Objective To analyze the correlation of carotid artery stenosis(CAS)with postoperative cognitive dysfunc?tion(POCD)in patients who underwent off-pump coronary artery bypass grafting(OPCABG). Methods Between March 2014 and October 2014, a total of 157 patients who underwent OPCABG in our hospital were enrolled and divided into POCD group and non-POCD group according to their performance respondent to MMSE questionnaire survey conducted 5 days before operation. LOTCA questionnaire survey was conducted at the first day and 7th days pre-and post-operation re?spectively in order to investigate the influence of CAS on POCD in patients. Results The incidence of POCD was 30.6%(48 out of 157). Advanced age, diabetes,cultural level,carotid artery stenosis, Hb level after operation, score of LOTCA question?naire survey conducted before surgery,time of respirator and the time spend in ICU were significant predictive factors for POCD. However, multivariate logistic regression analysis showed that age, CAS and the time spend in ICU were independent risk factors for POCD, especially CAS(OR=5.078,95%CI:2.211-11.662, P<0.001). Patients with severe CAS suffer from a significant decline in cognitive function on space, time, action and ideation. Conclusion CAS is a predominant risk factor for POCD in patients undergoing OPCABG.

ObjectiveTo observe the effect of ultrashort waves combined with medication on children with cerebral dysfunction syndrome (CDS) accompanied with pneumonia.Methods76 children with CDS accompanied with pneumonia were randomly divided into treatment group (n=38, treated with anti-inflammatory and ultrashort waves one time per day for ten days) and control group (n=38, treated only with anti-inflammatory). The effective rate and the days of rales vanished of children in two groups after treatment were compared.ResultsIn the treatment group, 14 cases cured, 20 cases got significant result, 4 cases were effective, total effective rate was 100%; in the control group, 10 cases cured, 14 cases got significant result, 9 cases were effective, 5 cases were invalid, total effective rate was 86.8%. There was a significant difference between therapeutic effects of two groups ( P<0.05).ConclusionThe ultrashort waves therapy is an effective method for the children with CDS accompanied with pneumonia.

Objective To explore the matrix effect on cyclosporine A (CsA) test by fluorescence polarization immunoassay (FPIA) and enzyme-multiplied immunoassay technique (EMIT), explain the discrepancy of external quality control results between these two methods and find the corrective action.Methods One hundred whole blood samples with various concentrations were adopted and CsA levels were detected by FPIA and EMIT.The results were compared with each other.Moreover, the influence of residual metal ions upon immunoreactions was assessed by adding Cu2+ and Zn2+.The effect of non-whole blood matrix on extraction efficiency for quality control materials and CsA calibrator was evaluated by adding identical volume of Hb-rich reagents followed with re-extraction.Results There is good correlation between results measured with FPIA(X) and EMIT(Y) methods ( Y=0.926 8X -8.115,R2 =0.996 9).Neither FPIA nor EMIT was affected by residual metal ions ( P ＞ 0.05 ). Non-whole blood matrix decreased the extraction efficiency of two methods, but it could be corrected by supplementation of the Hb-rich reagents (≥30 g/L).Conclusions Non-whole blood matrix may be the main reason for the inconsistent results measured by FPIA and EMIT methods.It could be corrected by using Hb-rich reagents.In addition,we should consider the influence of low lib on CsA test,espocially for organ transplant patients with lower Hb ( ＜30 g/L).

ObjectiveTo evaluate the efficacy of sphenopalatine ganglion stimulation with acupuncture for moderate-to-severe perennial allergic rhinitis.MethodsA total of 50 patients were recruited into a sphenopalatine ganglion stimulation group and a routine acupuncture group according to order of presentation, with 25 in each group. The sphenopalatine ganglion stimulation group received sphenopalatine ganglion stimulation with filiform needle, 1-2 sessions/week for 4 weeks. The routine acupuncture group received traditional acupuncture, withyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the maln points, andyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the adjunct points, 1-2 points from both the maln and adjunct points in each session, 2 sessions/week for 4 weeks. The nasal symptom score (2004 version), the total nasal symptom score (TNSS) and the total non-nasal symptom score (TNNSS) were used to evaluate symptom improvement. The Rhinoconjunctivitis Quality of Life Questionnalre (RQLQ) was used to assess the patients’ quality of life. The time to symptom alleviation, duration of symptom alleviation in every session and the recurrence duration during 1 month after the treatment were compared between the two groups.Results After the treatment, the score of the nasal symptom score (99.74 ± 31.89vs.196.83 ± 31.22;t=-4.912,P=0.001), TNSS (33.63 ± 12.37vs.71.82 ± 19.21;t=-3.463,P=0.003), TNNSS (33.63 ± 12.37vs.71.82 ± 19.21,t=-3.463,P=0.003) in the sphenopalatine ganglion stimulation were significant lower than those in the routine acupuncture group. Compared with the routine acupuncture group, the time to symptom alleviation was significant shorter (13.85 ± 4.21 minvs.45.63 ± 7.87 min;t=-1.763,P=0.008), while the duration of symptom alleviation was significant longer (37.92 ± 9.94 hvs.3.35 ± 1.23 h;t=7.637,P<0.01) after each session in the sphenopalatine ganglion stimulation group. Four weeks after the treatment, RQLQ score in the sphenopalatine ganglion stimulation group was significant lower than that in the routine acupuncture group (8.48 ± 3.71vs.37.68 ± 12.46;F=-7.312,P<0.01). The recurrence duration during 1 month after the treatment in the sphenopalatine ganglion stimulation group was significant longer than that in the routine acupuncture group (4.12 ± 2.15 dvs.23.53 ± 4.63 d;t=-8.879,P=0.003).ConclusionSphenopalatine Ganglion stimulation is superior to routine acupuncture in treatment of patients with moderate-to-severe perennial allergic rhinitis.

Objective:To discuss the problems that exist in the operation mechanism of the third -party media-tion mode of medical disputes in China and put forward suggestions for improvement , through comparative study of the third-party mediation mode of domestic and foreign medical disputes .Results:People's mediation mechanism of medical disputes in our country still hadsome problems .For example , mediation talents were insufficient;propa-ganda was inadequate;mediation results were difficult to implement;mediation support funds couldn ' t be guaran-teed, and so on.Conclusion:It is recommended to improve the remuneration of employees and standardize the staff selection system;increase propaganda and raise public awareness;improve the judicial confirmation system and en-hance the guarantee of agreement;save regulation cost and increase multi -financing channels .

Objective:To investigate the feasibility of coronary CT angiography(CCTA)-feature tracking(FT) for assessing global and regional myocardial strain in patients with heart failure(HF).Methods:From July 2019 to December 2020, twenty-five patients diagnosed with HF from Peking Union Medical College Hospital were prospectively enrolled into the study. All patients underwent retrospective electrocardiogram-gated CCTA and cardiac MR (CMR) imaging within 7 days. CCTA-FT and CMR-FT were undertaken using cvi 42 dedicated commercial software to measure global and regional strain parameters, including global peak radial strain (GPRS), global peak circumferential strain (GPCS) and global peak longitudinal strain (GPLS), as well as peak radial strain (PRS), peak circumferential strain (PCS) and peak longitudinal strain (PLS) of left ventricular basal segment, middle segment and apical segment. Conventional left ventricular functional parameters were also calculated, including left ventricular ejection fraction (LVEF), left ventricular stroke volume (LVSV) and left ventricular mass index (LVMI). Paired t test or Wilcoxon signed-rank test was used to compare the differences of measurements between CCTA group and CMR group. Pearson or Spearman correlation analysis was used to analyze the correlation between the two groups. Inter-and intra-observer consistence in CCTA group was evaluated by intraclass correlation coefficient (ICC) analysis. Results:The effective radiation dose of CCTA examination was 6.00 (4.86,7.63) mSv. Inter-and intra-observer consistence in CCTA group was excellent, and the ICC value was 0.85-0.98. In the overall strain parameters, GPCS in CCTA group[-8.10%(-10.32%, -5.20%)] was significantly lower than that of CMR group[-8.49%(-13.79%, -5.95%)] ( Z=-2.15, P=0.031). There was no significant difference in GPRS and GPRS between the two measurement methods ( P>0.05). Strong correlations were observed between GPRS, GPCS and GPLS ( r=0.65, 0.63, 0.71,all P<0.001). For local strain parameters, PCS in the middle segment and apical segment of CCTA group were lower than those of CMR group ( Z=-2.17, -2.62, all P<0.05). There were no significant differences in PCS of basal segment, PRS and PLS of all segments between groups (all P>0.05). The PCS and PLS of basal segment, PRS of middle segment and PRS of apical segment were moderately correlated ( r=0.46, 0.52, 0.58, 0.53, P<0.05); The other local strain parameters were strongly correlated, the range of r value was from 0.64 to 0.70 (all P<0.001). For left ventricular functional parameters, LVEF, LVSV and LVMI showed no significant differences between groups ( P>0.05), and the correlation was extremely strong ( r=0.90, 0.89, 0.96, all P<0.001). Conclusions:The repeatability of CCTA-FT technique in measuring myocardial strain was good, and the correlation of parameters measured by CCTA-FT technique and CMR-FT technique was excellent. Therefore, CCTA-FT technique can be used as a new noninvasive and simple method to evaluate myocardial motor function.

Depressive disorder ranks as a major bur-den of disease worldwide,yet the current antidepressant medications are limited by frequent non-responsiveness and significant side effects.The lateral septum(LS)is thought to control of depression,however,the cellular and circuit substrates are largely unknown.Here,we identified a subpopulation of LS GABAergic adenosine A2A receptors(A2AR)-positive neurons mediating depres-sive symptoms via direct projects to the lateral habenula(LHb)and the dorsomedial hypothalamus(DMH).Activa-tion of A2AR in the LS augmented the spiking frequency of A2AR-positive neurons leading to a decreased activation of surrounding neurons and the bi-directional manipula-tion of LS-A2AR activity demonstrated that LS-A2ARs are necessary and sufficient to trigger depressive pheno-types.Thus,the optogenetic modulation(stimulation or inhibition)of LS-A2AR-positive neuronal activity or LS-A2AR-positive neurons projection terminals to the LHb or DMH,phenocopied depressive behaviors.Moreover,A2AR are upregulated in the LS in two male mouse mod-els of repeated stress-induced depression.This identifica-tion that aberrantly increased A2AR signaling in the LS is a critical upstream regulator of repeated stress-induced depressive-like behaviors provides a neurophysiological and circuit-based justification of the antidepressant poten-tial of A2AR antagonists,prompting their clinical transla-tion.

Objective:To explore the feasibility in evaluating segmental extracellular volume (ECV) using dual-layer spectral detector CT in patients with heart failure with various percentages of delayed hyper-enhanced volume, using MRI as a reference.Methods:Twenty-seven patients with heart failure in Peking Union Medical College Hospital were prospectively enrolled in this study from July 2019 to January 2021. All the patients underwent both CT late iodine enhancement and MR late gadolinium enhancement imaging within a week. According to percentages of hyper-enhanced volume on cardiac MR image, myocardial segments were classified into 3 groups: 0-4% (group A), 5%-49% (group B) and 50%-100% (group C). ECV images were independently observed by 2 experienced radiologists. The correlation and agreement between CT-ECV and MRI-ECV for the whole myocardial assessment and for the segmental assessment were evaluated using Spearman correlation and Bland-Altman analysis. Inter-observer agreement was assessed using the ICC.Results:Of the 27 patients, 432 segments were analyzed, with 199 segments in group A, 151 segments in group B and 82 segments in group C. In the whole myocardial analysis, the CT-ECV and MRI-ECV were 32.25% (28.04%, 34.28%) and 32.27% (28.35%, 34.77%), respectively. A good correlation was found between CT-ECV and MRI-ECV ( r=0.969, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias (0.4%), with 95% limits of agreement of -6.9% to 7.8%. as for the segmental myocardial assessment, the CT-ECV was 28.23% (26.18%, 29.92%) for group A, 33.29% (30.16%, 35.96%) for group B and 40.22% (34.06%, 46.70%) for group C. There was statistically significant difference in ECV among three groups (all P<0.001). Good correlations between CT-ECV and MRI-ECV were found in group A ( r=0.614, P<0.001), group B ( r=0.852, P<0.001) and group C ( r=0.953, P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias 2.0% (95% limits of agreement:-17.6%-21.6%) in group A, a small bias -0.4% (95% limits of agreement: -13.8%-12.9%) in group B and a small bias -1.8% (95% limits of agreement: -17.4%-13.9%) in group C. The ICC values between 2 observers were 0.877 and 0.945 on CT-ECV and MRI-ECV, respectively. Conclusions:The larger percentage of hyper-enhanced volume on cardiac MR image, the stronger correlation are between the CT-ECV and MRI-ECV. CT-ECV may be taken as an alternative tool for quantitative evaluation of myocardial tissue in patients with heart failure.

Objective:To evaluate the feasibility of high concentrated contrast media combined with monochromatic images to improve image quality with double low scanning in dual-layer spectral coronary CT angiography.Methods:Fifty-six patients with suspected coronary artery disease were enrolled and randomly separated into two groups. All patients were scanned at 120 kVp in step-and-shoot mode using a dual-layer detector CT (IQon spectral CT). Patients were either injected with 18 ml high concentration contrast medium(400 mgl/ml) at 2 ml/s (group A) or 45 ml contrast medium (370 mgl/ml) at 4 ml/s (group B). Forty to 80 keV monoenergetic images with 10 keV increment and conventional image (group A2) were reconstructed for group A, conventional poly-energetic image was reconstructed for group B. Region of interest was placed on aorta root (AO), middle segment of left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) to measure the attenuation and noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality was assessed by two reviewers independently with a 4-point scale on image quality (1-undiagnostic,4-excellent). The objective and subjective image evaluation were compared using the Kruskal-Wallis test. The Steel Dwass was used for multiple comparisons between monoenergetic images in Group A and conventional images in Group B, after the Kruskal-Wallis test.Results:There were significant differences among the attenuation, noise, SNR and CNR of group B, group A2, and monoenergetic images(all P<0.001).The CT value in the aortic root was significantly higher at 40-50 keV monoenergetic images than that in group B(all P<0.05), and similarly, the CT value in LAD,LCX and RCA at 40 keV were superior than that in group B(all P<0.001). There was no significant difference in the noise of the aortic root among 40 keV image, group A2 and group B(all P>0.05),while the noise in the 50-80 keV monoenergetic images were significantly lower than that in Group B(all P<0.001). The SNR and CNR in the aortic root were significantly higher at 40-60 keV monoenergetic images than that in group B(all P<0.001).The SNR in LAD and RCA at 40，50 keV and the CNR in LAD and RCA at 40-60 keV were higher than that in group B(all P<0.01).The SNR at 40-60 keV and CNR at 40-70 keV in LCX were superior than that in group B(all P<0.05). There were significant differences among the subjective image quality score of group B, group A2, and monoenergetic images(all P<0.001).The subjective image quality score of 40，50 keV images were not significantly different from that in group B (all P>0.05),while the score in 60-80 keV image and group A2 were lower than that of Group B(all P<0.001). Conclusion:40，50 keV low monochromatic images derived from dual-layer spectral detect CT combined with high concentrated contrast media can provide comparable or superior image quality with double low scanning in CCTA study.

OBJECTIVE To explore the effects of Citrus medica before and after being steamed on blood metabolism and dryness indexes in rats. METHODS Twenty-four SD rats were randomly divided into blank group， C. medica group （2.4 g/kg）， processed C. medica group （2.4 g/kg）， Citrus aurantium group （positive control， 1.2 g/kg）， with 6 rats in each group. After 5 weeks of continuous administration， the body weight， food intake， water intake and urine volume were observed dynamically. The content of aquaporin 3 （AQP3） in serum was detected. The metabolic profile of rat serum samples was analyzed by liquid chromatography-mass spectrometry. Principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） were used to screen differential metabolites， and screened differential metabolites were mapped to the KEGG database for pathway analysis. RESULTS The body weight of rats in each group increased slowly； the food intake and water intake of processed C. medica group tended to be higher than those in C. medica group and C. aurantium group， but there was no significant difference among those groups （P＞0.05）. On the 21st day of administration， compared with C. aurantium group， the urine volume of processed C. medica group was significantly increased （P＜0.05）， the serum AQP3 content of processed C. medica group was significantly decreased （P＜0.05）， and were close to those of blank group. According to the metabonomic study， C. medica mainly affected the lipids metabolism， and processed C. medica mainly affected the amino acid metabolism. The differential metabolites pathway between C. medica and processed C. medica involved the metabolism of cysteine and methionine， metabolism of glycine， serine and threonine， and metabolism of taurine and hypotaurine. CONCLUSIONS Processed C. medica might relieve the dryness of C. medica by affecting adenosine phosphate-protein kinase A. The content of AQP3 in serum can be used as the 52 evaluation index for the dryness of C. medica before and after processing. The effects of C. medica and processed C. medica on endogenous metabolites in rat serum are quite different，especially in the aspect of lipid metabolism.