Gallstone ileus is a rare and potentially serious complication of cholelithiasis.Its clinical symptoms are nonspecific.From March 2005 to September 2012,19 patients with gallstone ileus confirmed by surgery or endoscopy were admitted to the Pudong New Area People's Hospital.The accuracies of X-ray,uhrasonography,CT and magnetic resonance imaging (MRI) were 0/10,0/5,19/19 and 9/9,respectively.CT examination might be the first choice for diagnosing gallstone ileus ; the classical computed tomography (CT) presentation of gallstone ileus was the Rigler triad,including pneumobilia,ectopic stone and mechanical ileus; MRI examination was superior to CT examination in exposing the fistula,and can provide abundant information,which is important for designing the surgical procedures and judging the prognosis; X-ray and ultrasonography are beneficial in screening the diseases.

Objective To investigate the value of magnetic resonance imaging (MRI)-based intravenous thrombolysis in patients with wake-up ischemic strokes (WUIS).Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke (hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery (FLAIR)).These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale (mRS) and the Barthal index (BI) at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients (261/563,56.4％) had confirmed diagnosis of hyperacute ischemic stroke (WUIS,n =73,73/121 =60.3％ vs within 12 hours,n =188,188/342 =55.0％).Altogether,192 patients (139 in within 12 hours group,and 53 in WUIS group) received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy(x2 =1.296 and 1.473,P =0.538 and 0.489,respectively).Also no significant differences were found in the incidence rate of secondary hemorrhage (including both of asymptomatic and symptomatic) and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.

Objective To discuss the imaging diagnostic features of adrenal injury. Methods The imaging features of the 29 patients of adrenal bruise and hernatoma (20 male and 9 females, average age 37) were retrospectively analyzed. The clinical appearances were all flank and hack pain, local sensitive to percus-sion and associated injury appearance. Among the 29 cases, 25 cases(86%) had adrenal injuries on right side, 2 cases(7%) on left side, and 2 cases(7%) on both sides, and no apparent abnormality was found in the relevant endocrine examination after injury. CT (n=29), MRI (n=5) and ultrasonography (n=6) were checked. CT follow-up were taken in 23 eases. MRI (n=1) and ultrasonography (n=l) were followed as well. Results The first-time exam coincidences of CT, MRI and sonography were 28/29 (97%), 5/5 (100%) and 3/6 (50%) respectively. One case of simple right-side adrenal hematoma 3 weeks after injury wasn't clearly diagnosed by CT, which was later diagnosed by MRI. The CT features of adrenal bruise were local or diffuse intumescence and focus high-density hemorrhage shadow. The CT appearances of acute stage adrenal hematoma were round-like high-density shadow without enhancement and the diameters were 1-3 cm. MRI appearances of 5 cases of subacute and chronic phase hematoma were typical high signal of T1WI, T2WI and DWI and toroid low signal around T2WI. Hematorna was not be enhanced when CT or MRI en-hancement scanning, and formed characteristic "nut-like" image feature with toroid high-density or high sig-nal enhanced shadow forming around. Uhrasonography appearances of 3 cases of hematoma were abnormal shadow of the adrenal gland. Conclusions CT is the prior imaging method for adrenal bruise and hemato-ma. MRI has the characteristic appearance for the few cases which are difficult to be identified by CT and ul-trasonography. Characteristic "nut-like" image feature is helpful for the diagnosis and differential diagnosis.

Objective To study the chronic toxicity and its severity of a Chinese medicine, Anshen Bunao Liquid ( ABL) , in rats, provide the target organs and extent of reversibility of their adverse effects, determine its non-toxic dose, and to evaluate the safety of medication and provide reference for clinical trial dose and observation indexes.Methods Two hundred and forty healthy 6-week old Wistar rats ( male:female=1:1) were divided into low,middle, and high dose Anshen Bunao liquid groups (2.5, 5, 10 mL/kg),and solvent control group (distilled water 2 mL/100 g), with 60 rats in each group.The drug was orally administered to rats once a day and 6 days per week for 26 weeks.The general state, body mass and food intake were measured.By the end of 13 weeks, 26 weeks of experiment and 4-week recovery period after drug withdrawal, hematological and biochemical indexes were assayed, organ coefficients were determined, and histopathological observation was performed.Results Long-term continuous oral administration of Anshen Bunao liquid, the general state, behavior and gross appearance showed no significant abnormal changes.Compared with the control group, no significant differences in all checked items were found in the treatment groups.During 3 and 6 months, the size and location of organs,organ weight and organ coefficient had no obvious changes, with only non-significant increase of weight of some organs.All the organ coefficients of the animals in different groups were within normal range.Histopathology showed no obvious patho-logical and toxicological changes even in the high-dose drug treatment group, and no delayed toxicity occurred after with-drawal of drug administration.Conclusions The Chinese drug, Anshen Bunao liquid has no obvious toxicity and no de-layed toxicity after withdrawal of the drug in rats.It is expected that the planned dose in clinical use is a safe dose.

Objective:To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein Ⅱb/Ⅲa inhibitor (GPI).Methods:The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization.Results:A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI ( OR=0.881, 95% CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group ( OR=1.401, 95% CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group ( OR=0.919, 95% CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group ( OR=1.559, 95% CI 1.130-2.150; P=0.007). Conclusion:In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.

Objective To investigate the value of MRI in thmmbolytic thempy of hyperacute cerebral arterial thrombosis.Methods One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited.plain CT and multi.modal MRI were performed in all patients.Thirty-three patients with hyperacute cerebral infarction were treated bv recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI.Results The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement.90 d moclified Rankin scale scores(mRs)were less than 2 and life quality Barthal indexes(BI)were from 80 to 100.The complication included one asymptomatic parenchymal hematoma(PH1)one weeks after thrombolytic therapy and 4(12.2%)hemorrhagic infarction(HI)6 to 24 hours after thrombolytic therapy.Condusions MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke.MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke.

Objective:To make the early clinical antibiotic regimen by finding out the infection of corynebacterium in the pus of patients with granulomatous mastitis in the early stage.Methods:A total of 42 patients who were diagnosed and treated in the Breast Center of Guangdong Maternal and Child Health Hospital from Jun. 2016 to Mar. 2017 with complete follow-up data were retrospectively analyzed. PCR method was used to detect corynebacterium in the patients’ pus. Patients in the positive group were treated with antibiotics alone, antibiotics + hormones and hormones alone, while patients in the negative group were treated with antibiotics + hormones and hormones alone. The postoperative recurrence rate and cure rate of different groups of patients were observed.Results:The antibiotic regimen for granulomatous mastitis in patients with corynebacterium infection included a combination of short-acting levofloxacin and azithromycin and long-acting anti-mycobacterium drugs. Among the 42 patients in the subgroup, 21 patients were confirmed positive for corynebacterium by PCR detection of pus, and the postoperative recurrence rate was 23.5%. There was a statistically significant difference between the antibiotic group, the antibiotic + hormone group and the hormone group in treatment of granulomatous mastitis infected with corynebacterium ( χ2=5.494, P=0.036) . PCR detection shouwed corynebacterium negative in 21 cases, and postoperative recurrence rate of 16.7%. No statistically significant difference in efficacy was found between antibiotic + hormone group and hormone only group for GM patients without bacterial infection ( χ2=1.129, P=0.719) . Conclusion:Early detection of corynebacterium infection in GM patients is significant for clinical guidance of the application of lipophilic antibiotics.

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.

Background and purpose:DDX is an adenosine triphosphate(ATP)-dependent RNA helicase closely related to mRNA regulation,tumor proliferation and invasion.This article aimed to explore the effect of DDX6,a member of the DDX family,on the stability of CKMT1A mRNA,as well as the effect of the DDX6 CKMT1A axis on the proliferation and migration ability of human nasopharyngeal carcinoma cell CNE2 and its molecular mechanism.Methods:We retrieved the data of expressions of DDX6 and CKMT1A in human head and neck squamous cell carcinoma from The Cancer Genome Atlas(TCGA)database and performed a correlation analysis.Western blot was performed to detect the expressions of CKMT1A and DDX6 in human nasopharyngeal carcinoma tissues and normal nasopharyngeal tissues preserved by Affiliated Hospital of Nantong University.This study was approved by the Ethics Committee of Affiliated Hospital of Nantong University(Number:2022-L114).We used transwell assay to detect cell migration ability,EdU assay to detect cell proliferation ability,and colony formation assay to detect clone formation ability.We transfect with lentivirus and plasmids to construct sh-DDX6,sh-CKMT1A,sh-CKMT1A+sh-DDX6 and oe-CKMT1A cell models derived from the human nasopharyngeal carcinoma cell line CNE2,preserved by Affiliated Hospital of Nantong University,to clarify the impact of DDX6 and CKMT1A expression levels on the malignant biological phenotypes of nasopharyngeal carcinoma cells.BALB/c nude mice subcutaneous xenograft tumor model was constructed to detect the effects of DDX6 and CKMT1A on nasopharyngeal carcinoma cells in mice.RNA stability assay was used to detect the effect of DDX6 knockout on CKMT1A mRNA and further clarify the molecular mechanism of DDX6.Results:DDX6 was highly expressed,CKMT1A level was low in human nasopharyngeal carcinoma tissue,and DDX6 was negatively correlated with CKMT1A expression.DDX6 inhibited protein translation of CKMT1A by disrupting its mRNA stability.Low expression of CKMT1A in CNE2 cells enhanced cell migration and proliferation ability,while high expression inhibited migration and proliferation ability.Knocking out DDX6 reversed the progression of malignant behavior caused by downregulation of CKMT1A.Low expression of CKMT1A promoted tumor cell growth in BALB/c nude mice subcutaneous xenograft tumor model,while low expression of DDX6 inhibited tumor cell growth.Knocking out DDX6 and CKMT1A simultaneously restored the inhibitory effect caused by knocking down DDX6 alone.Conclusion:DDX6 in nasopharyngeal carcinoma cells disrupts the stability of CKMT1A mRNA,negatively regulates CKMT1A protein translation,upregulates the proliferation and migration ability of nasopharyngeal carcinoma cells,and promotes malignant progression of nasopharyngeal carcinoma.

ObjectiveTo analyze the long-term trends of the disease burden of diabetes attributed to metabolic factors in China from 1990 to 2019, and provide scientific recommendations for diabetes prevention and control in China. MethodsDescriptive analysis was conducted on the disease burden data of diabetes attributed to metabolic factors in China from 1990 to 2019, obtained from GBD 2019, encompassing death form diabetes, disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD). Joinpoint regression models were employed to analyze the long-term trends in mortality and DALY rates. Furthermore, the study examined the impact of two metabolic risk factors, high fasting plasma glucose (FPG) levels and high body mass index (BMI) levels, on the disease burden of diabetes. ResultsFrom 1990 to 2019, the overall standardized mortality and DALY rates attributed to metabolic factors for diabetes in the general population in China showed an upward trend, with both average annual percent changes (AAPCs) of 0.1% in the total population. The trend was upward in males with AAPCs of 0.9% and 0.6%, while it was downward in females with AAPCs of -0.4% and -0.3%. As age increased, the disease burden of diabetes attributed to metabolic factors showed an upward trend, with high FPG and high BMI ranking as the top two attributing risk factors. The disease burden of diabetes attributed to metabolic factors was higher in Chinese males than females. ConclusionThe disease burden of diabetes attributed to metabolic factors is increasing among the overall population and particularly among males, while the burden for female is declining. There is a need to increase intervention efforts for males aged 65 and above, provide scientific guidance on residents’ diet and lifestyle habits, and control blood glucose and body weight.