Objective To investigate the incremental value of 99Tcm-MIBI SPECT/CT imaging in the preoperative diagnosis of PHPT.Methods Forty-one patients (13 males,28 females,age range:14-82 (50.0± 13.2) years)with PHPT were retrospectively enrolled.99Tcm-MIBI dual-phase planar scan,SPECT/CT imaging,CT and neck ultrasound were performed before surgery.All patients had pathological results.McNemarx2 test was used to compare the detection rates of the four imaging methods.ROI method was applied to calculate the uptake ratio (T/NT) and Pearson correlation analysis was used to evaluate correlation between T/NT and serum intact PTH,Ca,the lesion volume measured after parathyroidectomy.Results A total of 42 parathyroid lesions were confirmed by pathology.There were 39 patients with parathyroid adenoma (2 with double adenomas,and 37 with single adenoma containing 2 ectopic adenomas) and 1 patient with parathyroid carcinoma.The detection rate of planar scan,SPECT/CT imaging,CT and neck ultrasound were 78.0％ (32/41),92.7％ (38/41),73.2％ (30/41) and 70.7％ (29/41) respectively.Detection rate of SPECT/CT imaging was significantly higher than that of planar scan,CT or ultrasonography (x2 =4.17,4.90,5.82,all P＜0.01).However there were no remarkable differences between the detection rate of planar scan and that of CT or ultrasonography (x2=0.08,0.36,both P＞0.05).Detection rates of CT and ultrasonography were not significantly different either (x2 =1.90,P＞0.05).T/NT in delayed planar imaging were significantly correlated with PTH,Ca and the lesion volume measured after parathyroidectomy (r =0.56,0.54,0.56,all P＜0.01).Conclusions Compared with 99Tcm-MIBI dual-phase planar scan,CT and ultrasonography,SPECT/CT imaging could be of important clinical value for preoperative localization of PHPT because of its higher detection rate and accurate anatomical localization ability.

Atherosclerosis(AS)is the common pathological basis of ischemic cardiovascular diseases,and its formation mechanism is complex.Western medical treatment has problems such as a long cycle and a high relapse rate.Ethnic medicine is an important part of traditional medicine,which has unique efficacy in treating cardiovascular diseases.Studies have shown that the Mongolian medicine Eldon-Uriel regulates blood lipids and improves blood rheology in the treatment of AS.This paper aims to pro-vide new ideas for the prevention and treatment of AS by collecting,organizing,and summarizing the relevant literature on Eldon-Uriel and introducing its unique concept,mechanism of action,and clinical studies in the treatment of AS.

Objective Analyzing the status of medical device adverse events, the function of the clinical medical engineers in medical device adverse event monitoring was investigated.Methods Through introducing the functions of the various departments in the medical device adverse event monitoring, the technical requirements and management responsibilities of clinical medical engineer and medical staff were defined. Results Enhancing the function of clinical medical engineers in medical device adverse event monitoring,which is an effective measure to prevent medical device adverse events.Conclusion Play the functions of clinical engineers in the medical device adverse event monitoring, which is significant to improve the using quality of medical devices and to ensure patient safety.

Age-related hearing loss(ARHL)is a common chronic disease that poses a serious threat to the physical and mental health of the elderly in an aging society.It is a sensorineural hearing loss characterized by the loss of auditory hair cells,stria vascularis lesions,apoptosis of spiral ganglia,and degeneration of the audi-tory central nervous system,reducing the quality of life of the patients.This article reviews the research progress in the relationship of ARHL with Alzheimer's disease,depression,and frailty,as well as the daily intervention in ARHL.This review aims to improve people's awareness and attention to the health hazards of ARHL and to delay the occurrence and development of ARHL by implementing daily intervention measures to form a healthy lifestyle.

Objective:To investigate the power and prenatal diagnosis strategies of cell-free fetal DNA (cffDNA) testing for chromosomal aneuploidy screening apart from trisomy-13/18/21.Methods:This study collected the clinical data of three cases at high risk of trisomy-16 indicated by cffDNA testing in Hunan Provincial Maternal and Child Health Care Hospital from March 2019 to March 2020. Results of the conventional G-banding karyotype analysis of amniotic fluid, single nucleotide polymorphism array (SNP-array) and low-coverage massively parallel copy number variation sequencing (CNV-seq) of placenta/fetal skin samples were analyzed.Results:(1) cffDNA testing results suggested that case 1-3 were at high risk of trisomy-16 and the Z values of chromosome 16 were 20.57, 24.88 and 17.87, respectively. (2) Karyotype analysis of amniotic fluid samples did not identify any abnormalities in Case 1 and 2, while SNP-array revealed a 19.2 Mb and 23.0 Mb heterozygous deletion at 16p13.3p12.3 and 16q22.1q24.3 in Case 1, and a 16.0 Mb loss of heterozygosity at 16q22.3q24.3 in Case 2. Case 3 had a mosaicism karyotype of 47,XY,+16[3]/46,XY[97] and SNP-array analysis showed no heterozygous deletion greater than 5 Mb or copy number variation. (3) Ultrasonography indicated fetal growth restriction in Case 1 and 2 and fetal death in Case 3. All three pregnancies were terminated. CNV-seq analysis of placental tissue in the center of both fetal and maternal side revealed mosaic trisomy 16, with the copy numbers of chromosome 16 of 2.56/2.70, 2.73/2.82, 2.80/2.81, respectively. However, no copy number variation was detected in Case 1 or 2 by CNV-seq analysis of fetal skin tissues. Conclusions:cffDNA testing has a certain power in detecting trisomy-16 apart from trisomy-13/18/21. For high-risk cases of trisomy-16 indicated by cffDNA testing, SNP-array analysis combined with karyotype analysis is suggested to rule out low-level mosaicism and loss of heterozygosity.

Objective To further improve the value of clinical application of a quantitative analysis method called LF-index (LFI) which based on real-time tissue elastography (RTE). Methods We prospectively enrolled 116 consecutive patients with chronic hepatitis B (CHB) and all patients underwent a liver biopsy and RTE between January 2015 and December 2015 at the First affiliated hospital of Wenzhou Medical University. Univariate and multivariate analyses were performed, and the prediction models for predicting significant fibrosis and cirrhosis were derived from independent predictors. Results (1) In multivariate analyses, spleno-portal index (SPI) (OR=13.956, P=0.002) and LFI (OR=6.283, P=0.023) were confirmed as independent predictors of significant fibrosis. In multivariate analyses of patients with and without cirrhosis, we found significant differences in the γ-Glutamyl transferase (GGT) (OR=1.012, P=0.049), SPI (OR=5.676, P=0.002) and LFI (OR=14.102, P=0.001). (2)A novel model called LFI-SPI score (LSPS) for prediction of significant fibrosis was developed (area under receiver operating characteristic curve [AUROC]=0.87), showing the superiority of diagnostic accuracy than LFI (AUROC=0.76, P=0.0109), aspartate aminotransferase to platelet ratio index (APRI) (AUROC=0.64, P=0.0031), fibrosis-4 index (FIB-4) (AUROC=0.67, P= 0.0044) and Fibroscan (AUROC=0.68, P=0.0021). (3) We also developed a LFI-SPI-GGT score (LSPGS) for predicting cirrhosis, with an AUROC of 0.93. The diagnostic accuracy of LSPGS was similar to that of Fibroscan (AUROC=0.85, P=0.134), and was superior to LFI (AUROC=0.81, P=0.0113), APRI (AUROC=0.67, P<0.0001), and FIB-4 (AUROC=0.72, P=0.0005). Conclusions We developed new formulas, LSPS and LSPGS for predicting significant fibrosis and cirrhosis in this prospective study. LSP score was mainly used for screening of significant liver fibrosis, and LSPG score was mainly used to exclude cirrhosis.

Objective To investigate the effect of the peroxide proliferator-activated receptorgamma (PPAR-γ) agonist rosiglitazone on the motor function recovery of hind limbs in rats with spinal cord injury.Methods Sixty-eight female SD rats were used to establish spinal cord injury model by modified Allen method.(1) Eight rats were randomly divided into negative control group and rosiglitazone group with four rats in each group.The expression of aspartate proteolytic enzyme-1 (caspase-1) in spinal cord of rats 7 days after injury was detected by immunohistochemical staining.(2) Forty-eight rats were randomly divided into negative control group,rosiglitazone group,rosiglitazone + Clostridium chitosans group [nuclear factor kappa B (NF-kappa B) activator],rosiglitazone + monosodium urate group [oligomerization domain-like receptor protein 3 (NLRP3) antagonist],with 12 rats in each group.BBB scores of hindlimb motor function were assessed at 1,3,14,21 and 28 days after injury in each group.The expression of interleukin-1 β (IL-1 β) and tumor necrosis factor-α (TNF-α) in each group was detected by ELISA at 28 days after injury.Microglia were isolated from the spinal cord of 12 rats and cultured for 7 days.They were randomly divided into the following five groups:(1) negative control group:no drug treatment;(2) rosiglitazone group:1 micromol/L rosiglitazone treatment;(3) rosiglitazone + Clostridium chitin group:1 micromol/L rosiglitazone + 20 micromol/L Clostridium chitosporin treatment;(4) Clostridium chitosan treatment Mycoplasma group:20 μ mol/L shell Clostridium treatment;(5) Clostridium chitosanin + MCC950 group [(NLRP3) antagonist]:20 μmol/L Clostridium chitosanin + 100 nmol/L MCC950;Western blot was used to detect the expressions of caspase-1,NF-kappa B and NLRP3 in microglia cells;ELISA was used to detect the expressions of IL-1β and TNF-α in the supernatant of microglia culture.Results Compared with negative control group,caspase-1 expression was decreased in rosiglitazone group in spinal cord injury area [gray matter area:5.1 ± 0.8∶6.9 ± 1.1;white matter area:5.6 ± 0.9 ∶ 7.5 ± 1.1] (P ＜ 0.05).At 28 days after operation,the rosiglitazone group had the highest BBB score [(14.7 ± 1.6) points],and the BBB score of rosiglitazone + Clostridium chitosans group (10.5 ± 2.1) points was superior to that of rosiglitazone + monosodium urate group [(7.2 ± 1.3)points,P ＜ 0.05].The expressions of IL-1β and TNF-α in rosiglitazone + monosodium uric acid group were lower than those in other groups at 28 days after injury (P ＜ 0.05).In vitro,the expressions of caspase-1,NF-kappa B,IL-1β and TNF-α in rosiglitazone group were lower than those in negative control group (P ＜ O.05).The expressions of caspase-1,NLRP3,IL-1β and TNF-α in rosiglitazone + Clostridium chitosani group were higher than those in rosiglitazone group,(P ＜ 0.05).The expressions of caspase-1 and IL-1β were higher than those in Clostridium chitosani + MCC950 group (P ＜0.05),but there was no significant difference in the expression of TNF-α between the two groups (P ＞0.05).Conclusion Rosiglitazone can promote the recovery of hind limb motor function in rats with spinal cord injury by inhibiting the expression of NF-kappa B,thereby reducing the activation of NLRP3 inflammatory bodies in microglia and ultimately inhibiting the occurrence of inflammation.

[Objective]:To explore the effect evaluation of discharge preparation service on elderly patients with hip fractures.Methods:Totally 80 elderly patients with hip fractures admitted to Shanghai Sixth People′s Hospital from April 2019 to October 2019 were selected as the research objects, and they were divided into intervention group and control group according to admission time, 40 patients in each group. The control group was given routine nursing care, and the intervention group was given readiness service for hospital discharge.The application effect of the scheme was evaluated by the degree of readiness for discharge and the quality of discharge guidance, Barthel index score, Harris score and incidence of complications.Results:In the intervention group,the total score of readiness for hospital discharge of patients was 83.43±8.10,the total score of the quality of discharge guidance was 151.30±16.61,while those in the control group were 77.13 ± 9.30, 141.58 ± 18.34, the differences between the two groups were statistically significant( t=3.23, 2.49, both P<0.05).In terms of the follow-up after patients were discharged for 3 months, the Harris hip score and Barthel index scores for patients with hip fracture were 82.53 ± 7.83 and 88.13 ± 3.34,while those were 76.03 ± 12.15, 86.13 ± 2.65 in the control group,the differences between the two groups were statistically significant ( t=2.84, 2.97, both P<0.05). Conclusions:The discharge preparation service can effectively improve the readiness for hospital discharge and the quality of discharge guidance. It improves the hip joint function, the quality of life of patients, and the clinical outcome of patients effectively.

OBJECTIVE To observe the efficacy and safety of hydromorphone in patient-controlled intravenous analgesia(PCIA)after uvulopalatopharyngoplasty.METHODS A total of 90 patients who received uvulopalatopharyngoplasty in Central Theater General Hospital from January 2022 to June 2023 were selected and divided into three groups(n=30 in each group)by using random number table method.Control group was given sufentanil 2.0 μg/kg,group A was given hydromorphone 0.20 mg/kg and group B was given hydromorphone 0.30 mg/kg.The analgesic parameters of three groups were background infusion rate of 1.2 ml/h,PCA amount of 2 ml,and lock-up time of 10 min.VAS score and Ramsay sedation score at 2 h,6 h,12 h,24 h and 48 h after surgery were recorded,as well as the number of compressions within 48 h after surgery,and the incidence of adverse reactions were analyzed.RESULTS There were no significant differences in intraoperative blood loss,operation time and intraoperative urine volume among the three groups(P>0.05).VAS score in group A and group B at 2 h(2.0±0.3,2.2±0.4),6 h(1.8±0.4,1.9±0.4),12 h(1.8±0.4,1.7±0.4),24 h(1.6±0.3,1.5±0.4)and 48 h(1.1±0.3,1.2±0.4)were significantly lower than those in control group(2.8±0.5,2.3±0.5,2.1±0.4,2.0±0.5,1.7±0.5)(P<0.05),but there was no significant difference between group A and group B(P>0.05).The Ramsay score of group A and group B at 2 h,6 h,12 h,24 h,and 48 h after operation was significantly lower than that of the control group(P<0.05).There was no significant difference in Ramsay score between group A and group B(P>0.05).The total number of compressions and effective number of compressions in group A and group B at 12 h,24 h and 48 h after surgery were lower than those in control group(P<0.05),but there was no significant difference between group A and group B(P>0.05).The incidence of total adverse reactions in group B was higher than that in group A and control group(P<0.05).There was no significant difference in the incidence of total adverse reactions between group A and control group(P<0.05).CONCLUSION Hydromorphone can effectively be used for postoperative self-controlled analgesia in patients with uvulopalatopharyngoplasty,and the efficacy is better than sufentanil,but the dose of 0.20 mg/kg hydromorphone has better safety than that of 0.3 mg/kg hydromorphone.

Objective:To explore the causal relationship between human immune cells and hypertrophic scar (HS) using two-sample bidirectional Mendelian randomization (MR) method.Methods:This study was based on two-sample MR method, and the datasets of 731 immune cells and HS were obtained from the genome-wide association study (GWAS) catalog database and Finngen database, respectively. A significance threshold was established to discern single nucleotide polymorphism (SNP) significantly correlated with immune cells or HS, thereby eliminating the impact of weak instrumental variable bias. The inverse variance weighted (IVW) method (meanwhile, the Benjamini-Hochberg (BH) procedure of false discovery rate (FDR) to adjust P values) was used for preliminary detection of the causal relationship between immune cells and HS and screen the immune cells that had a significant causal relationship with HS. Further, the causal relationship between the selected immune cells and HS was detected through five two-sample MR methods: IVW method, weighted median method, simple mode method, weighted mode method, and MR-Egger method, and the scatter plot was drawn. SNPs conformed to the hypothesis were subjected to Cochran Q test for heterogeneity assessment, MR-Egger regression coupled with MR-PRESSO to eliminate horizontal pleiotropic effects, and a leave-one-out analysis was also conducted to determine if significant results were driven by individual SNP. Finally, the IVW method contained in the two-sample MR analysis was utilized to inversely examine the causal relationship between HS and immune cells. Results:The number of SNPs in 731 immune cells reaching the significance threshold varied from 7 to 1 786, while in HS, 119 SNPs met the significance threshold, with the F values of all SNPs being greater than 10, suggesting a low likelihood of bias from weak instrumental variables. The IVW method revealed that 60 types of immune cells potentially had a causal relationship with HS (with all P values <0.05), and after adjustment using the BH method, only CD45RA and CD39 positive regulatory T cell (Treg) maintained a potentially strong causal relationship with HS ( PFDR<0.05). The IVW method (with odds ratio of 1.16 and 95% confidence interval of 1.08-1.24, P<0.05, PFDR<0.05), weighted median method (with odds ratio of 1.16 and 95% confidence interval of 1.05-1.28, P<0.05), weighted mode method (with odds ratio of 1.14 and 95% confidence interval of 1.02-1.27, P<0.05), and MR-Egger method (with odds ratio of 1.18 and 95% confidence interval of 1.07-1.30, P<0.05) of scatter plot all suggested a causal relationship between the 14 SNPs of CD45RA and CD39 positive Treg and risk of HS, only simple mode method of scatter plot suggested a not obvious relationship between the 14 SNPs of CD45RA and CD39 positive Treg and risk of HS ( P>0.05). Cochran Q test indicated no heterogeneity in the causal relationship between CD45RA on CD39 positive Treg and HS ( P>0.05). MR-Egger regression and MR-PRESSO analyses showed that there was no horizontal pleiotropy in the significant causal relationship between CD45RA and CD39 positive Treg and HS ( P>0.05). Leave-one-out analysis confirmed that the significant causal relationship between CD45RA and CD39 positive Treg and HS remained stable after sequentially removing individual SNP. Reverse two-sample MR analysis showed that HS had no potential causal relationship with any of the 731 types of immune cells ( P>0.05). Conclusions:From the perspective of genetics, it is revealed that immune cells CD45RA and CD39 positive Treg may increase the risk of HS.