Objective To assess the efficacy of diffusion weighted imaging( DWI) with Magnetic Reso-nance Imaging to predict the T-staging in rectal cancer.Methods One hundred and seven cases confirmed by pathology of rectal adenocarcinoma patients were retrospectively analyzed.T-staging was determined by MRI and DWI combined with MRI.All the patients were underwent surgery within one week after MRI.We compared the results with the pathological T-staging after surgery,and compared the two methods of the preoperative T-stag-ing rectal cancer diagnosis accuracy.Results The accurate rates for T-staging of rectal cancer using MRI was 84.11%(90/107) .There was a correlation between the result of preoperative MRI and postoperative pathological T-staging(kappa=0.652,P<0.001);The accurate rates for T-staging of rectal cancer using combined MRI with DWI was 90.65%(97/107).There was a better correlation between the result of MRI with DWI and postop-erative pathological T-staging(kappa=0.732,P<0.001).Conclusion Compared with the conventional MRI sequences,the accuracy of MRI combined with DWI for diagnosis of T-staging in rectal carcinoma is higher.It can provide a more reasonable treatment.

Copeptin is a part of the C-terminal pro-arginine vasopressin. It is correlated with the prognosis of various diseases. Recent studies have found that copeptin is a novel,independent prognostic marker for stroke, and it may improve the existing risk stratification scheme of stroke.

Objective To explore the effect of glial cells on cerebral neuron damage induced by amyloid beta protein (Aβ) in Alzheimer′s disease rat .Methods 20 male Wistar rats were randomly divided into the control group and the model group ,10 cases in each group The gel state Aβ(10μg) was injected into the rat′s bilateral hippocampus in the model group ,while the control group was injected with normal saline ;the Morris water maze test was performed to assess the rat′s learning and memory ability ;the thio‐nine stain was used for observing the morphology and quantity of cerebral cortex neurons ;the enzyme linked immunosorbent assay (ELISA) was adopted to detect the serum tumor necrosis factor alpha (TNF‐α) and interleukin 1 beta(IL‐1β) levels ;the immuno‐histochemical was used to detect the expression of glial cell and glial fibrillary acidic protein (GFAP) .Results The various indexes in the model group were significantly lower than those in the control group(P<0 .05);the quantity of cerebral cortex neurons in the model group was significantly decreased compared with that in the control group (P<0 .01);the ELISA results showed that the lev‐els of TNF‐αand IL‐1βin the model group were significantly higher than those in the control group(P<0 .05);the immunohisto‐chemistry showed that the number of GFAP positive cells in the hippocampus in the model group was significantly more than that in the control group(P<0 .05) .Conclusion Aβmight activate the glial cells and promote the release of inflammatory cytokines ,which causes the damage of rat cerebral neurons and leads to decrease the rat′s learning and memory ability .

Objective To discuss the compatibility and current situation of social support and the influencing factors of nursing undergraduate students. Methods The university student compatible meter and the the social support meter were used to investigate 394 nursing undergraduate students and the re-sult underwent analysis. Results (1)The difference existed in compatibility and social support in un-dergraduate students of different grades. (2)The compatibility of students was correlated with the physical state and the properties of their high school. (3)The social support of the undergraduate students was cor-related with the disposition and the relations with their family. Conclusions The nursing undergraduate students have different compatibility and social support, which were influenced by many factors.Education managers should improve the compatibility and social support of them by adopting selective measures.

Objective To investigate the effect of Epimedium flavanoids (EF) on neuro-inflammatory reaction in Alzheimer disease (AD) mice model.Methods β-amyloid1-40 (Aβ1-40) was injected to the right lateral ventricle of 2-month-old male ICR mice to induce AD model. Morris water maze and step-through tests were used to measure the learning and memory ability of mice. The concentrations of interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α) in the hippocampus were determined by radioimmunoassay. The expression of glial fibrillary acidic protein (GFAP) positive cells (astrocytes) was detected by immunochemistry staining.Results Compared with the sham-operation group, the learning and memory ability decreased (P<0.05, P<0.01), the concentrations of IL-1β and TNF-α in the hippocampus increased (P<0.01) and the expression of astrocytes in the hippocampus elevated (P<0.05) in Aβ1-40 injection model mice. Intragastric administration of EF (100 and 300 mg/kg) for 3 weeks significantly improved the learning and memory ability (P<0.05, P<0.01), decreased IL-1β and TNF-α concentrations in the hippocampus (P<0.05, P<0.01) and inhibited the expression of astrocytes in the hippocampus (P<0.05), compared with Aβ1-40 injection model mice.Conclusion EF can decrease the inflammatory reaction in the brain of mice induced by Aβ.

Objective To investigate the effects of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis.Methods A prospective single-blind randomized controlled trial was conducted.60 septic patients were divided into three groups with the method of random number table,20 cases in the control group,20 in the Chinese herb group,and 20 in corticoid group.All of them received routine treatment.Patients in Chinese herb group were given Sini decoction in addition (decoction of monkshood 15 g,dried ginger 15 g,honey-fried licorice 10 g) 100 mL/d orally or by nasal feeding,while patients in corticoid group were given hydrocortisone 200 mg/d intravenously instead,both for 7 days.Before the treatment,3 days and 14 days after treatment,blood was collected to determine the levels of adrenocorticotropic hormone (ACTH) and cortisol,and the result of ACTH stimulating test was observed.At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was recorded,and 3-day shock recovery rate and 28-day death rate were also compared among these groups.Results None of the three groups showed different result in ACTH stimulating test (x2=1.101,P=0.605).ACTH in three groups was gradually decreased.Compared with that before treatment,ACTH in Chinese herb group and corticoid groups began to decrease obviously on day 3 (ng/L:29.90 ± 3.31 vs.33.10 ±.3.31,28.20 ±.2.45 vs.33.30 ± 3.84,both P＜0.01),while in control group declined ACTH appeared later (on day 14) compared with before treatment (ng/L:29.40 ±5.63 vs.33.50 ±4.89,P＜0.05).No obvious difference in ACTH level was showed between the Chinese herb group and the cortical group (both P＞0.05).Cortisol level in both Chinese herb and cortical groups showed a raise-fall biphase trend while there was no change in the control.The cortical levels on day 3 in Chinese herb and cortical groups were much higher than that before treatment (μg/L:343.04 ± 31.20 vs.294.70 ±42.10,331.25 ±42.80 vs.280.36 ± 38.10,both P＜0.01) and that of control group (μg/L:291.61 ± 41.50,both P＜0.01),though no significant statistical difference was observed between two groups (both P＞0.05).APACHE Ⅱ score on day 14 in control,Chinese herb and cortical groups was significantly lower than that before treatment (16.8 ± 5.1 vs.20.1 ± 4.3,13.4 ± 3.2 vs.18.3 ± 3.8,15.1 ± 2.5 vs.19.5 ± 4.0,all P＜0.01),and the score was much lower in Chinese herb group comparing with that of control group (P＜0.05).No statistical difference was observed among control,Chinese herb and cortical groups in lowering 28-day death rate [35.0％ (7/20),25.0％ (5/20),20.0％ (4/20)] and improving 3-day shock recovery rate [40.0％ (8/20),70.0％ (14/20),60.0％ (12/20),all P＞0.05].Conclusions Sini decoction could elevate cortisol while lower ACTH at the early stage of sepsis.Sini decoction could also effectively improve symptoms and hypothalamic-pituitary-adrenal axis function in septic patients without affecting death rate.

Inflammasomes are a group of multiprotein complexes in cells that could be activated when they perceive external microbial invasions and intrinsic aseptic stress signals. However, the activation of inflammasomes and the association between their structures and functions have not been elucidated. New progress has been made in the study of the structure and activation mechanism of NLRC4 inflammasome, which helps to fill the gaps. NLRC4 inflammasome plays an important role in systemic inflammation and programmed cell death, which provides important clues for the study of NLRC4-related inflammatory diseases including metabolic diseases, tumors and autoimmune diseases.

Objective:To investigate the clinical efficacy of Da Vinci robotic assisted and laparos-copic assisted complete mesocolic excision (CME) for right hemicolon cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatho-logical data of 119 patients with right hemicolon cancer who were admitted to Daping Hospital, Army Medical University from July 2016 to July 2019 were collected. There were 63 males and 56 females, aged (61±11)years. All the 119 patients underwent CME of right hemicolon. Of 119 patients, 37 cases undergoing Da Vinci robotic assisted CME of right hemicolon were divided into robotic group and 82 cases undergoing laparoscopic assisted CME of right hemicolon were divided into laparoscopic group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2)intraoperative and postoperative situations; (3) postoperative pathological examination; (4)follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect tumor metastasis and survival of patients after surgery up to August 2019. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rate and the GraphPad Prism 5 software was used to draw survival curve. The Log-rank test was used for survival analysis. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 68 of 119 patients had successful matching, including 34 cases in each group. Before propensity score matching, cases undergoing surgery by surgeon A or surgeon B were 32, 5 of the robotic group, versus 49, 33 of the laparoscopic group, showing a significant difference between the two groups ( χ2=8.381, P<0.05). After propensity score matching, the gender (males or females), age, body mass index (BMI), cases with tumor classified as stageⅠ, stage Ⅱ or stage Ⅲ of TNM staging, cases with tumor located at ileocecal region, ascending colon, hepatic flexor of colon or transverse colon, cases undergoing surgery by surgeon A or surgeon B were 17, 17, (62±10)years, (22.4±2.7)kg/m 2, 4, 14, 16, 3, 15, 10, 6, 29, 5 of the robotic group, versus 15, 19, (62±11)years, (22.4±2.8)kg/m 2, 4, 18, 12, 2, 19, 7, 6, 30, 4 of the laparoscopic group, showing no significant difference between the two groups ( χ2=0.236, t=0.127, 0.044, χ2=1.071, 1.200, 0.000, P>0.05). (2) Intraoperative and postoperative situations: after propensity score matching, the operation time, volume of intraoperative blood loss, cases undergoing conversion to open surgery, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay and treatment expenses were (235±50)minutes, (73±45)mL, 0, (1.9±0.7)days, (2.9±1.2)days, (3.1±2.4)days, (9.1±4.9)days, (9.6±1.8)×10 4 yuan of the robotic group, versus (183±35)minutes, (74±74)mL, 1, (2.1±0.6)days, (3.3±1.4)days, (3.5±4.2)days, (9.1±3.9)days, (6.3±1.6)×10 4 yuan of the laparoscopic group, respectively. There were significant differences in the operation time and treatment expenses between the two groups ( t=5.050, 8.165, P<0.05) while there was no significant difference in the volume of intraoperative blood loss, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake or duration of postoperative hospital stay between the two groups ( t=0.118, ?0.462, ?1.129, ?1.291, 0.027, P>0.05). There was no significant difference in the conversion to open surgery between the two groups ( P>0.05). Five patients of the robotic group and 7 patients of the laparoscopic group had postoperative complications. There was no significant difference in the postoperative complications between the two groups ( χ2=0.405, P>0.05). (3) Postoperative pathological examination: after propensity score matching, cases with R 0 resection, the number of lymph node dissected, cases with lymph node metastasis and cases with tumor differentiation as well differentiated adenocarcinoma, moderately differentiated adeno-carcinoma, poorly differentiated adenocarcinoma or mucinous adenocarcinoma were 34, 17±5, 14, 1, 22, 6, 5 of the robotic group, versus 34, 17±5, 12, 2,20, 2, 10 of the laparoscopic group, respectively. There was no significant difference in the R 0 resection between the two groups ( P>0.05) and there was no significant difference in the number of lymph node dissected, lymph node metastasis and tumor differentiation between the two groups ( t=0.488, χ2=0.249, 4.095, P>0.05). (4) Follow-up: after propensity score matching, 68 patients were followed up for 1?36 months, with a median follow-up time of 24 months. The follow-up time was (20±13)months of the robotic group, versus (21±13)months of the laparoscopic group, showing no significant difference between the two groups ( t=0.409, P>0.05). During the follow-up, 3 cases of the robotic group and 4 cases of the laparoscopic group had tumor distant metastasis. The disease-free survival rate and overall survival rate at postoperative 3 years were 83.9% and 86.8% of the robotic group, versus 82.0% and 86.6% of the laparoscopic group, showing no significant difference between the two groups ( χ2=0.188, 0.193, P>0.05). Conclusion:Da Vinci robotic assisted CME for right hemicolon cancer is safe and feasible.

Objective:To investigate the effect of irisin on pyroptosis in rats with ventilator-induced lung injury.Methods:Thirty-six healthy clean-grade male Sprague-Dawley rats, weighing 200-250 g, aged 6-8 weeks, were divided into 3 groups ( n=12 each) using a random number table method: control group (group C), ventilator-induced lung injury group (group V) and ventilator-induced lung injury plus irisin group (group V+ I). In group V+ I, irisin 1 μg/kg was injected via the tail vein before mechanical ventilation.The animals were mechanically ventilated (tidal volume of 40 ml/kg, respiratory rate 60 breaths/min, inspiratory/expiratory ratio 1∶2, positive end expiratory pressure 0 and inspired oxygen fraction ratio 21%.Blood samples were then taken from the femoral artery for blood gas analysis, and PaO 2 was recorded.Bronchoalveolar lavage fluid (BALF) was collected, the total protein concentrations in BALF were measured, and the concentrations of BALF and serum interleukin-1β (IL-1β) and IL-18 were measure by enzyme-linked immunosorbent assay.The lung tissues were obtained for determination of the pathological changes after HE staining which were scored, wet to dry weight (W/D) ratio, expression of pyroptosis-related proteins N-terminal gasdermin D (GSDMD-N) and caspase-1 protein and mRNA (by Western blot or using real-time polymerase chain reaction). Results:Compared with group C, the lung injury score and W/D ratio were significantly increased, PaO 2 and OI were decreased, the total protein concentrations in BALF, concentrations of IL-1β and IL-18 in BALF and serum were increased, and the expression of caspase-1 and GSDMD-N protein and mRNA was up-regulated in group V ( P<0.01). Compared with group V, the lung injury score and W/D ratio were significantly decreased, PaO 2 and OI were increased, the total protein concentrations in BALF, concentrations of serum IL-1β and IL-18 in BALF and serum were decreased, and the expression of caspase-1 and GSDMD-N protein and mRNA was down-regulated in group V+ I ( P<0.01). Conclusion:The mechanism by which irisin reduces ventilator-induced lung injury is probably related to inhibiting pyroptosis in rats.

Objective To evaluate the efficacy of oxycodone combined with thoracic paravertebral block ( TPVB) for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass grafting ( MIDCABG) . Methods Thirty-two American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes, aged 60-75 yr, weighing 50-85 kg, scheduled for elective MIDCABG un-der general anesthesia, were divided into 2 groups ( n=16 each) using a random number table method:morphine plus TPVB group ( group MT) and oxycodone plus TPVB group ( group OT) . Paravertebral cathe-ter was placed at T4,5 before induction of anesthesia to perform left thoracic paravertebral puncture, patients were tracheally intubated, and 0. 375％ ropivacaine 15 ml was injected followed by continuous infusion of 0. 375％ ropivacaine 5 ml∕h until 0. 5 h before the end of surgery. Both groups received patient-controlled analgesia ( PCA) after surgery. The PCA solution contained 1 mg∕ml morphine 60 ml in group MT or 1 mg∕ml oxycodone 60 ml in group OT, and the PCA pump was set up to deliver a 1 mg bolus dose with a 10-min lockout interval and background infusion at 1 ml∕h after a loading dose of 2 mg, with the maximum dose of 20 mg every 4 h. Pethidine 50 mg was intravenously injected as a rescue analgesic to maintain visual ana-log scale≤4. The intraoperative consumption of fentanyl, consumption of analgesics for PCA within 48 h after surgery, ratio of total to effective pressing times of PCA, consumption of analgesics for rescue analge-sia, requirement for rescue analgesia, score of satisfactory analgesia, extubation time, duration of inten-sive care unit stay and length of hospital stay were recorded. The development of nausea and vomiting, pru-ritus, respiratory depression, atelectasis and somnolence was recorded within 72 h after surgery. Results Compared with group MT, the intraoperative consumption of fentanyl, consumption of analgesics for PCA, consumption of analgesics for rescue analgesia, requirement for rescue analgesia and ratio of total to effec-tive pressing times of PCA were significantly decreased, the score of satisfactory analgesia was increased, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting, pruritus, respiratory depression and somnolence was decreased in group OT (P<0. 05). Con-clusion Oxycodone combined with TPVB provides safe and effective efficacy for postoperative analgesia in patients undergoing MIDCABG.