Objective To observe the effects of different anesthesia methods on immune function of patients with biliary tract surgery in patients.Methods 64 patients with ASA Ⅰ～Ⅱ grade elective biliary tract surgery were randomly divided into general anesthesia group (n= 32) and epidural anesthesia group(n = 32) respectively.The changes of T cell subsets and natural killer(NK) cells were observed.Results The levels of CD3+ 、CD4+、 CD4+、CD8+ and NK cells after anesthesia 2h,postoperation 1d and 3d were significantly lower than those before anesthesia in two groups(P<0.05) .general anesthesia group after surgery 5d were significantly lower than those before anesthesia(P<0.05) ;After surgery 1d,3d and 5d,general anesthesia group was significantly lower than epidural anesthesia group (P<0.05) ;The levels of CD3+、CD4+ in general anesthesia group was significantly lower than epidural anesthesia group(P<0.05) ,after surgery 1 d,the levels of CD4+、 CD8+ and NK cells in epidural anesthesia group were significantly lower than those in general anesthesia group(P<0.05).Conclusion Anesthesia had an inhibition of transient varying degrees for the immune function of patients uaderwent biliary tract surgery,which general anesthesia was more evident than epidural anesthesia.

Objective To explore the correlation between acute infarctions in different parts of the brain and the risk of vascular cognitive impairment (VCI). Methods 212 patients with acute cerebral infarction were tested using Mini Mental State Examination(MMSE)and Montreal cognitive assessment(MoCA),and were divid-ed into normal cognition group,VCI group,vascular dementia group,and mixed dementia group. We analyzed the gender,age,past medical history,personal history,MMSE and MoCA scores,and imaging data. Results Of the 212 patients,61(28.77%)had normal cognition level,74(34.91%)had VCI,56(26.42%)had vascular demen-tia,and 21(9.91%)had mixed dementia. Multiple regression analysis showed that frontal lobe infarct increased the risk of VCI(OR,41.72)and vascular dementia(OR,48.49);cerebellar infarction also increased the risk of vascular dementia(OR,4.70)and mixed dementia(OR,12.38);and temporal lobe infarction increased the risk of mixed dementia significantly(OR,56.98). Conclusions Approximately 71.3%of the patients with acute cere-bral infarction develop vascular cognitive impairment. The infarcts occurring in the frontal lobe ,temporal lobe and cerebellum increase the risk of VCI significantly ,which should be given interventional therapies.

Objective:To explore the efficiency of a new scoring system of gastric cancer screening for early gastric cancer in health examination population.Methods:The risk score of gastric cancer was assessed based on the new scoring system in health examination population. A notice for further gastroscopy was sent to the medium-risk and high-risk people. Gastroscopy was performed on those who agreed to undergo the examination.Results:From January to April 2019, a total of 5 357 people in health system visited the Physical Examination Center of Shanghai Songjiang Clinical Medical College of Nanjing Medical University for health examination. Seven hundred and forty people were classified as medium- and high-risk groups by the new screening system, 576 in medium-risk group, and 164 in high-risk group. Among them, 131 cases (17.70%) came for further gastroscopy, of whom 91 (69.47%) were in the medium-risk group and 40 (30.53%) in the high-risk group. After gastroscopy, 4 cases of gastric cancer and 1 case of esophageal cancer were detected, and both were early cancer. In the medium-risk group, 2 cases (2/91, 2.20%) of early gastric cancer and 1 case (1/91, 1.10%) of early esophageal cancer were found. In the high-risk group, 2 cases (2/40, 5.00%)of early gastric cancer were found. The tumor detection rate of high-risk group (5.00%) was higher than that of medium-risk group (3.30%), but there was no significant difference ( P>0.05). Conclusion:Risk stratification with the new scoring system of gastric cancer screening can improve the detection rate of early gastric cancer.

Objective To explore the alteration of brain pain functional areas in patients with functional dyspepsia (FD) irritable bowel syndrome (IBS) overlap by rectal balloon volume stimulation and magnetic resonance imaging (MRI) and the differences with IBS alone patients and healthy individuals were compared.Methods A total of 11 IBS alone patients,16 IBS overlapped with FD patients (IBS-FD) and 10 healthy controls were recruited.Sensory thresholds and visual analogue scale (VAS) were recorded during the rectal balloon air injection process. The changes of brain activated areas were analyzed by functional MRI (fMRI) when the rectum was stimulated at the volume of 50,100 and 150 ml.The data were analyzed by least significant difference (LSD) test.Results Under rectal volumetric stimulation,the sensory thresholds of IBS-FD group and IBS alone group were (53.14 ± 16.05) ml and (59.20 ± 20.55) ml and the difference was not statistically significant (LSD test,P＞0.05).There was no significant difference in VAS score between IBS alone group and IBS-FD group (LSD test,P＞0.05).Rectal stimulated under different volume,the results of fMRI indicated the activation of anterior cingulated cortex, dorsolateral prefrontal cortex,postporietal cortex,thalamus and insular cortex in both IBS alone group and IBS-FD group.And there was no significant difference in activated areas and intensity between IBS alone group and IBS-FD group (LSD test,P＞0.05).Conclusions There was no significant difference in activations of brain areas between IBS alone and IBS-FD patients under rectal volumetric stimulation. Under rectal volumetric stimulation,although symptoms overlapped,there was no evidence of the overlap of braingut axis and visceral hypersensitivity between IBS alone and IBS-FD.

Objective To explore the correlation between food allergies and duodenal mast cells in pathogenesis with functional dyspepsia (FD).Methods The symptoms of FD were scored in 48 patients with FD,which included 23 patients with postprandial distress syndrome (PDS) and 25 patients with epigastric pain syndrome (EPS).The specimens of duodenal and descending part of duodenum mucosa were obtained under gastroscopy in 48 FD patients and 21 healthy volunteers,and 3 mL venous blood was taken at same time.The percentages of mast cells and degranulated mast cells were calculated after the specimens were stained by toluidine blue.The serum specific IgG antibodies of 14 food allergies were detected by enzyme-linked immunosorbent assay.Two-sample comparison was performed by t test,LSD-t-test for groups' comparison,chi-square or Fisher’s exact test for rates comparison and Pearson linear correlation for correlation analysis.Results The number of mast cells in duodenal and descending part of duodenum of FD group,PDS group and EPS group was significantly higher than that of control group and the differences were statistically significant (duodenal:t =3.387,3.536 and 3.510; descending part of duodenum:t=5.810,4.400 and 3.813; all P＜0.01).In duodenal and descending part of duodenum,the percentages of degranulated mast cells in all mast cells of FD [(60.23± 5.10)％ and (66.97±5.30)％],PDS [(59.84±4.50)％ and (66.63±5.37) ％] and EPS [(60.58±5.66) ％ and (67.28±5.32) ％] were all higher than those of control group [(25.38 ± 2.32％) and (30.66 ±2.89)％],and the differences were statistically significant (duodenal:t=33.639,25.496 and 26.563; descending part of duodenum:t=32.513,30.521 and 31.612; all P＜0.05).There was no correlation between the number of mast cells,percentage of degranulated mast cells in duodenal or descending part of duodenum and the scores of symptoms (all P＞0.05).In PDS group,the rates of positive specific IgG antibodies of beef,crab,shrimp,wheat and chicken were significantly higher than those of control group,and the differences were statistically significant (beef x2=12.108,crab x2=17.771,shrimp x2=6.832 and wheat x2=4.375,chicken (Fisher’s exact test); all P＜0.05).In EPS group,the rates of positive specific IgG antibodies of beef,soy and chicken were significantly higher than those of control group,and the differences were statistically significant (beef x2 =8.915,soy x2 =18.600,chicken (Fisher' s exact test) ; all P ＜0.01).The scores of positive specific IgG antibodies of food allergies and types of FD,PDS and EPS were significantly higher than those of control group,and the differences were statistically significant (the score of positive IgG:t=14.988,4.062 and 3.693; the positive type of IgG:t=8.805,4.177 and 3.388; all P＜0.01).The scores of positive specific IgG antibodies of food allergies and types were positively correlated with the number of mast cells and the percentage of degranulated mast cells in duodenal part of duodenum (the score of positive IgG:r=0.247 and 0.307,the positive type of IgG:r=0.243 and 0.326; all P＜0.05).Conclusion The specific IgG antibody of food allergies might play a role in the pathogenesis of FD through inducing an increase in the number of mast cells and the percentage of degranulated mast cells in duodenal mucosa.

Objective:To explore the teaching of medical record writing based on tutorial system.Methods:The tutors and residents in standardization training both scored the medical record. The observation indexes included the difference of scoring time between the two editions, the difference of scoring value between tutors and doctors, the distribution of deduction points in medical record writing, and the change trend of medical record score in one year.Results:The scoring value of tutors was significantly lower than that of residents undergoing standardization training ( t=8.919, P<0.05); the deduction of medical records was mainly in the aspects of history of present illness, physical examination, diagnosis and analysis, and treatment plan. After one year of implementation, the score of tutors increased, while that of residents decreased. Conclusion:This method can effectively improve the teaching quality of medical record writing and the ability of residents to discerning problems in medical record writing.

Objective:To investigate the effect of the adaptive computerized cognitive training(ACCT) on patients with mild cognitive impairment(MCI).Methods:A total of 114 patients with mild cognitive impairment (53 cases in the treatment group and 61 cases in the observation group) were selected.In the treatment group, routine treatment combined with ACCT were given for 24 weeks, then routine treatment only for 24 weeks, 48 weeks altogether. In the observation group, routine treatment was given for 48 weeks.At week 0, 24, 48, both groups were assessed by scales including: mini-mental state examination (MMSE), Montreal cognitive assessment(MoCA), numerical memory span test, activities of daily living, Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA). SAS 9.4 was used for statistical analysis.The data were analyzed by χ 2 test, rank sum test and multi-level model analysis. Results:Interactions between group and time on MMSE( treatment group: 0 week 22.0 (21.0, 23.0), 24 weeks 24.0 (24.0, 25.0), 48 weeks 25.0 (24.0, 26.0); observation group: 0 week 23.0 (21.0, 24.0), 24 weeks 23.0 (21.0, 24.0), 48 weeks 23.0 (21.0, 24.0)), MoCA( treatment group: 0 week 18.0 (17.0, 20.0), 24 weeks 22.0 (20.0, 23.0), 48 weeks 22.0 (20.0, 24.0); observation group: 0 week 19.0 (17.0, 20.0), 24 weeks 19.0 (18.0, 20.0), 48 weeks 19.0 (18.0, 20.0)), IADL( treatment group: 0 week 11.0 (10.0, 13.0), 24 weeks 12.0 (10.0, 12.0), 48 weeks 12.0 (10.0, 12.0); observation group: 0 week 12.0 (11.0, 13.0), 24 weeks 11.0 (10.0, 12.0), 48 weeks 11.0 (10.0, 12.0)), DST-forwards and HAMD scores were significant(all P<0.05), and DST-backwards had significant group main effect ( P<0.05). Further simple effect analysis showed that the influence of group and time on MMSE, MoCA and DST-forwards were statistically significant (all P<0.05), and the influence of time on IADL and HAMD were statistically significant (both P<0.05). Further comparison of the difference between the two groups at each time point: D-value of MMSE, MoCA, DST-forwards, and DST-backwards score in the treatment group were higher than those in the observation group, while D-value of HAMD score was lower than that in the observation group, and the differences were statistically significant (all P<0.05). Conclusion:ACCT may have long term effect on improving the cognitive function and depression of MCI patients.

Objective:To compare the role and efficacy of serum Helicobacter pylori ( HP) antibody combined with pepsinogen (PG) (ABC method), serum PG combined with gastrin-17 (G-17) (new ABC method) and a new gastric cancer screening scoring system for early gastric cancer screening in healthy people. Methods:Serological examinations were performed on healthy people who underwent physical examination and gastroscopy at the Physical Examination Center of Shanghai Songjiang District Central Hospital from January 2019 to December 2021. The population were divided into low-risk population, medium-risk population and high-risk population based on the above three primary screening methods for gastric cancer. Using gastroscopy and biopsy pathology as the gold standard, the ratio of each risk stratification and the detection rate of gastric cancer of the three screening methods were calculated. Advantages and disadvantages of the three methods were evaluated.Results:A total of 3 199 people who completed physical examination and gastroscopy were included in the study. Ten cases (0.31%) of esophageal cancer were detected by endoscopy, all of whom were early esophageal cancer. Thirty-seven cases (1.16%) of gastric cancer were detected,and the detection rate of early gastric cancer was 86.49%(32/37). The three gastric cancer screening methods were used to evaluate the risk of gastric cancer. According to ABC method, there were 1 853 cases (7.92%) in the low-risk group, 1 339 cases (41.86%) in the medium-risk group, and 7 cases (0.22%) in the high-risk group. The detection rates of gastric cancer were 0.97% (18/1 853), 1.42% (19/1 339), and 0.00%, respectively. According to the new ABC method, there were 2 362 cases (73.84%) in the low-risk group, 804 cases (25.13%) in the medium-risk group, and 33 cases (1.03%) in the high-risk group. The detection rates of gastric cancer were 1.14% (27/2 362), 1.24% (10/804), and 0.00%, respectively. According to the new gastric cancer screening scoring system, there were 1 448 cases (45.26%) in the low-risk group, 1 213 cases (37.92%) in the medium-risk group and 538 cases (16.82%) in the high-risk group. The detection rates of gastric cancer were 0.28% (4/1 448), 1.32% (16/1 213) and 3.16% (17/538), respectively. The detection rate of gastric cancer in the medium- and high-risk groups in total was significantly higher than that in the low-risk group with significant difference ( χ 2=17.935, P<0.001). The ROC curve showed that the AUC of the ABC method, the new ABC method and the new gastric cancer screening scoring system were 0.546, 0.503 and 0.760, respectively. The AUC of the new gastric cancer screening scoring system was significantly higher than those of the ABC method and the new ABC method, and the differences were statistically significant ( P<0.001). Conclusion:The detection rate of gastric cancer in the medium- and high-risk groups of the new gastric cancer screening scoring system is higher than that of the low-risk group, and the missed diagnosis rate of the new gastric cancer screening scoring system is lower than those of the ABC method and the new ABC method. The screening score is of high value for early gastric cancer screening in the healthy population.

Objective : To investigate the effect of resveratrol (RSV) in the treatment of peri-implantitis in a murine model and its effect on nuclear factor kappa-B (NF-κB) signaling and mitogen-activated protein kinase (MAPKs) signaling. Methods: This study has been reviewed and approved by the Ethics. After extracting the right maxillary molars of 40 C57BL/6 mice and allowing them to heal naturally for 8 weeks, implants were implanted at the site of the first molar. The mice were randomly divided into a control group, a mouse peri implantitis model group, a low-dose group of 20 mg/kg resveratrol (RSV-L), and a high-dose group of 40 mg/kg resveratrol (RSV-H). After 4 weeks of implant implantation, a silk thread ligation induced peri implantitis model was established in all mice except for the control group. The model group received intervention with physiological saline by gavage, while the drug group received intervention with resveratrol by gavage for 6 consecutive weeks. After 6-week treatment, observe the swelling of the gums around the implant and measure the bone resorption around the mouse implant using micro CT. Enzyme linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) in gingival crevicular fluid. HE staining was used to observe the infiltration of inflammatory cells in the surrounding tissues of mouse implants. Protein expression level and phosphorylation level of extracellular regulated protein kinases (ERK), p-ERK, c-Jun N-terminal kinase (JNK), p-JNK, p38 mitogen activated protein kinase (p38 MAPK), p-p38MAPK, nuclear factor kappa-B (NF-κB), p-NF-κB, nuclear factor-κB inhibitory protein (IκΒα), p-IκBα in MAPKs/NF-κB signaling pathway were detected by Western blot (WB). Results: Resveratrol group showed reduced tissue edema and decreased alveolar bone resorption. Among them, the high-dose resveratrol group had lighter tissue edema and weaker bone resorption compared to the low-dose group. The micro CT results showed that significant changes in the bone level around the implant were observed in the model group mice at four sites: proximal, distal, buccal, and palatal. High dose resveratrol intervention reduced alveolar bone resorption (P<0.05); compared with the low-dose group, the high-dose group showed a decrease in palatal bone resorption (P<0.05), while there was no significant difference in absorption between the mesial, distal, and buccal sides (P>0.05). The ELISA results showed that compared with the model group, the levels of TNF - α and IL-6 in the gingival crevicular fluid of mice in the low-dose and high-dose resveratrol groups were lower (P<0.05). The IL-6 in the gingival crevicular fluid of mice in the high-dose resveratrol group was lower than that in the low-dose group (P<0.05). However, there was no significant difference in TNF-α levels between the two groups. HE staining showed a decrease in inflammatory cell infiltration in mice after treatment with resveratrol. The WB results showed that compared with the control group, the expression levels of p-Erk, p-JNK, p-p38MAPK, p-IκA, and p-NF-κB phosphorylated proteins in the gingival tissue of the model group mice were significantly increased (P<0.01). The resveratrol treatment group significantly inhibited the phosphorylation of p-Erk, p-JNK, p-p38MAPK, p-IκA, and p-NF-κB proteins. Compared with the low-dose group, the high-dose group inhibited the phosphorylation of MAPKs/NF-κB signaling pathway related proteins more significantly (P<0.05). Conclusion Resveratrol protect ligature induced peri-implantitis murine model, which may be related to its inhibition of phosphorylation of MAPKs/NF-κB pathway.