Object To develop an HPLC method for the determination of plasma level of ferulic acid and study the in vivo pharmacokinetics in rats. Methods The used analytical column was Nucleosil C_ 18 . The mobile phase was methanol-water-acetic acid (35∶65∶0.1). The flow rate was 1.0 mL/min and detection wavelength at 320 nm. Plasma samples were prepared for analysis by addition of internal standard (Tinidazole) followed by extracting with ethyl acetate. Results Linear caliration curve was obtained by plotting concentration vs peak area ratio over the rang 0.25—16.0 mg/L with a correlation coefficient of 0.999 2. The average recovery of ferulic acid was 96.9%—100.6%. The minimum detectable concentration of ferulic acid was 0.2 mg/L. The relative standard deviations for within-day and between-days were less than 3.0% and 5.3%,respectively. The plasma concentration-time curve of ferulic acid in Xinshu Oral Liquid ig given to rats was found to fit a two-compartments model with T_ 1/2? of 12.6 min and T_ 1/2? of 305 min. Conclusion The method is simple,rapid,accurate,and precise, which can be used for the determination of plasma level of ferulic acid and the study of its pharmacokinetics.

Objective To compare the pressor responses to ephedrine during general anesthesia with different drugs.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective gastrointestinal tumor resection under general anesthesia,aged 20-64 yr,weighing 45-90 kg,were included in this study.The patients were randomized to receive dexmedetomidine + remifentanil + sevoflurane (group Ⅰ,n =20),propofol + remifentanil + sevoflurane (group Ⅱ,n =20),or dexmedetomidine + propofol + remifentanil + sevoflurane (group Ⅲ,n =20) to maintain the depth of anesthesia.Ephedrine 0.1 mg/kg was injected intravenously when the systolic blood pressure (SBP) was decreased to about 90 mm Hg during anesthesia.Blood pressure was monitored and recorded at 1-min intervals for 10 min after the injection.The onset time (TSBP,TDBP,TMAP) for ephedrine to raise the SBP,diastolic blood pressure (DBP) and mean arterial pressure (MAP) and the maximal amplitude (△SBP,△DBP,△MAP) were also recorded.Results Compared with Ⅱ group,TSBP,TDBP and TMAP were significantly shortened,and △SBP,△DBP and △MAP were increased in Ⅰ and Ⅲ groups (P ＜ 0.05).Conclusion Compared with propofol + remifentanil + sevoflurane combined anesthesia,dexmedetomidine + remifentanil + sevoflurane combined anesthesia and dexmedetomidine + propofol + remifentanil + sevoflurane combined anesthesia augment the pressor responses to ephedrine in patients.

Objective To analyze the expression of ROCK2 in osteosarcoma tissues and explore its effect on the invasion and migration of osteosarcoma cells and related mechanism. Methods Real-time fluorescent quantitative PCR, Western blot and immunohistochemical staining were used to detect the expression of ROCK2 in osteosarcoma tissues. The migration and invasion of osteosarcoma cells were analyzed by wound-healing and Transwell assays after the knockdown of ROCK2 expression. The effect of reducing ROCK2 expression on metastasis in vivo was tested by tail vein metastasis experiment. We detected the expression of EMT-related proteins in osteosarcoma cells, and added the EMT inducer TGF-β to osteosarcoma cells with down-regulated ROCK2 expression to detect the changes of cell invasion and migration. Results The expression of ROCK2 in osteosarcoma tissues was significantly higher than that in corresponding adjacent tissues (P < 0.05). After down-regulating the expression of ROCK2 in osteosarcoma cells, the invasion and migration abilities in vivo and in vitro were significantly inhibited (P < 0.05). The expression of EMT-related protein E-cadherin decreased, while N-cadherin and Vimentin proteins increased significantly. Inducing EMT could attenuate the inhibitory effect of down-regulating ROCK2 on the invasion and migration of osteosarcoma cells. Conclusion The expression of ROCK2 is increased in osteosarcoma tissues, which promotes the invasion and migration of osteosarcoma cells by inducing EMT. ROCK2 may be a potential biomarker for targeted therapy of osteosarcoma.

Objective:To investigate the importance, satisfaction and influencing factors of college students in a medical university, and to provide reference for the teaching reform of public elective courses.Methods:A questionnaire survey was conducted in this study among Batch 2018 students of Southern Medical University. A total of 691 questionnaires were distributed and 674 valid ones were recovered. The data were analyzed descriptively, and one-way ANOVA analysis and multiple linear regression analysis were carried out by using SPSS 20.0.Results:There were statistical differences between students' objective of elective course, evaluation of teachers, evaluation of courses and harvest of courses and students' satisfaction and attention to public elective courses ( P<0.05). Students who chose courses for improving their comprehensive quality paid more attention to public courses [(4.3±0.73) points] and had higher satisfaction [(4.34±0.69) points] than other options. Students with good evaluation on teachers' teaching paid more attention to public elective courses [(4.32±0.71) points] and their satisfaction [(4.45±0.62) points] was higher than other options. Students with good evaluation on the courses had the highest degree of attention [(4.35±0.71) points] and satisfaction [(4.47±0.63) points]. Students paid the highest attention [(4.75±0.53)points] to and had the highest satisfaction [(4.85±0.36) points] with the public elective courses with more course harvest. The multiple linear regression analysis found that the 5 variables, gender, teaching forms, teaching evaluation, course quality and course harvest had significant differences in the scores of public elective course satisfaction ( P<0.05). Conclusion:The male students, in inquiry teaching form, the higher evaluation on the teacher, the higher the course quality, and the more the course harvest, the higher the students' satisfaction with the public elective courses.

Objective:To examine the mid - and long-term outcomes of surgical treatment of brachiocephalic Takayasu arteritis.Methods:This is a retrospective case series study. The clinical data of 39 patients,which had been diagnosed as brachiocephalic Takayasu arteritis (244 cases),who underwent surgical treatment,were analyzed between July 2012 to November 2022 at Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 34 females, aged (37.9±14.0)years (range:13 to 71 years). Despite medical treatment, the patients suffered severe ischemic symptoms continually and then underwent surgical interventions. Among them, 20 patients underwent endovascular procedures, 11 underwent open surgical procedures, and 8 underwent hybrid procedures. Patients were followed up through outpatient visits at 1, 3, 6 months after surgery and once every year later. Follow-up was conducted until November 2022. Operation status, postoperative complications and re-intervention of patients were recorded and the Kaplan-Meier survival curves were used to analyze postoperative vascular patency rates.Results:All 39 surgeries were successful, with no intraoperative death or serious complications. The follow-up period was (48.8±38.2) months(range:1 to 123 months). Thirty-three patients experienced symptom relief after surgery, and 6 patients required secondary surgical interventions. The patency rates for the endovascular treatment group at 1-, 3-, 5-, and 10-year were 95.0%, 75.2%, 60.2%, and 60.2%, respectively, while the patency rates for open surgery were all 90.9%. In the hybrid surgery group, the patency rates at 1-, 3-, 5-, and 8-year were all 87.5%.Conclusion:For patients with brachiocephalic Takayasu arteritis, choice of an appropriate blood flow revascularization intervention should be based on the patient′s condition,and the mid-and long-term outcomes are satisfactory.

Objective:To examine the mid - and long-term outcomes of surgical treatment of brachiocephalic Takayasu arteritis.Methods:This is a retrospective case series study. The clinical data of 39 patients,which had been diagnosed as brachiocephalic Takayasu arteritis (244 cases),who underwent surgical treatment,were analyzed between July 2012 to November 2022 at Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 34 females, aged (37.9±14.0)years (range:13 to 71 years). Despite medical treatment, the patients suffered severe ischemic symptoms continually and then underwent surgical interventions. Among them, 20 patients underwent endovascular procedures, 11 underwent open surgical procedures, and 8 underwent hybrid procedures. Patients were followed up through outpatient visits at 1, 3, 6 months after surgery and once every year later. Follow-up was conducted until November 2022. Operation status, postoperative complications and re-intervention of patients were recorded and the Kaplan-Meier survival curves were used to analyze postoperative vascular patency rates.Results:All 39 surgeries were successful, with no intraoperative death or serious complications. The follow-up period was (48.8±38.2) months(range:1 to 123 months). Thirty-three patients experienced symptom relief after surgery, and 6 patients required secondary surgical interventions. The patency rates for the endovascular treatment group at 1-, 3-, 5-, and 10-year were 95.0%, 75.2%, 60.2%, and 60.2%, respectively, while the patency rates for open surgery were all 90.9%. In the hybrid surgery group, the patency rates at 1-, 3-, 5-, and 8-year were all 87.5%.Conclusion:For patients with brachiocephalic Takayasu arteritis, choice of an appropriate blood flow revascularization intervention should be based on the patient′s condition,and the mid-and long-term outcomes are satisfactory.

Purpose/Significance According to the experience of Sichuan Provincial People's Hospital in implementing the internet outpatient special disease services,the paper puts forward some thoughts and suggestions,so as to provide references for further promoting the application of"internet+"healthcare in outpatient special disease management.Method/Process Based on the operational data of the internet hospital,the paper analyzes the operation status and existing problems of internet outpatient special disease services from the aspects of patient visits,departments,and complaints feedback.Result/Conclusion At present,there are problems such as low utiliza-tion rate of internet outpatient special disease services,poor prescription circulation,and untimely drug delivery.It is necessary to opti-mize online service for key groups,establish the regional electronic prescription sharing platform,improve the drug distribution system,strengthen cooperation between medical institutions at different levels,and build a regional outpatient special disease management system.

Objective:To investigate the effect of homocysteine (Hcy) on cerebral perfusion and cognitive function in patients with arteriosclerotic cerebral small vessel disease (aCSVD).Methods:A total of 117 patients with aCSVD who visited the First Affiliated Hospital of Anhui Medical University from June 2020 to September 2022 were enrolled and divided into the aCSVD cognitive impairment group (aCSVD-CI, n=57) and aCSVD non-cognitive impairment group (aCSVD-NCI, n=60) according to the Montreal Cognitive Assessment score. Serum Hcy measurement, cognitive function assessment, and three-dimensional pseudo-continuous arterial spin labeling perfusion imaging scan were performed in all patients, and multivariate Logistic regression analysis was used to explore risk factors for cognitive impairment in patients with aCSVD. The cerebral blood flow and perfusion differential brain regions of the whole brain, grey matter, and white matter were compared between the two groups. Partial correlation analyses were performed between the serum Hcy, overall cognitive function scores and cerebral blood flow in grey matter, as well as between the cerebral blood flow in the perfusion differential brain area and cognitive function scores. The mediating effect model was used to analyze the role of grey matter blood flow in the relationship between serum Hcy and overall cognition. Results:The serum Hcy level in the CSVD-CI group was higher than that in the CSVD-NCI group [16.38(14.02, 18.58) μmol/L vs 14.40 (11.93, 15.73) μmol/L, Z=-3.81, P<0.001]. In terms of cerebral perfusion, compared with the aCSVD-NCI group, the aCSVD-CI group had significantly lower cerebral blood flow in grey matter ( Z=-3.22, P=0.001), left middle frontal gyrus ( t=-4.91, P<0.05), right middle frontal gyrus ( t=-5.14, P<0.05), and right orbital medial frontal lobe ( t=-4.38, P<0.05). In contrast, the left hippocampus ( t=4.58, P<0.05) had increased cerebral blood flow. Multivariate Logistic regression analysis showed that serum Hcy level was independent risk factor for cognitive impairment in aCSVD after controlling for multiple risk factors. Partial correlation analysis showed that left middle frontal gyrus blood flow ( r=-0.39, P=0.006), right middle frontal gyrus blood flow ( r=-0.44, P=0.002), and right orbital medial frontal lobe cerebral blood flow ( r=-0.43, P=0.002) were negatively correlated with the Stroop Color Word Test-C results. Left hippocampal cerebral blood flow was negatively correlated with Auditory Word Learning Test-long-delayed recall ( r=-0.43, P=0.002). Further mediation analysis showed that the effect of Hcy on cognitive function was partly mediated by grey matter cerebral blood flow (indirect effect=-0.11, P<0.001). Conclusion:Hcy is an independent risk factor for cognitive impairment in aCSVD, and part of the effect of elevated Hcy on cognitive impairment in aCSVD may be mediated by decreased gray matter cerebral perfusion.

Objective:To explore the long-term effect of endoscopic radiofrequency ablation for the treatment of unresectable ampullary carcinoma.Methods:Clinical data of patients with ampullary carcinoma who received endoscopic radiofrequency ablation in the Third Affiliated Hospital of Naval Medical University from January 2012 to May 2019 were retrospectively collected, including basic information, frequency of radiofrequency ablation, the type of biliary stent, postoperative complications, and follow-up. Kaplan-Meier method was used to analyze the survival of patients after endoscopic radiofrequency ablation. Relationship between frequency of radiofrequency ablation, type of biliary stent and overall survival time was analyzed.Results:A total of 50 patients were enrolled, including 31 males and 19 females, aged 73.0±9.7 years. Twenty-five patients (50.0%) underwent 1 radiofrequency ablation treatment, while 25 patients (50.0%) underwent radiofrequency ablation treatments more than twice. Postoperative complications occurred in 6 patients (12.0%), all of which were mild symptoms. The average follow-up was 22.3 months, with a total of 39 (78.0%) deaths, 5 (10.0%) lost to follow-up, and 6 (12.0%) surviving. The median overall survival time was 16.9 (95% CI: 9.1-24.8) months, with cumulative survival rates of 62.0%, 38.5%, 27.0%, and 12.6% at 1, 2, 3, and 5 years, respectively. The median overall survival time of those treated with radiofrequency ablation ≥2 times showed a trend of prolongation compared to patients treated once, but the difference was not statistically significant [26.7 (95% CI: 9.7-43.7) months VS 12.6 (95% CI: 4.9-20.3) months, χ2=3.049, P=0.081]. Plastic stents were used in 32 patients (64.0%) and metal stents in 18 patients (36.0%). There was no significant difference in median overall survival time between patients using metal and plastic stents [17.1 (95% CI: 6.1-28.0) months VS 15.9 (95% CI: 6.9-24.9) months， χ2=0.029， P=0.865]. Conclusion:Endoscopic radiofrequency ablation is a safe treatment for unresectable ampullary carcinoma, and multiple consecutive treatments may increase the survival benefit.

Objective:To analyze the clinical characteristics of patients with spontaneous splenorenal shunt (SSRS) in liver cirrhosis, and to compare the effects and prognosis of different treatments.Methods:The data of cirrhotic patients with SSRS at the First Affiliated Hospital of Zhengzhou University between 2016-2022 were retrospectively analyzed.Patients were divided into Group A receiving conservative treatment, Group B by simple embolization, Group C undergoing TIPS combined with embolization, and Group D given liver transplantation. Life status, liver function changes, incidences of adverse events, and survival between groups were compared.Results:SSRS diameter was positively correlated with blood ammonia ( R=0.478) and negatively correlated with portal vein diameter ( R=-0.301). SSRS diameter is a protective factor for gastrointestinal hemorrhage and ascites and a risk factor for hepatic encephalopathy; Blood ammonia decreased and prothrombin time prolonged after treatment in group A ( P<0.05), blood ammonia decreased and albumin increased in group B ( P<0.05). Hemoglobin and bilirubin increased in group C ( P<0.05), blood ammonia and bilirubin decreased and platelets and albumin increased in group D ( P<0.05); Survival analysis showed that the prognosis of groups A and C was related to liver function, and the survival rate of group D was the highest of all ( P<0.05). Conclusions:SSRS embolization is safe and effective, and liver transplantation improves patient survival. Individualized treatment should be selected based on patient symptoms, liver function, and shunt diameter.