoxic group,p-Akt and GPX4 expression decreased in the erastin group(P＜0.05);compared with the erastin group,the erastin+Jiawei Ditan Decoction intervention group showed increased p-Akt and GPX4 expression(P＜0.05).Compared with the normoxic group,p-PI3K and GPX4 expression decreased in the low-oxygen intervention 12 h group(P＜0.01);compared with the low-oxygen intervention 12 h group,the low-oxygen intervention 12 h+740Y-P group showed increased p-PI3K and GPX4 expression(P＜0.05).Compared with the normoxic group,GPX4 expression and the p-Akt/Akt and p-PI3K/PI3K were reduced in the low-oxygen intervention 6 and 12 h groups(P＜0.05);compared with the low-oxygen intervention 6 h and 12 h groups,the p-PI3K/PI3K and p-Akt/Akt values increased in the low-oxygen intervention 12 h+Jiawei Ditan Decoction low,medium,and high-dose groups(P＜0.05).GPX4 expression was also increased(P＜0.05).Conclusion Jiawei Ditan Decoction may improve cardiomyocyte ferroptosis in rats by regulating the PI3K/Akt signaling pathway,thereby playing a protective role against chronic intermittent hypoxia-induced cardiac injury in rats.