Objective To observe changes of erythropoietin (EPO) and rheology in moderate and severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients after the noninvasive positive pressure ventilation (NPPV) treatment. Methods Healthy adults were selected as control group (n=40) while moderate to severe OSAHS patients were selected as OSAHS group. OSAHS group was underwent NPPV treatment then, Levels of sleep apnea hypopnea index (AHI), sleep mean minimum oxygen saturation (LSaO2) and serum erythropoietin (EPO) were assessed, routine blood test and hemodynam-ic indexes were also checked before treatment and 1 and 3 months after treatment in both groups. Results In both groups serum EPO, blood, blood rheology indexes, AHI, LSaO2 were analysised at each time point by ANOVA repeated measures, all of which show significant different between groups and between each time points within the same group. Indexes in OSAHS group improved with prolonged treatment , but they are in the normal range in the control. Conclusion OSAHS pa-tients with NPPV therapy can significantly relieve hypoxia, reduce serum EPO level and blood viscosity. So NPPV has impor-tant clinical significance in prevention and treatment of OSAHS.

Objective To investigate the effect of lysyl oxidase (LOX) gene expression on proliferation, invasion and radiotherapy sensitivity in laryngeal cancer Hep-2 cells. Methods Hep-2 cells were divided into control group (normal cultured), negative control group (transfection reagent) and transfection group (LOX siRNA transfected). The expressions of LOX, Ki-67, PCNA, MMP-2 and MMP-9 mRNA were detected by real time-PCR and Western blot methods. The cell sur-vival rate and apoptosis irradiated by different doses of X-rays (0, 3, 6, 9, 12, 15 and 18 Gy) were detected by MTT and flow cytometry (FCM). Results The expression levels of LOX, Ki-67, PCNA, MMP-2 and MMP-9 protein and mRNA were sig-nificantly lower in Hep-2 cells after transfection than those of control group and negative control group (P<0.05). The cell survival rate was significantly inhibited 24 hours after irradiation (12, 15 and 18 Gy) in a dose-dependent manner (P<0.05). The apoptotic rate of transfection cells combined with radiotherapy was significantly higher than that of control and the nega-tive control groups (%:79.11 ± 1.26 vs 5.01 ± 1.02, 4.95 ± 1.12, 43.21 ± 2.1,P<0.05). Conclusion The expression of LOX can be down-regulated after LOX siRNA transfection, inhibiting proliferation and enhancing radiosensitivity, which may be related to the down-regulation of Ki-67, PCNA, MMP-2 and MMP-9 protein expression.

Objective To explore the application of ABCD3 score on stratifying the antithrombotic treatment strategy in patients with capsular warning syndrome (CWS).Methods The clinical features of 15 patients with CWS were analyzed retrospectively,and the risk of stroke were evaluated by ABCD3 score and to guide the treatment of Stratifying antithrombotic therapy.The status of patients hospitalized,discharged and discharged after 90 d were evaluated.Results The frequency of patients with CWS accounted for 2.51％ (15/ 597) of all patients with transient ischemic attack(TIA),and the mean age in patients with CWS was (70.27 ±8.29) years old.The duration of the first onset was (10-30) min,the mean time was (17.33±1.53) min,and ABCD2 score was 5.0-9.0 points,mean score was 7.00±0.26 points,and the total episodes of CWS were 51 times during 24 hours,the mean duration was (18.13 ± 15.36) minutes ((3.0-60.0) min).All 15 cases presented with limb hemiparesis.Of them,9 cases had dysarthria,5 case with ipsilateral facial palsy.All 15 cases CWS patients showed no signs of cortical deficit.The mean NIHSS score at onset was 1.0-6.0 points,mean scores was 3.20±0.31 points.Fourtheen patients were treated with clopidogrel plus aspirin,and 2 cases with administration of the loading dose 300 mg of clopidogrel,1 case was treated with clopidogrel plus aspirin orally followed by intravenous rt-PA thrombolysis.The average hospital periods of all 15 patients was (7.67±0.29) days.The NIHSS score were 0 point at discharge.There was no symptomatic intracranial hemorrhage or death within 90 days follow-up periods.Conclusion CWS is prone to develop a completed stroke.Stratified antithrombotic therapy guiding by ABCD3 score may decrease the risk of ischemic stroke.

BACKGROUNDPathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound (EBUS) elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA). The current study was conducted to investigate the diagnostic value of EBUS elastography for mediastinal and hilar lymph node metastasis in lung cancers.

METHODSFrom January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes.

RESULTSElastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes (P = 0.000). The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score (r = 0.561, P = 0.000).

CONCLUSIONSEBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.

Aged ; Elasticity Imaging Techniques ; methods ; Endosonography ; methods ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; pathology ; Male ; Mediastinum ; pathology ; Middle Aged

Objective To investigate PLCE1 protein expression in esophageal squamous cell carcinoma (ESCC)tissues,and understand the effect of PLCE1 protein expression on the prognosis of patients with ESCC.Methods The PLCE1 protein were detected in 85 patients with surgically resected ESCC paraffin-embedded tissue using immunohistochemical staining,the patients' information were selected from March 1997 to December 2011 in the database of the Henan Key Laboratory for Esophageal Cancer Research,and the survival analysis were operated with Kaplan Meier single factor and Cox multivariate regression.Results In the 85 cases,the lost to follow-up were 5 cases,the follow-up rate was 94.1％ (80/85).In the 80 cases with ESCC,the positive expression rate of PLCE1 was 77.5％ (62/80).PLCE1 positive expression was not significantly associated with differentiation,infiltration depth,lymph node metastasis and family history with ESCC (P ＞ 0.05).The univariate survival analysis by Kaplan-Meier showed that protein expression of PLCE1 had no significant association with overall survival (P ＞ 0.05).Cox regression survival analysis showed that the lymph node metastasis was associated with the survival time of ESCC patients [the relative risk were 1.763,95％ CI(1.008,3.084),P =0.047].Conclusion The expression of PLCE1 protein was involved in mechanism of ESCC,and might not predicted the prognosis of the patients with ESCC.

Objective:To study on the association between vasoactive-inotropic score(VIS) and mortality of total arch replacement in Stanford type A aortic dissection(TAAD) patients.Methods:Data of TAAD patients admitted from January 2018 to November 2018 were analyzed retrospectively. According to the inclusion and exclusion criteria, 187 patients were finally included in the analysis. 30-day mortality was calculated and the patients were divided into death group(18 cases) and non-death group(169 cases). The VIS at each time point and perioperative indexes of the two groups were compared. The value of VIS in predicting mortality was analyzed.Results:The 30-day mortality was 9.63%(18/187). The operation time, cardiopulmonary bypass time, ventilator assistance time, the incidence of tracheotomy and major postoperative complications in the death group were significantly higher than those in the non-death group( P<0.05). VIS of death group was significantly higher than that of non-death group( P<0.05). At each time point, the area under ROC curve(AUC) of VIS was greater than 0.500( P<0.05), among which AUC of ICU 48 h VIS was the largest(0.817), and the best cut-off point of ICU 48 h VIS was determined to be 9, sensitivity 61.1%, specificity 92.3%. Logistic regression analysis showed that ICU 48 h VIS was an independent risk factor for predicting the death of total arch replacement in TAAD patients( OR=1.465, 95% CI: 1.194-1.796, P<0.001). Conclusion:When ICU 48 h VIS≥9, the risk of death was increased in patients with total arch replacement of TAAD. VIS may be a useful reference index for predicting the mortality of total arch replacement in TAAD patients in the early postoperative period.

Objective To evaluate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP)-based comprehensive minimally invasive treatment for biliary anastomotic stenosis (BAS) after liver transplantation. Methods Clinical data of 60 BAS recipients after liver transplantation were retrospectively analyzed, 54 male and 6 female, aged (48±10) years. ERCP was initially carried out. If it succeeded, plastic or metallic stents were placed into the biliary tract. If it failed, percutaneous transhepatic cholangial drainage (PTCD) or single-operator cholangioscopy (SpyGlass) was adopted to pass through the stenosis. If all these procedures failed, magnetic anastomosis or other special methods were delivered. The incidence and treatment of BAS after liver transplantation were summarized. The efficacy, stent removal and recurrence were observed. Results The median time of incidence of BAS after liver transplantation was 8 (4, 13) months. Within postoperative 1 year, 1-2 years and over 2 years, 39, 16 and 5 recipients were diagnosed with BAS, respectively. All 60 BAS recipients after liver transplantation were successfully treated, including 56 cases initially receiving ERCP, and 41 completing BAS treatment, with a success rate of 73%. The failure of guide wire was the main cause of ERCP failure. The success rates of PTCD, SpyGlass and magnetic anastomosis were 5/9, 5/7 and 7/8, respectively. Two recipients were successfully treated by percutaneous choledochoscope-assisted blunt guide wire technique and stent placement in the biliary and duodenal fistula. After 3 (3, 4) cycles of ERCP and 13 (8, 18) months of stent indwelling, 38 recipients reached the stent removal criteria, including 25 plastic stents and 13 metallic stents. The indwelling time of plastic stents was longer than that of metallic stents (P < 0.05). Six cases suffered from stenosis recurrence at 12 (8, 33) months after stent removal, and the recurrence rate was 16%. Six patients were treated with ERCP, and 5 of them did not recur after the stents were successfully removed. Multivariate analysis showed that delayed diagnosis of stenosis and frequent ERCP before stent removal were the independent risk factors for BAS recurrence (both P < 0.05). Conclusions ERCP-based comprehensive minimally invasive treatment may improve the success rate of BAS treatment after liver transplantation and yield satisfactory long-term efficacy. Delayed diagnosis of BAS and high frequent ERCP required for stent removal are the independent risk factors for BAS recurrence.

Objective To develop an intelligent positioning system for mobile medical equipment in the operating room based on Bluetooth technology to enhance medical equipment management efficiency.Methods The intelligent positioning system for mobile medical equipment used received signal strength indication(RSSI)algorithm and multi-gateway trajectory filtering algorithm to realize Bluetooth positioning,which was composed of Bluetooth gateways,Bluetooth beacons,Bluetooth labels and a background data processing platform.The Bluetooth gateway consisted of an active power over ethernet(POE)module,a DC power module,a CPU,a Wi-Fi module and a Bluetooth module;the Bluetooth beacon included a beacon control unit,a Bluetooth transmitter module and a Bluetooth receiver module;the Bluetooth label was made up of a microcontroller unit(MCU),a Bluetooth module,an anti-temper switch and a accelerometer;the data processing platform had the front end developed with Vue architecture and the back end with Java language.Results The system developed could accurately locate the medical equipment in the operating room without electromagnetic interference to other medical devices.Conclusion The system developed gains advantages in high positioning accuracy,low electromagnetic interference,high stability and reliability and low cost,which improves the positioning and management efficiency of medical equipment under the premise of ensuring safety.[Chinese Medical Equipment Journal,2023,44(9):29-32]

Objective:To observe the projections from tyrosine hydroxylase(TH)positive neurons in locus coerule-us(LC)to tachykinin-1(TAC1)neurons in paraventricular nucleus of the thalamus(PVT),and morphologically determine whether they are involved in transmission and modulation of nociceptive information.Methods:TAC1-ires-Cre mice were hybridized with Rosa26:CAG-LSL-tdTomato(Ai9)mice.And spared nerve injury(SNI)induced neu-ropathic pain model was established with TAC1-ires-Cre::Ai9 mice to observe the colocalization of TAC1 and Fos and the close appositions between TAC1/FOS double-labeled neurons and TH positive axonal terminals.The distribution of the TH positive neurons and FG retrogradely labeled neurons were observed in the LC after Fluorogold(FG)was injec-ted into the PVT.Finally,the coexistences of TH positive neurons and RV labeled neurons in the LC were observed after injection of RV-mediated retrograde tracing system.Results:TAC1 positive neurons were shown with red fluores-cence in TAC1-ires-Cre::Ai9 mice.TAC1/FOS double-labeled neurons were found in the PVT of the SNI model.Some TAC1/FOS double labeled neurons made close appositions with TH positive axonal terminals.FG retrogradely labeled neurons were observed in the LC after FG injected into the PVT,and some of the FG labeled neurons coexisted with TH positive neurons.Using RV retrograde transsynaptic tracing virus,the results showed that presynaptic neurons of TAC1 positive neurons in the PVT were found in the LC,and most of the presynaptic neurons were TH positive neu-rons.Conclusion:TH positive neurons in the LC project to TAC1 positive neurons of the PVT,forming LCTH+-PVTTAC1+neural circuit,which were activated by nociceptive information.It demonstrates that this pathway plays a role in pain transmission or regulation.

Aim To investigate the mechanism of py-roptosis mediated by the NLRP3/caspase-1/GSDMD signaling pathway and the intervention effect of Radix Angelica Sinensis and Radix Astragalus ultrafiltration extract(RAS-RA)in radiation-induced pulmonary fi-brosis.Methods Fifty Wistar rats were randomly di-vided into five groups,with ten rats in each group.Ex-cept for the blank control group,all other groups of rats were anesthetized and received a single dose of 40 Gy X-ray local chest radiation to establish a radiation-in-duced pulmonary fibrosis rat model.After radiation,the rats in the RAS-RA intervention groups were orally administered doses of 0.12,0.24 and 0.48 g·kg-1 once a day for 30 days.The average weight and lung index of the rats were observed after 30 days of contin-uous administration.Hydroxyproline(HYP)content in lung tissue was determined by hydrolysis method.The levels of IL-18 and IL-1 β in serum were detected by ELISA.Lung tissue pathological changes were ob-served by HE and Masson staining.Ultrastructural changes in lung tissue were observed by transmission e-lectron microscopy.The expression levels of NLRP3/caspase-1/GSDMD pyroptosis pathway-related proteins and fibrosis-related proteins in lung tissue were detec-ted by Western blot.Results Compared with the blank group,the HYP content in lung tissue and the levels of IL-18 and IL-1 β in serum significantly in-creased in the model group(P＜0.01).HE and Mas-son staining showed inflammatory cell infiltration and collagen fiber deposition.Transmission electron mi-croscopy revealed increased damaged mitochondria,disordered arrangement,irregular morphology,shallow matrix,outer membrane rupture,mostly fractured and shortened cristae,mild expansion,increased electron density of individual mitochondrial matrix,mild sparse structure of lamellar bodies,partial disorder,unclear organelles,and characteristic changes of pyroptosis.Western blot analysis showed increased expression of caspase-1,GSDMD,NLRP3,CoL-Ⅰ,α-SMA,and CoL-Ⅲ proteins(P＜0.01).Compared with the model group,the RAS-RA intervention group showed signifi-cant improvement in body mass index and lung index of rats,decreased levels of IL-18 and IL-1 β inflammatory factors(P＜0.01),improved mitochondrial structure,reduced degree of fibrosis,and decreased expression of caspase-1,GSDMD,NLRP3,COL-Ⅰ,COL-Ⅲ,and α-SMA proteins in lung tissue(P＜0.01).Conclusion RAS-RA has an inhibitory effect on radiation-in-duced pulmonary fibrosis,and its mechanism may be related to the inhibition of pyroptosis through the regu-lation of the NLRP3/caspase-1/GSDMD signaling pathway.