Objective To evaluate the accuracy of endoscopic ultrasonography (EUS) in preoperative TNM staging of gastric cancer.Methods EUS and abdominal helical computed tomography (HCT) were performed one week before the surgery in 126 gastric cancer patients who would receive surgery to determine the depth of tumor invasion (T),lymph node metastasis (N) and distant metastasis (M) stage and which were also compared with pathologic TNM stage after surgery to evaluate the accuracy of EUS in TNM staging.Pairing x2 test was performed for data analysis.Results Compared with pathologic TNM stage after surgery,the accuracy of EUS in T1,T2,T3 and T4 staging of gastric cancer were 84.6％,14/18,82.0 ％ and 85.7％ respectively.The accuracy of EUSin N0,N1,N2 and N3 staging of gastric cancer were 74.2％,75.0％,57.9％ and 5/17 respectively.The accuracy of HCT in N0,N1,N2 and N3 staging of gastric cancer were 80.6％,75.0％,73.7％ and 12/17 respectively.The accuracy of EUS was similar to HCT in N0 and N1 stage.For N2 and N3 stage,HCT was obviously better than EUS (x2 =4.89,P=0.027; x2 =13.88,P＜0.01).The accuracy of EUS and HCT in M1 stage of gastric cancer were 36.4％ and 95.5％respectively,HCT was better than EUS in M1 determination (x2 =7.90,P=0.001).Conclusions The clinical application value of EUS in the preoperative gastric cancer T staging was high,however the accuracy in determining lymph node metastasis N2 and N3 staging and distant metastasis M staging should be improved.In order to acquire more accurate preoperative TNM stage to guide the treatment selection,the combination with HCT examination is necessary.

Objective To evaluate the accuracy of air column width difference (ACWD) between inflation and deflation of the cuff of the endotracheal tube (ETT) in predicting post-extubation stridor (PES).Methods A total of 102 intubated patients of both sexes and all ages,who were mechanically ventilated for ≥24 h in the intensive care unit,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,were enrolled in the study.After the patients were in a stable condition and recovered consciousness and myodynamia,they were weaned from the ventilator,and ultrasound examination of the larynx was performed to determine ACWD between ETT cuff inflation and deflation.PES was assessed using blinding nethod after extubation,and the patients were divided into 2 groups depending on whether or not the patients developed PES:PES group (group P) and non-PES group (group N).Results There were 94 patients in group N and 8 patients in group P.Compared with group N,ACWD was significantly decreased in group P (P＜ 0.05).The cut-off value of ACWD determined by the receiver operating characteristic curve was 1.65 mm,the sensitivity and specificity of ACWD were 0.830 and 0.750,respectively,and the area under the receiver operating characteristic curve was 0.801.Conclusion For the intubated patients who are mechanically ventilated for ≥24 h in an intensive care unit,ACWD between ETT cuff inflation and deflation＜ 1.65 mm can effectively predict PES.

Objective:To analyze the clinical efficacy of Seretide combined with noninvasive positive pressure ventilation (NIPPV) in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type 2 respiratory failure (RF).Methods:120 patients of COPD complicated with type 2 RF were randomly divided into the observation group and the control group.All patients were treated with routine,symptomatic and supportive treatment,based on that NIPPV was used in the control group,and the observation group was treated with Seretide on the basis of NIPPV.The levels of arterial blood gas,inflammatory factors,pulmonary function and CAPS score before and after treatment were compared and analyzed.Results:After treatment,the pH,PaO2 and SaO2 of both groups were significantly increased,PaCO2 levels weresignificantly decreased,serum IL-33,TNF-oα and sICAM-1 levels were significantly decreased,FVC,PEFR,FEV1％ and FEV1/FVC were significantly decreased,and the CAPS scores were significantly decreased;the changes of all the index mentioned above in the observation group were more statistically significant (P＜0.05).Conclusion:Seretide com bined with NIPPV could more effectively decrease the levels of inflammatory factors and improve the blood gas and lung function in the patients of COPD with type 2 respiratory failure.

OBJECTIVE: To evaluate the role of human calcium-activated chloride channel 1 (hCLCA1) and mucin MUC5AC in allergic rhinitis. METHOD: The expression of hCLCA1 and MUC5AC were determined by RT-PCR and immunohistochemical assay in nasal mucosa on 20 patients with allergic rhinitis and 7 normal persons. RESULT: The expression of hCLCA1mRNA in allergic rhinitis group was positive, whereas in normal control group was absent (P<0.01). The expression of MUC5AC mRNA and MUC5AC protein in the allergic rhinitis group were higher than that in the control, respectively (both P<0.01). The increased expression of hCLCA1mRNA in allergic rhinitis group were well correlated with the expression of MUC5ACmRNA and MUC5AC protein and the correlation coefficients were 0.752 and 0.694(both P<0.05). CONCLUSION Upregulation of hCLCA1 mRNA expression may play a pivotal role in mucus overproduction in allergic rhinitis group. The inhibition of HCLCA1 expression may provide a new strategy for the treatment of allergic rhinitis.
Adolescent ; Adult ; Chloride Channels ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Mucin 5AC ; metabolism ; Nasal Mucosa ; metabolism ; Rhinitis, Allergic, Perennial ; metabolism ; Young Adult

Objective: To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model. Methods: This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group (n=52) received tertiary hospital(Peiking University Peoples′ Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group (n=28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months. Results: Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P<0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P>0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P>0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P>0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P<0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P<0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P<0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P<0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P<0.05), know how to take medicines (44.52% vs. 5.00%, P<0.05), know how much exercise was right for yourself (26.43% vs.0, P<0.05) were significantly higher in rehabilitation group than in control group. There were no cardiac rehabilitation training related cardiovascular events. Conclusion Tertiary hospital guided and community-driven family self-help cardiac rehabilitation model is an effective and safe management model of cardiovascular disease in chronic phase, and it is necessary to further expand the study population to verify the efficacy of this model.

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by paroxysmal tachycardia, increased blood pressure, tachypnea, hyperthermia, profuse sweating, abnormal posture or dystonia. It occurs in diseases such as moderate to severe brain injury, cerebral hypoxia, hydrocephalus, brain tumor and encephalitis. At present, the etiology and pathogenesis are still unclear, and it is easy to be misdiagnosed as epilepsy clinically. This article reports a 43-year-old male patient with late-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) confirmed by genetic testing. During hospitalization, he suddenly developed episodic involuntary limb movements, profuse sweating, tachycardia, and arterial hypertension. He was initially diagnosed with symptomatic epilepsy, but long-term electroencephalogram monitoring showed no synchronized discharge, and he was given antiepileptic drugs. The treatment was also ineffective. Brain magnetic resonance imaging revealed a new lesion in the left insular and insular operculum. Dexmedetomidine, baclofen, and gabapentin were given to suppress sympathetic nerve excitability. Drugs were effective, so the diagnosis was corrected to PSH. There is no report of MELAS complicated with PSH in the previous literature. It is speculated that it may be related to the low clinical cognition of PSH. In this case, new lesions in the insula and insular operculum appeared during the onset of PSH, suggesting that may be related to the pathogenesis of PSH.

Objective:To study the mechanism of the effect of Jiajian-Zhujing Decoction on the expression of VEGF on ARPE-19 cells after AKT transfection. Methods:To prepare the serum and blank serum of Jiajian-Zhujing Decoction and divide ARPE-19 cells into the normal group, model group, blank serum group, medicated serum group, Conbercept group and combined group. Except normal group, this research established AKT transfected cell model. Then cultured the normal group and model group with conventional method, and the blank serum group was cultured with 10% blank serum, the medicated serum group was cultured with 10% medicated serum, the Conbercept group was cultured with 20 μg/ml Conbercept, the combined group was cultured with 10% medicated serum and 20 μg/m Conbercept. The proliferation of ARPE-19 cells in each group was detect by the CCK-8 method. The levels of AKT, mTOR and VEGF mRNA were detected by real-time quantitative PCR. Western blot was used to detect the expression of AKT, mTOR and VEGF. Results:After being cultured for 24, 48 and 72 hours, compared with the model group, the cell proliferation rate in blank serum group, medicated serum group, Conbercept group and combined group significantly decreased ( P<0.05). Compared with the model group, the expression of AKT mRNA (24 h: 3.10 ± 0.48, 1.97 ± 0.14, 1.26 ± 0.24 vs. 4.77 ± 0.68; 48 h: 3.52 ± 0.82, 2.62 ± 0.77, 1.10 ± 0.19 vs. 6.12 ± 1.21), mTOR mRNA (24 h: 3.02 ± 0.26, 2.45 ± 0.75, 1.13 ± 0.15 vs. 4.48 ± 0.80; 48 h: 1.29 ± 0.30, 1.30 ± 0.57, 0.65 ± 0.19 vs. 2.54 ± 0.62), VEGF mRNA (24 h: 3.33 ± 0.62, 2.18 ± 0.20, 1.55 ± 0.28 vs. 5.53 ± 1.02; 48 h: 2.35 ± 0.54, 1.23 ± 0.28, 0.93 ± 0.25 vs. 3.59 ± 0.40), AKT protion (24 h: 0.45 ± 0.09, 0.25 ± 0.05, 0.14 ± 0.04 vs. 0.62 ± 0.04; 48 h: 0.36 ± 0.06, 0.23 ± 0.04, 0.14 ± 0.03 vs. 0.54 ± 0.08), mTOR protion (24 h: 0.35 ± 0.05, 0.24 ± 0.02, 0.18 ± 0.02 vs. 0.52 ± 0.09; 48 h: 0.23 ± 0.04, 0.29 ± 0.04, 0.14 ± 0.03 vs. 0.40 ± 0.10), VEGF protion (24 h: 0.14 ± 0.03, 0.33 ± 0.04, 0.24 ± 0.03 vs. 0.54 ± 0.10; 48 h: 0.24 ± 0.03, 0.17 ± 0.02, 0.11 ± 0.02 vs. 0.42 ± 0.10) significantly decreased ( P<0.05), and the combined group was significantly lower than that of the Conbercept group ( P<0.05). Conclusions:AKT transfection can promote the proliferation of ARPE-19 cells, and Jiajian-Zhujing Decoction can significantly inhibit this proliferation. Jiajian-Zhujing Decoction may inhibit the activity of AKT/mTOR signaling pathway to reduce the expression of VEGF.

Objective:To study the effects of recombinant human erythropoietin (rhEPO) on cerebral blood flow (CBF) in preterm infants using arterial spin labeling (ASL) magnetic resonance imaging (MRI).Methods:From September 2021 to June 2022, preterm infants (gestational age ≤32 weeks, birth weight ≤1 500 g) admitted to NICU of our hospital within 24 h after birth were randomly assigned into rhEPO group and control group for this prospective study. The rhEPO group was given rhEPO (500 IU/kg iv, once every other day for 2 weeks) within 72 h after birth plus symptomatic supportive treatment. The control group received same amount of normal saline injection. Both groups received brain MRI, diffusion-weighted imaging and ASL at adjusted gestational age of 35~37 weeks and CBF values of interested areas were measured.Results:A total of 85 infants were enrolled, including 40 in the rhEPO group and 45 in the control group. No significant differences existed in the incidences of periventricular-intraventricular hemorrhage, periventricular leukomalacia, focal white matter injury and extensive white matter injury between the two groups ( P>0.05). The CBF values [ml/(100 g·min)] of frontal cortex [left 15.1±3.9 vs. 17.9±3.1, right 15.9 (12.5, 17.8) vs. 18.1(16.1,20.2)], temporal cortex [left 15.8±4.3 vs. 18.6±3.8, right 16.3(13.2,19.4) vs. 18.1(15.7,19.7)], occipital cortex (left 15.8±6.1 vs. 18.8±3.3, right 16.8±5.5 vs. 19.3±4.8), basal ganglia (left 24.7±7.2 vs. 28.7±6.2, right 26.0±7.9 vs. 29.3±6.4) and thalamus (left 32.7±11.8 vs. 37.9±8.6, right 32.1±11.6 vs. 37.6±10.2) in the rhEPO group were significantly lower than the control group ( P<0.05). No significant differences existed of CBF value at the parietal cortex between the two groups ( P>0.05). Conclusions:Early application of rhEPO can reduce CBF in premature infants, which may be related to the neuro-protective effects of EPO.