Objective To investigate the potential role of T follicular helper cells (Tfh) in the pathogenesis of autoimmune thyroid diseases by comparing the expression of C-X-C chemokine teceptor type 5 (CXCR5) and CD57 in Hashimoto's thyroiditis (HT) and Graves' disease (GD) thyroid tissues.Methods The expression of CXCR5 and CD57 proteins was determined by immunohistochemical analysis in 15 HT thyroid samples,18 GD samples and 10 normal thyroid samples.Results Immunohistochemical staining showed that CXCR5 and CD57 were mainly positive in cytomembrane and cytoplasm of the infiltrated lymphocytes both in HT and GD tissues,with much higher levels than that of normal thyroid tissues ( P ＜ 0.05 ).Both CXCR5 and CD57 were not significantly different between the HT and GD tissues.Conclusion CXCR5 and CD57 expressions were increased with a similar expression pattern in both of the two main autoimmune thyroid diseases( AITD),indicating that Tfh may participate inthe development and progression of AITD.

Objective To evaluate the risk factors for diabetic foot in patients with type 2 diabetic mellitus (T2DM).Methods One hundred and forty-three patients with T2DM including 63 cases with diabetic foot(DF) and 80 cases with non-diabetic foot (NDF) were recruited.All possible risk factors for diabetic foot were documented,including low density lipoprotein-cholesterol (LDL-C),homocysteine (Hcy),diabetic polyneuropathy(DPN),diabetic retinopathy(DR),peripheral vascular disease(PVD) and so on.Results (1) There were significant differences between DF group and NDF group in terms of general clinical data,including age(65.38±11.58) years old and (60.12±9.92) years old,precious history of foot ulcer(28.6％ (18/63) and 3.8％(3/80)),serum homocysteine(Hcy) ((23.24± 11.77) μmol/L and (18.62±7.74) μmol/L)),glycosylated hemoglobin(HbA1c) ((10.22±2.81) ％ and (8.67±2.30) ％),blood albumin (Alb) ((32.45±5.83) g/L and (38.58±4.71) g/L),LDL-C ((2.15±0.72) mmol/L and (2.60±0.78) mmol/L),diabetic nephropathy (DN) (77.8％ (49/63) and 45.0％ (36/80)),diabetic retinopathy (DR) ((73.0％ (46/63) and 33.8％ (27/80)),diabetic peripheral vascular disease (PVD) (93.7％ (59/63) and 65.0％ (52/80)) and diabetic peripheral neuropathy (DPN) (77.8％ (46/63) and 60.0％ (48/80)) (P ＜0.05).(2) Logistic regression analysis showed that the development of diabetic foot was significantly correlated with age(OR =1.09,95％ CI:1.02-1.16,P =0.01),Hcy (OR =1.12,95％ CI:1.03-1.22,P =0.01),DR(OR=8.47,95％CI:1.85-38.87,P=0.01),PVD(OR=8.73,95％CI:1.07-70.92,P =0.04) and precious history of foot ulcer (OR =12.28,95％ CI:1.57-96.28,P =0.02).Conclusion Complications due to multiple factors of Diabetic foot,and Hcy is another risk factor for that.

Objective:To investigate the effect of enhanced external counterpulsation(EECP)on heart failure with preserved ejection fraction(HFpEF)and hemodynamics in elderly patients.Methods:Clinical data of 66 elderly HFpEF patients admitted to the enhanced external counterpulsation center of our hospital from January 2018 to December 2019 were retrospectively analyzed.The primary assessment parameter was the six-minute walk distance, and the secondary parameters included the Minnesota Living with Heart Failure Questionnaire(MLHFQ). Noninvasive hemodynamic parameters including the cardiac index(CI), stroke volume(SV), isovolumic relaxation period(A2-mitral valve opening, A2-O), pulmonary capillary wedge pressure(PCWP)and total peripheral resistance(TPR)were monitored and mean arterial blood pressure(MAP)was calculated.Results:After EECP treatment, the six-minute walk distance increased(372±87 m vs.341±85 m, P<0.05), the score of MLHFQ decreased(47.0±16.0 vs.50.0±17.0, P<0.05), CI increased(2.8±0.7)L·min -1·m -2vs.(2.6±0.6)L·min -1·m -2( P<0.05), SV, PCWP and A2-O did not show significant change(73.3±16.4 ml vs.71.5±17.1 ml, 10.0±3.3 mmHg vs.11.0±3.6 mmHg, 1 mmHg=0.133 kPa, 98.0±29.5 ms vs.91.0±29.1 ms, P>0.05), TPR decreased(1 719.0±427.0 DS/cm 5vs.1 821.0±508.0 DS/cm 5, P<0.05), and there was no significant change in MAP(96.9±10.7 mmHg vs.98.8±13.1 mmHg, P>0.05), compared with pre-EECP treatment levels.Compared with patients without hypertension, MAP decreased in patients with hypertension(14 cases), when stratified by the initial MAP( P<0.05). Conclusions:For elderly patients with HFpEF, EECP can increase the six-minute walk distance, improve the quality of life and hemodynamic parameters, and is a safe adjuvant treatment.

Objective:To observe the effect of sodium fluoride (NaF) on the expression of phosphatidylinositol-3-kinase/protein kinase B (PI3K/Akt) signal and apoptosis in human osteosarcoma Saos-2 cells.Methods:Saos-2 cells were divided into 0 (control), 5, 10, 20 and 40 mg/L fluoride groups ( n= 3) according to the dose of NaF. The cells were collected after 24 and 48 h of culture in vitro. Western blotting was used to detect the expressions of PI3K/Akt signal and Forkhead transcription factor (FoxO) 1, and the apoptosis level of Saos-2 cells was detected by flow cytometry. Results:There were no significants differences in the expressions of PI3K and Akt in Saos-2 cells at 24 and 48 h ( P > 0.05). At 24 h, the expressions of phosphorylated PI3K (p-PI3K) in 5, 10, 20 and 40 mg/L fluoride groups (0.40 ± 0.06, 0.45 ± 0.02, 0.37 ± 0.06, 0.32 ± 0.06) were higher than that in the control group (0.28 ± 0.04, P < 0.05); at 48 h, the expressions of p-PI3K in 5 and 10 mg/L fluoride groups (0.46 ± 0.06, 0.58 ± 0.03) were higher than that in the control group (0.29 ± 0.04, P < 0.05), and that in the 40 mg/L fluoride group (0.21 ± 0.03) was lower than that in the control group ( P < 0.05). At 24 h, the expressions of phosphorylated Akt (p-Akt) in 5, 10 and 20 mg/L fluoride groups (0.27 ± 0.01, 0.30 ± 0.03, 0.27 ± 0.03) were higher than that in the control group (0.20 ± 0.02, P < 0.05); at 48 h, the expressions of p-Akt in 5 and 10 mg/L fluoride groups (0.42 ± 0.04, 0.60 ± 0.02) were higher than that in the control group (0.27 ± 0.01, P < 0.05), and that in the 40 mg/L fluoride group (0.18 ± 0.02) was lower than that in the control group ( P < 0.05). The expressions of FoxO1 in 10, 20 and 40 mg/L fluoride groups at 24 h (0.38 ± 0.07, 0.41 ± 0.06, 0.47 ± 0.08) were higher than that in the control group (0.34 ± 0.04, P < 0.05). At 48 h, the expressions of FoxO1 in 5, 10, 20 and 40 mg/L fluoride groups (0.36 ± 0.08, 0.37 ± 0.10, 0.54 ± 0.04, 0.73 ± 0.04) were higher than that in the control group (0.28 ± 0.04, P < 0.05). At 24 and 48 h, the apoptosis rates of control group and 5, 10, 20 and 40 mg/L fluoride groups were (2.867 ± 0.583)%, (3.647 ± 0.035)%, (3.773 ± 0.095)%, (5.440 ± 0.325)%, (7.203 ± 0.476)%; (3.707 ± 0.286)%, (4.023 ± 0.241)%, (4.970 ± 0.368)%, (12.473 ± 0.949)%, (19.387 ± 1.892)%, respectively. The apoptosis level of 40 mg/L fluoride group was higher than that of control group at 24 h ( P < 0.05), and that of 20 and 40 mg/L fluoride groups were higher than that of control group at 48 h ( P < 0.05). Conclusion:Fluoride can directly activate the PI3K/Akt signaling pathway in osteoblasts, and then has anti-apoptotic effect.

Objective: To optimize the determination of pentachlorophenol in wooden chopping boards through pretreatment of miniaturized samples. Methods: The pretreated wooden chopping board samples were subjected to ultrasound extraction (1 mL of 0.5 mol/L K2CO3 added in 5 mL extraction solution) in 8 mL acetone and 2 mL water, followed by derivatization with 0.3 mL acetic anhydride, extraction with n-hexane and separation with DB-5ms column (30 m×0.25 mm, 0.25 μm). Gas chromatography tandem mass spectrometry (GC-MS/MS) was performed in multiple reaction monitoring (MRM) mode with quantitative analysis using the internal standard method. Results: The GC-MS/MS assay showed a good linear relationship within the range of 0.01 to 0.2 µg/mL (R2>0.999), with a 0.003 mg/kg limit of detection and 0.01 mg/kg limit of quantitation. The mean recovery rates were 84.2% to 96.7% at spiked concentrations of 0.003, 0.01 and 0.03 mg/kg, with relative standard deviation of 2.2% to 6.1%. Conclusions The established GC-MS/MS assay is easy to perform, environment-friendly, highly accurate and sensitivity, which is feasible for determination of pentachlorophenol in wooden chopping boards.

Objective To investigate the expression of circular RNA(Circ RNAS)Actinin α 4(ACTN4)and platelet thrombin protein 1(THBS1)in intrahepatic cholangiocarcinoma(ICC)and their relationship with clinicopathological characteristics and prognosis,and provide reference for clinical diagnosis and treatment.Method A retrospective analysis was conducted on 84 ICC patients diagnosed and treated in the Second Affiliated Hospital of Xian Jiaotong University from May 2017 to June 2020.The expressions of CircACTN4 mRNA,THBS1 mRNA and protein were detected by real-time fluorescent quantitative PCR and immunohistochemistry.Pearson correlation analysis was used to analyze the correlation between CircACTN4 mRNA and THBS1 mRNA in ICC cancer tissue.The prognostic differences of ICC patients with different CircACTN4 mRNA and THBS1 mRNA expressions were compared by the Kaplan-Meier method(log rank test).COX regression analysis was performed to identify prognostic factors in ICC patients.The prognostic value of CircACTN4 mRNA and THBS1 mRNA in evaluating the risk of death in ICC patients was assessed by receiver operating characteristic(ROC)curve analysis.Results The expression of CircACTN4 mRNA in ICC tissues(3.14±0.42)was higher than that in adjacent tissues(0.76±0.25),with significant difference(t=44.094,P＜0.001).The positive rates of THBS1 mRNA(2.82±0.36)and protein positive rate(92.86％)in ICC tissues were higher than those in adjacent tissues(0.81±0.24,7.14％),and the differences were statistically significant(t/x2=42.068,123.429,all P＜0.001).CircACTN4 mRNA was positively correlated with THBS1 mRNA in ICC cancer tissue(r=0.669,P＜0.001).The expressions of CircACTN4 mRNA,THBS1 mRNA in ICC cancer tissues with TNM stage Ⅲ,low differentiation,and lymph node metastasis were higher than those in TNM stage Ⅰ～Ⅱ,high differentiation,and non-lymph node metastasis cancer tissues,and the differences were statistically significant(x2=7.949,9.164,12.207;23.270,18.625,19.828,all P＜0.001).The 3-year cumulative survival rates of the high expression group of CircACTN4 mRNA and THBS1 mRNA were lower than those of the low expression group of CircACTN4 mRNA(25.00％vs 56.82％)and THBS1 mRNA(19.51％vs 62.79％),and the differences were statistically significant(Log rank x2=13.601,24.310,all P＜0.001).CircACTN4 mRNA(OR=1.839,95％CI:1.228～2.753),THBS1 mRNA(OR=1.744,95％CI:1.245～2.443),lymph node metastasis(OR=1.925,95％CI:1.316～2.816),TNM staging(OR=1.613,95％CI:1.223～2.126),and tumor differentiation(OR=1.510,95％CI:1.205～1.892)were independent factors affecting the prognosis of ICC.The area under the curve of the combination detection of circACTN4 and THBS1 mRNA on the prognosis of death in patients with ICC was 0.868,which was greater than that of the single index(0.812 and 0.784),with significant differences(Z=3.348,3.847,all P＜0.001).Conclusion The expressions of CircACTN4 mRNA and THBS1 mRNA were increased in ICC,and they were associated with TNM stage,differentiation,and lymph node metastasis.These markers may serve as novel indicators to evaluate the poor prognosis of ICC patients.

Objective To explore the Effects of nursing model on anxiety and sleep of laparoscope cholecystectomy ( LC) patients based on story theory. Methods Totally 50 cases of LC patients were divided into the observation group and the control group according to convenience sampling method, with 25 cases in each group. Patients in the control group received routine nursing care, while patients in the observation group received nursing intervention based on the the story theory. Self-rating Anxiety Scale ( SAS) and Pittsburgh Sleep Quality Index ( PSQI ) were used to evaluate patients′ anxiety and sleep status before and after the intervention. The plasma cortisol concentration of patients in two groups were compared before and after the intervention.Results The SAS score in the observation group after surgery was (33.76±4.62);the PSQI score was (8.28±1.54);the plasma cortisol concentration was (17.35±6.32) ng/mL, and they were all lower than the data in the control group. Repeated measurement anova showed that the differences of SAS score, PSQI score and plasma cortisol concentration in two groups at different time were significant ( Ftime=12.230,16.512,18.041;P<0.05) , and in a downward trend. The nursing effect in the observation group was superior than that in the control group.Conclusions The nursing model based on story theory could significantly improve the anxiety and sleep of LC patients, which was conducive to the rehabilitation of patients after surgery.

Objective:To explore the effect of diabetes specialist nurse sharing management in diabetic patients in primary medical institutions under the medical alliance model.Methods:From January 2018 to December 2019, convenience sampling was used to select type 2 diabetes patients in the First Affiliated Hospital of Xinxiang Medical University as the research object. A total of 147 patients with type 2 diabetes who were enrolled from January to December 2018 were set as the control group, and 162 patients with type 2 diabetes who were enrolled from January to December 2019 were set as the observation group. Control group adopted routine diabetes management, and observation group conducted the diabetes specialist nurse sharing management under the medical alliance model. Both groups of management lasted for 6 months. Morisky Medication Adherence Scale and Scale of the Diabetes Self-care Activities (SDSCA) were used to evaluate medication adherence and self-management behavior scores of the two groups of patients. The fasting blood glucose and glycosylated hemoglobin of the two groups of patients before and after the intervention were compared, and the readmission rate and the incidence of hypoglycemia of the two groups of patients during the intervention were evaluated.Results:After the intervention, the observation group's medication adherence was better than that of control group, and the difference was statistically significant ( P<0.05) . After the intervention, the fasting blood glucose and glycosylated hemoglobin of observation group were lower than those before intervention and of control group, and the SDSCA score was higher than that before intervention and of control group, and the differences were statistically significant ( P<0.05) . The readmission rate and the incidence of hypoglycemia in observation group were 8.02% and 5.56%, respectively, which were lower than 19.73% and 25.17% in control group, and the differences were statistically significant ( P<0.05) . Conclusions:The diabetes specialist nurse sharing management under the medical alliance model can effectively improve the medication adherence, self-management behavior and blood glucose of diabetic patients in primary medical institutions, and reduce the readmission rate and the incidence of hypoglycemia.

Objective To investigate the comprehensive improvement of multi-system diseases in elderly patients treated with enhanced external counterpulsation(EECP).Methods Clinical data of an elderly patient with multiple systemic diseases were collected and analyzed.The therapeutic effect of EECP was assessed and EECP-related literatures were reviewed.Results The 62-year-old male patient was diagnosed with coronary atherosclerotic heart disease,unstable angina,New York Heart Association(NYHA)functional class Ⅱ,hypertension(grade 3,very high risk),type 2 diabetes,acute cerebral infarction (recovery period)and benign prostatic hyperplasia.After two courses of EECP treatment,angina in the patient was significantly relieved,cardiac systolic and diastolic function was improved,activity tolerance was increased and the corresponding dosage of therapeutic drugs was reduced.In addition,the patient's blood pressure and blood glucose levels were decreased after versus before treatment and the retinal superficial blood flow was enhanced in both eyes assessed by optical coherence tomography.The frequency and volume of nocturia were reduced.The symptoms of numbness on the left side were improved.Conclusions EECP treatment has shown significant therapeutic effects on multi-system diseases in the elderly patient.EECP is safe,effective and simple and has a broad application prospect in geriatrics.

Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.