Objective To explore the effect of the family-centered prenatal maternal health education on delivery modes and breastfeeding.Methods Two hundred and thirty pregnant women who accepted prenatal maternal health education were divided into the observation group and the control group according to whether their families involved in the prenatal education.There were 108 cases in the observation group and 122 in the control group.The observation group was given prenatal health education involving the pregnant women and their caregivers or their husbands.The control group was given prenatal health education according to the previously-designed course without presence of their families.The two groups were compared in delivery mode,extent of pain during production and breast feeding.Results The rates of vaginal delivery and the breast feeding at discharge in the observation group were higher than the control group(P<0.05 for both).The rate of breast swelling in 72 hours was significantly lower than the control group(P<0.01). Conclusion Family-centered prenatal maternmal health education is good for the natural birth rate,improvement of breastfeeding rate and reduction the breast swelling.

Objective To compare imaging quality and radiation dose on DR and dual-sided reading of CR system.Methods The TRG of ALVIM statistics phantom was exposed by DR and dual-sided reading of CR with the same radiation dose,then the exposure factor and the entrance surface dose (ESD) were recorded.After that,the phantom was exposed by dual-sided reading of CR with various mAs ( 3.2,4.0,4.3,4.8 and 5.2 mAs) and the same kV,and the ESD was recorded,too.The acquired images were read by three radiologists on the monitor of diagnosis work station with the same window width and window level,then the total points of the images were given with the method of a five-level confidence scale.ROC curves were drawn and probability Pdet was calculated.Then the data was analyzed statistically by analysis of variance (ANOVA).Results The ROC analysis of bone substitute with diameter from 0.5 to 1.0 mm and muscle substitute with diameter from 0.9 to 2.0 mm showed A (z) values of 0.742 to 0.923 and 0.635 to 0.900 for DR system when the radiation dose was 137.5 μGy.The ROC analysis of bone substitute and muscle substitute showed A(z) values of 0.526 to 0.586 and 0.473 to 0.560 for dual-sided reading of CR at the same radiation dose.The probability Pdet discrepancy of bone substitute in two systems was from 0.216 to 0.337,with the highest of 0.337 in the diameter of 1.0 mm.The probability Pdet discrepancy by muscle substitute in two systems was from 0.075 to 0.342,with the highest of 0.342 in the diameter of 2.0 mm.There was significant statistical difference between the two groups ( F =35.30,P ＜ 0.01 ).When the exposure factor of dual-sided reading of CR system was 75 kV,4.8 mAs,the ESD was 180.4 μ Gy,the ROC analysis in the bone substitute with diameter from 0.5 to 1.0 mm and muscle substitute with diameter from 0.9 to 2.0 mm showed A(z) values was the same.The probability Pdet discrepancy of bone substitute in two systems was from - 0.003 to 0.009.The probability Pdet discrepancy of muscle substitute in two systems was from -0.005 to 0.008,and there was no statistical difference between the two groups ( F =5.23,P ＞0.05).When the probability Pdet of two systems was the same,the ESD was 180.4 μGy by dual-sided reading of CR system,and the ESD was 137.5 μGy by DR system.Conclusion Detection with DR system was proved to be superior to dual-sided reading of CR system at the same radiation dose.When the image quality was similar,the radiation dose of DR system was less than the dual-sided reading of CR system.

Objective To explore the optimum voltage for digital chest radiography in adult. Methods PMMAs of Different thickness (7.2, 9.0, 10. 8 and 12. 6 cm) were used to simulate chest of different depth ( 17. 5, 22. 5, 27.0 and 32. 5 cm). The combinants of contrast-detail Cdrad 2.0 phantom and above PMMAs were exposed with automatic exposure control (AEC) and different tube voltages. The images of these combinants were obtained and the entrance surface dose (ESD) was recorded. The imaging quality factor (IQF) was calculated and the curves were drawn between the ESD,IQF and kV. The PMMAs of different thickness, on which a contrast object ( PMAA of 5 cm diameter and 1.8 cm thickness ) was placed, were exposed with the same condition used for above test. Their images were obtained and SNRs were calculated. Results The ESD, SNR and IQFinv of different chest depth decreased with increase of kV.When tube voltages of 70, 100 and 140 kV were used, for 17. 5 cm chest depth, the ESD was 0. 22, 0. 09 and 0. 06 mGy, the IQF was 43.3, 58. 8 and 72. 0, the SNR was 7.5, 6. 2 and 5.0; for 22. 5 cm chest depth, the ESD was 0.37, 0.12 and 0.06 mGy, the IQF was 56. 0, 61.4 and 65.3, the SNR was 6. 4, 5.2 and 3. 8; for 27. 0 cm chest depth, the ESD was 0. 52, 0. 20 and 0. 09 mGy, the IQF was 54. 2, 64. 3 and 91. 0, the SNR was 6. 0, 4. 8 and 3. 5; for 31.5 cm chest depth, the ESD was 0.53, 0.24 and 0. 10 mGy,the IQF was 53.2, 66. 8 and 95.3, the SNR was 5. 7, 4. 5 and 3. 0. Conclusion To balance ESD, SNR and IQF, proper tube voltage should be chosen for chest radiography according to thickness and constitution of patients.

Objective To investigate the microRNAs expression profile in human colorectal cancer with or without liver metastasis and try to screen miRNA associated with liver metastasis in colorectal cancer. Methods Twenty five surgical resected colorectal cancer specimens were collected and frozen in liquid nitrogen. Three without liver metastasis and three with liver metastasis were selected, from which total RNAs were isolated. The expressions of miRNAs in these two types of specimens were detected by illumine microRNA microarray, and the difference of miRNA expression was screened. The biochip results were verified with real-time RT-PCR in all colorectal caner specimens. Results The miRNA expression was significantly different in colorectal cancer with liver metastasis and without liver metastasis. Compared with colorectal cancer without liver metastasis, 28 miRNA expressions was different in colorectal cancer with liver metastasis, 4 up regulated and 24 down regulated. The quantity of miR-139-3p expression in colorectal cancer with liver metastasis was 1.75±0.40, up regulated compared with that incolorectal cancer without liver metastasis(0. 69 ±0.58,P＜0.05). The quantity of miR-19a expression in liver metastasis was 0. 39±0. 20, downregulated compare with no liver metastasis( 1.38 ± 0.98, P＜0. 05). The result of miRNA biochip was consistent with that of RT-PCR. Conclusion The difference of miRNA expression might relate to liver metastasis of colorectal cancer. The specific miRNAs expression profile might provide new target for diagnosis and treatment of colorectal cancer with liver metastasis.

Objective To assess the effect of continuous early enteral nutrition(EEN)combined with intestinal mucosal protective agents on gut barrier function in patients with severe acute pancreatitis.Methods A total of 79 patients with severe acute pancreatitis selected from four centers between May 2004 to June 2006 were enrolled and divided into EEN combined with intestinal mucosal protective agents group(combined group,n=39)and total parenteral nutrition(TPN)group(n=40).The patients were received either EEN or TPN when homeostasis were achieved within 72 hours after onset.The patients in combined group were administered pepti-2000 variant combined with glutamine,arginine and intestinal mucosal protective agents.The patients in TPN group were administered through a central vein.APACHE-Ⅱ score was recorded every week;The concentration of serum amylase,plasmic diamine oxi dase(DAO)and endotoxin were mesured on day 1,7,14 and 21 as well as urinary excretion of lactulose (L)and mannitol(M).Complications,lenth and charges of hospital stay were recorded.Results There was no death in both groups.The APACHE-Ⅱ score decreased on day 7,but lower in combined group (6.00±1.60)than that in TPN group(7.08±2.34)(P＜0.05).On day 7,14 and 21,the concentrations of endotoxin in combined group was(39.30±15.82),(22.64±14.31),(14.81±10.93)Eu/L,respectively,urinary L/M ratio was 0.28±0.25,0.21±0.18 and 0.08±0.04,respectively,IFABP-c was 15.62±5.26),(5.46±1.18)and(3.26±0.94)pg/ml,respectively.All of these parameters were significantly lower than those in TPN group(P＜0.05).The infectious rates including pancreatic,peritoneal and respiratory infection in TPN group were much higher than that in combined group(26.47% vs 3.44%,P＜0.01).The composition of flora fecal remained unchange in combined group rather than TPN group.The mean hospital stay was shorter in combined group[(20.0±5.7)days]compared to TPN groups[(34.5±12.9)days].The charges were also significantly lower in combined group,with average cost of RMB 25,900±14,200,while it was 46,800±4,030 in TPN group.Conclusions EEN combined with intestinal mucosal protective agents can improve gut barrier function via reducing the gut permeability,improving the hypoperfusion,maintaining the integrity and gut fecal flora.It might reduce the course and charges of hospital stay.

Objective To investigate the protective effects of irbesartan against cardiac inflammation associated with diabetes and obesity in the db/db mouse model of type 2 diabetes and explore the underlying mechanisms. Methods Twenty- four 10-week-old diabetic db/db mice were equally randomized into irbesartan treatment (50 mg/kg per day) group and model group, using 12 nondiabetic littermates (db/+) as the controls, The mice were treated with irbesartan or saline vehicle for 16 consecutive weeks, after which the heart pathology was observed and the heart weight, body weight, and serum levels of fasting blood glucose (FBG), total cholesterol(TC), and triglycerides(TG) were measured. The expression of nuclear factor-kappaB (NF-κB) p65 in the myocardium was assessed with immunohistochemistry, the protein levels of P-IкBα ,IкBαandβ-actin were analyzed with Western blotting, and the pro-inflammatory cytokines IL-6 and TNF-αmRNA were detected using quantitative real-time PCR (qPCR). Results Compared with db/+mice, the saline-treated db/db mice developed obesity, hyperglycemia and hyperlipidemia (P<0.01). Histopathological examination of the heart tissue revealed inflammatory cell infiltration, increased myocardial interstitium and disorders of myocardial fiber arrangement. The diabetic mice showed increased P-IкBα and decreased IκBα protein levels, enhanced activity and expression of NF-κB in the hearts, and increased mRNA expression of IL-6 and TNF-αin the myocardium. These abnormalities were all associated with increased inflammatory response. Treatment with irbesartan improved the heart architecture and attenuated high glucose-induced inflammation in the diabetic mice. Conclusion Treatment with irbesartan attenuates cardiac inflammation in type 2 diabetic db/db mice, and this effect was probably associated with the suppression of cardiac angiotensin Ⅱ and NF-κB signaling pathway.

Objective To investigate the protective effects of irbesartan against cardiac inflammation associated with diabetes and obesity in the db/db mouse model of type 2 diabetes and explore the underlying mechanisms. Methods Twenty- four 10-week-old diabetic db/db mice were equally randomized into irbesartan treatment (50 mg/kg per day) group and model group, using 12 nondiabetic littermates (db/+) as the controls, The mice were treated with irbesartan or saline vehicle for 16 consecutive weeks, after which the heart pathology was observed and the heart weight, body weight, and serum levels of fasting blood glucose (FBG), total cholesterol(TC), and triglycerides(TG) were measured. The expression of nuclear factor-kappaB (NF-κB) p65 in the myocardium was assessed with immunohistochemistry, the protein levels of P-IкBα ,IкBαandβ-actin were analyzed with Western blotting, and the pro-inflammatory cytokines IL-6 and TNF-αmRNA were detected using quantitative real-time PCR (qPCR). Results Compared with db/+mice, the saline-treated db/db mice developed obesity, hyperglycemia and hyperlipidemia (P<0.01). Histopathological examination of the heart tissue revealed inflammatory cell infiltration, increased myocardial interstitium and disorders of myocardial fiber arrangement. The diabetic mice showed increased P-IкBα and decreased IκBα protein levels, enhanced activity and expression of NF-κB in the hearts, and increased mRNA expression of IL-6 and TNF-αin the myocardium. These abnormalities were all associated with increased inflammatory response. Treatment with irbesartan improved the heart architecture and attenuated high glucose-induced inflammation in the diabetic mice. Conclusion Treatment with irbesartan attenuates cardiac inflammation in type 2 diabetic db/db mice, and this effect was probably associated with the suppression of cardiac angiotensin Ⅱ and NF-κB signaling pathway.

Objective:To compare the eradication rate and incidence of adverse reactions between cefuroxime-containing and amoxicillin-containing bismuth quadruple regimen in the treatment of Helicobacter pylori ( H. pylori), and to evaluate the efficacy and safety of cefuroxime in the H. pylori infection patients with positive penicillin skin test results. Methods:From December 2020 to December 2021, a total of 498 patients who received initial H. pylori eradication treatment at the H. pylori Specialized Outpatient Clinic of the First Affiliated Hospital of Soochow University were selected to participate in this prospective cohort study. According to the history of penicillin allergy or positive penicillin skin test results, the patients were divided into amoxicillin group and cefuroxime group. A total of 394 patients were included in the amoxicillin group, and the treatment regimen was esomeprazole 20 mg, bismuth 220 mg, amoxicillin 1 g and clarithromycin 500 mg orally twice a day. A total of 104 patients were included in the cefuroxime group, and the treatment regimen was esomeprazole 20 mg, bismuth 220 mg, cefuroxime 500 mg and clarithromycin 500 mg orally twice a day. The treatment period was 14 days. 13C-urea breath test was conducted during 4 to 8 weeks after the treatment. The eradication rates of the 2 groups were compared by intention-to-treat (ITT) analysis and per-protocol (PP) analysis. The incidence of adverse reactions was compared between the 2 groups. Chi-square test was used for statistical analysis. Results:The results of ITT analysis and PP analysis indicated that the eradication rates of amoxicillin group were 84.3% (332/394, 95% confidence interval (95% CI) 80.6% to 87.6%) and 90.5% (332/367, 95% CI 87.2% to 93.3%), respectively, and the eradication rates of cefuroxime group were 62.5% (65/104, 95% CI 52.7% to 71.7%) and 69.1% (65/94, 95% CI 58.8% to 78.7%), respectively. The eradication rates of amoxicillin group in ITT and PP analysis were both higher than those of cefuroxime group, and the differences were statistically significant ( χ2=24.11 and 28.44, both P<0.001). The incidence of adverse reactions of amoxicillin group and cefuroxime group was 10.9% (43/394) and 14.4% (15/104), respectively, and there was no significant difference ( P>0.05). Conclusion:Cefuroxime and clarithromycin containing bismuth quadruplex regimen failed to achieve a satisfactory eradication rate in patients with H. pylori infection and penicillin allergy.

Objective To evaluate the effectiveness and safety of transarterial ehemoembolization(TACE) combined with radiofrequency ablation(RFA) and surgical resection(SR) in the treatment of early stage hepatocellular carcinoma(HCC).Methods PubMed,Medline,Embase,China biomedical database,Wanfang database,CQVIP database and Chinese Journal Full-text database were retrieved by computer.Prospective or retrospective studies of TACE combined with RFA and SR for treating early HCC published from January 2000 to March 2016 were collected.Results Four randomized or non-randomized concurrent controlled trials were included,involving 697 patients.The 1-year and 3-year overall survival(OS) rates in the TACE-RFA group were[94.40％(337/357) and 59.94％(214/357),which in the SR group were 92.35％(314/340) and 68.24％ (232/340),the difference between the two groups was not statistically significant(OR=1.43,95％CI:0.79-2.60,P=0.24,I2 =0％;OR=0.77,95％CI:0.56-1.07,P=0.12,I2 =45％).The 1-year relapse-free survival(RFS) rate of the TACE-RFA group and the SR group was similar [81.5％(291/357) vs.80.3％(273/340),OR=1.07,95％CI:0.73-1.57,P=0.74,I2=0％],while the 3-year RFSrate of the TACE-RFA group was obviously lower than that of the SR group(29.97％ vs.44.41％,OR=0.56,95％CI:0.40-0.77,P=0.000 5,I2 =0％).The incidence rate of severe complications in the TACE-RFA group was evidently lower than that in the SR group(1.43％ vs.5.07％,OR=0.23,95％CI:0.10-0.54,P=0.000 7,I2 =10％).Conclusion Compared with TACE-RFA,SR can significantly reduce the long term recurrence rate of early stage HCC,but the occurrence rate of severe complications in SR is higher than that in TACE-RFA.

Colonoscopy with polypectomy significantly reduces the incidence of colorectal cancer and cancer - related mortality. However, a pooled miss rate of 22% for polyps was documented. Aims: To explore the clinical application value of an artificial intelligence (AI)-based colorectal polyp diagnostic system for polyp detection. Methods: A total of 400 patients who underwent colonoscopy in the First Affiliated Hospital of Soochow University from September to November 2021 were selected according to the inclusion and exclusion criteria and were randomly divided into two groups: one group received routine colonoscopy, and the other group received AI system assisted colonoscopy. There were 200 cases in each group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate bowel preparation quality. The primary outcome was polyp detection rate (PDR), and the secondary outcome was polyps per colonoscopy (PPC). Results: AI system significantly increased PDR and PPC (37.0% vs. 23.0%, 0.775 vs. 0.495, all P<0.05), especially for diminutive and small polyps (diminutive polyps: 23.0% vs. 13.0%, 0.410 vs. 0.295; small polyps: 16.0% vs. 8.0%, 0.255 vs. 0.095; all P<0.05). No significant difference in large polyp detection was observed between the two groups (all P>0.05). The bowel preparation quality was classified as“poor”(BBPS 0-5 points),“qualified”(BBPS 6-7 points) and“excellent”(BBPS 8-9 points). There were no significant differences in polyp detection between the two groups when the bowel preparation quality was“poor”or “excellent”(all P>0.05). PDR and PPC were significantly increased in AI group when the bowel preparation quality was “qualified”(33.0% vs. 20.0%, 0.670 vs. 0.450, all P<0.05). Conclusions: AI-based colorectal polyp diagnostic system can significantly improve PDR and PPC because of the significant increase in the number of diminutive and small polyps detected. In addition, when the bowel preparation is qualified, the AI system can play better for polyp detection.