Objective To investigate differences in the expression of Ras 1,Rac1 and Rho1 genes between yeast and hyphal phases of Trichosporon asahii (T.asahii),and to explore their roles in the formation of hyphae.Methods The yeast phase and hyphal phase of T.asahii were cultured and served as yeast phase group and hyphal phase group respectively.Total RNA was extracted from the 2 groups,and real -time fluorescence-based quantitative PCR (RT-PCR) was performed to measure the mRNA expression of Ras1,Rac1 and Rho1.Results The hyphal formation rate was significantly lower in the yeast phase group than in the hyphal phase group (0.40％ ± 0.53％ vs.99.33％ ± 0.57％,t =13.93,P ＜ 0.05).When the mRNA expression of Ras1,Rac1 and Rho1 in the yeast phase group was all set as 1,that in the hyphal phase group was 25.17 ± 10.99,16.81 ± 7.80,42.61 ± 18.50,respectively,with significant differences between the two groups in the three parameters (t =3.81,3.51,3.90,respectively,all P ＜ 0.05).Conclusion Ras1,Rac1 and Rho1 genes may participate in the regulation of hyphal formation in T.asahii.

Objective To study the efficacy and safety of endobiliary radiofrequency ablation (RFA) with stent placement in treatment of unresectable extrahepatic cholangiocarcinoma (EHCC).Methods The patients with unresectable EHCC in Hangzhou First People's Hospital between October 2013 and January 2015 were enrolled in a prospective, randomized, single-blind cohort study, and were assigned randomly into two groups: RFA+stent group and stent-only group.The jaundice fade time, stent patency period, overall survival rate, and postoperative adverse events were analyzed between two groups.Results Among 59 patients with non-resectable EHCC, 28 were divided into RFA+stent group, and 31 were in stent-only group.There was no statistical difference in preoperative serum total bilirubin between the two groups.Mean serum bilirubin decrease time was significantly lower in the RFA+stent group than that in the stent-only group[17.9 d(7-22 d) VS 29.9 d(10-55 d),P=0.03].The biliary patency period in RFA+stent group was significantly longer than that of stent-only group (8.9 months VS 4.5 months, P=0.02).The mean survival time in RFA+stent group was significantly longer than that of stent-only group[13.3 months(6.2-16.5 months) VS 8.6 months(4.5-11.7 months), P=0.000).Incidence of postoperative adverse events showed no statistical difference between the two groups(P=0.727).Conclusion RFA with stent placement is effective and safe as a palliative measure in the treatment of non-resectable EHCC, and it can significantly shorten the jaundice fade time, prolong the biliary patency period and overall survival, while without increase of the incidence of adverse events.

OBJECTIVE To prepare the glutathione adducts of divinylsulfone (DVS), which is an important oxidative metabolism product of SM in vivo, and to investigate their reactive capability with DNA in vitro. METHODS The mustard sulfoxide (SMO) and mustard sulfone (SMO2) were prepared by oxidation reaction using HNO3 and KMnO4 as oxidants, respectively. Then, DVS was prepared through dechlorination reaction using CaCO3 under alkaline conditions. Furthermore, the DVS-GSH adduct and DVS-GSH-purine adducts were prepared and identified using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) and nuclear magnetic resonance (NMR). Finally, the adduct reac?tion process of DVS with GSH was monitored using UPLC-MS/MS. RESULTS The DVS-GSH and GSH-DVS-purine adducts were obtained through preparative HPLC and characterized using NMR and high-resolution MS. In aqueous solution, the reactive activity of DVS with GSH was significantly higher than that of SM, and the DVS-GSH adduct had high or reactive activity, which could produce a series of adducts with adenine and guanine in DNA, and the abundance of the adenine adducts was higher than that of the guanine. CONCLUSION DVS-GSH adducts still have high reactive activity with DNA, and more attention should be paid to its potential damage to DNA.

Objective To evaluate the cognitive level of proton pump inhibitors for the clinicians who prescribe these drugs often. Methods 10 cognitive latitudes for proton pump inhibitors were selected, which were receptor site, indication, indication of prophylaxis during perioperation, patients in contraindi-cated, high risk factors of stress ulcer, standard dose, daily dosing frequency, solvent selection for intrave-nous drip and main adverse reactions. Every cognitive latitude was assigned to points and one evaluation form was assigned 120 points. 175 clinicians participated the assessment voluntarily. Results Overall,the total average score is 58. 89. Each average score of 10 cognitive level is 10. 63, 1. 07, 6. 99, 5. 23, 3. 81, 11. 86, 11. 66, 3. 81, 7. 49 and 3. 81 respectively. The error rate is 10. 86％, 84. 57％, 45. 14％, 80. 00％, 59. 43％, 4. 00％, 2. 86％,80. 57％, 21. 71％ and 28. 00％ accordingly. Conclusions Over-all, the clinicians'cognitive level is low, while the senior doctors'are high in surgical prophylaxis;the physi-cians'are high in compatibility than surgeons ;the clinicians who used proton pump inhibitors ( PPI) more frequently are high in solvent selection for intravenous drip.

Objective: To evaluate and compare cardiac structure and function pre- and post-percutaneous interventional treatment of pulmonary hypertension (PH) using echocardiography. Methods: Eight female patients received percutaneous interventional treatment in our hospital were enrolled. All of them were suffered moderate to severe PH. Echocardiographic parameters included: right ventricular diameter (RVD), left ventricular diameter (LVD), right atrial diameter (RAD), left atrial diameter (LAD), main pulmonary arterial diameter (DMPA), left ventricular eccentric index (EI), left ventricular ejection fraction (LVEF), right ventricular systolic pressure (RVSP), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s′), right ventricular index of myocardial performance (RIMP) and right ventricular free wall longitudinal strain (RVLS_FW). The median time for follow-up after interventional treatment was 98 d. Results: ①In our study, 8 patients had no significant serious complications, and only one patient had mild intimal avulsion during stenting. ②RVSP and RVD/LVD increased significantly before intervention in patients with PH (P<0.05). After interventional treatment, RVSP (P<0.01) and RVD/LVD decreased significantly (P<0.05). ③The result of follow-up showed that RVFAC, RIMP, s′and RVLS_FW improved significantly(P<0.05). Conclusions Echocardiography could evaluate the recent effect of interventional treatment and illustrates that the interventional treatment for pulmonary artery stenosis is effective and safe.

Objective To evaluate the clinical efficiency of endoscopic ultrasound-guided celiac plexus neurolysis(EUS-CPN)for pain associated with advanced pancreatic carcinoma.Methods EUS-CPN was performed in 29 patients with advanced pancreatic carcinoma in Hangzhou First People′s Hospital from May 2010 to April 2015. The pain status before and after treatment was measured by visual analogue scale (VAS),and the clinical efficacy was assessed by pain anesis rate(PAR). Results All the 29 patients successfully completed EUS-CPN. The mean VAS value of the first day after treatment(3.6±1.5)was lower than that of preoperative(8.2±2.3,P=0.00). The mean VAS value of 1 month after treatment(2.0±0.6) was statistically different compared with the value of the first day after treatment(P=0.00). There were 10, 9,4,and 3 patients who had complete,obvious,moderate and mild relief,respectively. Three patients had no pain relief. The overall efficiency rate was 79.3%(23/29). Conclusion EUS-CPN is a safe and effective method for relieving pain in pancreatic carcinoma.

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)for common bile duct(CBD)stones before endoscopic retrograde cholangiopancreatography(ERCP). Methods Data of patients with suspected CBD stones admitted to The First People′s Hospital of Hangzhou from July 2012 to July 2013 were reviewed. Diagnostic efficiency and rates of complications were analyzed between patients undergoing EUS(EUS group)and MRCP(MRCP group)before ERCP, and between patients who underwent EUS and ERCP in different sessions(non-one-session group)with those in one session(one-session group). Results A total of 657 patients were included. With ERCP and follow-up results as the gold standard, the sensitivity(97.5% VS 88.4%), accuracy(96.3% VS 88.0%)and negative predictive value(88.9% VS 60.0%)of EUS in the diagnosis of CBD stones were significantly higher than those of MRCP(P<0.05). There were no significant differences between one-session group and non-one-session group in the sensitivity(97.5% VS 97.4%), specificity(91.7% VS 90.0%), positive predictive value(98.3% VS 97.4%), negative predictive value(88.0% VS 90.0%), and accuracy (96.6% VS 95.9%)in diagnosis of CBD stones(P>0.05). There were no significant differences in incidence of postoperative complications of ERCP between EUS and MRCP group[5.4%(13/242)VS 5.1%(21/415),P>0.05],and between one-session group and non-one-session group[5.5%(8/145)VS 5.2%(5/97),P>0.05].Conclusion Preoperative EUS before ERCP could increase diagnostic sensitivity and negative pridictive value of CBD stones without increasing the incidence of complications.

Objective To evaluate the application of fractional exhaled nitric oxide (FeNO) in the reducing treatment of bronchial asthma.Methods From October 2015 to September 2016,60 asthmatic patients with FeNO＞25 ppb were randomized into FeNO group and control group with 30 cases in each group.Patients in both groups were treated with combined inhaled corticosteroids and long-acting beta 2 agonist (ICS/LABA) starting with low doses;the dosage was adjusted according to the symptom control alone in control group,while in FeNO group the dosage was adjusted according to the symptom control and FeNO level.After 1 year-follow up,the Asthma Control Test (ACT) scores,Asthma Life Questionnaire (mini AQLQ)scores,pulmonary function,FeNO levels,blood eosinophil counts,total IgE,hierarchical control level,cumulative corticosteroid use and cumulative months of leukotriene receptor antagonists (LTRA) use were compared before and after treatment within group,and between two groups.Stratified analysis was carried out in the patients complicated with allergic rhinitis.Results After treatment,ACT scores,mini AQLQ scores and FEV1/pred (％) were significantly higher than those before treatmentin both groups (t=10.755,10.189,8.632 and 13.311,8.102,12.456,respectively,all P＜0.05),while the FeNO,EOS and total IgE levels were significantly lower than those before treatment (t=8.005,3.313,3.924 and 8.967,3.885,3.270,respectively,all P＜0.05),and the numbers of patients with good control were significantly increased (Z=-5.035 and-4.976 respectively,P＜0.05).Compared with control group,FeNO level was lower,mini AQLQ scores of symptom scores and emotional scores were higher and the average numbers of asthma attacks per patient per year were less after treatment in FeNO group (t=2.912,4.214,4.589,U=2.154,all P＜0.05).However,there was no significant difference in cumulative corticosteroid use and cumulative months of LTRA use between two groups (U=564.000 t=1.921 and 0.165,respectively,P＞0.05).For patients complicated with allergic rhinitis,the numbers of acute asthma attack were increased and the cumulative dosage of systemic corticosteroid use was higher in control group than those in FeNO group (both P＜0.05).Conclusion The reducing treatment strategy based on FeNO level and symptom control is of clinical value for patients with bronchial asthma,especially for those complicated with allergic rhinitis.

Objective To evaluate the cardiac hemodynamics and function before and after balloon pulmonary angioplasty ( BPA ) treatment in patients with chronic thromboembolic pulmonary hypertension ( CTEPH) using echocardiography ,and to discuss the clinical value of the treatment . Methods A total of 36 CT EPH patients with medium‐high risk stratification underwent BPA during the period of September 2016 to January 2019 in Beijing Chao‐Yang Hospital ,Capital M edical University were recruited . T he following conventional echocardiographic parameters including right ventricular basal diameter ( RVD ) ,left ventricular basal diameter ( LVD) ,right atrial diameter ( RAD) ,left atrial diameter ( LAD) ,main pulmonary artery diameter ( DM PA ) , left ventricular eccentricity index ( LVEI ) , left ventricular ejection fraction ( LVEF) and pulmonary artery systolic pressure ( PASP ) were recorded .Echocardiographic parameters of right ventricular ( RV ) function including tricuspid annular plane systolic excursion ( T APSE ) , right ventricular fractional area change ( RVFAC ) ,tissue Doppler – derived tricuspid lateral annular systolic velocity ( S′) ,RV index of myocardial performance ( RIM P ) and right ventricular free wall longitudinal strain ( GLS) were measured . T he patients were divided into 2 groups according to the threshold value of postoperative SPAP of 50 mmHg (group Ⅰ :SPAP ≤ 50 mmHg ,group Ⅱ :SPAP＞50 mmHg) . Changes between each parameter before and after BPA were analyzed . Results ① T he frequency of BPA treatment for CT EPH patients ranged from 1 to 6 times . After BPA treatment ,SPAP decreased significantly ,and the measurements of RV function including T APSE ,RVFAC ,RIM P and GLS improved significantly ( all P ＜0 .05) . ②Patients in group Ⅰ showed significantly better RV function including T APSE ,RVFAC and GLS compared with group Ⅱ before BPA ( P ＜0 .05) . ③Univariate logistic regression showed that parameters of preoperative RV function T APSE , RVFAC and GLS had certain effects on the curative effect of interventional surgery . Conclusions Echocardiography can evaluate the hemodynamics and RV function in CT EPH patients with BPA .After BPA ,pulmonary artery pressure decreases and RV function improves to some extent ,suggesting that the treatment of BPA has certain clinical application and popularization value .

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment of pancreas divisum (PD) combined with chronic pancreatitis (CP) in children.Methods:Data of patients under 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2010 to January 2020 were retrospectively analyzed. The general information, endoscopic procedures and follow-up of the children were recored. The number of acute pancreatitis attacks, visual analogue scale (VAS) scores of the abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 19 children diagnosed as having PD with CP underwent 82 ERCP procedures with the mean number of 4.31 (1-9). The mean number of pancreatic stent replacement was 3.21 (0-8). The success rate of minor papilla cannulation was 97.6% (80/82) with the pain relief rate of 89.5% (17/19) after the first ERCP. ERCP-related complication rate was 4.9% (4/82)without transference to surgery. The mean follow-up time was 55.8 months (9-114 months). The median number of acute pancreatitis attacks decreased from 3.0 to 0 compared with that before the procedure ( Z=-3.839, P<0.001) and the median VAS score decreased from 6 to 1 ( Z=-3.748, P<0.001), both of which had significant difference. However, the median diameters of main pancreatic duct were both 0.35 cm before and after procedure with no significant difference ( Z=-0.699, P=0.484). Conclusion:ERCP is safe and effective to diagnose and treat pediatric patients with PD with CP.