Objectives To investigate the relationships of the expressions of heat shock protein 70(HSP70) and HSP90 genes in bone marrow mononuclear cells (BMMNCs) with glucocorticoid (GC)-resistence (GCR) in acute lymphoblastic leukemia (ALL) patients.Methods The expressions of HSP70 and HSP90 in bone marrow mononuclear cells from 43 newly diagnosed ALL patients and 16 healthy volunteers were examined by real time polymerase chain reaction.Of them,43 patients received glucocorticoid therapy were divided into GC-sensitive (GCS) group and GC-resistant(GCR) group according to GC response.Results (1)The expressions of HSP70 mRNA (0.95 ± 0.36) and HSP90 mRNA (1.97 ± 0.63) in BMMNCs from ALL patients were significantly higher than that in the controls [(0.28 ±0.17)and (0.62 ±0.21),P＜0.01]; (2)The expressions of HSP70 mRNA(1.09 ± 0.22)and HSP90 mRNA(2.18 ± 0.42) in BMMNCs from GCR group patients were significantly higher than that in the GCS group patients [(0.57 ±0.19)and (1.43 ± 0.35),P ＜ 0.05,P ＜ 0.01] ; (3)The expressions of HSP70 mRNA (0.97 ± 0.34)and HSP90 mRNA (2.01 ± 0.58) in BMMNCs from the ALL patients with high-degree tumor burden were significantly higher than that in the patients with low-degree tumor burden [(0.61 ±0.22) and (1.34 ±0.29),P ＜0.01].Conclusions The mRNA expressions of HSP70 and HSP90 in BMMNCs from GCR group patients were significantly increased.Detection of HSP90 and HSP70 expressions may help ALL patients for prognosis judgment,chemotherapy plan selection and therapeutic effect evaluation.

Objective To explore the effect and mechanism of atorvastatin on pulmonary hypertension (PAH) in chronic pulmonary heart disease.Methods Seventy eight patients with chronic pulmonary heart disease were randomly signed into treating group and observing group.Forty healthy people were picked up from people taking physical examination at the same stage as control group.Patients in observing group were given routine treatment,and patients in treating group were given atorvastatin (20 mg/d) supplement beside routine treatment.Pulmonary function,ultrasound cardiogram,plasma interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured before and after 24 weeks of treatment.Results There were no difference in terms of forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FVC),pulmonary arterial pressure (PAP) and the levels of IL-6 and TNF-α between the observing group and treating group before treatment(P ＞ 0.05).While there were significant difference in terms of the serum levels of IL-6,TNF-α and PAP of treating group,observing group and normal control group at before treatment (IL-6:(106.61 ± 31.34) ng/L,(105.33 ± 30.16) ng/L,(73.81 ± 31.12) ng/L,F =67.17 ; TNF-α:(19.41 ± 10.21) ng/L,(18.25 ± 11.37) ng/L,(14.82 ± 4.33) ng/L,F =15.43 ; PAP:(58.33 ± 8.95) mmHg,(56.04 ± 8.57) mmHg,(15.88 ±7.01) mmHg,F =88.78;P =0.00),and these levels in observing and treating group were higher than those in normal control group(P ＜0.01).After 24 weeks treatment,the IL-6,TNF-α,PAP in the treating group were (73.90 ± 27.12) ng/L,(14.91 ± 5.35) ng/L and (45.96 ± 5.61) mmHg respectively,significantly lower than those in observing group ((103.00 ± 28.12) ng/L,(17.22 ± 7.17) ng/L and (53.11 ± 9.21) mmHg respectively; P =0.025,0.045 and 0.031 respectively).The pulmonary function indexes including FEV1 and FEV1/FVC in treating group were much better than those in observing group at 24 weeks treatment (FEV1:(57.85±10.31)％ vs.(43.9±31.33)％;FEV1/FVC:(57.83±10.38)％ vs.(47.97± 14.79) ％ ;P =0.001,0.024 respectively).Conclusion Atorvastatin can effectively improve the life quality and pulmonary function,decrease PAP of patients with chronic pulmonary heart disease,and the mechanism may be related to the inhibition of inflammation in pulmonary vessels.

Objective Colour ultrasound was used to detect the hemodynamic changes in patients with internal carotid artery kingking,in order to investigate the relationship between the carotid distortion angle and blood flow changes and to explore the assessment of severe internal carotid artery twist operation indications.Methods Forty-five patients with carotid artery kingking hospitalized in the Brain Hospital of Liaocheng were performed colour ultrasound to detect systolic blood flow velocity (PSV), end-diastolic velocity EDV) and to measure the angle of carotid artery kingking.Results According Metz classification, of the 45 patients, Ⅰ level 17 cases, Ⅱ level 17 cases, Ⅲ level 11 cases.With the decrease of carotid distortion angle,the influence on hemodynamics was more and more obvious, especially while the angle less than 30 degrees, the carotid artery blood flow was severely affected.The difference of PSV before and after Kinking was statistically significant in patientes of Metz Ⅲ level (Z=-2.934,P=0.003) and Metz Ⅱ level (Z=-3.053,P=0.002), but was statistically no significant in patientes of Metz Ⅰ level (Z=-0.382, P=0.702).There was a negative correlation between the ratio of the twist angle and PSV before kinking/PSV after kinking (rz =-0.842, P ＜0.05),that was, with the decrease of the twist angle, PSV before kinking/ PSV after kinking increase accordingly.Conclusion Kinking seriously affect the carotid artery blood flow dynamics.Ultrasound can accurately detect distortions arterial hemodynamics

Objective To compare the efficacy of oxycodone versus sufentanil for intravenous analgesia after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope.Methods One hundred fifty-four patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective radical resection of pulmonary carcinoma performed via video-assisted thoracoscope, were randomly divided into either sufentanil group (group S, n=76) or oxycodone group (group O, n =78) using a random number table.The 2 groups received combined intravenous-inhalational anesthesia.When postoperative visual analogue scale (VAS) score ≥ 4, sufentanil 5 μg or oxycodone 2 mg was injected intravenously, and the administration was repeated when necessary until VAS score ≤ 3.Patient-controlled intravenous analgesia (PCIA) was then used for postoperative analgesia (lasting for 48 h).PCIA solution contained tropisetron 20 mg and sufentanil 200 μg in 100 ml of normal saline in group S.PCIA solution contained tropisetron 20 mg and oxycodone 50 mg in 100 ml of normal saline in group O.The PCIA pump was set up to deliver a 2 ml bolus dose with a 10 min lockout interval and background infusion at a rate of 1 ml/h.VAS score was maintained ≤3.When VAS scores ≥4, morphine 10 mg injected intramuscularly was used as rescue analgesic.The requirement for rescue analgesic, level of patient's satisfaction with analgesia,and analgesia-related adverse events were recorded.Results The incidence of nausea and vomiting was significantly lower in group O than in group S (P＜0.05).There was no significant difference in the requirement for rescue analgesic, level of patient's satisfaction, and incidence of dizziness and over-sedation between the two groups (P＞0.05).No patients developed respiratory depression and pruritus in the two groups.Conclusion Compared with sufentanil, oxycodone can produce similar analgesic efficacy when used for PCIA after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope, with lower incidence of nausea and vomiting.

Objective To compare the efficacy and safety of DOX (docetaxel + oxaliplatin + capecitabine) program with mFOLFOX6 (oxaliplatin + fluorouracil) program as neoadjuvant chemotherapy in locally advanced gastric cancer patients.Methods 72 patients who was diagnosed as local advanced gastric cancer in our hospital from October 2014 to December 2017,were treated by neoadjuvant chemotherapy,36 of which were mFOLFOX6,and 36 were DOX.After 3 cycles of chemotherapy,the clinical efficacy was determined and the adverse reactions were analyzed.Results In the 36 cases of mFOLFOX6 group,the clinical remission rate was 27.8％ (10/36),and the tumor control rate was 63.9％ (23/36).Among the 36 patients in the DOX group,the clinical remission rate was 36.1％ (13/36),and the tumor control rate was 75.0％ (27/36).The recent clinical efficacy of the two groups were not statistically significant (both P ＞ 0.05).The R0 cutting rate of mFOLFOX6 group was 66.7％ (24/36),and the DOX group was 77.8％ (28/36).There was no statistically significant difference between the R0 cut rate of the radical operation of the two groups (both P ＞ 0.05).The incidence of nausea,vomiting and leukocyte reduction in DOX group was significantly higher than that in the mFOLFOX6 group,and the difference was statistically significant (all P ＜ 0.05).Conclusions The combination of mFOLFOX6 and DOX is similar in the treatment of neoadjuvant chemotherapy in gastric cancer,but the incidence of gastrointestinal reaction and hematological toxicity in DOX scheme is higher.

Objective: To understand school physician in primary and secondary schools in Yichang City, Hubei Province from 2019 to 2020, and to provide a reference for strengthening the school physician team in primary and secondary schools. Methods: 149 and 102 primary and secondary schools from 6 municipal districts in Yichang City, Hubei Province, were randomly selected in November 2019 and November 2020, respectively, and were administered by questionnaire survey. Results: The proportion of school physicians increased from 39.6% in 2019 to 65.7% in 2020. In the past two years, the equipment rate of school physician in both central and fringe urban areas increased, especially the fringe urban areas, number of school physician increased from 38 to 96. A total of 93 and 141 school physicians were selected to pariticipate in questionaire survey in 2019 and 2020 respectively. The survey showed that more than 90% of school physicians in primary and secondary schools in Yichang received training, and 74.5% had college education level. However, most of them lack professional qualification and medical background. Conclusion School physician of primary and secondary of Yichang is well development over the past two years, and the proportion substantially increased. However, there is still room for improvement in the quantity and quality of school physicians, and professional qualification needs to be improved. More attention should be paid to the marginal urban areas to achieve a balance between quantity and quality.

Objective To investigate the feasibility and safety of hybrid surgery in treatment of chronic symptomatic internal carotid artery occlusion.MethodsFrom April 2016 to December 2018, 9 patients with chronic symptomatic internal carotid artery occlusion confirmed by digital subtraction angiography were treated with carotid endarterectomy (CEA)+double chamber Fogarty balloon (3F) embolectomy or stent implantation when necessary. The clinical data of these patients were retrospectively analyzed. Vascular recanalization and complications during perioperative period and follow-up of the patients were analyzed.ResultsCEA+double chamber Fogarty balloon (3F) thrombectomy was performed in 5 patients; and stent placement was performed in 4 patients after Fogarty balloon thrombectomy. The internal carotid arteries of all 9 patients were unobstructed immediately during the operation. Postoperative hyperperfusion syndrome occurred in 3 patients; blood pressure was strictly controlled and the symptoms gradually relieved after proper dehydration. No serious complications such as cerebral hemorrhage, cerebral infarction, or nerve injury occurred. The duration of follow-up was 4-36 months; no patient developed a new stroke or death; no re-occlusion appeared; but one mild restenosis (50％) was detected. one patient suffered from a TIA attack 6 months after operation. ConclusionHybrid surgery is an effective method for treatment of chronic symptomatic internal carotid artery occlusion; however, preoperative evaluation and selection of patients should be carefully; individualized treatment plans should be developed.

Objective To investigate the clinical significance and difference in the expression of endostatin and vascular endothelial growth factor (VEGF) in non-small cell lung cancer (NSCLC) patients with different response to recombinant human endostatin (rh-endostatin) combined with chemotherapy.Methods Serum levels of endostatin and VEGF in peripheral blood of 30 patients with stage Ⅳ NSCLC (NSCLC group) and 30 healthy controls (control group) were determined by enzyme-linked immunosorbent assay.Two cycles of chemotherapy combined with rh-endostatin were provided to NSCLC patients to evaluate the efficacy of the regimen.Simultaneously,serum levels of endostatin and VEGF were measured before and after treatment.Results The level of serum endostatin was (37.96 ± 9.01) ng/ml and (40.12 ± 12.11)ng/ml in NSCLC patients and healthy controls,respectively,which was lower in the former than that of the latter,without statistical difference (P ＞ 0.05).Furthermore,the level of serum VEGF was (127.98 ± 33.88) pg/ml and (36.33 ± 15.43) pg/ml in NSCLC patients and healthy controls,respectively,which was higher in the former than that of the latter,with statistical difference (t =13.48,P ＜ 0.05).Besides,levels of endostatin and VEGF in serum were not correlated with the sex,age,tumor pathological type and differentiation of NSCLC patients (P ＞ 0.05).After two cycles of chemotherapy combined with rh-endostatin treatment,the level of serum endostatin in partial response (PR) or stable disease (SD) patients was (76.22 ± 20.41) ng/ml,higher than that of progressive disease (PD) patients,which was (31.24 ± 13.09) ng/ml (t =7.143,P ＜ 0.05).In addition,the level of serum VEGF in PR or SD patients was (93.28 ± 21.33) pg/ml,which was lower than (155.81 ± 48.38) pg/ml of the PD patients (t =3.503,P ＜ 0.05).Conclusions The levels of endostatin and VEGF are associated with the efficacy of anti-angiogenesis combined with chemotherapy in NSCLC patients.

This study aimed to compare the safety and effectiveness between unilateral biportal endoscopy (UBE) technique and microscopic decompression (MD) technique in lumbar spinal stenosis treatment. PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, and other databases were used to conduct extensive literature searches. RevMan ver. 5.3 software was used for the statistical analysis. Eleven studies were included with 930 patients, including 449 patients in the UBE group and 521 in the MD group. Both techniques revealed similar operative times at −1.77 minutes (95% confidence interval [CI], −7.59 to 4.05 minutes; p =0.55), the postoperative dural expansion area at −1.27 (95% CI, −19.30 to 16.77; p =0.89), the postoperative complications at 0.76 (95% CI, 0.47 to 1.22; p =0.26), the preoperative Visual Analog Scale (VAS) for leg pain, and the last follow-up (>12 months) VAS for leg pain at −0.04 (95% CI, −0.14 to 0.06; p =0.47), the preoperative Oswestry Disability Index (ODI), and the last follow-up (>12 months) ODI scores at −0.18 (95% CI, −0.76 to 0.40; p =0.54), and patient satisfaction (the modified MacNab score) at 1.15 (95% CI, 0.54 to 2.42; p =0.72). However, intraoperative bleeding was lower following the UBE technique at −52.78 mL (95% CI, −93.47 to −12.08 mL; p =0.01) and was shorter following the UBE technique at −3.06 (95% CI, −3.84 to −2.28; p <0.01). UBE and MD technology have no significant differences in efficacy or safety in the treatment of patients with lumbar spinal stenosis based on this meta-analysis. However, the UBE technique has less intraoperative bleeding and a shorter hospital stay. It has a slight advantage and is a better surgical option than the MD technique. It can be an alternative minimally invasive spinal surgery method.

Objective To establish a direct extraction ultra-high performance liquid chromatography tandem mass spectrometry method for the determination of bongkrekic acid in corn flour. Methods Bongkrekic acid was directly extracted with 80% methanol from corn flour samples, and the supernatant after vortex and centrifugation was determined after passing through membrane filtration. At the same time, the corn flour samples were extracted by solid phase extraction. The determination results of the two methods were compared. Results The linearity of standard series was good within the range of2-20 μg/L, and the linearity coefficient was＞0.999. The determination result of the positive sample by direct extraction method was 193.40 mg/kg (n=6). Adding the standard to the blank sample at the levels of 2, 6, and 10 μg/L, the calculated recovery rate was 75.82% - 99.33%, and the relative standard deviation was 3.54 % - 8.45%. The detection limit of the method reached 6 μg/kg. After extraction by solid phase extraction, the determination result of the positive sample was 196.84 mg/kg (n=6). The recovery rate was 77.12% -100.83%, with a relative standard deviation of 8.32% - 9.54%. Conclusion Compared with the solid phase extraction, the direct extraction method for the extraction of bongkrekic acid from corn flour has the advantages of rapidity, simplicity, and cost savings.