AIM:To investigate the effects of p62 on drug resistance of human laryngocarcinoma cell line Hep-2.METHODS:The abundance of p62 in Hep-2/5-FU and Hep-2 cells was measured by RT-qPCR and Western blot.After silencing of p62 with p62 siRNA in the Hep-2/5-FU cells, the cell viability and cell apoptosis were determined by CCK-8 assay and flow cytometry.The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured to reflect the status of oxidative stress in the cells.The protein levels of apoptosis-related molecules Bcl-2, Bax, caspase-8/cleaved caspase-8 and caspase-3/cleaved caspase-3,and the activity of anti-oxidative stress pathway-related proteins Keap1/Nrf2 were measured by Western blot.RESULTS:The expression of p62 at both mRNA and protein levels was significantly up-regulated in the Hep-2/5-FU cells.The expression of p62 and Nrf2 increased in a dose-dependent manner in the Hep-2 cells.Knockdown of p62 inhibited the viability and promoted the apoptosis of the Hep-2/5-FU cells.Increased content of MDA, and suppressed activity of SOD and GSH-Px were also observed.Furthermore, knockdown of p62 up-regulated the protein levels of Bax, cleaved caspase-8, cleaved caspase-3 and Keap1, but down-regulated the protein levels of Bcl-2, Nrf2 and HO-1.CONCLUSION:Knockdown of p62 increases the sensitivity of Hep-2/5-FU cells to 5-FU exposure.The mechanism may be related to the inhibition of Keap1/Nrf2 pathway and the modulation of oxidative stress and cell apoptosis.

Objective To compare the curative effects of multi-level puncture versus single-level puncture percutaneous vertebroplasty(PVP) for treatment of multiple-level osteoporotic vertebral body compression fractures(OVCF) in senile patients.Methods From June 2008 through November 2014,89 senile patients with fresh multiple-level OVCF underwent PVP guided by C-arm fluoroscopy in prone position.Of them,51 received PVP in which the vertebrae of multiple levels were simultaneously punctured for bone cement injection while the other 38 received PVP in which the vertebrae of multiple levels were punctured one by one for bone cement injection.The 2 groups were compatible with no significant differences in preoperative demographic data (P ＞ 0.05).The 2 groups were compared in terms of visual analgesic scale (VAS),operation time for a single vertebra,fluoroscopy times for a single vertebra,bone cement injection amount for a single vertebra,and extraosseous cement leakage.Results PVP procedures were successful in both groups without serious complications.The VAS scores in both groups at 2 days post-operation were significantly lower than those at pre-operation(P ＜ 0.05).The operation time and fluoroscopy times for a single vertebra in the multi-level puncture PVP group were significantly less than those in the single-level puncture PVP group (P ＜ 0.05).There were no significant differences between the 2 groups in bone cement injection amount for a single vertebra or extraosseous cement leakage (P ＞ 0.05).Conclusions The curative effects of multi-level puncture and single-level PVP are satisfactory for senile OVCF,but multi-level puncture PVP may lead to less operation time and less X-ray exposure.

Objective To investigate the state of Th1/Th2 cytokine imbalance in patients with lupus nephritis (LN) and its role in the pathogenesis. Methods Plasma level of interleukin-18 and interleukin-13 in 18 patients with active LN and 16 normal controls were measured by enzyme-linked immunoadsordent assay (ELISA). IL-18 and IL-13 expression in the renal tissues from 18 patients and 6 normal renal tissues were also detected by immunohistochemical assay. The ratio of plasma and renal IL-18/IL-13 was then calculated. Results Plasma levels and renal expression of IL-13 and IL-18 in patients with LN were increased significantly compared to those of normal controls (P0.05). The ratio of renal IL-18/IL-13 was not significantly different among all types of LN and normal controls. The ratio of plasma IL-18/IL-13 was positively correlated with LN renal tissue activity index (AI), but no correlationship could be found in renal IL-18/IL-13 ratio. Conclusion It seems that the immune disturbance in systemic lupus erythematosus (SLE) can not be simply divided into Th1 predominant and Th2 predominant. It seems far complicated than this Th1/Th2 paradigm. It may be affected by the state of disease activity, the lesion location and the type of pathology.

Objective To explore the value of bedside ultrasound used by ICU doctor in the rapid diagnosis of traumatic abdominal,and to evaluate the advantage of bedside ultrasound in the treatment decision.Methods 60 patients with traumatic abdominal blood in our hospital admitted to the ICU were selected.All patients were checked through bedside ultrasonography by physicians with professional training of ICU,bedside ultrasound and abdominal CT and abdominal flat piece of traumatic hematocelia,and compared the diagnosis of the time of the bedside ultrasound,abdominal CT and abdominal X -ray and ultrasound physician ultrasound examination.Results The difference of abdominal blood detection rate between bedside ultrasonography and abdominal computed tomo-graphy (CT)had no statistical significance (P >0.05);bedside ultrasonography of abdominal blood detection rate was higher than plain film of the abdomen,the difference was statistically significant (χ2 =73.346,P <0.01);bed-side ultrasound received a preliminary diagnosis of time -consuming (4.37 ±2.1)min was significantly lower than that of the examination of ultrasound physicians (13.86 ±5.6)min,abdominal CT (22.13 ±6.9)min and abdominal plain film (28.19 ±7.32)min,the differences were statistically significant (t =3.947,14.607,21.139,26.338,all P <0.01 ).Conclusion By the professional training of ICU physicians for bedside ultrasound traumatic blood abdominal patients can make a more accurate diagnosis,time -shorten,more accord with the requirement of treating critically ill patients in ICU,which has important clinical value for trauma abdominal blood in early rapid diagnosis and treatment.

Objective To investigate the role of intra-operative and percutaneous three-dimensional contrast-enhanced ultrasonic cholangiography (3D-CEUSC) in the diagnosis of biliary anomalies. Methods Diluted SonoVue, an ultrasonic contrast agent, was injected into the cystic duct of 13 living liver donors via a cannula for intra-operative 3D-CEUSC, while injection via a T tube or a PTCD tube were done in 14 patients for percutaneous 3D-CEUSC. The maximum branching order of the intra-hepatic bile ducts, the percentages of display of the first-, second-, and third-order intra-hepatic bile ducts, and the rates of detection of biliary anatomical anomalies were evaluated. Results The median of the maximum branching order of the intra-hepatic bile ducts shown was fourth-order on intraoperative 3D-CEUSC and third-order on percutaneous 3D-CEUSC, respectively. The difference was significant (P=0.01). From the first- to the third-order of intra-hepatic bile ducts, the percentages of display for intra-operative 3D-CEUSC were 100% (23/23), 96.2% (50/52) and 82.7% (86/104),respectively, while they were 100% (24/24), 94.6% (54/56) and 60. 7% (68/112) for percutaneous 3D-CEUSC. The differences were not significant when comparing the first- and the second-order branches of intra-hepatic bile ducts as shown either on intra-operative or percutaneous 3D-CEUSC (P=1).The percentages of display of the third-order branches using intra-operative 3D-CEUSC was higher than that of percutaneous 3D-CEUSC (P＜0. 0001). Three biliary anatomical anomalies were detected by intra-operative 3D-CEUSC and 4 anomalies were detected by percutaneous 3D-CEUSC. All of these anomalies were confirmed by X-ray cholangiography. Conclusion Both intra-operative and percutaneous 3D-CEUSC could diagnose biliary anatomical anomalies accurately. These procedures may become important techniques to evaluate the biliary anatomy in hepatobiliary surgery pre-operatively or intraoperatively.

Objective To investigate the role of contrast-enhanced ultrasound(CEUS) for detection of hepatic artery stenosis(HAS) in recipients following orthotopic liver transplantation(OLT). Methods CEUS was performed in 50 OLT recipients (42 men and 8 women) with abnormal liver function test and/or abnormal findings on color Doppler ultrasound(CDUS). Digital subtraction angiography (DSA), computed tomographic angiography(CTA) or follow-up CDUS was used as the reference standard. The degree (mild,narrowing rate＜50 %; moderate, narrowing rate 50 % ～ 75 %; severe, narrowing rate＞ 75 % ), location and type (single or multiple) of HAS were evaluated. Moderate and severe stenosis were defined as substantial stenosis. Results CTA or DSA depicted substantial HAS in 39 patients, 8 patients with mild HAS or normal HA were depicted on CTA,and the remaining 3 patients were diagnosed as non-substantial HAS on clinical and CDUS follow-up. CEUS depicted substantial HAS in 38 cases. Moreover,CEUS corrected falsepositive findings on CDUS in 9 of 50 cases(18.0% ). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CEUS in diagnosing HAS were 90.0% ,92.3% ,81.8% ,94. 7% and 75.0%,respectively. Conclusions CEUS is able to provide comprehensive information including presence,degree,location and type of HAS, which may facilitate the further interventional procedure or surgical treatment.

Objective To discuss the clinical effects of Zhuang medicine tendons method with Zhuang herbal medicine inunction after ironing therapy in the nursing of knee osteoarthritis. Methods From February 2014 to December 2015, a total of 80 patients from the Orthopaedics Department and the Zhuang Medical Clinic of the First Affiliated Hospital of Guangxi University of Chinese Medicine were selected, and divided into observation group and control group by random number table method, with 40 cases in each group. The patients in the control group received routine Zhuang herbal medicine inunction and ironing therapy, while the patients in observation group received Zhuang medicine tendons method on the basis of the treatment of the control group. The Japanese Orthopedic Association (JOA) scores and the effects of the two groups were compared before and after the intervention. Results After 2 weeks of intervention, the JOA scores of the observation group and the control group were (91.1±4.3) and (63.2±4.2) respectively, and the difference was statistically significant (P< 0.01). Additionally, the effective rates of the observation group and the control group were 100.0% and 87.5% respectively. It was significantly higher in the observation group than in the control group (P< 0.05). Conclusions Zhuang medicine tendons method with Zhuang herbal medicine inunction after ironing therapy can improve the score of clinical symptoms and theraputic effects in knee osteoarthritis patients

Objective:To investigate the diagnostic value of integrated 18F-fluorodeoxyglucose (FDG) PET/MRI multimodal imaging in the grading of adult diffuse gliomas. Methods:A retrospective analysis was performed; 29 patients accepted cranial 18F-FDG PET/MRI multimodal imaging and diagnosed as having adult diffuse gliomas in our center from January 2020 to December 2021 were chosen; their clinical and image data were collected. These patients were divided into low-grade group (WHO grading II, n=13) and high-grade group (WHO grading III and IV, n=16) according to the pathological results confirmed by surgery or biopsy. T1WI, T2WI, DWI, arterial spin labeling (ASL), magnetic resonance spectroscopy (MRS) and PET were performed in these patients. Differences in T1WI and T2WI signs between the two groups were compared. Differences in maximum standard uptake value (SUV max), apparent diffusion coefficient (ADC), choline/ N-acetylaspartate (Cho/NAA), NAA/creatine (Cr), Cho/Cr, relative cerebral blood flow (rCBF) between the two groups were compared. The diagnostic efficacies of above parameters in differentiating high-grade from low-grade adult diffuse gliomas were determined by receiver-operating characteristic (ROC) curves. The predictive probabilities for differentiating high-grade from low-grade adult diffuse gliomas using combined parameters were obtained by binary Logistic regression analysis. Results:There were no statistical differences in T1WI and T2WI signs, proportion of adjacent parenchyma edema, proportion of crossing the midline into the contralateral side, proportion of mass effect, proportion of cystic degeneration/necrosis, or site of growth between low-grade and high-grade groups ( P>0.05). The values of SUV max, ADC, Cho/NAA, Cho/Cr and rCBF were statistically different between the two groups, and the order of diagnostic efficiency was SUV max>ADC>Cho/NAA>rCBF>Cho/Cr>NAA/Cr. SUV max had the highest diagnostic efficacy in differentiating high-grade from low-grade adult diffuse gliomas with an area under the curve (AUC) of 0.894, a sensitivity of 75% and a specificity of 100%; the diagnostic efficacy of combined parameters (mean AUC>0.9) was higher than that of single parameter, and the combined parameters of SUV max and Cho/NAA showed the highest diagnostic efficacy with an AUC of 0.933, a sensitivity of 81.3% and a specificity of 92.3%. Conclusion:The 18F-FDG PET/MRI multimodal imaging is helpful in the grading diagnosis of adult diffuse gliomas, and combination of PET and MRS may play a greater role.

Objective:To evaluate the association between thrombus composition and mechanical recanalization,operation procedure and clinical outcome.Methods:One hundred and ninety-two consecutive stroke patients with large-vessel occlusion treated by mechanical thrombectomy using a stent retriever and (or) aspiration catheter in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2018 and January 2020 were collected. The retrieved thrombi were quantitatively analyzed for red blood cells, white blood cells, platelets, and fibrin. The patients were divided into two groups, a erythrocyte-rich group and a fibrin-rich group based on the predominant composition in the clot. The clinical prognosis, CT value of thrombus, procedure time,number of recanalization maneuvers, and degree of vascular recanalization were compared between the two groups.Results:The retrieved clot from 138 patients with acute ischemic stroke from internal carotid artery occlusion ( n=56), middle cerebral artery occlusion ( n=62), intracranial segment of vertebral artery or basilar artery occlusion( n=20) were histologically analyzed. Erythrocyte-rich clots were present in 59 cases, while fibrin-rich clots were present in 79 cases. Cardioembolic thrombi had higher proportions of fibrin/platelets [77.2%(61/79)], less erythrocytes than noncardioembolic thrombi [45.8%(27/59), χ2=8.115, P=0.004]. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers [2 (1, 2) vs 3 (2, 4), Z=-7.613, P<0.001], shorter procedure time [45 (30, 60) min vs 80 (60, 90) min, Z=-6.944, P<0.001], higher thrombus CT value [42 (32, 53) vs 36 (31, 41), Z=-2.003, P=0.045], good clinical prognosis (the ratio of modified Rankin Scale score ≤2, 62.7% (37/59) vs 39.2% (31/79), χ2=7.444, P=0.006). There was no significant difference in the location of vascular occlusion between the two groups. Conclusion:For patients whose thrombotic components are mainly red blood cells, the cause of stroke may be non cardiogenic cerebral embolism, the CT value of embolus is relatively high, the embolus is easy to remove, and the clinical prognosis is relatively good.

Objective To investigate the clinical value of postoperative platelet-to-neutrophil ratio(PNR)in predicting the prognosis of patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.Methods A total of 95 patients with acute anterior circulation cardiogenic large-vessel occlusion stroke,who were admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University of China from January 2019 to January 2022,were enrolled in this study.Venous blood sampling was performed at admission and within 24 hours after thrombectomy,and the PNR,platelet-white blood cell ratio(PWR),platelet-lymphocyte ratio(PLR),and neutrophil-lymphocyte ratio(NLR)were calculated.According to the modified Rankin Scale score at 90 days(mRS-90),the patients were divided into good prognosis group(mRS-90 ≤2 points,n=45)and poor prognosis group(mRS-90 3-6 points,n=50).The clinical data were compared between the two groups.Multivariate logistic regression analysis was used to analyze the predictors of 90-d good prognosis.The area under the receiver operating characteristic curve(AUC)was used to compare the efficacy of PWR,PNR,and NLR in predicting good prognosis.Results Compared with poor prognosis group,in good prognosis group the patients were younger,the NIHSS score at admission was smaller,the incidence of postoperative contrast extravasation was lower,the postoperative 24-hour PWR and PNR values were higher,and the postoperative 24-hour NLR value was lower,the differences in the above indexes between the two groups were statistically significant(all P＜0.05).Multivariate analysis showed that bridging therapy(OR=4.746,P=0.021,95％CI:1.262-17.856),postoperative contrast medium extravasation(OR=0.254,P=0.022,95％CI:0.079-0.824)and postoperative 24-h PNR(OR=1.087,P=0.006,95％CI:1.025-1.153)were the independent predictors for 90-d good prognosis in patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.AUCs of postoperative 24-h PWR,PNR and NLR for predicting a good prognosis after thrombectomy were 0.734,0.736 and 0.704 respectively.PNR had the highest predictive efficacy,with a cutoff value of 25.08,a specificity of 84.00％,and a sensitivity of 67.78％.Conclusion In patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment,a better clinical prognosis can be expected when the patient has a higher postoperative 24-h PNR value.