Objective To explore the roles of vascular endothelial growth factor (VEGF) and P38MAPK in the pathogenesis of Alzheimer's disease(AD) rats,and the effects of butyIphthalide on the influence of VEGF and P38MAPK in hippocampus of AD rats.Methods SD rats were randomly divided into blank group,AD model group,butylphthalide low-dose group and high dose group (n =8 rats per group).Aggregated Aβ1-42 was injected into the bilateral hippocampus of rats by stereotaxic coordinates method to induce AD.Morris water maze test was used to determine the abilities of learning and memory.Western blotting combined with Gel Doc imagine systems were used to investigate the expression of VEGF and P-P38MAPK in hippocampus of AD rats.Results The result of Morris water maze experiment showed that one week after modeling,escape latency was different(F =66.658,P ＜ 0.05),and either dose the frequency of crossing platform (F =6.884,P ＜0.05).Compared with the blank group,the other three groups'latent period of escape was extended significantly(P ＜ 0.05),and frequency of crossing platform was significantly less (P ＜ 0.05).After drug intervention for 4 weeks,the expression of VEGF was difference(F =171.064,P ＜0.05),it was decreased obviously in the model group than blank group(P ＜=0.05),but it was increased in the drug intervention groups than model group (P ＜ 0.05),and increased more significantly in the high dose group than low dose group (P ＜ 0.05).The expression of P38MAPK had no obvious change among four groups (P ＞ 0.05),however,the expression of P-P38MAPK showed difference(F =104.395,P ＜ 0.05),it was increased in drug intervention and model group than blank group (P ＜ 0.05),it was increased in drug intervention and model group than blank group (P ＜ 0.05),reduced significantly in drug intervention groups than model group (P ＜ 0.05),and decreased more significantly in high dose groups than low dose group (P ＜ 0.05).Conclusions Butylphthalide could obviously enhance the expression of VEGF,reduce the expression of P-P38MAPK in hippocampus of AD rats.

OBJECTIVE To detect ESBLs genes in 5 Shigella sonnei isolates.METHODS Susceptibility test to common antibiotics was performed through disk diffusion test,and ESBLs were confirmed according to CLSI.Conjugation experiment was performed to determine whether the resistance was transferable.The ESBLs gene was detected by PCR using universal primers for TEM,SHV,CTX-M,and the PCR products were also directly sequenced and analyzed.At the same time,the five isolates were analyzed by PFGE. RESULTS The five S.sonnei isolates were ESBLs producers and produced CTX-M-15 ESBLs,which were resistant to the most of the ?-lactams such as aztreonam,the first and second generation cephalosporins,cefotaxime,and non ?-lactam such as gentamicin,SF,but susceptible to ceftazidime,the 4th generation cephalosporins,Amikacin and meropenem.These strains were also intermediate to quinolones.CTX-M-15 gene could be transferred through conjugation.PFGE patterns of one isolate were different from the others.CONCLUSIONS Five S.sonnei isolates producing CTX-M-15 ESBLs are resistant to the most antibiotics.Clone spread is evident in these isolates.We should pay more attention to monitor these strains.

Objective:To construct an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.Methods:This was a cross-sectional study. The draft of evaluation indexes for clinical thinking ability of general practitioners in treatment of multimorbidity was preliminary developed through literature review, collation, analysis and discussion. Nineteen clinical and teaching experts of general practice were selected for consultation via anonymous convenient sampling. From January to June 2022, 2 rounds of expert consultation were conducted using the Delphi method. During the first round of consultation, according to the survey feedback, we modified and improved the evaluation system of general practitioners′ clinical thinking ability for multi-disease co-treatment. During the second round, experts were asked to assess the importance of each index, and to calculate the weight of each index accordingly. Questionnaires were sent to experts via letters. The content of the questionnaires encompasses the basic information of experts, evaluation for various indexes and relevant opinions. The mean value of importance assignment ≥3.5, coefficient of variation ≤0.25 and the full score frequency ≥30% were taken as the criteria. Indexes unsatisfying the criteria were removed, so that the final index system could be constructed.Results:The average age of 19 experts was 50.2 years old, 9 of them were male. A total of 2 rounds of expert consultation were conducted, 19 questionnaires were issued in each round, and 19 effective questionnaires were received afterwards. In the first round of consultation, 10 experts put forward revised opinions, and some indexes were adjusted according to the definition criteria and the discussion of the research group. In the second round of consultation, 3 experts put forward suggestions for modification. According to the definition criteria, no need to delete the indexes. After discussion by the research group, some indexes were adjusted, and finally an evaluation system of clinical thinking ability for multi-disease co-treatment of general practitioners was established, including 4 first-level indexes and 30 second-level indexes. The weights of the 4 first-level indexes in descending order were "overall thinking ability" (38.01%), "diagnostic thinking ability" (33.96%), "evidence-based thinking ability" (14.75%), and "critical thinking ability" (13.28%). Among the 30 secondary indexes, the top 5 were "ability to identify and handle priority emergency incidents" (5.04%), "risk assessment and critical illness identification ability" (4.63%), "emergency referral ability" (4.61%), "communication and expression ability" (4.57%), and "standardized diagnosis and treatment ability" (4.23%).Conclusion:This study successfully constructed an evaluation system for clinical thinking ability of general practitioners in the treatment of multimorbidity.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.