BACKGROUND:Studiesin vitro have suggested that icarin can attenuate lipopolysaccharide (LPS)-induced acute pneumonia. Is the anti-inflammatory effect of icarin stil valid in the presence of wear particles? OBJECTIVE:With studiesin vivo andin vitro, to investigate the regulatory effect of icarrin on titanium particle-induced inflammatory reaction. METHODS:(1) Studiesin vivo: Eighty male C57BL/6 mice aged 6-8 weeks were randomly divided into four groups: control group, icarin group, titanium particle group, and titanium particle+icarin group. Mice in the titanium particle group and titanium particle+icarin group received surgical procedure, and sterile and endotoxin-free titanium particles were implanted on the calvaria surfaces to induce inflammatory reaction. Mice in the control group and icarin group received the same surgery, but no wear particles were implanted. Then icarin was given oraly to mice in the titanium particle group and titanium particle+ icarin group with a dose of 200 mg/kg per day for 2 weeks from the day of modeling. Mice in the control group and icarin group were given oraly the same dose of placebo. Two weeks later, tumor necrosis factor-α and interleukin-1β at protein and mRNA levels were respectively detected with enzyme-linked immunohistochemical (ELISA) and quantitative real time reverse transcription PCR (qRT-PCR) analysis. (2) Studiesin vitro: Mouse monocyte/macrophage RAW264.7 cels were cultured with different conditioned media: control group, nuclear factor receptor ligand кB (RANKL); icarin group, RANKL+icarin; titanium particle group, RANKL+titanium particles; titanium particle+icarrin group, RANKL+icarin+titanium particles. Titanium particles stimulated RAW264.7 cels were co-cultured with RANKL and icarin for 72 hours. Tumor necrosis factor-α and interleukin-1β at protein and mRNA levels in the supernatant were detected with ELISA analysis and qRT-PCR, respectively. RESULTS AND CONCLUSION: (1) Resultsin vivo: icarin treatment obviously decreased titanium particle-induced inflammatory cellinfiltration and made the thickness of periosteum thinner, down-regulated tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels. (2) Results in vitro: when RAW264.7 cels were stimulated with titanium particles for 72 hours, tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels in culture media increased obviously; when icarin was administrated, tumor necrosis factor-α and interleukin-1βexpressions at protein and mRNA levels down-regulated significantly. These results suggest icarin can obviously suppress titanium particle-induced inflammatory reactionin vivo andin vitro.

OBJECTIVETo investigate the clinical features and prognosis factors of α-fetoprotein (AFP) positive gastric cancer patients.

METHODSClinical data of 512 gastric cancer patients undergoing surgery from January 2003 to December 2008 in the General Surgery Department, the First Affiliated Hospital, Dalian Medical University were collected. According to serum AFP level, patients were divided into AFP positive group and AFP negative group. Clinical data and survival time were compared between the two groups. Effect of positive AFP on prognosis was evaluate.

RESULTSThere were 50 AFP positive patients and the ratio was 9.8%. As compared to AFP negative group, AFP positive group had a higher incidence of vascular tumor invasion [12.0%(6/50) vs. 3.7%(17/462), χ(2)=7.28, P<0.05] and liver metastasis [36.0%(18/50) vs. 2.6%(12/462), χ(2)=4.20, P<0.01]. The median survival time of AFP positive and negative groups was 30 months and 42 months, the 5-year survival rate was 20.8% and 27.5%, respectively(P<0.05). Univariate analysis showed that AFP level, tumor size, tumor infiltration, lymphatic metastasis, pathological stage, liver metastasis and vascular tumor invasion were risk factors influencing the prognosis of AFP positive gastric cancer(P<0.05). Cox analysis showed that the independent prognostic factors included tumor infiltration (HR=1.464, 95% CI: 1.068-2.007, P=0.018), lymphatic metastasis (HR=1.136, 95% CI: 1.011-1.275, P=0.032) and liver metastasis (HR=4.116, 95% CI: 2.610-6.489, P=0.000), but not AFP level(P>0.05).

CONCLUSIONGastric cancer patients with positive serum AFP usually present vascular tumor invasion and liver metastasis, but AFP level is not the independent prognostic factor.

Objective. To assess the effectiveness of the flashlamp-pumped pulsed dye laser (Photogeneca V, Synosure Corp, Boston, United States) in the treatment of port-wine stains. Methods. One hundred and ninety-four consecutive patients with port-wine stains were treated with a flashlamp-pumped pulsed dye laser in Peking Union Medical College Hospital from January 1998 to August 1999. Results. Of 194 patients who completed treatment, 56.2％ had more than 60％ fading of the lesion and only 6.7％ had less than 20％ fading. An average of 3.6 treatments were needed to achieve more than 60％ fading. The response was better in children than in adults, although the difference was not significant. Pigmentary change (usually transient) occurred in 3.1％ of patients. Conclusions. This study confirms the efficacy of the flashlamp-pumped pulsed dye laser in the treatment of port-wine stains in children and adults.

Objective:To evaluate the effect of self-management model of community diabetes patients under the guidance of general practitioners.Methods:A total of 22 communities in Hangzhou were selected as intervention pilot from 2016 to 2017, and 10-15 diabetic patients were recruited to form a self-management team in each community. Relying on the construction of medical alliance and there sources of contracted service of family doctors, intervention teams were set up to conduct regular, personalized and continuous self-management interventions on patients. Intervention continued for 4-6 months. Before, after and 6 months after the intervention, the basic information of patients, knowledge of diabetes, faith in managing disease, self-management behavior, self-management ability of patients, and quality of life were collected through questionnaire survey, body mass index (BMI), 2-hour postprandial blood glucose and glycosylated hemoglobin were detected uniformly, and statistical analysis was conducted.Results:A total of 292 patients were involved in the self-management group, the average age was (66.38±7.90) years old, most of them were female (64.73%). Six months after the intervention, the awareness rate of basic knowledge, risk factors and prevention and treatment knowledge about diabetes in patients (68.64%, 78.75%, 63.41%) were significantly higher than those before the intervention (28.08%, 48.29%, 39.38%), the proportion of patients with reasonable diet, moderate exercise, active problem-solving, management plan making and action according to the plan increased (from 65.41%, 28.76%, 39.04%, 31.85%, 27.74% to 86.76%, 60.28%, 65.16%, 78.05%, 73.17%)(all P<0.05).In terms of time effect, the scores of physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health in SF-36 after intervention and 6 months after intervention were all increased step by step (all P<0.05). Before the intervention, BMI, 2-hour postprandial blood glucose and glycosylated hemoglobin were (24.20±3.11) kg/m 2, (9.29±2.23) mmol/L, (6.81±1.01)% respectively. After the intervention, the three indexes all showed a downward trend, which were (22.89±2.98) kg/m 2, (8.81±1.61) mmol/L, (6.57±0.76)% respectively ( F=14.832, 6.828, 9.667; all P<0.05). Conclusion:Under the guidance of general practitioners, the self-management model of community diabetes patients can effectively improve the level of recognition, belief and behavior of patients, improve their self-management ability and quality of life, and improve BMI and blood glucose control level.

Objective:To analyze the mediating effects of emotional changes in self-management interventions on the relationship between behavioral management and quality of life in elderly patients with type 2 diabetes and therefore to provide a reference for improving the emotional status of elderly diabetes patients and future community-based self-management interventions.Methods:From 2016 to 2020, a total of 69 self-management groups were formed in Hangzhou, each consisting of 10-15 patients with type 2 diabetes.Based on the construction of a medical consortium and family doctors signing up to provide services, intervention teams were established to conduct a series of group self-management activities for each group.Surveys via questionnaires were conducted before and after the intervention, as well as 6 months after the intervention, to collect patient data on demographics, disease status, emotions, quality of life, and self-management behaviors.The intervention effects were evaluated, and the correlations between emotional changes, self-management behaviors, and changes in quality of life were analyzed.Bootstrap analysis was used to test the mediating effects.Results:A total of 707 elderly diabetes patients were included.There were statistically significant differences in the scores of the Self-Rating Anxiety Scale(SAS), the Self-Rating Depression Scale(SDS), physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health, physical component summary, mental component summary, the dietary control dimension of the type 2 diabetes self-care scale(2-DSCS), regular exercise, medication adherence, blood glucose monitoring, foot care, the dimension of prevention and management of hyperglycemia and hypoglycemia, and the total score of 2-DSCS( P<0.05 for all).Compared with pre-intervention, changes in SAS, SDS, physical component summary and mental component summary scores were all correlated with each dimension of 2-DSCS right after intervention and 6 months after intervention( r=-0.336-0.333, P<0.05), with the exception of changes in the blood glucose monitoring dimension score and changes in the emotional status score.The direct effect of self-management behavior on the quality of life in elderly patients with type 2 diabetes was 0.159, and the indirect effect through emotions was 0.229, with the mediating effect accounting for 59.02% of the total effect. Conclusions:Community-based group self-management activities can effectively improve the emotions and management behaviors of elderly diabetes patients and enhance their quality of life, Emotional changes play a certain mediating role between self-management behaviors and improvement in quality of life.

Objective:To investigate the behavior and emotion of trainees (residents) in the standardized residency training under the novel coronavirus pneumonia (NCP) epidemic, and adjust the training plan and mode of standardized residency training during the NCP epidemic according to the survey results.Methods:A real-name closed questionnaire survey was conducted among 40 residents (27 ultrasound majors and 13 other majors) in ultrasound department using the "Questionnaire Star" WeChat applet, including basic personal information, questions related to NCP, behavioral change survey, behavioral attitude survey and emotional status survey. All the collected data were further statistically analyzed by Chi-square test and rank sum test using SPSS 19.0Results:There were forty valid questionnaires and the participation rate was 100.0%. The accuracy of 24 NCP-related questions was not significantly different between residents majoring in ultrasound and other specialties [92.0%(596/648) vs. 93.6%(292/312), P>0.05]. All the residents had a good understanding of NCP. The main behaviors of going out were significantly reduced, while various behaviors of being at home were significantly increased. Their interest in learning declined. When the epidemic happened (or possibly) in the community or village they lived in, their negative emotions, such as nervousness, fear pessimism and depression, were obviously expressed. Network teaching and evaluation through WeChat public number were adopted and we guided residents to adjust their home behaviors and emotions according to the survey results. Conclusion:Under the NCP epidemic, the behaviors and emotions of residents had been extensively changed. The training center should adjust the teaching plan and mode of training in time, and provide more counselling service in psychology and learning for residents during the epidemic.

Objective:To explore the clinical data of patients with metastatic pheochromocytoma/paraganglioma (PPGL).Methods:The clinical data of 57 patients with metastatic pheochromocytoma/paraganglioma diagnosed and treated at Peking Union Medical College Hospital from January 2016 to June 2022 were reviewed, including 28 cases of pheochromocytoma(PCC) and 29 cases of paraganglioma(PGL). The clinical manifestations, biochemical indexes, tumour characteristics, and metastatic characteristics of the 57 patients were analysed.Results:There were 34 males and 23 females. The median age at the time of initial diagnosis was 34 (20, 54) years, 17 (29.3%) presented with concurrent metastases, and 40 (70.7%) with heterochronous metastases. The median time to presentation of metastases was 2.2 (0, 5.0) years (range 0-22 years). Adrenergic symptoms were present in 45 cases (78.6%) at the time of initial diagnosis, and the median size of the primary tumour was 6.7 (5.0, 9.0) cm. Excessive catecholamine secretion was present in 48 cases (81.4%). The most common locations of metastasis were lymph nodes (71.9%, 41/57), bone (47.3%, 27/57), lung (38.6%, 20/57), and liver (35.1%, 20/57). Metastatic PGL had more multifocal metastases than PCC [10 (34.5%) vs. 2 (7.1%), P=0.011)], was more frequently associated with SDHB mutations [13 (42.9%) vs. 3 (10.7%), P=0.008], and was more likely to have concurrent metastases [12 (41.3%) vs. 5 (17.9%), P=0.005]. Metastatic PCC primary tumours were larger compared to PGL [median length 8.9 (4.0, 17.0) cm vs. 6.1 (1.0, 15.8) cm, P=0.020]. Conclusions:Patients with PGL present with metastases over an extremely wide time span, and patients diagnosed with PPGL should be followed throughout their lives. PGL is more prone to multifocal metastases and simultaneous metastases than PCC, and PGL is more highly correlated with the SDHB mutation.

Objective To explore the key points of forensics appraisal of medical disputes in mental hospitals,strengthen the management of mental hospitals,prevent medical disputes and improve medical quality.Methods Using the written judgment of China Judgments Online as materials,the order multi-class Logistic regression analysis was conducted on the common faults and level of responsibility in cases of death resulting from mental hospital treatment.Results Improper nursing,improper management,insufficient knowledge of the disease,unclear information,inadequate rescue,improper medication,unclear diagnosis were the risk factors of the degree of responsibility of medical disputes,and other diseases were protective factors.Conclusion Analyzing the common faults and identification points of death disputes in mental hospitals and rectifying them from two aspects can effectively prevent the occurrence of medical disputes,improve the quality of medical treatment,and achieve a win-win situation for doctors and patients.

Alzheimer's disease (AD) is a complex neurodegenerative disease. Its pathogenesis involves many factors such as environment, heredity, aging, diet, personal preference and underlying diseases. And the complex pathogenic factors of AD lead to many social and economic problems such as delayed diagnosis, difficulty of drug research and development, low cure rate and high cost of care. In this paper, the relationship between AD disease progression and its risky diseases such as metabolic diseases, chronic inflammatory diseases and cardiovascular diseases was analyzed based on energy metabolism abnormalities. The role of energy metabolism signal/path abnormality activity in the course of risk disease to AD disease was analyzed. Finally, it is suggested that the prevention and treatment of risk disease evolution and adjustment of abnormal energy metabolism signals may be effective strategies for the treatment of AD.

It is great value to analyze the pathogenesis of Alzheimer's disease for the formulation and research of prevention and treatment strategies. The change of zang-fu meridians and collaterals is the essential rule of the pathogenesis of internal injury and miscellaneous diseases. Based on the analysis of the physiological basis of the aging changes of zang-fu meridians and the relationship between dementia and the abnormal function of zang-fu meridians and collaterals, this paper systematically explored the relationship between the changes of zang-fu meridians and the pathogenesis of dementia. It is considered that the change of zang-fu meridians and collaterals is the basic law of its pathogenesis development. Therefore, it is proposed that strengthening Qi is the essential principle throughout the whole process of dementia, and dredging channels and collaterals and maintaining normal function of meridians and collaterals are the key to block the pathogenesis evolution of dementia.