Background:CT portography(CTP)permits comprehensive evaluation of portal vein and its collateral pathways. It is widely used for assessment of portal hypertension in clinical practice. Aims:To assess the value of CTP in esophagogastric varices in cirrhotic patients. Methods:A retrospective cohort study was performed in 143 cirrhotic patients admitted from Jan. 2013 to Sep. 2015 at the Affiliated Hospital of Qingdao University. All patients fulfilled the inclusion criteria and underwent CTP and gastroscopy within 7 days after admission. According to the occurrence of gastrointestinal bleeding at admission,patients were allocated into two groups:bleeding group( n = 70 ) and non-bleeding group( n = 73 ). Consistency of the results of CTP and gastroscopy was analyzed by kappa coefficient;the accuracy of CTP parameters, including diameters of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)for prediction of variceal bleeding was evaluated by ROC curve. Results:CTP and gastroscopy had a good consistency in typing and grading of esophagogastric varices,with the kappa value of 0. 793 and 0. 775,respectively. The diameters of MPV,SPV and LGV were significantly higher in bleeding group than in non-bleeding group(P < 0. 01),and their area under the ROC curve (AUC)in predicting variceal bleeding was 0. 741,0. 627 and 0. 816,respectively. The accuracy of diameter of LGV was superior to that of MPV and SPV. With the cutoff value of 6. 1 mm,the sensitivity and specificity of diameter of LGV were 65. 71% and 84. 93% ,respectively. With the cutoff value of 16. 3 mm,the sensitivity of diameter of MPV was 75. 71% , which was higher than that of LGV and SPV. Conclusions:CTP can be used in clinical diagnosis of esophagogastric varices in cirrhotic patients,and two CTP parameters,the diameters of LGV and MPV,might be helpful for prediction of variceal bleeding.

Objective:To investigate the effect of 12(S)-HETE on the p27~(kip1) expression in mesangial cells and glomeruli.Methods:Mesangial cells were exposed to 12(S)-HETE.12(S)-HETE was infused to rats by osmotic mini-pump.Total protein content measurement for cell hypertrophy,RT-PCR for mRNA expression and Western blot for protein expression were performed respectively.Results:12(S)-HETE stimulation induced mesangial cell hypertrophy and p27~(kip1) protein expression,but not p27~(kip1) mRNA expression.Furthermore,p27~(kip1) mRNA and protein expression in the glomeruli were significantly increased by 12(S)-HETE stimulation using osmotic mini-pump.Conclusion:12(S)-HETE plays an important role in the pathogenesis of glomerular cell hypertrophy and senescence through upregulation of p27~(kip1) expression.

Objective To investigate the effect of 12-lipoxygenase(12-LO) on the p27Kip1 expression in diabetic glomeruli. Methods Mesangial cells were exposed to 12-LO product 12 (S)-HETE (10-7 mmol/L) with or without p38 MAPK (p38) inhibitor (SB203580, 1 μmol/L) for 24 hours. Rats fed with high fat diet received low dose streptozotoein (ST-Z, 35 mg/kg, IP injection) to develop type 2 diabetes and were divided into 2 groups: low dose STZ, low dose STZ+12-LO inhibitor cinnamyl-3,4-dihydroxy-α-cynanocinnamate (CDC, 8 mg/kg) treatment. Rats fed with regular chow were divided into two groups: controls, CDC treatment. The rats received injection of CDC or vehicle subcutaneously in the hind leg. CDC or vehicle injection was performed three times weekly on alternate days. All the rats were sacrificed after 4 weeks, Wild type and 12-LO knockout C57BL/6 mice were divided into 4 groups: wild type control, 12-LO knockout, STZ-induced wild type type 1 diabetes and STZ-induced 12-LO knockout type 1 diabetes. All the mice were sacrificed after 16 weeks. Urine, blood, kidney cortical tissue and isolated glomeruli by sieving method were collected at the end of study respectively. Western blot and immunohistochemistry for target protein were performed respectively. Results Inhibition of p38 activation could significantly reduce p27Kip1 expression induced by 12 (S)-HETE in mesangial cells (P<0.01). Increased glomerular volume, microalbuminuria, elevated glomeluli p38 activation, p27Kip1 expresssion in type 2 diabetic glomeruli was decreased after CDC treatment (P<0.01). Compared with wild type diabetic mice, glomerular p38 activation, p27Kip1 exprcsssion and extracellular matrix accumulation in the 12-LO knockout diabetic mice were significantly decreased (P <0.01, respectively). Conclusions 12-LO induces p27kipl expression via p38 pathway in diabetic glomeruli.

Objective:To study the effects of hypertensive disorders of pregnancy (HDP) on the birth weight (BW) differences in twins.Method:From January 2011 to January 2020, twins delivered in our hospital were retrospectively analyzed. The twins born to HDP mothers were the HDP group and those born to healthy mothers were the control group. The maternal and neonatal data of the two groups were collected and the effects of HDP on the BW differences were analyzed.Result:The age of the mothers, the proportion of mothers of older ages and more-than-once delivery in HDP group (418 cases) were significantly higher than the control group (499 cases) [(31.4±5.3) years vs. (30.4±3.8) years, 26.6% (111/418) vs. 12.6% (63/499), 20.6% (86/418) vs. (15.0% (75/499)] ( P<0.05). The gestational age (GA) of newborns in the HDP group (836 cases) was significantly lower than the control group (998 cases) [(35.1±2.2) weeks vs. (36.7±1.2)]( P<0.05). The proportion of twins with GA <34 weeks in the HDP groups was significantly higher than the control group [24.2% (101/418) vs. 3.8% (19/499)] ( P<0.05). Cesarean section was the main delivery mode in both groups. The BW differences of the twins in the HDP group were larger than the control group [22.4% (9.1%, 31.9%) vs. 13.1% (5.8%, 19.6%)]. Significantly more twins in the HDP group showed ≥30% BW difference than the control group [28.7% (120/418) vs. 3.8% (19/499)] ( P<0.05). The incidences of BW discordant in twins (BWDT) in the HDP group was significantly higher than the control group [BWDT≥15%:61.5% (257/418) vs. 38.3% (191/499), BWDT≥20%: 51.4% (215/418) vs. 25.3% (126/499)] ( P<0.05).Among twins with GA of 34~37 weeks, the BW of the bigger infants and the smaller infants in the HDP group were all lower than the control group and the percentage of BW difference was significantly higher than the control group ( P<0.05). Conclusion:HDP may influence the intrauterine growth of the twins, aggravate the BW differences and increase the incidences of BWDT. It is necessary to make better prenatal management of HDP and closely monitor the intrauterine growth of the fetuses.

Objective To explore the effect of the intervention of clinical pharmacists on the rational use of piperacillin-tazobactam by using PDCA cycle, in order to provide reference for rational drug use. Methods The problems of piperacillin-tazobactam in our hospital was analyzed. PDCA cycle was used to manage the problems. Then, the data before and after PDCA cycle was compared and analyzed. Results After using PDCA cycle, the irrational use rate of piperacillin-tazobactam gradually decreased, from 9% in February 2018 to 2% in February 2019; the doses decreased from 4380 in February 2018 to 3346 in February 2019; and the frequency of usage decreased from 391 DDDs in February 2018 to 298 DDDs in February 2019. The effectiveness and continuous improvement of PDCA cycle in managing piperacillin-tazobactam were significant. Conclusion PDCA cycle can effectively improve the management effectiveness of piperacillin-tazobactam administration.