Objective To study the expression of transforming growth factor -β1 (TGF -β1 )in myocardial tissue and the concentration of serum B -type natriuretic peptide (BNP)in myocardial remodeling of SD rats induced by isoproterenol (ISO)and the effects of carvedilol intervention.Methods According to random number table,30 male SD rats were divided into 3 groups:(1 )after 9 g/L saline was injected with 5 mL/(kg·d)for 1 0 days,9 g/L sa-line was used at the dose of 1 0 mL/(kg·d)by way of gavage for 4 weeks in the control group (n =1 0);(2)after ISO was injected with 5 mg/(kg·d)for 1 0 days,9 g/L saline was used at the dose of 1 0 mL/(kg·d)by way of gavage for 4 weeks in the model group (n =1 0);(3)after ISO was injected with 5 mg/(kg·d)for 1 0 days,carvedilol was used at the dose of 1 0 mg/(kg·d)by way of gavage for 4 weeks in the treatment group (n =1 0).Then,all the rats were killed and the cardiac weight index (CWI)was measured.The pathological changes of myocardial tissue were ob-served through HE staining and Masson staining.The mRNA expression of TGF -β1 was detected by adopting reverse transcription -polymerase chain reaction.The protein of TGF -β1 was detected by means of immunohistochemistry and Western blot.The concentration of serum BNP was tested by adopting enzyme -linked immuno sorbent assay.Results (1 )Pathological changes by light microscope:no significant pathological changes were observed in myocardial tissue of the control group.The denaturization,hypertrophy,edema,necrosis of myocardial cells and collagen fibers increased in myocardial tissue of the model group were more serious than those of the treatment group.(2)CWI:CWI of the model group[(3.31 ±0.07)mg/g]was significantly higher than that of the treatment group[(3.03 ±0.04)mg/g],and CWI of the treatment group was significantly higher than that of the control group[(2.98 ±0.1 0)mg/g].There was significant difference among 3 groups (F =54.383,P =0.000).There was also significant difference between any 2 groups (all P <0.01 ).(3)The level of TGF -β1 of myocardial tissue:the level of TGF -β1 of the model group was significantly higher than that of the treatment group,and the level of TGF -β1 of the treatment group was significantly higher than that of the control group by using three detection methods.There was significant difference among 3 groups (F=1 3.62,P =0.000).There was also significant difference between any 2 groups (all P <0.01 ).(4)The concentration of serum BNP:the concentration of serum BNP of the model group[(61 .1 3 ±2.00)ng/L]was significantly higher than that of the treatment group[(57.08 ±1 .52)ng/L],and the concentration of serum BNP of the treatment group was sig-nificantly higher than that of the control group[(51 .56 ±1 .80)ng/L].There was significant difference among 3 groups (F =72.81 ,P =0.000).There also was significant difference between any 2 groups (all P <0.01 ).Conclusions The expression of TGF -β1 in myocardial tissue was up -regulated and the concentration of serum BNP was increased in my-ocardial remodeling of SD rats induced by ISO.The carvedilol intervention can down -regulate the expression of TGF -β1 and decrease the concentration of BNP,then inhibit myocardial remodeling,and improve cardiac function.

OBJECTIVE: To investigate the value of combination of thyroid imaging reporting and data system (TI-RADS) and enhanced flow (e-Flow) in the qualitative diagnosis of thyroid nodules; and to compare the diagnostic efficiency between e-Flow and color doppler flow imaging (CDFI. METHOD: The study chose 133 patients with 179 nodules (127 benign, 52 malignant nodules) who had per-operative ultrasound examination of their thyroid using grey-scale ultrasound, CDFI, e-Flow, and their noudles were graded by TI-RADS. Then the ultrasound diagnostic value were compared with their surgical pathology results by TI-RADS; TI-RADS and CDFI; TI-RADS and e-Flow, and diagnostic efficiency between e-Flow and CDFI were compared. RESULT: The results revealed that combination of TI-RADS and e-Flow had a higher sensitivity (94.23%, P < 0.05). There was no statistically significant difference between TI-RADS and the combination of TI-RADS and CDFI. Likewise, there was no significant difference between the combination of TI-RADS and e-Flow and the combination of TI-RADS and CDFI. The e-Flow showed a higher sensitivity, specificity and accuracy compare to the CDFI. CONCLUSION Combining e-Flow and TI-RADS could improve the sensitivity in qualitative diagnosis of thyroid nodules. Also, e-Flow has a better diagnostic efficiency of thyroid nodules.
Diagnosis, Differential ; Diagnostic Imaging ; Humans ; Sensitivity and Specificity ; Thyroid Nodule ; diagnosis ; diagnostic imaging ; Ultrasonography

Objective To know the efficacy and safety of the blood sugar control by double-pump a-mong severe patients with duodenectomy. Methods Divided 60 severe patients with doudenectomy into the experimental group and the,control group randomly, there were 30 cases in each group. In the control group, pa-tients received intravenous infusion with the liquid containing glucose and neutral insulin (4g: 1 U), intravenous injection of 50U neutral insulin added into 50ml normal saline by micro-pump, the pump speed was In the ex-perimental group, sugar-containing liquid without insulin was infused within 24 hours by infusion pump with u-niform speed, a neutral insulin 50U mixed with 5Oral normal saline were injected by micro-pump according to the ratio fo glucose 4g: 1U neutral insulin through the same vein. Which also adjusted the pump speed according to maintaining blood sugar in the range of 4.4～8.3mmol/L. Compared the level of blood sugar control, treatment safety, efficacy and the workload of nurses between the two groups. Results The highperglycemic index and the time to achieve target values of blood sugar in the experimental group was shorter than in the control group respectively, while the time of keep blood sugar in idea level in the experimental group was longer than in the control group. There were no significant difference about incidence rale of hypoglycemia and workload of nurses between the two groups. Conclusions Double-pump can effective control blood sugar for severe patients with duodenectomy without burden nurses' workload, which is more reasonable than the traditional method.

Objective To evaluate the surgical approaches for gastric carcinoma accompanied by portal hypertension ( PHT).Methods The clinical data of 22 patients with PHT undergoing operation during 5 years were retrospectively analyzed.The liver function was Child's A in 12 cases, Child's B in 10 cases.Total gastrectomy + pericardial devascularization was performed in 11 cases, distal subtotal gastrectomy in 9 cases, distal subtotal gastrectomy + splenectomy in one, distal subtotal gastrectomy + pericardial devascularization in one.12 cases with Child's A underwent D2 lymph node (LN) dissection and 10 cases with Child's B were treated with D1 LN dissection.Liver biopsy was taken in all patients.Results Postoperative complications developed in 50% and mortality rate was 9%.The rate of liver function deterioration in patients of Child A ungergoing D2 lymph node dissection was 42% , and that of patients with Child B was 70%.The rate of postoperatiave complications in patients with Child A ungergoing D2 lymph node dissection was 25% , while that of patients with Child B was 80%.There was no significant difference in liver function deterioration rate between Child A and Child B (P ＞ 0.05) , but the rate of postoperative complications in Child A is much lower than those in Child B(P ＜ 0.05).The complication rate in patients receiving PHT targeting measures was 77% ,much higher than 11% in those without concurrent treatment of PHT ( P ＜ 0.05 ).Conclusions Individualized surgical approache is crucial for treatment of gastric carcinoma accompanied by PHT.Surgical treatment should be on the basis of liver function and the severity of PHT.

Objective To investigate the effect of intracoronary tirofiban bolus administration on platelet-derived microparticles (PMPs) and its correlation with the short term clinical benefit in patients with acute ST-segment elevation myocardial infarction (ASTEMI) undergoing emergency percutaneous coronary intervention (PCI).Methods A total of 90 patients with ASTEMI undergoing emergency PCI were selected and randomized into the intracoronary group (intracoronary tirofiban 10.00 μg/kg bolus within 1-3 min followed by intravenous continuous infusion at 0.15 μg· kg-1 · min-1 for 36 h,n＝ 30),intravenous group (intravenous tirofiban 10.00 μg/kg bolus within 1-3 min followed by intravenous continuous infusion at 0.15 μg· kg-1 · min-1 for 36 h,n＝30) and control group (without tirofiban administration,n＝ 30).The 3 ml blood samples from coronary artery were obtained before and 10 min after tirofiban infusion.The 3 ml blood samples from radial artery were collected 24 hours after tirofiban infusion and 12 hours after drug withdrawal.The counts of PMPs were analyzed by flow cytometry.The thrombolysis in myocardial infarction (TIMI) flow grade classification and TIMI Myocardial Perfusion Grade in the culprit blood vessel after PCI,and the incidences of bleeding and major adverse cardiac events (MACE) within 30 days after surgery were recorded.Results There was no significant difference in baseline of PMPs among intracoronary group,intravenous group and control group (all P＞0.05).The level of PMPs was decreased in the intracoronary and intravenous group as compared with the control group [(3.6 ±2.3)％,(5.1±2.7)％ vs.(6.7±3.2)％,P＜0.01 or 0.05] 10 min after tirofiban infusion.The PMPs were lower in intracoronary group than in intravenous group (P＜0.05).At 24 hours after tirofiban infusion,the levels of PMPs in intracoronary versus intravenous groups were similar (P＞0.05),and PMPs levels were lower in intracoronary and intravenous group than in control group (both P＜0.05).The levels of PMPs had no significant diferences among the 3 groups at 12 hours after drug withdrawal (P＞0.05).Immediately after PCI,the TIMI flow grade and TIMI myocardial perfusion grade in the culprit blood vessel in intracoronary group were superior to those in the intravenous group and control group (P＜ 0.05 or 0.01).There was no statistically significant difference in the total incidence of MACE among the three groups (P＞0.05).Conclusions The intracoronary versus intravenous tirofiban administration can effectively and immediately reduce the number of PMPs in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional treatment,quickly inhibit the activated platelets,and decrease the total major adverse cardiovascular events without increasing the risk of bleeding.

Objective To study vascular anatomy between the pancreatic head and duodenum,providing anatomy basis for performing surgery of pancreatic head,duodenum and distal common bile duct in surgical practice. Methods Anatomy study was performed in 30 formaldehyde fixed and 10 fresh bodies in reference to blood supply to duodenum,the distal common bile and Vater ampulla. Results The anterior and posterior pancreaticoduodenal arterial arcade gives off branches to descending and horizontal portion of the duodenum. The posterior superior pancreaticoduodenal artery goes to distal common bile duct. The papilla artery arising from the posterior superior pancreaticoduodenal artery goes to Vater ampulla. Conclusions The pancreaticoduodenal anterior and posterior arterial arcades are main arteries that give off branches to the descending and horizontal portion of the duodenum,distal common bile duct and the Vater ampulla,hence should be carefully protected in duodenum-preserving resection of the pancreatic head.

Objective: To understand the characteristics of different pulmonary function grades and comprehensive assessment groups among patients with chronic obstructive pulmonary disease (COPD) from community survey, so as to provide the evidence for the comprehensive community management of COPD. Methods: The survey data of five monitoring sites in Zhejiang Province during 2014-2015 in the COPD surveillance of Chinese residents aged 40 years and above was collected. The patients with COPD were classified by pulmonary function according to the percentage of forced expiratory volume in the first second (FEV1) in the predicted value, and by comprehensive assessment according to modified British Medical Research Council (mMRC) score, COPD Assessment Test (CAT) score and acute exacerbation in the past year. The characteristics of different pulmonary function grading and comprehensive assessment groups were compared. Results: A total of 355 patients with COPD were found, with an average age of (63.00±9.63) years. The male-to-female ratio was 3.18:1. There were 243 patients with an education level of primary school or below, accounting for 68.45%. The awareness rate of COPD related knowledge was only 1.69%. There were 257 (72.39%) patients with mild, 86 (24.23%) patients with moderate, and 12 (3.38%) patients with severe pulmonary function. The proportions of patients with childhood history of severe respiratory infection, self-reported respiratory system diseases, chronic cough, chronic sputum, acute exacerbation in the past year, CAT score ≥10 points, and inhaled medication were lower in the patients with mild pulmonary function than with moderate and severe pulmonary function; the body mass index and waist circumference were higher in the patients with mild pulmonary function than in the patients with moderate and severe pulmonary function (all P<0.05). The comprehensive assessment resulted in 158 (44.51%) patients of Group A, 134 (37.75%) patients of Group B, 1 (0.28%) patient of Group C, and 7 (1.97%) patients of Group D. The average age and systolic pressure were lower in Group A than in Group B, C and D; the proportions of patients with self-reported respiratory system diseases, family history of respiratory diseases, chronic cough, chronic sputum, dyspnea, acute exacerbation in the past year and CAT score ≥10 points were lower in Group A than in Group B, C and D (all P<0.05). Conclusion The community patients with COPD are mainly classified to mild pulmonary function and Group A in the comprehensive assessment; thus they need different levels of management.

Objective To investigate the effect of electro-acupuncture on behavior alterations,the expression of amyloid precursor protein(APP),amyloid β-protein(Aβ) proteins and neuroapoptosis in the cerebral cortex in the APPswe/PS1dE9 double transgenic mice with Alzheimer's disease (AD) induced by isoflurane.Methods Sixmonth-old AD mice and wild-type mice at the same age were randomly divided into wile-type control group,AD group,isoflurane group,electro-acupuncture group (N =8).The mice were given pretreatment with electro-acupuncture at Baihui(GV20) acupoint and Yongquan(KI 1) acupoint once a day for 3 successive days,15 min each time.And then the mice in electro-acupuncture group and isoflurane group were exposed to a box full of 1.2％ isoflurane for 4 hours.Morris water maze was used to test the learning and memory abilities of the mice,Western blotting method was used to detect the expression of APP-C83,APP-C99 and Aβ,and terminal deoxynucleotidyl transferase(TdT)-mediated dUTP nick end labeling(TUNEL) was used to detect neuroapoptosis in the cerebral cortex.Results The escape latency of AD group was longer than that of wild-type mice group(P＜0.05),and the latency of isoflurane group was longer than that of AD group (P ＜ 0.05),while the latency of electro-acupuncture group was shorter than that of isoflurane group(P ＜ 0.05).The percentage of retention time in the target quadrant and the times for crossing the target quadrant in isoflurane group were lower than those of AD group (P ＜ 0.05),but were higher in electro-acupuncture group than those in isoflurane group (P ＜ 0.05).APPC83 expression level in isoflurane group was significantly lower than that in AD group (P ＜ 0.05),while APP-C83 expression level in electro-acupuncture group was higher than that in isoflurane group (P ＜ 0.05).APP-C99 expression level in isoflurane group was significantly higher than that in AD group (P ＜ 0.05),and APP-C99 expression level in electro-acupuncture group was lower than that in isoflurane group (P ＜ 0.05).The cortical apoptosis index in isoflurane group was significantly higher than that in AD group (P ＜ 0.05),and the cortical apoptosis index in electro-acupuncture group was lower than that in isoflurane group (P ＜ 0.05).The expression level of Aβ in AD group,isoflurane group and electro-acupuncture group was significantly higher than wild-type control group (P ＜ 0.05).Conclusion Electro-acupuncture can relieve the AD-like neurotoxicity induced by isoflurane and inhibit the decline of learning and memory abilities of AD mice,and the mechanism is probably related with suppressing the overexpression of APP-C99 and reducing the production and accumulation of Aβ,thereby alleviating the neuroapoptosis.

Objective To investigate the efficacy and safety of Bevacizumab (Bev) combined with chemotherapy protocols in the patients with metastatic colorectal cancer (mCRC).Methods 43 patients with mCRC were treated with Bev combined with various of chemotherapy protocols.The efficacy was assessed based on Response Evaluation Criterion for Solid Tumors (RECIST),and the adverse events were evaluated according to National Cancer Institute-Common Toxicity Criterion for Adverse Events (NCI-CTCAE) 3.0.Results The data of 43 patients (16 males and 27 females) were analyzed.17 patients achieved partial remission (PR),19 patients stable disease (SD) and 7 patients progressive disease (PD).The median progression-free survival (PFS) time was 10.3 months.The major of 3-4 adverse events included leucocytopenia,neutropenic febrile,and nausea/vomiting.Bey-associated adverse events were proteinuria,hypertension,rhinorrhagia,hemorrhagic hemorrhoid,menstrual blood increased,gastrointestinal perforation and venous thrombosis.Conclusions Bey combined with various chemotherapy protocols is more effective for patients with mCRC.Most patients can tolerate the side effects of the combined treatment.The long-term effects of the combined treatment need to be followed up.

Objective: To evaluate the risk of fine particulate matter (PM2.5) on excess mortality among residents. Methods: The data of residential mortality in Yangzhou City, Jiangsu Province from 2015 to 2021 were collected from the Chinese Disease Prevention and Control Information System. The average daily mass concentration of PM2.5 and meteorology data were collected from the Yangzhou Environmental Monitoring Station and Yangzhou Meteorological Bureau, respectively. The effects of PM2.5 on non-accidental mortality, morality of respiratory diseases and mortality of circulatory diseases were evaluated using a generalized additive model. The risk of excess mortality was evaluated using excess risk (ER) and the number of excess mortality. Results: The median average annual mass concentration of PM2.5 was 38.00 (interquartile range, 31.95) µg/m3 in Yangzhou City from 2015 to 2021, decreasing from 51.75 (interquartile range, 32.82) µg/m3 in 2015 to 28.00 (interquartile range, 23.42) µg/m3 in 2021. The median average annual number of non-accidental mortality, mortality of respiratory diseases and mortality of circulatory diseases were 96 (interquartile range, 22), 9 (interquartile range, 5) and 38 (interquartile range, 13) cases, respectively. The greatest effects of per 10 μg/m3 increase in PM2.5 mass concentration on non-accidental mortality, mortality of respiratory diseases, and mortality of circulatory diseases were seen at a cumulative lag of 1 day (ER=0.528%, 95%CI: 0.293%-0.763%), a cumulative lag of 2 days (ER=0.917%, 95%CI: 0.125%-1.714%) and a cumulative lag of 1 day (ER=0.595%, 95%CI: 0.232%-0.961%), respectively. The number of excess mortality caused by PM2.5 on non-accidental mortality, mortality of respiratory diseases, and mortality of circulatory diseases in Yangzhou City from 2015 to 2021 were 2 125, 412 and 977 cases, respectively; compared with 2015, the number of excess mortality in 2021 decreased by 66.95%, 75.53% and 64.42%, respectively. Conclusions An increase in the mass concentration of atmospheric PM2.5 may elevate the risk of excess mortality among residents. Compared to 2015, the number of excess deaths attributed to exposure to atmospheric PM2.5 declined in 2021.