Objective To investigate the serum levels of liver function-related proteins (cholinesterase,ChE;album,Alb,prealbumin, PA;transferrin,TRF;ferritin,FRT;C-reactive protein,CRP;and ceruloplasmin,CER)and assess their clinical diagnostic significance for chronic hepatitis B virus (HBV)carriers.Methods The study selected 86 HBV carriers who were diagnosed in the Affiliated Yong-Chuan Hospital of Chongqing Medical University from January 2012 to July 2014 (the observation group).Additionally,102 healthy individ-uals who underwent physical examination in the hospital were selected (the control group).Biochemical indices including serum ChE,Alb, PA,FRT,TRF,CRP,and CER levels were measured in both groups.Liver biopsy was performed in part of the observation group.Group comparison of continuous data was performed using the independent-samples t test.Results Serum CER levels in the observation and con-trol groups were (0.20 ±0.04)g/L vs (0.29 ±0.06)g/L,showing a statistically significant difference (t=2.03,P=0.03).No signifi-cant differences occurred in the rest of biochemical indices between groups (P>0.05 for all).Serum CER levels were significantly de-creased in patients with higher severity of liver inflammation and fibrosis [(0.23 ±0.01)g/L vs (0.18 ±0.02)g/L,t=-2.6,P=0.01;(0.22 ±0.02)g/L vs (0.17 ±0.04)g/L,t=-3.2,P=0.004].Conclusion The change in serum CER level can reflect the severity of liver inflammation and fibrosis in the early stage.Thus,serum CER level may become an important index for early diagnosis and treatment of HBV carriers.

Objective To explore the correlation between the polymorphism of TRIB3 gene rs2295490 and coronary heart disease (CHD) with dyslipidemia.Methods In the case control study,we enrolled 220 CHD patients as observation group (60.15 years mean age,150 males and 70 females) and 151 age and gender matched healthy individuals as control group (59.22 years mean age,102 males and 49 fe males).Genotypes of TRIB3 gene rs2295490 polymorphisms in the two groups were detected by PCR and sequence-based testing.At the same time,blood glucose (GLU),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C) were measured.The correlations between the polymorphism of TRIB3 gene rs2295490 and CHD,biochemical indicators of two groups were analyzed,respectively.The comparison of genotype and allele frequency between two groups used x2 test,while the comparison of biochemical indexes between two groups used t test.Results In the control group,genotypic frequencies of AA,AG and GG of TRIB3 gene rs2295490 were 57％,35％ and 8％,and the frequencies of A and G alleles were 75％ and 25％,respectively.In the CHD group,genotypic frequencies of AA,AG and GG of TRIB3 gene rs2295490 were 50％,41％ and 9％,and the frequencies of A and G alleles were 71％ and 39％,respectively.There was no significant difference of genotype and allele frequencies of polymorphism of TRIB3 gene rs2295490 between CHD and healthy controls(x2 =1.74,P =0.42;x2 =1.26,P =0.243).In the CHD group,the HDL-C levels of the AA genotype were higher than those of AG + GG genotype (t =-9.78,P =0.00);The TG,LDL-C levels of the AA genotype were lower than those of AG + GG genotype (t =2.59,P =0.01;t =6.15,P =0.00).All the differences were statistically significant.Conclusions TRIB3 gene rs2295490 polymorphism has no correlation with CHD,but the G allele may be correlated with dyslipidemia in CHD patients.

Objective To observe the application effect of point massage combined with physiotherapy in the treatment of insomnia for community elderly.Methods 30 elderly patients with insomnia who accepted point massage combined with physiotherapy were selected as observation group,and 30 elderly patients treated in tertiary hospital with insomnia who took alprazolamum for treatment were selected as control group.The SRSS score of the two groups before and after treatment,as well as treatment efficacy were compared.Results The insomnia treatment efficacy of the observation group was higher than that of the control group(Z =2.45,P <0.05).The SRSS rating of the observation group before treatment was (30.76 ±7.1 9)points and after treatment was (1 5.43 ±3.95)points.The SRSS rating of the control group before treatment was (32.33 ±6.98)points,which after treatment was (21 .93 ±6.73)points.The SRSS scores of both two groups after treatment were decreased (t =1 0.23,5.87,all P <0.05),with obvious differ-ences.The SRSS scores of the observation group decreased more obviously and was lower than that of the control group (t =4.56,P <0.05).Conclusion The point massage combined with physiotherapy can effectively improve insomnia of the elderly,which is also with advantages of easy operation and no obvious side effects and high cooperation degree etc,and it is suitable to be promoted in community.

Objective To assess the effect of snapshot freeze (SSF) motion correction algorithm on the image quality of coronary CT angiography (CCTA).Methods Thirty-one consecutive patients underwent coronary CTA without heart rate control.All of the CCTA images were reconstructed by the means of both standard (STD) and SSF motion correction.Image quality and interpretability of STD and SSF reconstructions were compared.CCTA images were interpreted with Likert 4-points score system by two experienced radiologists.The image qualities were assessed on per-artery and per-segment level,and interpretability was performed on per-segment,per-artery,and per-patient levels.Comparisons of variables were performed with paired Wilcoxon rank sum test and paired Chi-square test.Results SSF reconstructions showed higher interpretability than STD reconstructions on per-patient [100.0％ (31/31) vs 64.5％ (20/31),x2 =9.09,P =0.002] and per-artery [100.0％ (124/124) v s 83.9％ (104/124),x2 =18.05,P =0.001] and per-segment level [99.0％ (413/417) vs 89.2％ (372/417),x2 =35.56,P =0.001].Image qualities were higher with the use of SSF than STD reconstructions on LAD [3.3 ± 0.7 vs 2.9 ± 1.0,Z =2.70,P=0.007],LCX [3.1 ±0.8 vs 2.5 ± 1.1,Z =3.23,P =0.001] and RCA [3.3 ±0.6 vs 2.1 ±0.9,Z =4.60,P =0.001],but they were similar on LM [3.9 ± 0.4 vs 3.7 ± 0.6,Z =1.89,P =0.059].Image quality was higher with the use of SSF versus STD reconstructions on per-segment [3.5 ± 0.7 vs 3.0 ± 1.0,Z =10.31,P =0.001] level.Conclusions The use of SSF motion correction algorithm improves image quality and interpretability of coronary CTA without heart rate control.

RT-PCR and immunohistochemistry were used to measure the mRNA and protein expression of insulin receptor substrate 2 (IRS-2) in the muscle of smoking rats. The mRNA and protein expressions of IRS-2 in the smoking subgroups fed with normal diet or high-fat diet were significantly lower than those in corrsponding control groups (0.27±0.02 vs 0.41±0.25, 0.40±0.04 vs 0.51±0.02 for mRNA; 2.91±0.42 vs 4.90±0.29, 2.43±0.36 vs 3.80±0.30 for protein, all P<0.01). There were no differences in mRNA and protein expressions of IRS-2 between the smoking group of diabetic rats and the matched control rats (P>0.05). The variation of gene expression of IRS-2 may be involved in the mechanism of insulin resistance caused by smoking.

Objective To investigate the image quality and radiation dose of the wider detector array CT scanner with low dose scanning mode in young children with congenital heart disease.Methods Totally 100 consecutive pediatric patients younger than 3 years with congenital heart disease were enrolled.They were divided into two groups.The low dose group with fifty patients underwent axial CT scanning with ECG gating,and the control group with fifty patients were scanned with volume helical shuttle (VHS) technique.CT number and noise of two groups images at the level of ascending aorta,main pulmonary artery,left ventricle,descending aorta and adjacent muscle were measured,and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.The double blind method was used to evaluate subjective image quality of the level of intra-cardiac,extra-cardiac and coronary artery.Effective dose was also calculated for both groups.Results No significant difference was found in the CT number,image noise,SNR,and CNR between the two groups in the same anatomic regions (P ＞ 0.05).No significant difference was found in subjective image quality between the two groups for the intra-cardiac and extra-cardiac structure(P ＞0.05).The subjective image quality of coronary artery was significant higher in low dose group than the control group(4.10 ± 0.90 vs.2.88 ± 0.82,Z =-5.818,P ＜ 0.05).Effective dose was (0.57 ± 0.30)mSv in group A and (2.39 ± 1.15)mSv in group B with dose savings of 76％ (t =-11.642,P ＜ 0.05).Conclusions The wider detector array CT scanner with low dose scanning mode can improve image quality with lower radiation dose.

Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.

To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.

Objective To investigate the accuracy,image quality and effective dose (ED)of the whole-heart CT scanner in infants with congenital heart disease.Methods Totally 86 consecutive pediatric patients younger than 2 years old with congenital heart disease were enrolled.They were divided into 2 groups:whole-heart CT scanner with low dose group,43 patients(28 males,15 females,aged 12 d -19 months)underwent CT acquisition by using the whole-heart CT,and the other 43 patients(23 males,20 females,aged 19 d-16 months)examined with volume helical shuttle (VHS)of high definition CT were assigned as VHS group.With surgical results as the standard,the sensitivity, specificity,positive predictive value (PPV),negative predictive value (NPV)and the diagnostic accuracy of the 2 groups for cardiovascular abnormalities were evaluated.Attenuation and noise of 2 groups of ascending aorta,main pul-monary artery,and muscle were measured,and the signal -to -noise ratio (SNR)and contrast -to - noise ratio (CNR)were calculated.The double blind method was used to evaluate the subjective image quality of the level of intra-cardiac,extra-cardiac and coronary artery.Both the volumetric CT dose index (CTDIvol)and dose-length product(DLP)of each child were recorded,and the ED was also estimated in both groups.Results By using surgical findings as the reference standard,a total of 124 and 113 separate cardiovascular anomalies were confirmed by the whole-heart CT scanner in the low dose group and the VHS group.The diagnostic accuracy in 2 groups was 99.2%and 98.8%,respectively,without significant difference(χ2＝0.035,P＝0.852).The sensitivity,specificity,PPV and NPV in 2 groups were 97.8%,99.7%,98.4%,99.6% and 95.2%,99.3%,98.2%,98.7%,respectively.No signifi-cant difference was found in the attenuation,image noise,SNR,and CNR between 2 groups in the same anatomic regions (all P＞0. 05).No significant difference was found in subjective image quality between 2 groups on the intra-cardiac and extra-cardiac structure(all P＞0.05).But the subjective image quality of coronary artery was significantly higher in whole-heart CT scanner in the low dose group than that of the VHS group(4.02 ± 0.91 vs.2.79 ± 0.74),and the differ-ence was significant(Z＝ -5.562,P＝0.000).ED was (0.59 ± 0.31)mSv in whole-heart CT scanner in the low dose group and (2.28 ± 1.07)mSv in the VHS group,reflecting dose savings of 74% by using the whole-heart CT scanner with high temporal resolution,and the difference was significant(t＝ -11.285,P＝0.000).Conclusions The whole-heart CT scanner with low dose can improve image quality with lower ED,especially for the image quality of coronary artery,which is an effective examination method for the diagnosis of congenital heart disease of children, especially for complex congenital heart disease.