Objective To detect the tissue stiffness of liver lesions by using acoustic radiation force impulse imaging (ARFI) and to evaluate the clinical value on the characteristics of liver lesions.Methods ARFI was perforrned in 91 patients with 103 liver lesions (56 benign,48 malignant).Tbe elastographic images of virtual touch tissue imaging (VTI) and the values of virtual touch tissue quantification (VTQ) were analyzed.The area under the curve and cutoff value for VTQ value were used to assess diagnostic performance.Results On the elastographic images of VTI,79.17 ％ (31/55) malignant liver lesions and 56.36 ％ (38/48) benign liver lesions appeared stiffer compared with the surrounding liver parenchyma.There was statistical difference between malignant and benign liver lesions (x2 =0.627,P ＜ 0.01).The VTQ values of malignant and benign liver lesions were (2.64±0.65) m/s and (1.72±0.39) m/s,respectively,and there was statistical difference between them (t =8.638,P ＜ 0.01).With a cutoff value of 2.10 m/s for VTQ value,the sensitivity and specificity of diagnosis for liver malignancy were 83.3 ％ and 81.8 ％,respectively.Conclusion ARFI can provide information of the tissue stiffuess in live lesions,which is helpful in the differentiation between benign and malignant liver lesions and might become the imaging modality in the future.

Objective To evaluate the strength of tobacco control at or below county-level governments of Zhejiang Province,to explore the strategies and measures on tobacco control,and promote a smoke-free government.Methods By multistage stratified random sampling method,12 government ageucies were selected in 4 counties.The information of tobacco control strength and smoke-free environment creation was collected by interview and field observation,and the scores were calculated by using the percentage assignment method.An intercept suuvey was carried out in four counties and there were 405 civil servants under investigation.The data were analyzed by frequency statistic and correlation analysis.Results The smoking rate of civil servants was 17.8％,and the secondhand smoking rate was 61.9％;84.7％ of civil servants adnmitted the harm of smoking and 96.8％ admitted the harm of secondhand smoking.Support for forbidding the cigarette advertisements was highest and increasing the cigarette price was the weakest.The scores of smoke-free environment creation of project counties showed that the average score was 50.60,Zhuji and Luqiao got a maximum score of 57.14,Haiyan got a minimum score of 42.86.The scores of tobacco control strength showed that the average score was 82.35,Zhuji got a maximum score of 92.16,followed by Luqiao,Jiande and Haiyan counties,82.35,80.39 and 74.51 respectively.The scores of tobacco control strength,include policy,political will,capacity,and tobacco control efforts were the highest in Zhuji county.The results of correlation analysis showed that the total score of tobacco control strength had significant association with the score of smoke-free environment creation,smoking rate of civil servants,and approval rate of anti smoking in public places (P＜0.05).Conclusion The overall situation of tobacco control strength at or below county-level governments of Zhejiang province is good,but there is a relative shortage of smoke-free environment creation.Civil servants master the knowledge related to tobacco and support tobacco control policy.We should further promote the construction of smoke-free government.More effective smoking control measures should be conducted in order to raise the strength of tobacco control and finally implement the tobacco control legislation.

Objective To understand the prevalence of tobacco use among college students in different populations by sex,age and major,and to provide evidence for smoking control and health decision.Methods A total of 4 638 college students selected in 21 colleges through stratified multi-stage cluster sampling from Zhejiang Province were surveyed by using questionnaire analysis.Indicators such as tried smoking,current smoking,and secondhand smoke exposure,etc.,were calculated by weight on age proportions from the numbers of college students in Zhejiang.Results The prevalence of tried smoking and currcut smoking among college students were 29.72％ and 10.57％,respectively.The prevalence of tried smoking was 46.52％ for men,18.25％ for women;28.57％ for undergraduate,31.53％ for junior college;the prevalence of current smoking was 18.86％ for men,3.86％ for women;8.88％ for undergraduate,13.23％ for junior college students.The snoking rate in college students increased with age,the group of ≥21 Years was the highest (37.87％,16.09％).The lowest level of smoking was medical student (21.76％,2.19％).The prevalence of secondhand smoke exposure in outdoor and indoor places,and dormitory among students were 65.49％,60.33％,and 23.66％,respectively.In the past 30 days,college students have seen tobacco advertisement (47.38％),smoking scenes (60.20％),and got tobacco related gifts (10.40％),free tobacco products (8.93％);college students have seen information about tobacco control (60.50％),cigarette pack warning labels (58.45％),and learned the tobacco knowledge in class in the past 12 months (14.03％).Conclusion Current prevalence of smoking in college students in Zhejiang province remained at a high level,the rate of secondhand smoke exposure is high and in college students there was lack of tobacco control education in class.The results indicated that the policy about tobacco control in school was not enough and the task of health promotion should be taken more arduously.

Objective:To investigate the differences in the expression levels of miR-196a-5p and miR-105-5p in serum of patients with benign and malignant pulmonary nodules and their diagnostic value of malignant pulmonary nodules.Methods:The expression levels of miRNAs in cancer tissues of lung adenocarcinoma and lung squamous cell carcinoma and paracancerous tissues in The Cancer Genome Atlas (TCGA) database were analyzed, and the miRNAs with significantly different expression levels in cancer tissues and paracancerous tissues were selected as target miRNAs. A total of 72 patients with pulmonary nodules admitted to Weifang People′s Hospital of Shandong Province from June 2019 to July 2020 were selected. The expression levels of target miRNAs in serum of patients with pulmonary nodules were detected by qRT-PCR. Receiver operating characteristic (ROC) curve was used to compare the diagnostic value of target miRNAs with tumor markers Cyfra21-1, NSE and CEA in malignant pulmonary nodules.Results:After screening, the target miRNAs were identified as miR-196a-5p and miR-105-5p. Twenty-six patients in the benign pulmonary nodules group and 46 patients in the malignant pulmonary nodules group were included. The levels of serum miR-196a-5p [ M ( P25, P75)] in the benign and malignant nodules group were 0.63 (0.09, 2.15) and 1.93(0.93, 4.97) respectively, and the levels of miR-105-5p in the two groups were 2.03 (0.54, 7.95) and 10.65 (5.94, 18.39) respectively. Compared with the benign pulmonary nodules group, the levels of serum miR-196a-5p and miR-105-5p in the malignant pulmonary nodules group were increased, and there were statistically significant differences ( Z=-3.083, P=0.002; Z=-4.092, P<0.001). The levels of serum Cyfra21-1 in the benign and malignant pulmonary nodules group were 2.48 (1.84, 3.78) and 2.20 (1.47, 3.32) μg/L respectively, the levels of serum NSE in the two groups were 15.58 (12.45, 18.95) and 14.43 (12.07, 17.87) μg/L respectively, and the levels of serum CEA in the two groups were 1.16 (0.55, 2.11) and 1.17 (0.61, 1.68) μg/L respectively. There were no significant differences in serum Cyfra21-1, NSE and CEA between the benign and malignant pulmonary nodules group ( Z=-1.161, P=0.246; Z=-0.305, P=0.761; Z=-0.271, P=0.786). The area under the curve (AUC) of the combination of miR-196a-5p and miR-105-5p for the diagnosis of malignant pulmonary nodules was 0.762 (sensitivity 89.1%, specificity 61.5%), which was higher than the value of the combination of Cyfra21-1, NSE and CEA for the diagnosis of malignant pulmonary nodules (AUC=0.591, sensitivity 58.7%, specificity 64.5%). Conclusion:The combination of serum miR-196a-5p and miR-105-5p can assist in the diagnosis of malignant pulmonary nodules and has higher diagnostic value.

Objective To develop a simple high-resolution melting ( HRM) analysis method for differentiation of Pc and P2 variants in class 1 integron.Methods DNA fragments containing Pc and P2 variants were amplified from plasmids pACW ( PcW ) and pACWP2 ( PcW-P2 ) respectively , then these purified PCR products and P 2 promoters were analyed full-length amplicon by HRM .Eight DNA fragments containing different Pc promoters were amplified and site-specific mutated from plasmids pACS ( PcS ) , pACH2 ( PcH2 ) , pACH1 ( PcH1 ) , pACW ( PcW ) , genomic DNA of Klebsiellar pneumonia HS07-68 (PcWTGN-10)and HS05-1792(PcH2TGN-10)respectively.The purified PCR products and eight Pc variants were characterized by HRM analyses of an unlabeled probe and full-length amplicon.This assay was applied to the differentiate Pc and P2 variants in 109 class 1 integrons from 95 urine clinical Escherichia coli isolates in Huashan Hospital during 2004 -2007.The differentiation results were compared with that determined by direct sequencing .Results P2 promoter with a significant higher melting temperature ( Tm ) can be identified by HRM analysis clearly .P2 promoters were identified in 2 class 1 integrons and consistent with direct sequencing results .Eight Pc variants were classified into three groups: PcS, PcSTGN-10 , PcW, PcWTGN-10, PcH1, PcH1TGN-10.Using direct HRM analysis.PcH2, PcH2TGN-10 were classified into four groups:PcS, PcH1, PcH2, PcW, PcSTGN-10 , PcH1TGN-10 , PcH2TGN-10 , PcWTGN-10 according to the melting curves of the unlabeled probe .Combined the HRM analyses of the whole amplicon and unlabeled probe , the eight Pc variants can be differentiated from each other .Five different Pc variants, PcS, PcW, PcH1, PcH2TGN-10 and PcWTGN-10 , were identified and consistent with direct sequencing results .Conclusions This developed a simple Pc and P 2 variants differentiation method via simultaneous HRM analyses of an unlabeled probe and full-length amplicon .This method is cost-effective and accurate , could be used in differentiation of Pc and P2 variants of class 1 integrons in clinical isolates .

Objective To investigate the effects of hydrogen sulfide on autophagy and the apoptosis after acute spinal cord injury in rats. Methods Thirty-six adult male SD rats (250-300 g) were randomly divided into three groups (n=12 for each group):sham operation group (Sham group), spinal cord injury group (Model group) and hydrogen sulfide pre-treatment group (H2S group). Allen’s method was used to establish the rat model of spinal cord injury. Rats of sham operation group re?ceived only laminectomy. Rats of H2S group received sodium hydrosulphide injection intraperitoneally (50μmol/kg) 1h after spinal cord injury, and Model group was given the same amount of saline solution. Rats in the three groups were sacrificed 24 h after spinal cord injury, then the spinal cord was removed. The expressions of LC3, p70S6K and Cleaved caspase-3 were detected by Western blot assay. The expression of LC3 was also detected by immunofluorescence. The cell apoptosis was as?sessed by TUNEL stain. Results Compared with Sham group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were increased in Model group, but the expression of p70S6K decreased and cell apoptosis increased in Model group (P<0.01). Compared with Model group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were decreased significant?ly, while the expression of p70S6K increased and cell apoptosis decreased significantly in H2S group (P < 0.01). Conclu?sion Hydrogen sulfide can inhibit autophagy and reduce cell apoptosis after acute spinal cord injury in rats.

Objective To investigate the protective effect of Ebselen on mitochondrial damage and its influence to Cytochrome C expression and the neuronal apoptosis after spinal cord injury in rats. Methods Sixty adult SD rats were ran-domly divided into 5 groups (12 each group). Spinal cord injury model was made using Allen's method. Sham operation group received only laminectomy;SCI group received laminectomy and spinal trauma;Saline group received saline injection intraperitoneally (0.1%DMSO) after injury;methylprednisolone group received 30 mg/kg methylprednisolone injection intra-peritoneally, ebselen group received 10 mg/kg ebselen injection intraperitoneally. The malonaldehyde (MDA) and glutathi-one (GSH)level at the injured sites of the spinal cord were detected 24 hours after trauma, and the expression level of Cyto-chrome C was also observed. Finally, neuronal apoptosis was identified by TUNEL staining. Results MDA level in the Eb-selen group was significantly lower than that in the SCI group, and GSH level was significantly elevated in the Ebselen group compared with SCI group (P<0.01). Expression of Cytochrome C in Ebselen group was lower than that in SCI group shown by Western blot, and the neuronal apoptosis in Ebselen group reduced significantly too compared with SCI group (P<0.01). Conclusion Ebselen can alleviate peroxidation,prohibit expression of Cytochrome C and inhibit neuronal apoptosis,thus it shows a protective effect to experimental acute SCI.

Objective To discuss the feasibility and accuracy of dual-source CT ( DSCT) in the evaluation of aortic stenosis ( AS) with transthoracic echocardiography ( TTE) as reference.Methods A total of 53 patients who underwent both DSCT and TTE were prospectively evaluated.All of them were assessed by TTE for aortic stenosis.Maximum aortic valve area ( AVA) in systolic phase was measured with DSCT , and was compared to that index obtained from the continuity equation on TTE.The severity of AS was graded as mild , moderate , or severe according to the AVA.Linear regression analysis and Bland-Altman plots were used to compare the AVA measured by using CT and TTE.Agreement on semi-quantitative grades of AS severity between the two methods was tested by using Kappa statistics.Results The mean AVA using DSCT was (1.45 ±0.35 ) cm2 compared to the mean AVA of ( 1.33 ±0.36 ) cm2 using TTE, with a significant correlation between them (r=0.92,P<0.01).Bland-Altman analysis demonstrated good inter-modality consistency between DSCT and TTE.However , DSCT demonstrated a slight overestimation of the AVA compared to TTE.As identified by TTE, there were 53 patients with AS, 13 with mild AS, 21 with moderate AS , and 19 with severe AS.In 3 patients DSCT showed no AS , TTE detected mild AS.In 6 cases, TTE had graded the stenosis as moderate , but the stenosis degree was graded as mild using DSCT.Kappa analysis showed a good agreement between the two methods on semi -quantitative grades of aortic stenosis severity (Kappa=0.75,P<0.01).Conclusion AVA measurements using DSCT is feasible and reasonably accurate for those patients with moderate to severe aortic stenosis.

This paper discussed the main point specifically from the three aspects which are the certainty and uncertainty of technological function , the predictability and unpredictability of technological efficiency , and“should do”or“not should do”of technological application .It presented an ethics argument of medical technology clinical admittance restriction and defends the standpoint -what we can do does not mean what we should do , aiming to provide moral theoretical support of ethical review of medical technology application .

Objective To investigate the effect of fructose-1,6-diphosphate (FDP) pretreatment on myocardial connexin 43 (Cx43) in a rat model of acute myocardial ischemia.Methods Thirty-six male Sprague Dawley rats (aged 8-12 weeks and weighing 220-280 g) were randomly divided into three groups (n =12 each):sham operation group (group S),ischemia group (group Ⅰ) and FDP + ischemia group (group F).The animals were anesthetized with intraperitoneal injection of 10％ chloral hydrate 40 mg/100 g,then tracheostomized and mechanically ventilated.Acute myocardial ischemia was induced by occlusion of the left anterior descending coronary artery for 30 minutes.Myocardial ischemia was verified by elevation of the S-T segment on echocardiogram (EGG).In group F,FDP 100 mg/kg was injected intravenously 10 minutes before ischemia.The hearts were removed after 30 minutes of myocardial ischemia.The myocardial infarct size (IS) and area at risk (AAR) were measured and the IS/AAR ratio was calculated.The expression of myocardial Cx43 protein was determined by immunohistochemestry and analysis of mean optical density.Results The severities of arrhythmia were significantly higher in groups F and I than in group S,while lower in group F than in group Ⅰ (P＜ 0.05).The IS/AAR ratio was significantly lower in group F than in group Ⅰ.The myocardial Cx43 protein expression was down-regulated in group Ⅰ and group F as compared with group S,and was significantly lower in group Ⅰ than in group F.Conclusion FDP pretreatment can protect myocardium against acute ischemia by up-regulation of myocardial Cx43 expression.