ObjectiveTo establish a surface location method and acupuncture manipulation standard by dissecting the local structure of rat point Renying(ST9)and make a validation through the hypotensive effect of acupuncture.MethodA Wistar rat was sacrificed and fixed by cryogenic freezing. According the anatomical characteristics of human point Renying, cervical point Renying region was dissected layer by layer, and the common carotid artery, the internal carotid artery and the external carotid artery were bluntly separated. Location and measurement were made using vernier calipers and digital photographs were taken. Body surface location and acupuncture point depth were statistically analyzed to establish acupuncture manipulation standards. Point Renying and a non-acupoint were separately acupunctured to treat rat spontaneous hypertension. The changing tendency of blood pressure was statistically analyzed after four weeks.ResultAccording to the 95% reference value range, the surface location of rat point Renying was determined to be (8±0.3)mm below a line connecting bilateral mandibular angles and (5.5±0.4)mm lateral to the anterior midline, one on each side. Acupuncture manipulation standards were perpendicular insertion (5.5±0.4)mm and cautious lifting and thrusting to avoid injuring the artery. Acupuncture at point Renying had a marked hypotensive effect as compared with a non-acupoint (P<0.05).ConclusionThe surface location of rat point Renying is reliable and can be applied to animal experimental study.

0.05), after treatment all the indexes in the 2 groups were decreased(P

Objective To evaluate the value of annular calcification in CT in the diagnosis and differential diagnosis for benign and malignant thyroid nodules.Methods CT findings of 67 nodules in 67 patients pathologically diagnosed with annular calcifications were retrospectively analyzed to identify 49 benign nodules and 18 malignant nodules.The interior or boundaries of annular calcification before and after contrast-enhancement were compared,and the degree of enhancements of both interior annular calcification and thyroid tissues were observed.After contrast-enhancement,the numbers of lesions showing clearer boundaries and higher degree of enhancement were summarized.Statistic analysis was conducted by using x2 test.Results Among 67 nodules with annular calcifications,clearer boundaries after contrast-enhancement were observed in 61.2％ (30/49) benign nodules and 16.7％ (3/18) malignant nodules,showing significant statistical difference (x2 =10.457,P ＜ 0.05).The sensitivity and specificity of clearer edge after contrast-enhancement for benign nodules were 61.2％ (30/49) and 83.3％ (15/18) respectively.Higher degree of enhancement were observed in 16.3％ (8/49) in benign nodules and 0(0/18) malignant nodules,showing no significant statistical difference (x2 =3.337,P ＞ 0.05).The sensitivity and specificity of higher degree of enhancement for benign nodules were 16.3％ (8/49) and 100.0％ (18/18) respectively.The combination of clearer boundaries and higher degree of enhancement after contrast-enhancement was observed in 77.6％ (38/49) benign nodules and 16.7％ (3/18) malignant nodules,showing significant statistical difference (x2 =20.549,P ＜ 0.05).Meanwhile,the sensitivity and specificity of such combination for benign nodules were 77.6％ (38/49) and 83.3％ (15/18) respectively.Conclusions CT is important in the diagnosis of thyroid nodules with annular calcification.Clearer boundary after contrast-enhancement and its combination with higher degree of enhancement are helpful for the diagnosis of benign nodules.Boundaries that similar to or more obscure than that of plain scan indicate malignant nodules.

Objective To assess the value of CT hyperenhancement sign in diagnosis and differential diagnosis of benign and malignant thyroid nodules.Methods CT findings of 2926 nodules in 1676 patients were retrospectively analyzed,among which 2174 nodules were benign and 752 nodules were malignant.All the patients had pathological diagnosis.The degrees of enhancement were divided into hyperenhancement and iso/hypoenhancement.The distribution of hyperenhancement in benign and malignant nodules were summarized.The sensitivity,specificity,positive and negative predictive value and accuracy of hyperenhancement for benign nodules and adenomatoid nodules were observed.Results Hyperenhancement was more common in benign nodules than in malignant nodules (10.3％ vs 0.7％,x2 =70.259,P ＜ 0.05),and its sensitivity,specificity,positive and negative predictive value and accuracy was 9.8％,99.5％,98.2％,27.6％ and 32.8％,respectively.Hyperenhancement was more common in adenomatoid nodules than in nonadenomatoid benign nodules (67.4％ vs 6.1％,x2 =525.025,P ＜ 0.05),and its sensitivity,specificity,positive and negative predictive value and accuracy was 67.4％,93.9％,41.6％,97.8％ and 92.3％,respectively.Conclusion Hyperenhancement sign is an important sign which can effectively differentiate benign nodules from malignant nodules,and adenomatoid nodules from nonadenomatoid benign nodules,and it is helpful for diagnosis of benign nodules and adenomatoid nodules.

OBJECTIVE To investigate the inhibitory effect of eight lignan compounds of Fructus Schisandrae chinensis in vitro on carboxylesterase 2 (CES2) and to estimate the herb-drug interaction (HDI) risks of strong CES2 inhibitors selected from the above compounds. METHODS Fluorescein diacetate (FD) was employed as a specific fluorescent probe of CES2. The residual activity of CES2 was detected in human liver microsomes after the intervention with deoxyschizandrin, schisanhenol, schisantherin E, schisandrol A, schisandrol B, gomisin J, gomisin G, and gomisin O at 37℃ for 10 min, respectively. 1% DMSO served as control. Residual activity of CES2 was assessed with metabolite production of FD detected by fluorescent intensity, combined with IC50 values of the above compounds to predict HDI risks between lignans and CES2-metabolizing drugs. RESULTS Compared with control group, the activity of CES2 was significantly inhibited by deoxyschizandrin and schisanhenol (P<0.01), with IC50 values of 8.06 μmol · L- 1 and 8.91 μmol · L- 1, respectively. The other six lignans compounds exhibited mild inhibitory effect on CES2. HDI risk prediction of deoxyschizandrin or schisanhenol indicated that exposure of CES2-metabolizing drugs might increase 11.24 and 0.40 times, respectively. CONCLUSION Deoxyschizandrin and schisanhenol exhibit strong inhibitory effects against CES2 in vitro so that potential HDI risks should be taken into account during administration of drugs containing Fructus Schisandrae chinensis.

Objective To investigate the correlation between admission hyperglycemia and clinical prognosis in elderly patients with community-acquired pneumonia.Methods Based on the electrical medical record (EMR),information of the patients with pneumonia was retrospectively collected and the necessary data were prepared and arranged.Based on clinical outcomes,demographic characteristics and clinical indicators were compared between groups in order to screen potential variables affecting clinical outcomes.Then,the random blood glucose level 8.6 mmol/L was considered to be the cutoff point for grouping patients,with clinical outcomes as outcome variables,random blood glucose levels as grouping variables,propensity score value analysis method was applied along with the ratio of 1:1 nearest neighbor matching method to generate paired samples in order to assess the impact of blood glucose level on mortality rate;With hospitalization time serving as time variable,survive analysis method was used to analyze COX proportional model.Results Five hundred and fifty-eight patients were enrolled in the analysis,197 patients of which were recorded dead during hospitalization (the dead group).After the correction of demographic characteristics,past medical history and blood test indexes,white blood cells,C reactive protein,random blood glucose at admission and triglyceride levels were regarded as potential factors for the deaths of patients (P<0.05).However,the propensity score analysis method suggested that there was no significant difference between the blood glucose levels and mortality.The survival analysis showed that the mortality in the high blood glucose group was higher than that in the normal blood glucose group (HR=1.68,95%CI(1.22,2.31)).Conclusion Admission hyperglycemia is an important indicator of adverse prognosis in elderly patients with pneumonia.It may be of significance for screening and identifying high-risk patients.

Objective To investigate the clinical efficacy of esmolol combined with atorvastatin on se-vere sepsis complicated with cardiac insufficiency.Methods This study was a prospective,double-blind,ran-domized controlled clinical trial.A total of 153 patients with severe sepsis complicated with cardiac insufficien-cy admitted to this hospital from January 2021 to December 2022 were selected and divided into groups A,B,and C by random number table method,with 51 cases in each.Patients in group A were given routine symp-tomatic supportive treatment after admission.On this basis,patients in group B and group C were given esmo-lol,esmolol+atorvastatin,respectively.The hemodynamic indexes,serological indexes and clinical prognosis of the three groups before and after intervention were compared.Results There was no significant difference in baseline data,and hemodynamic and serological indexes of three groups before intervention(P＞0.05).Compared with before intervention,after five days of intervention,heart rate,systemic vascular resistance in-dex(SVRI),blood levels of creatine kinase-MB(CK-MB),cardiac troponin Ⅰ(cTn Ⅰ),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and high sensitive C-reactive protein(hs-CRP)in three groups were de-creased,while the values of cardiac index(CI)were increased,and the differences were statistically significant(P＜0.05).After five days of intervention,the heart rate,SVRI,blood levels of CK-MB,cTn Ⅰ,TNF-α,IL-6,and hs-CRP in group C were lower than those in group A and group B,and the levels in group B were lower than those in group A;the value of CI in group C was higher than that in group A and group B,and group B was higher than that in group A,the differences were statistically significant(P＜0.05).After intervention,the length of stay in intensive care unit(ICU)in group C was the shortest,and that in group B was shorter than that in group A,the difference was statistically significant(P＜0.05).There was no significant difference in 28 d mortality among the three groups(P＞0.05).Conclusion Esmolol combined with atorvastatin can signif-icantly inhibit the inflammatory response in patients with severe sepsis complicated with cardiac insufficiency,relieve myocardial injury and promote rehabilitation,and the therapeutic effect is better than esmolol alone.

Objective To examine the impact of vacuum sealing drainage on clinical outcomes of patients with post-sternotomy mediastinitis after cardiac surgery. Methods A systematic search were performed in Cochrane Library, Pubmed, Embase, China Biology Medicine(CBM), WanFang, VIP database. The quality of articles was critically appraised and data were extracted by 2 reviewers independently. Meta-analysis were conducted for the eligible researches. Results Fourteen cohort studies were inclued finally. Patients treated with VSD had significantly lower in-hospital mortalityand lower re-infection compared to those treated without VSD. While there had no significant defferences in length of ICU stay(days) and in-hospital stay (days) between VSD group and control group. Conclusions VSD therapy was associated with lower re-infection and in-hospital mortality than other conventional methods in patients with post-sternotomy mediastinitis after cardiac surgery and those results should be further tested in future research and practice.

Objective:To explore the effect of combined orbicularis muscle double stitch operated on blepharoplasty.Methods:A total of 90 patients, 79 females and 11 males, aged 18-49 years, were treated by using combined orbicularis muscle double stitch procedure, that is, to fix upper lifting muscle, to remove partial fat, and to perform blepharoplasty.Results:All 90 cases＇ incisions were healed at the first phase, no obvious swelling and bleeding. Within 3-24 months follow up, all patients＇ upper eyelids were significantly improved. The skin was smoothy when closing eyes, and eyelash was up when opening eyes, and arc was natural and satisfactory.Conclusions:This method can improve the shape of the upper eyelid swelling and get long-lasting and stable physiological eyelid.

OBJECTIVETo investigate the phenotype and genotype defect characteristics of a Chinese patient with hereditary factor XI deficiency.

METHODSThe activated partial thromboplastin time (APTT), prothrombin time (PT), FXI activity (FXI:C) of the proband and his relatives were measured by a clotting method using automatic coagulation analyzer. FXI antigen (FXI:Ag) was assayed by enzyme-linked immunosorbent assay (ELISA). Fifteen exons of the F11 gene were amplified by PCR and sequenced. Pymol software was used to analyze the novel mutations.

RESULTSThe APTT of the proband was significantly prolonged (70.3 s, reference 34.5 s) with decreased FXI activity (6%, reference 50%-150%) and FXI antigen (1.9%, reference 50%-150%). The FXI activity and FXI antigen of his son was 31% and 39%, respectively. Two heterozygous F11 mutations were identified in the proband, which included a G to T substitution at nucleotide 1296 in exon 11 resulting in substitution of glycine by valine at codon 400 (p.Gly400Val) and a A to T substitution at nucleotide 1691 in exon 14 resulting in substitution of arginine (AGA) by a termination codon (TGA) at codon 532 (p.Arg532Ter). Analysis using Pymol indicated that the number of hydrogen bonds has changed, which led to a transformation of the structure of the FXI protein. The son of the proband was found to be heterozygous for the c.1296G to T (p.Gly400Val) mutation. NM_13142 c.1691A to T (p.Arg532Ter) is a novel mutation based on HGMD professional 2016.4. Based on 2015 Guidelines of ACMG, it is PVS1 (very strong pathogenicity).

CONCLUSIONThe compound heterozygous mutations of F11 NM_13142 c.1296G to T (p.Gly400Val) and F11 NM_13142 c.1691A to T(p.Arg532Ter) probably underlies the FXI deficiency in the proband.