Objective To clarify the protective effect of nrsodeoxycholic acid ( UDCA ) on endoplasmic reticulum stress-mediated apoptosis in pancreatic β-cell of streptozotocin ( STZ )-induced diabetic rats.Methods Rats( n =40) received a single injection STZ( 50 mg/kg) intra-peritoneally and formed a β-cell injury model.Weight-matched normal rats( the control group,n =10 ) were injected with the buffer alone.STZ-treated rats with persistent random blood glucose higher than 16.7 mmol/L for 1 week were considered as diabetic status( n=14 ),then divided randomly into STZ-induced diabetes mellitus ( DM ) group ( n =7 ) and UDCA-treated DM group ( n =7 ).UDCA (40 mg· kg- 1,d-1 ) was administered daily by intragastric intubations throughout the experimental period (30 d).During the entire experiment,blood glucose in all rats was assessed.By the end of the experiment,all rats were sacrificed with the pancreas removed and the blood sample collected immediately.Fasting insulin levels were assayed by radioimmunoassay.The morphological changes of pancreatic β-cells apoptosis were determined by TUNEL assay.RNA in pancreas was abstracted and microarray containing 89 pieces of apoptosis related genes was applied.The related gene expressions were detected by RT-PCR and Western blot.Results The concentration of blood glucose in diabetic rats was gradually decreased after UDCA treatment,but at the end of the experiment it was still higher than that in the normal control group.The treatment with UDCA raised the fasting insulin level in diabetic rats,but this concentration was significantly lower as compared to the control group.Based on TUNEL stained tissue sections,the percentage of β-cell apoptosis of UDCA-treated DM group was significantly lower than that of STZ-induced diabetic group(P＜0.05 ).Among 89 genes,42 genes up-regulated and 46 genes down-regulated in diabetic rats,some of which were ameliorated by UDCA treatment.The expressions of Caspase-3,Bax,Bip,and CHOP mRNA in pancreas of DM group were significantly up-regulated as compared with those in the control group ( P ＜ 0.05 ) ; while the expression of Bcl-2 mRNA was markedly down-regulated (P＜0.05 ).However,these parameters in the U DCA-treated animals showed a marked improvement.Conclusion Ursodeoxycholic acid seems to protect pancreatic β-cell from apoptosis in STZ-induced diabetes by attenuating the severity of endoplasmic reticulum stress.

Objective To study and analyze the perinatal outcomes of different glycosylated hemoglobin levels in gestational diabetes mellitus (DM).Methods 53 pregnant women diagnosed gestational diabetes in our hospital were selected as the observation group,and 53 pregnant women without gestational diabetes were selected as the control group.The two groups were followed up to terminate pregnancy.The glycosylated hemoglobin level was detected by HPLC.The postpartum hemorrhage,pregnancy induced hypertension syndrome and urinary tract infection and other complications were compared between the two groups.And the premature delivery,polyhydramnios,fetal macrosomia,intrauterine distress,premature rupture of membranes and other adverse pregnancy outcomes were compared between the two groups.According to the different HbA1 c levels in the observation group,they were divided into group A (HbAlc ＜ =6％),group B (HbAlc between 6.1％ ～ 6.5％),group C (HbAlc between 6.6％ ～7.0％) and group D (HbAlc ＞ 7％),the incidences of adverse pregnancy outcome were compared among four groups.Results The incidence rates of postpartum hemorrhage,pregnancy induced hypertension and urinary system infection of the observation group (18.86％,13.21％,11.32％) were higher than those of the control group (3.77％,1.89％,3.77％),the differences were statistically significant (x2 =11.356,9.179,4.085,all P ＜ 0.05).The incidence rates of premature delivery,polyhydramnios,fetal macrosomia,intrauterine distress,premature rupture of membranes of the observation group (9.43％,9.43％,11.32％,13.21％,15.09％) were higher than those of the control group (1.89％,1.89％,1.89％,3.77％,5.66％),the differences were significant (x2 =5.323,5.323,7.207,5.735,4.781,all P ＜ 0.05).The higher the level of glycosylated hemoglobin,the higher the incidence rates of adverse pregnancy outcomes,such as premature delivery,polyhydramnios,fetal macrosomia,fetal distress.And the incidence rate of premature rupture of membranes had no significant correlation with glycated hemoglobin levels (r =0.955,P ＜ 0.05).Conclusion Glycosylated hemoglobin as an important index of gestational diabetes,its change has great influence on the outcome of pregnancy,HbAl c level higher,adverse pregnancy outcomes and the high incidence of clinical pregnancy,should strengthen the HbAlc test,in order to take timely and effective measures to reduce the incidence of adverse pregnancy outcomes and ensure the safety of mother and child.

Objective To investigate the effect of heat-sensitive point on improvement of lung function and life quality of COPD patients in stable period.Methods A total of 80 COPD patients in stable period in our hospital were randomly divided into observation group and control group,with 40 cases in each group.The control group received conventional therapy and treatment,and the observation group was given heat-sensitive point based on the control group,the changes of pulmonary function and quality of life before and after treatment were compared.Results There was no significant significance in pulmonary function and life quality in the two groups before treatment (P ＞0.05).After treatment,the lung function and life quality in the two groups were improved,but FVE1,FVE1/FVC,FVE1％ in the observation group were higher than that in the control group,influence score and symptom score and activity strength scores were lower than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Heat-sensitive points can significantly improve the pulmonary function of COPD patients in stable period,improve the life quality,and reduce adverse reactions,so it is worth promoting.

Objective To investigate the effect of heat-sensitive point on improvement of lung function and life quality of COPD patients in stable period.Methods A total of 80 COPD patients in stable period in our hospital were randomly divided into observation group and control group,with 40 cases in each group.The control group received conventional therapy and treatment,and the observation group was given heat-sensitive point based on the control group,the changes of pulmonary function and quality of life before and after treatment were compared.Results There was no significant significance in pulmonary function and life quality in the two groups before treatment (P ＞0.05).After treatment,the lung function and life quality in the two groups were improved,but FVE1,FVE1/FVC,FVE1％ in the observation group were higher than that in the control group,influence score and symptom score and activity strength scores were lower than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Heat-sensitive points can significantly improve the pulmonary function of COPD patients in stable period,improve the life quality,and reduce adverse reactions,so it is worth promoting.

The maintenance of the balance between oxygen supply and oxygen consumption is a key measure in preventing acute kidney hypoxic/reoxygenation injury. Morphine can inhibit metabolism and reduce the oxygen consumption. We tried to investigate the protective effects of morphine hypoxic preconditioning on acute kidney hypoxic/reoxygenation injury in rabbit and its influence on expression of caspase-3 protein. Kidney hypoxic and reoxygenation were induced by making the tested rabbits inhale 8% oxygen for three hours firstly, and then putting them in the air to breathe in normal oxygen for another three hours. Morphine hypoxic preconditioning was induced by administering morphine 3 mg/kg, and then hypoxic of 8% oxygen was induced. Caspase-3 protein expression in renal tissue was assessed by immunohistochemical method. In the present study, the expressions of caspase-3 protein were significantly higher in saline-control hypoxic group than in morphine hypoxic preconditioning group ((29.3+/-5.7)% vs. (12.16+1.23)%, P<0.05). These observations suggested that morphine hypoxic preconditioning can protect rabbit against acute kidney hypoxic/reoxygenation injury by decreasing expression of caspase-3 protein.
Animals ; Caspase 3 ; metabolism ; Ischemic Preconditioning ; methods ; Kidney ; blood supply ; metabolism ; Male ; Morphine ; pharmacology ; Rabbits ; Random Allocation ; Reperfusion Injury ; prevention & control ; Superoxide Dismutase ; metabolism

Objective:To construct an individualized nomogram prediction model for predicting the risk of the occurrence of covert hepatic encephalopathy (CHE) in patients with liver cirrhosis.Methods:325 cases of liver cirrhosis admitted from January 2020 to December 2022 were selected as the study subjects. Patients were divided into training ( n=213) and validation ( n=112) sets using a cluster randomization method. The risk factors for CHE occurrence in patients with cirrhosis in the training set were analyzed by univariate and multivariate logistic regression. A prediction model related to the nomogram was established. Results:Independent risk factors for the occurrence of CHE in patients with cirrhosis were a history of hepatic encephalopathy, co-infection, gastrointestinal bleeding, severe ascites, prothrombin time ≥16 seconds, high total bilirubin, and high blood ammonia levels ( P<0.05). Nomogram model validation results: The model had a net benefit for the training and validation sets, with C-indices of 0.830 (95% CI: 0.802-0.858) and 0.807 (95% CI: 0.877-0.837), respectively, within the range of 0-96%. The calibration curves of both sets were evenly close to the ideal curves. The AUCs for the ROC curves in both sets were 0.827 (95% CI: 0.796-0.858) and 0.811 (95% CI: 0.787-0.836), respectively. Conclusion:Patients with cirrhosis have many risk factors for CHE occurrence. The nomogram model constructed based on these risk factors possesses a good predictive value for assessing CHE occurrence in cirrhotic patients.

Objective:To evaluate the safety and efficacy of Toumai ? endoscopic robotic system in radical prostatectomy. Methods:This study was a single-center phase Ⅲ randomized controlled study. From June 2020 to January 2021, patients with prostate cancer who met the inclusion criteria in Changhai Hospital Affiliated to Naval Military Medical University were divided into the experimental group and the control group by random table method. Inclusion criteria included aged 18 to 80 years, pathologically diagnosed as prostate cancer, clinical stage ≤T 2N 0M 0. Exclusion criteria included patients requiring emergency surgery, having serious cardiovascular diseases and cannot tolerate surgery, having participated in other investigational drug or device clinical trials within the last 3 months. The experimental group used Toumai ? laparoscopic robotic system, and the continence group used the Da Vinci robotic system. The patients in both groups underwent radical prostatectomy via a transabdominal approach, which was performed by two surgeons. The clinical characteristics between the two groups were compared, related adverse events were recorded, and PSA and urinary continence were followed up one month after the operation. Results:A total of 44 patients were enrolled in this study, including 22 cases in the experimental group and 22 cases in the control group. The mean age of patients in the trial group and the control group was (67.7±7.5) years and (66.4±6.3) years, respectively. The median PSA at diagnosis was 10.5 (7.7, 23.7) ng/ ml and 13.5 (8.9, 24.7) ng/ ml, respectively. Biopsy Gleason score of 6, 7, 8 and 9 in experimental group were 13.6% (3/22), 68.2% (15/22), 4.5% (1/22) and 13.6% (3/22), respectively, and in the control group were 4.5% (1/22), 59.1% (13/22), 22.7% (5/22) and 13.6% (3/22) respectively. The middle risk and high risk group in the experimental group was 50.0% (11/22), 50.0% (11/22), and the control group was 36.4% (8/22), 63.6% (14/22). There was no statistical difference between the two groups.The operations in both groups were successfully performed. There were no conversions to open or laparoscopic surgeries, and no Clavien-Dindo grade Ⅲcomplications. There was no significant difference in the estimated blood loss during the operation [(109.1±51.6)ml vs.(94.5±51.6)ml] and the blood transfusion rate [9.1%(2/22)vs. 4.5%(1/22)] in both groups. The operation time was significantly higher in the experimental group than that in the control group [164.5(130.5, 214.3) min vs. 88.0(65.3, 110.5)min, P<0.001]. The positive rate of surgical margin was 13.6% (3/22) in the experimental group and 36.4% (8/22) in the control group, respectively, showing no significant difference. The pathologic stages of pT 2, pT 3a and pT 3bin experimental group were 63.6% (14/22), 13.6% (3/22) and 22.7% (5/22), respectively, while those in control group were 36.3% (8/22), 40.9% (9/22) and 22.7% (5/22), respectively, showing no significant difference. The recovery rates of urine control in the experimental group and the control group were 22.7% (5/22) and 22.7% (5/22), respectively. The median PSA in the experimental group and the control group were 0.055 (0.021, 0.103) ng/ ml and 0.032 (0.010, 0.089) ng/ ml, respectively, with no statistical difference. Conclusions:The Toumai ? endoscopic robotic system can successfully perform radical prostatectomy, based on insignificant difference from Da Vinci robotic system in safety and efficacy. The short-term follow-up showed that tumor control and urinary continence have recovered well in the test group. The long-term effect of the new system on tumor control and functional recovery after radical prostatectomy needs further multi-center studies.

Objective:To investigate the prediction of the tumor proliferation antigen(Ki-67) expression status in breast cancer patients based on ultrasound radiomics combined with clinicopathologic features.Methods:Breast cancer patients who underwent 2D ultrasound and Ki-67 examination from January 2018 to February 2022 in Changzhou Second People′s Hospital, Nanjing Medical University were retrospectively analyzed. Among them, 427 patients from Chengzhong campus were randomly divided into training and validation sets in the ratio of 8∶2, and 229 patients from Yanghu campus were used as an independent external test set. Radiomics features were extracted from the region of interest of 2D ultrasound images, and the Mann-Whitney U test, recursive feature elimination, and minimum absolute shrinkage and selection operators were used to perform feature dimensionality reduction and to establish a radiomics score(Rad-score). Subsequently, single/multifactor logistic regression regression analyses were used to construct a joint prediction model based on Rad-score and clinicopathological features. Model performance and utility were assessed using the subject operating characteristic area under the curve (AUC), calibration curve, and decision curve analyses. Results:The AUCs of the joint model for predicting Ki-67 expression status in breast cancer in the training, validation, and test sets were 0.858, 0.797, and 0.802, respectively, which were superior to those of the radiomics (0.772, 0.731, and 0.713) and clinical models (0.738, 0.750, and 0.707). Calibration curve and decision curve analyses indicated that the joint model had good calibration and clinical value.Conclusions:A joint model based on ultrasound radiomics and clinicopathological features can effectively predict the Ki-67 expression status of breast cancer, which is expected to become a non-invasive tool for Ki-67 detection and provide clinicians with an important auxiliary diagnostic and therapeutic decision-making basis.

【Objective:】 To compare and analyze the trends and hotspots in the field of medical ethics at home and abroad, and explore their teaching enlightenment for medical ethics in China. 【Methods:】 The relevant papers indexed in CNKI and Web of Science database from December 31, 2011 to December 31, 2022 were retrieved with "medical ethics" as the key word. The bibliometric method was used to compare and analyze the research trends, keyword co-occurrence, and changes of research hotspots of medical ethics at home and abroad. 【Results:】 A total of 1,187 Chinese and English papers were included. Medical ethics education and bioethics were the common research topics both domestically and internationally. The research topics in China focused on ethical teaching and the ethical principles in clinical practice, and the research hotspots in the past two years were curriculum ideological and political education, teaching practice, etc. Foreign research focused on ethical issues in clinical practice, and in the past two years, the hotspots were clinical trial ethics, informed consent, and so on. 【Conclusion:】 Medical ethics research at home and abroad has different emphasis, with domestic research being theoretical oriented and foreign research being practical oriented. By deepening the content of courses, improving the sustainable education system, and strengthening interdisciplinary cooperation, the development of ethical education in China can be promoted. This paper can provide reference for improving the education system of medical ethics in China and pointing out the direction of further research on medical ethics.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.