[Objective] The purpose of this study was to evaluate the association of ultrasound findings and different treatments with the prognosis of the pump twin in twin reversed arterial perfusion sequence (TRAP).[Methods] The 55 cases that were diagnosed as TRAP during the period from January 4th 2010 and August 31st 2015 were included.Ultrasound appearances of monochorionic twins were documented in detail when the twins were diagnosed with TRAP initially.At the initial evaluation,presence or absence of the following abnormalities were documented,including the ratio of the acardiac twin to the weight of the pump twin,hydrops fetalis in the pump twin,cardiomegaly in the pump twin,polyhydramnios in the pump twin,oligohydramnios in the acardiac twin and different treatments.The relationship between these ultrasound characteristics and different treatments with mortality of pump twin were analyzed with logistic regression.[Results] A total of 55 cases with TRAP were diagnosed in our institution and three cases were lost to follow up.Selective reduction was performed in 21 cases,termination of pregnancies in 13 and expectant management in 18.Excluding the cases that underwent termination of pregnancy,the remaining 39 cases were divided into two groups according treatment,expectant management group (n=18) and selective reduction group (n=21).Overall survival rate of the pump twin in these two groups was 66.7％ and 71.4％,respectively,P =0.748.The markers of perinatal outcome were not significantly different between expectant management group and selective reduction group.Logistic regression demonstrated that cardiomegaly in the pump twin (OR=21.73,95％CI:1.15 ～ 203.89,P ＜ 0.001) were significant correlated with mortality of the pump twin.[Conclusion] The prognosis markers were not significantly different between conservative management and selective reduction group.Cardiomegaly in the pump twin should be considered as risk predictors for mortality of the pump twin in TRAP.

Objective To estimate the efficacy and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the treatment of lichen sclerosus et atrophicus of the vulva.Methods An open and noncontrolled clinical study was performed.Forty-two patients were enrolled in this study and received ALA-PDT once every two weeks for 2 to 4 times.Follow-up visits were arranged at 2,4 and 8 weeks after initiation of treatment,and patients were evaluated at the baseline (before treatment) and all the follow-up time points for the efficacy and safety of treatment.Results Finally,38 patients completed the trial and 4 patients were lost to follow up.The total response rate was 81.6％ (31/38) at the end of the treatment.The average symptom and sign score in these patients was significantly lower at 2,4 and 8 weeks after initiation of treatment than that before treatment (17.6 ± 10.18,11.6 ± 8.35 and 7.6 ± 5.93 vs.29.3 ± 9.17,t =5.26,8.80,12.22,respectively,all P ＜ 0.01).A significant improvement was also observed in the other aspects,such as skin lesion area,hypopigmentation,erosion/rhagades and itching score at 2,4 and 8 weeks,as well as in skin atrophy at 8 weeks after initiation of treatment compared with those before treatment (all P ＜ 0.05).Local burning sensation was the main adverse reaction to ALA-PDT,and 16％ (6/38) of these patients complained of severe pain during the first treatment.Conclusion ALA-PDT shows favorable efficacy in patients with lichen sclerosus et atrophicus of the vulva with a rapid onset of action.

Objective To explore the correlation between myeloperoxidase(MPO) and white blood cell (WBC) and other related numerical values in blood .Methods 50 common patients were randomly selected .The two blood samples in each patient were re-spectively collected by the biochemical tube anticoagulated by heparin sodium and the blood routine tube anticoagulated by ethylene diamine tetraacetic acid kalium(EDTA-K2 ) .Then plasma MPO content and WBC count ,absolute neutrophils count ,percentage of neutrophils ,platelet count in whole blood were detected .The MPO content and the above 4 items of detection results were per-formed the correlation analysis .Results The correlation coefficients(r) between plasma MPO with WBC count ,neutrophils count , percentage of neutrophils and platelet count in whole blood were 0 .253 ,0 .220 ,0 .111 and 0 .133 respectively ,which indicating that no correlation existed between them .Conclusion Blood MPO is mainly derived from polymorphonuclear neutrophils ,but WBC count ,neutrophils count and platelet count in whole blood do not cause the change of the myeloperoxidase content .

Objective To research of acupuncture for the perioperative analgesia and immune function of the breast cancer patients.Methods A total of 40 breast cancer patients who were carried out the radical operation was randomly (random number table method) divided into acupuncture combined drugs group and control group in our hospital during from 2015.1 to 2016.12. The patients in acupuncture combined drugs group was carried out acupuncture combined TCI anesthesia,and the patients in control group was carried out TCI anesthesia. The analgesic effect was evaluated by Visual analogue scales(VAS) in 2h, 6h, 12h, 24h and 48h after operation. The percentage of peripheral blood subgroups of T-lymphocytes (CD3+, CD4+, CD8+), natural killer cell (CD16+CD56+) and the ratio of CD4+/CD8+ was detected in 30 min before anesthesia,2h after beginning of operation,1d , 2d and 5d after operation.Results he VAS scores at 2 h (2.30 ± 1.12vs. 3.75 ± 1.06,t=2.378), 6 h (2.64 ± 1.23vs. 5.56 ± 1.41,t=3.289) and 12 h (3.49 ± 1.46vs. 4.99 ± 1.27,t=2.040) after operation of acupuncture combined drugs group wwere significantly lower than those of control group (P<0.05). The CD3+ (52.35％ ± 4.20％vs. 48.01％ ± 4.42％,t=2.127), CD4+ (27.81％ ± 2.72％vs. 24.96％ ± 2.60％,t=2.250), CD4+/CD8+ (1.12 ± 0.15vs. 1.01 ± 0.13,t=2.136) in acupuncture combined drugs group were significantly higher than those of the control group in 1d after operation (P<0.05). The CD16+ CD56+ 2 h (14.79％ ± 2.04％vs. 13.58％ ± 1.50％,t=2.852), 1 d (14.43％ ± 2.27％vs. 13.11％ ± 1.82％,t=2.933) in acupuncture combined drugs group were significantly higher han those of control group in 2h after beginning of operation and 1d after operation (P<0.05).Conclusions The analgesic effect of acupuncture could be applied to radical operation of breast cancer under general anesthesia. This method could protect the subgroups of T-lymphocytes and natural killer cell, and improve the immune function of breast cancer patients.

Objective To explore the effective evaluation of"internet+iMedLib"health education on pregnant women. Methods Totally 200 pregnant women who established pregnancy care manual and were about to deliver babies in Shaoxing Women&Children's Hospital from June to October in 2016 were selected. The pregnant women were randomized into the experimental group and the control group. The health education model of "internet+iMedLib"were used for the pregnant women of the experimental group, when they established the pregnancy care manual for the first time. Health education prescriptions were handed out, and health related knowledge were communicated face to face for the control group. Finally the experimental group had 96 cases pregnant women, and the control group 94 cases. After delivery, self-care ability, delivery style and satisfaction were investigated and analyzed. Results The scores of pregnant women' s self-care ability in the experimental group were higher than those of the control group (t=2.137-6.155,P < 0.05 or 0.01). The eutocia rate of the experimental group was 81.3%(78/96), higher than that of the control group (63.8%, 60/94) (χ2=7.251, P < 0.01). The average time of nurse's health education in the experimental group were (5.6 ± 1.3) min, less than that of the control group (15.2 ± 1.2) min ( t=-52.863, P<0.01). The satisfaction rate of the experimental group were higher than that of the control group (Z=-6.609, P < 0.05). Conclusions The model of "internet+iMedLib" on pregnant women can not only improve the effect of health education and satisfaction of hospital service, but also they can greatly liberate nurse' s productivity and health education time. The health education model of"internet+iMedLib"is worth being promoted.

Objective To explore the impacts of NPHP1 knockdown on the phenotype of Madin-Darby canine kidney (MDCK) cells. Methods The expression of NPHP1 in MDCK cells was knockdown by siRNA interference. Cells were divided into normal control group, negative control group and siRNA group. The cellular morphology and migration were observed by light microscope. The mRNA expressions and activities of matrix metalloproteinases 2 and 9 (MMP2 and MMP9) were detected by real time PCR and gelatin zymography. The mRNA and protein expressions of E-cadherin, β-catenin, zonula occluden-1 (ZO-1), ZO-1-associated nucleic acid binding protein (ZONAB) and α-smooth muscle actin (α-SMA) were analyzed by real time PCR, Western blotting and immunocytochemistry. Results Compared with those in normal control group, in siRNA group the mRNA expressions of E-cadherin, β-catenin and ZO-1 decreased, and MMP9, MMP2, α-SMA and ZONAB increased after interfering NPHP124 h (all P<0.05); the protein expressions of E-cadherin,β-catenin and ZO-1 decreased and ZONAB and α-SMA increased after 48 h (all P<0.05), and MDCK cells became elongated with enhanced migration capacity; siRNA cells had decreased expressions of E-cadherin and β-catenin on the membrane, but increased expression of ZONAB in cytoplasm and nucleoplasm after 72 h, and α-SMA was also observed in some interfered cells. Conclusions NPHP1 knockdown induces epithelial-mesenchymal transition in MDCK cells, and ZO-1/ZONAB signaling pathway was activated. These changes may associate with renal interstitial fibrosis of Nephronophthisis type I.

Objective To construct risk prediction models of death or readmission in patients with acute heart failure(AHF)during the vulnerable phase based on machine learning algorithms and screen the optimal model.Methods A total of 651 AHF patients with admitted to Department of Cardiology of the Second Affiliated Hospital of Army Medical University from October 2019 to July 2021 were included.The clinical data consisting of admission vital signs,comorbidities and laboratory results were collected from electronic medical records.The composite endpoint was defined as all-cause death or readmission for worsening heart failure within 3 months after discharge.The patients were divided into a training set(521 patients)and a test set(130 patients)in a ratio of 8:2 through the simple random sampling.Six machine learning models were developed,including logistic regression(LR),random forest(RF),decision tree(DT),light gradient boosting machine(LGBM),extreme gradient boosting(XGBoost)and neural networks(NN).Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical benefit of the models.Shapley additive explanation(SHAP)was used to explain and evaluate the effect of different clinical characteristics on the models.Results A total of 651 AHF patients were included,of whom 203 patients(31.2%)died or were readmitted during the vulnerable phase.ROC curve analysis showed that the AUC values of the LR,RF,DT,LGBM,XGBoost and NN model were 0.707,0.756,0.616,0.677,0.768 and 0.681,respectively.The XGBoost model had the highest AUC value.DCA showed that the XGBoost model exhibited greater clinical net benefit compared with other models,with the best predictive performance.SHAP algorithm analysis showed that the clinical features that had the greatest impact on the output of the model were serum uric acid,D-dimer,mean arterial pressure,B-type natriuretic peptide,left atrial diameter,body mass index,and New York Heart Association(NYHA)classification.Conclusion The XGBoost model has the best predictive performance in predicting the risk of death or readmission of AHF patients during the vulnerable phase.

OBJECTIVE：To investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and cerebral function in patients undergoing intracranial aneurysm embolization. METHODS ：Totally 44 patients undergoing intracranial aneurysm embolization in the First Affiliated Hospital of Hunan University of TCM during Jun. 2017-Aug. 2019 were collected and randomly divided into group D （22 cases）and group C （22 cases）. Ten minutes before anesthesia induction ，group D was given intravenous injection of Dexmedetomidine hydrochloride injection 1 μg/kg；group C was given buffered normal saline 20 μL. Both groups were induced with Propofol emulsion injection+Midazolam injection+Fentanyl citrate injection+Cisatracurium besylate for injection. During the operation ，group D was given Dexmedetomidine hydrochloride injection 0.5 μg（/ kg·h）+Fentanyl citrate injection+Benzsulfosum atracurium for injection+Propofol emulsion injection to maintain anesthesia ；group C was continuously pumped with buffered normal saline 0.5 μg（/ kg·h）+Fentanyl citrate injection + Benzsulfosum aratracurium for injection Propofol emulsion injection to maintain anesthesia. Before anesthesia induction （T0）， immediately after anesthesia。induction （T1）， 1 min after tracheal intubation （T2）， immediately after operation finished （T3），immediately afte extubation（T4），the mean arterial pressure（MAP），heart rate 中国药房 2021年第32卷第7期 China Pharmacy 2021Vol. 32 No. 7 ·865· （HR），regional cerebral oxygen satur ation（rSO2）were observed in 2 groups. The levels of neuron specific enolase （NSE）and S100 β protein in serum were measured at T1，T3，6 h after operation （T6）. The recovery time ，intraoperative blood loss ， nitroglycerin amount and the occurrence of ADR were recorded. RESULTS ：MAP and HR of group D at T 2-T4 were significantly lower than those at T 0；MAP and HR of group C at T 2-T4 were significantly higher than those at T 0；the group D were significantly lower than the group C at the same period （P＜0.05）；there was no statistical significance in rSO 2 between 2 groups at T 0-T4（P＞ 0.05）. The levels of serum NSE and S 100β protein in 2 groups at T 3 were significantly higher than at T 1；those in 2 groups at T 6 were significantly lower than at T 3，but those of group D were significantly lower than the group C at T 3（P＜0.05）；there was no statistical significance in the levels of serum NSE or S 100β protein between 2 groups at T 1（P＞0.05）. The recovery time of anesthesia，the amount of nitroglycerin ，the incidence of tachycardia ，nausea and vomiting ，restlessness，shivering and cough in group D were significantly shorter or lower than group C （P＜0.05）；there was no statistical significance in the intraoperative blood loss between 2 groups（P＞0.05）. CONCLUSIONS ：Dexmedetomidine can maintain the hemodynamic stability of patients with intracranial aneurysm embolization during the perioperative period ，has little effect on rSO 2 and brain function ，and has good safety.