Objective To investigate the technical feasibility and clinical significance of non-vascular contrast-enhanced ultrasound(NVCEUS) in screening pyelogenie cyst out of simple renal cysts so as to avoid damage to the urinary tract from absolute ethanol while undergoing percutaneous aspiration and ethanol sclerotherapy(PAEST). Methods Following an inclusion criteria 23 patients with renal cysts were selected to receive NVCEUS scanning by means of administrating SonoVue contrast agents through puncture needle into their renal cyst lumen prior to the injection of absolute ethanol for sclerosing treatment. By the demonstration of hyperechoic contrast agents leaving from intra cyst into renal collecting system,a pyelogenic cyst was defined. The patients with this kind of cyst was not allowed for further ethanol sclerotherapy. Results NVCEUS made 3 patients with pyelogenic cyst resembling simple ones free from ethanol selerotherapy,and 4 patients suspicious of pyelogenic cyst due to weird cyst configuration remain in the list of simple cyst for further selerotherapy. Conclusions NVCEUS of renal cyst is highly capable of differentiating pyelogenie cyst from simple cyst and highly valuable in increasing the safety for the procedure of PAEST.

Objective To represent the high-resolution ultrasonic profiles of diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) and highlight the importance of ultrasound examination for detecting this rare entity. Methods The document of clinical presentations and thyroid ultrasound imaging information leading to correct diagnosis were reviewed in association with the microscopic findings of excised thyroid specimen. Results The average age of the eight patients was (18.88 ± 3.59) years(range from 12 to 24) with a gender ratio of 2 males to 6 females. Their predominant clinical presentations were enlargement (8/8) and hardening(6/8) of the involved thyroid lobes. The ultrasound imaging features were increase in the width and thickness of involved thyroids, hypoechoic and heterogeneous internal echoes, containing multiple,diffuse,and fine hyperechoic spots but without formation of any masses, and multiple enlarged lymph nodes in the bilateral jugular chains due to cancer cell metastasis. Ultrasound diagnosis of the first case was malignant thyroid tumor, but the following consecutive 7 patients were all definitely interpreted as DSVPTC. Conclusions The clinical presentations alone is less valuable in diagnosis of DSVPTC, but the characteristic features on high-resolution ultrasonography are highly sensitive and indicative.

Objective To investigate the relationship between retinal vessel diameters and cerebral infarction of carotid artery stenosis patients.Methods Eighty seven patients (174 eyes) with carotid stenosis were included in this study.There were 49 males and 38 females,with an average age of (65.25±7.85) years.Thirty-four patients were suffered from cerebral infarction (cerebral infarction group),and the other 53 patients had no cerebral infarction (control group).There was no significant difference in age (t=1.916),male rate (x2=0.142) and carotid stenosis extent (x2=0.785) between the two groups (P=0.059,0.706,0.675).All patients underwent color fundus photography after mydriasis.Retinal vascular caliber measurements were performed using IVAN software.The main parameters were central retinal artery diameter (central retinal artery equivalent,CRAE),the diameter of the central retinal vein (central retinal vein equivalent,CRVE) and the retinal arteriole to venular ratio (AVR).The relationship between retinal vessel diameter and cerebral vascular disease were analyzed with logistic regression analysis.Results In cerebral infarction group,CRVE,CRAE and AVR ratios were (132.90 ± 20.67) μm,(243.47 ±43.92) μm and 0.56±0.10,while the control group was (145.26±21.59) μm,(224.99±32.35) μm and 0.68±0.13 respectively.There were significant differences between the two groups (t=-2.648,2.257,-4.631;P＜0.05).After correction for risk factors,such as age,smoking history,CRAE reduction and CRVE increases were significantly correlated with cerebral infarction.Conclusion CRAE reduction and CRVE increases are risk factors of cerebral infarction in patients with carotid stenosis,and it is useful in the prediction.

Objective:To establish an HPLC method for the determination gensenoside Rg1 , Rb1 and notogensenoside R1 in Sanqi Jiegu pills and to investigate the stability of saponins in the granulation process. Methods:The separation was performes on a COSMO-SIL 5 C18 MS-II(250 mm × 4. 6 mm,5μm)column with gradient elution using water and acetonitrile as the mobile phase, the flow rate was 1. 0 ml·min-1 , the detection wavelength was 203nm, the column temperature was 30℃, and the injection volume was 10 μl. The content change of triterpene saponins in Sanqi Jiegu pills prepared by the granulation process at different drying temperature was al-so investigated. Results:The linearity of notogenoside R1 , gensenoside Rg1 and gensenoside Rb1 was good within the range of 0. 211 8-2.648 0 μg·ml-1(r=0.999 7),0.566 1-7.076 0 μg·ml-1(r=0.999 7) and 0.317 2-3.964 5μg·ml-1(r=0.999 7) with the average recovery of 98. 2%(RSD=0. 82%,n=6), 98. 1%(RSD=0. 72%,n=6) and 98. 1%(RSD=0. 59%,n=6),respectively. The content of saponins in Saqi Jiegu pills was decreased obviously with the increase of the drying temperature. Conclusion:The meth-od is simple, quick and reliable, and can be applied in the quality control of Sanqi Jiegu pills. It is recommended that the drying tem-perature in the granulation process should be controlled below 60℃.

Objective: To develop an HPLC method for the simultaneous determination of 3 anthraquinones components in Knoxia valerianoides.Methods: The separation was performed on a Waters Xbridge C18column(250 mm×4.6 mm,5 μm), the mobile phase A was 0.05% phosphoric acid, and acetonitrile served as the mobile phase B, and the analysis was with gradient elution;the flow rate was 1.0 ml·min-1;the detection wavelength was 280 nm;the column temperature was 30℃.Results: The linearity of lucidin, 3-hydroxymorindone and knoxiadin was 0.147-29.400 μg·ml-1 (r=0.999 6), 0.126-25.200μg·ml-1 (r=0.999 9) and 0.135-27.000μg·ml-1 (r=0.999 5), and the average recovery was 98.50%(RSD=1.20%), 98.72%(RSD=0.73%) and 101.10%(RSD=1.12%)(n=6), respectively.Conclusion: The developed method for the simultaneous determination of 3 components can be used to control the quality of Yunnan Knoxia valerianoides.

Objective To establish a simple method to extract the methylated ctDNA in urine using magnetic beads as solid phase adsorption carri?er with a specific design reagent system and extraction process,and evaluate its application feasibility for methylated gene detection in urine sample . Methods Fourty cases of methylated ctDNA were extracted in urine using magnetic beads. After methylated modification,the concentration and pu?rity of DNA was determined by ultraviolet spectrophotometer. Results The extraction of 50 mL urine can gain 61?200 ng/mL methylated ctDNA, and the OD260/280 was 1.8 ± 0.05. Conclusion There are methylated ctDNA exist in the urine which can be extracted by magnetic beads. The estab?lished extraction method is simple,effective,and with high purity.

Objective:To explore the metabolic regulations of different Traditional Chinese Medicine (TCM) syndromes in the diabetic patients with high risk for foot ulceration.Methods:Based on gas chromatography-mass spectrometer and multi-dimensional data processing methods, the metabolomics analysis was used to compare the serum metabolites profile of healthy people (32 cases) and the high-risk foot patients in Cold and Blood Stagnation syndrome (44 cases), Heat-toxin hurting Yin syndrome (54 cases), and Qi-Blood deficiency syndrome (33 cases), who were hospitalized at Shanghai TCM-Integrated Hospital from Apirl to December, 2018.Results:This study suggested that compared with healthy people, the diabetic patients with high risk for foot ulceration showed significantly lower serum level of urea [(2.41 ± 1.57)×10 5vs. (3.32 ± 2.10)×10 5], L-leucine [(4.94 ± 3.15)×10 5vs. (6.39 ± 3.57)×10 5], aspartic acid [(3.94 ± 4.48)×10 5vs. (9.62 ± 6.93)×10 5], 9H-purine [(1.74 ± 1.95)×10 5vs. (3.34 ± 2.23)×10 5] ( P<0.05 or P<0.01), while higher level of d-Glucose [(3.72 ± 1.71)×10 5vs. (2.21 ± 1.32)×10 5] and d-glucopyranose [(3.32 ± 2.10)×10 5vs. (1.35 ± 1.43)×10 5] ( P<0.01). Energy metabolism, amino acid metabolism and sugar metabolism were mainly involved. the content of L-tyrosine in the group of patients with Cold and Blood Stagnation syndromewas significantly higher than that in healthy people. The urea, purine, leucine, aspartic acidcontent in patients of Heat-toxin hurting Yin syndrome were significantly lower than that in healthy people. The purine content in patients of Qi and Blood Deficiency Syndrome was significantly lower than that in healthy people. Compared with the syndrome of Heat-toxin hurting Yin syndrome, patients in Cold and Blood Stagnation syndrome showed a significantly higher content of beta-1-galactopyranoside and butanoic acid. Compared to the Qi-Blood deficiency syndrome, serum urea level in patients of Heat-toxin hurting Yin syndrome was significantly higher than those in the patients of other two TCM syndromes. Conclusions:The serum metabolomics profiling differentiate three TCM-syndrome in high-risk DF patients, which can provide objective basis for clinical TCM syndrome differentiation and treatment of high-risk diabetic foot patients.

[ ABSTRACT] AIM:To explore the mechanisms of fluctuant high blood glucose-induced apoptosis of hepatocytes. METHODS:SD rats were randomly divided into normal control group ( N) , stable high blood glucose group ( S) , fluctu-ant high blood glucose group ( F) and insulin group ( I) .Diabetic rats were induced by intraperitoneal injection of strepto-zotocin (65 mg/kg) , and the fluctuant high blood glucose animal model was induced by intraperitoneal injection of ordinary insulin and glucose at different time points every day.The blood glucose fluctuation patterns of the animals in F group with-in 12 weeks were similar every day and no significant difference of the HbA1c concentration was observed compared with S group, indicating that the fluctuant hyperglycemia was successfully established in F group.The activity of superoxide dis-mutase ( SOD) and glutathione peroxidase ( GSH-Px) , and the content of malondialdehyde ( MDA) and nitric oxide ( NO) in the homogenate of the liver tissues were detected by colorimetry.The mRNA and protein levels of JNK, p-JNK, Bax and Bcl-2 were examined by RT-PCR and Western blot.RESULTS:After 12 weeks, the increases in the intakes of food and water, the urine output, and the abnormal liver function were observed in S group, I group and F group.Compared with N group, the MDA level was increased, the content of NO and the activity of SOD and GSH-Px were decreased, and up-regu-lation of JNK mRNA and p-JNK and Bax proteins, and down-regulation of Bcl-2 were also found in S group, I group and F group.The above effects were more obviously showed in F group.CONCLUSION:Oxidative stress activates JNK-MAPK signaling pathway, which is involved in fluctuant high glucose-induced apoptosis of hepatocytes.

Objective:To survey the training requirements for doctoral candidates in general practice.Methods:A questionnaire survey was conducted to investigate the requirements for general practice doctorate training; the items included the training target, training objectives and training contents. A total of 130 stakeholders of general practice participated in the survey, including administrators in health committees, general practice educators of medical schools, general practitioners in hospital and community health service centers and students in general medicine. The participants were divided into training unit group ( n=42), employer group ( n=42) and doctor and student group ( n=46). Results:Among all training objectives, the training "general medicine scientific research ability" ranked the first (121, 93.1%); while 114 (87.7%) respondents believed that the training target should be the leading talents in general medicine. Regarding the content of clinical competence training, 86 (66.1%) respondents believed that there was a lack of medical care training for whole life-cycle and whole population currently. The training requirement for acute disease management and referral competence in employer group was significantly higher than the training unit group (χ2=25.73, P<0.01) and the doctor and student group (χ2=24.37, P<0.01). Most survey respondents believed that the doctorate candidates in general medicine should focus on scientific research training in community clinical medicine ( n=110, 84.6%), community preventive medicine and epidemiology ( n=114, 87.7%); 117 (90.0%) respondents believed that clinical research design and methodology training should be strengthened, and 125 (96.2%) respondents believed that clinical teaching thinking training should be strengthened; 108 (83.1%) survey respondents believed that it is necessary for their units to recruit personnel with doctoral degree in general medicine. Conclusion:The training of doctorate candidates in general medicine should aim at cultivating leading talents in general medicine, strengthen the training of clinical scientific research capabilities, and focus on cultivating their comprehensive abilities of "being able to research, be good at teaching, and understand management", so that they can truly become the leaders in this discipline.

Objective:To observe the clinical efficacy and adverse reactions of rituximab in the treatment of systemic sclerosis (SSc).Methods:Eight SSc patients who received rituximab treatment in the Department of Rheumatology of Shanghai Ruijin Hospital from November 2016 to May 2020 were treated with rituximab at week 0, week 2, week 4, week 24 and week 48. The clinical symptoms and laboratory parameters were evaluated at baseline, week 4, week 24 and week 48 respectively. All data were analyzed by Wilcoxon test.Results:All the patients were diagnosed as diffuse SSc, including seven females and one male, with a median disease course of 2.5 years. At week 0, week 24 and week 48, the modified Rodnon skin scores (MRss) were 16.5 (11.8, 29.5) , 14.5 (9.5, 27) ( Z=0.841) and 10.5 (7, 24.3) ( Z=0.420) respectively, which were significantly improved as compared with the baseline ( P<0.05). The patients' self-scores were 60(50, 77.5), 52.5(41.3, 67.5)( Z=0.113) and 47.5(36.3, 57.5)( Z=0.474) respectively, which were significantly improved at week 24 and week 48, and the High Resolution CT (HRCT) scores at baseline and week 48 were 2.7(1.02, 3.7) and 1.6(0.65, 2.95)( Z=0.964) respectively, significantly improved after treatment ( P<0.05). The pulmonary aterial hypertension (PAH) values were 48(41, 58.5) mmHg and 47(38.5, 57) mmHg ( Z=0.315) respectively. There was no significant difference between the two groups. Clinical observation showed that the condition was improved and no adverse reaction occurred at the same time period. Conclusion:The improvement of skin sclerosis, pulmonary interstitial lesion and pulmonary artery pressure can be observed during the treatment with rituximab, which may be a new choice for the treatment of SSc. There is no serious adverse reaction during the treatment, and the patients are well tolerated and safe.