Objective To evaluate the role of MR imaging and MR cholangiopancreatography(MRCP) for the diagnosis of hepatic hilar cholangiocarcinoma and assessment of tumor resectability.Methods MR imagings were analyzed retrospectively and compared with surgical result in 20 patients with hepatic hilar cholangiocarcinoma.Results The tumor masses were found in the hilar regions on the MR images for 18 patients. It was found that only dilatation of the intrahepatic biliary tree and thickness of the bile duct wall for the other 2 patients. According to the Bismuth classifying, classification of MR was: typeⅠ (n=3), typeⅡ(n=4), type Ⅲ(n=6),type Ⅳ(n=7). Compared with the operative findings, the accurate ratio of classification was 80%, sensitivity specificity and coincidence was 75%, 75%,80% for the assessment of tumor resectablility by MR. Conclusion MRCP combined with MRI is very useful for diagnosis and classification of the hepatic hilar cholangiocarcinoma and assessment of tumor respectability.

Objective To explore the current status and influencing factors of oral health knowledge,attitudes and practice (KAP) among the teachers of primary and secondary schools in Gongshu District of Hangzhou City.Methods A total of 652 teachers of primary and secondary schools were selected by using multi-stage stratified cluster random sampling method and completed a self-designed questionnaire,which included demographic characteristics and oral health KAP.The status and influencing factors of oral health KAP were analyzed by single and multiple-factor analysis methods.Results The questionnaire was completed by all the 652 teachers,627 of whom were qualified (96.2％).The total ratios of oral health knowledge awareness,attitudes correctness and behaviors formation were 77.1％,68.7％ and 46.3％,respectively.There was significant difference of knowledge awareness rate by age,gender,marriage status,monthly income,life status and current cigarette smoking (x2 values were 11.48,8.57,8.12,8.46,23.97 and 4.64,respectively; all P＜0.05).There was significant difference in oral health attitudes correctness rate by gender (x2=10.65,P＜0.05) and behaviors formation rate by gender,education level and life status (x2 values were 3.95,10.88 and 10.41,respectively; all P＜0.05).In logistic regression model,impact factors of oral health knowledge awareness were age,gender,life status and physical exercises; the impact factors of oral health attitudes correctness were gender and monthly income; the impact factors of oral health behaviors formation were gender,level of education and physical exercises.Conclusion The oral health awareness and attitudes correctness are acceptible among the teachers of primary and secondary schools in Gongshu District of Hangzhou City,although the formation rate of oral health behaviors is low.Oral health education should be enforced among the teachers of primary and secondary schools.

Objective To investigate the mechanism of pulmonary inflammation induced by influenza virus , and provide reference for the development of effective drugs for viral pneumonia .Methods An influenza PR8 infection mouse model was established .The levels of inflammatory cytokines and complement molecules were determined using RT -PCR and ELISA.The pathological changes were examined using biopsy .The complement inhibitor cobra venom factor ( CVF) was injected intraperitoneally at a dose of 50 μg/( kg· 24 h) , and then body mass .The survival rate and inflammatory factors were examined .Results Compared with the control group , the expressions of complement regulatory molecule Crry and CD59 were significantly decreased (P<0.01), while those of complement C9 and complement receptor C3aR and C5aR were significantly increased in the lungs of influenza model mice (P<0.01).Pro-inflammatory cytokines TNF-α, IL-6 and IFN-γwere highly expressed , but anti-inflammatory cytokine IL-2 was lowly expressed in serum .Treatment with CVF caused a sight body mass loss, a survival rate increase and a lung index decrease (P <0.05).Moreover, an IL-2 expression increase and a decrease of IL-6, TNF -αand INF-γexpression were observed in CVF treatment mice ( P< 0.05).Conclusion Inhibition of complement activation can increase the survival rate of mice with influenza pneumonia and decrease pulmonary indexes .thus delaying the pathogenesis of PR 8.

In recent years,with the progress of the technology in genetics,imaging and molecular biology,the study of malformation of cortical development (MCD) has gradually shifted from phenotype to genotype.Genetic studies of MCD have found that MCD is associated with a number of non-ion channel family genes and so far more than 100 genes have been reported to be associated with one or more kinds ofMCD.Tubulin gene is one of the important categories,and it has been found that can lead to mcrolissencephaly,lissencephaly or polymicrogyria of MCD.Based on these three key links of MCD,we will review the relationship between the diseases and the tubulin genes from many aspects.

Objective:To investigate the relationship between serum fibrous gel protein-3 (ficolin-3) and serum alanine (ALA) levels and gestational diabetes (GDM) .Methods:A total of 98 pregnant women with GDM admitted to our hospital from Jan. 2020 to Aug. 2020 were selected as the observation group, and 98 healthy pregnant women undergoing physical examination during the same period were taken as the control group. The level of serum ficolin-3 was measured by enzyme-linked immunosorbent assay (ELISA) , and the level of serum ALA was measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) . The two groups were compared in terms of serum ficolin-3, ALA levels and biochemical indicators (hemoglobin (HbA1c) , total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , serum total protein (TP) , serum urea (SU) levels) , and pregnancy outcomes. Pearson method was used to analyze the correlation between serum ficolin-3 and ALA levels and various biochemical indexes. Univariate analysis and binary logistic regression analysis were used to investigate the risk factors of GDM.Results:Serum ficolin-3, HbA1c, and SU levels in the observation group were all higher than that in the control group. Serum ALA level was lower than that in the control group, and the difference was statistically significant ( P<0.05) . TC, HDL-C, LDL-C, TPT showed no significant difference between the two groups ( P>0.05) . In the observation group, serum ficolin-3 was positively correlated with HbA1c and Su, and serum ALA was negatively correlated with HbA1c and SU ( P < 0.05) . The incidence of adverse outcomes including gestational neonatal asphyxia, neonatal jaundice, giant size, and amniotic fluid contamination in the observation group (26.53%) was higher than that in the control group (12.24%) , The difference was statistical significant ( P<0.05) . The univariate analysis showed that GDM was associated with age, weight gain during pregnancy, serum ficolin-3, ALA, HbA1c, SU, family history of diabetes ( P<0.05) ; Binary logistics regression analysis found that age ≥28 years, weight gain≥ 14 kg, serum ficolin-3≥24ng/ml, HbA1c 6.0%, and a family history of diabetes were risk factors for GDM, while serum ALA≥1.9 μg/ml was a protective factor of GDM, ( P<0.05) . Conclusion:The increase of serum ficolin-3 and the decrease of ALA level in pregnant women are risk factors of GDM, and have an adverse impact on the final delivery outcome

Objective To investigate the correlation between C-reactive protein (CRP) level at admission and severity and early outcome of acute ischemic stroke.Methods Inpatients with acute ischemic stroke were enrolled retrospectively.The demographic and clinical data were collected.The National Institutes of Health Stroke Scale (NIHSS) at admission was used to evaluate the neurologic deficits,≤8 was defined as a mild stroke and ＞ 8 was defined as a severe stroke.The modified Rankin scale was used to evaluate the outcomes at discharge,0-2 was defined as good outcome and ＞ 2 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of severity and early outcome of acute ischemic stroke.Results A total of 120 patients with acute ischemic stroke were enrolled in the study.Their mean age was 63.35 ± 11.51 years,71 (59.17％) were males;81 had mild stroke (67.5％),39 (32.5％) had moderate to severe stroke;71 (59.17％) had good outcome,and 49 (40.83％) had poor outcome.There were significant differences in the age,CRP level,and proportions of ischemic heart disease,atrial fibrillation,smoking,and drinking between the mild stroke group and the moderate to severe stroke group (all P ＜0.05).Multivariate logistic regression analysis showed that ischemic heart disease (odds ratio [OR] 4.407,95％ confidence interval [CI] 1.100-17.653;P=0.036),atrial fibrillation (OR 6.603,95％ CI 1.190-36.635;P =0.031) and CRP (OR 1.022,95％ CI 1.001-1.043;P =0.041)were independently and positively correlated with the severity of stroke.There were significant differences in baseline NIHSS score,fibrinogen and CRP level,as well as the proportions of the patients with atrial fibrillation,smoking,and drinking between the good outcome group and the poor outcome group (all P ＜0.05).Multivariate logistic regression analysis showed that smoking (OR 8.895,95％ CI 1.699-46.557;P=0.010),baseline NIHSS score (OR 2.241,95％ CI 1.567-3.206;P ＜0.001),and CRP (OR 1.195,95％ CI 1.030-1.386;P =0.019) were independently correlated with the early poor outcomes.Conclusion CRP level at admission was the independent influencing factor of severity and early outcome of acute ischemic stroke.

Objective:To analyze the risk factors of three-vessel disease (TVD) in patients with stable coronary artery disease (SCAD).Methods:The clinical data of 447 patients with SCAD diagnosed in Zhongshan Hospital from May 2019 to April 2020 were retrospectively analyzed, including 108 cases with the single-vessel disease (SVD), 136 cases with the two-vessel disease, and 203 cases with three-vessel disease. The general data and hematological indexes were compared between patients with SVD and those with TVD; the related factors for TVD in SCAD patients were analyzed with univariate and multivariate logistic regression.Results:There were 244 males (78.5%) and 67 females (21.5%) with a median age of 57 years (64, 69). Univariate analysis showed that there were significant differences in diabetes history ( χ2=7.75, P=0.005), uric acid ( Z=-2.10, P=0.036), glycosylated hemoglobin ( Z=-2.77, P=0.006) and high density lipoprotein cholesterol (HDL-C) ( Z=-2.99, P=0.003) levels between SVD and TVD groups. Multivariate analysis showed that the high level of blood uric acid ( OR=1.01, 95% CI: 1.00-1.01, P<0.05) and the low level of HDL-C ( OR=3.29, 95% CI:1.23-8.85, P<0.05) were related risk factors of TVD. Conclusion:High blood uric acid level and low HDL-C level are related factors for TVD in patients with SCAD.

Objective In observational studies or non-randomized design,the researchers' ability to make causal inferences from data was hampered by confounding factors.This study used this method to analyze a group of observational medical data in order to instruct relevant medical personnel to carry out their own causal inference studies.Methods At present,the four main types of propensity scoring methods:matching,stratification,inverse probability weighting and covariate adjustment have been widely used in the study of causal inference.Propensity score method can theoretically eliminate the bias of the observable confounding factors,so that the treatments variables are close to the result of random assignment design,thus,it is estimated that the treatment factor has a causal effect on the outcome.Results Considering the advantages of the inverse probability weighting method over other methods,this paper summarizes the applicable conditions for the estimate of causal effect,particularly illustrates the use of a modern nonparametric statistical technology--Generalized Boosted Models (GBM) and its advantages and disadvantages.Conclusion When there is a lot of different types of confounding factors,and uncertain functional forms for their associations with treatment selection in linear,non-linear or interaction effect,and other issues,GBM propensity score weighting method can overcome the obstacles in the process of accurately estimating propensity score.

Objective:To investigate the feasibility and safety of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma.Methods:The clinical data of 12 patients from January 2018 to November 2019 with unilateral retrograde nephroureterectomy were analyzed retrospectively. There were 7 males and 5 females with an average age of 65.9 years, the age ranged from 50 to 78 years.There were 8 cases with left ureteral tumor, 6 cases with left renal pelvis tumor, 4 cases with right tumor(2 cases of right ureteral tumor and 2 cases of right renal pelvis tumor). Surgical methods: 1470 laser sleeve was used to remove the inner segment of the ureter bladder wall after the lower ureter was clipped through abdominal approach, and the urethra was inserted under the guidance of zebra guide wire.The operation time, intraoperative blood loss, intraoperative auxiliary cannula, postoperative hospital stay, postoperative drainage tube removal time, intraoperative and postoperative complications, postoperative pathology were recorded.Results:All of the operations were successful. The mean operation time was 194(135-260)min, the mean estimated blood loss was 50(25-100) ml, and the mean hospitalization time was 11.6(5-24)d. Among the 12 patients, 8 patients had abdominal drainage tube after operation. The mean time for drainage was 6.8(3-11)d. One patient added a 5 mm ancillary port.One patient had urinary leakage at the bladder anastomotic site, the catheter was removed 3 weeks later. The other patients had no postoperative incision infection, fever, bleeding, venous thrombosis and other related complications.No patient received blood transfusion and the pathological margin was negative. The median follow-up time was 12 months (5-15 months). One patient died of lumbar metastasis 8 months after operation, and others were neither tumor recurrence nor distant metastasis.Conclusions:The application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma is safe, accurate and effective, with less trauma and less bleeding. It is worth applying in clinical practice.

Objective:To investigate the effect of sodium octanoate on renal-intestinal ischemia- reperfusion injury (IRI) after resuscitation from traumatic cardiac arrest in pigs.Methods:Twenty-two miniature piglets with a body weight of (37.6±2.5)kg were divided into three groups according to the random-number table method: normal group ( n=7), IRI group ( n=7) and IRI-treated group ( n=8). A renal-intestinal IRI model of the pig was established by allowing femoral artery to bleed through blood pump at a rate of 2 ml·kg -1·min -1 until cardiac arrest, followed by whole blood transfusion through the femoral vein at a rate of 5 ml·kg -1·min -1 after observation for 6 minutes, and 50% of total blood loss was reinfused before resuscitation. Both the IRI group and IRI-treated group were with IRI model, while normal group was just monitored without induction of IRI. Besides, IRI-treated group was injected intravenously with sodium octanoate (30 mg/kg) for 1 hour at 5 minutes after restoration of spontaneous circulation (ROSC). (1) The rate of resuscitation success, survival rate at 4, 24 hours after resuscitation, blood loss when reaching cardiac arrest criteria and resuscitation time when reaching the ROSC criteria were compared in the three groups. (2) Levels of serum creatinine (SCr), urea nitrogen (BUN), intestinal fatty acid binding protein (iFABP) and diamine oxidase (DAO) were measured before resuscitation and at 1, 2, 4, 24 hours after resuscitation. (3) The animals were sacrificed at 24 hours post-resuscitation to harvest renal and intestinal tissues rapidly. TUNEL test was applied for the cellular apoptosis index. Prussian blue was used to detect the rate of iron deposition. Western blot analysis was used to measure levels of glutathione peroxidase 4 (GPX4) and acyl-CoA synthetase long-chain family member4 (ACSL4). Results:In three groups, all pigs survived. There was no significant difference in blood loss or resuscitation time between IRI group and IRI-treated group (all P>0.05). There was no significant difference in levels of SCr, BUN, iFABP or DAO before resuscitation and at 1, 2, 4, 24 hours after resuscitation in normal group (all P>0.05). But their levels were gradually increased at 1, 2, 4, 24 hours after resuscitation from that before resuscitation in IRI group and IRI-treated group (all P<0.01). Among three groups, levels of SCr, BUN, iFABP and DAO had no significant difference before resuscitation (all P>0.05), but showed obvious increase in IRI group and the IRI-treated group at 1, 2, 4, 24 hours after resuscitation compared with normal group, especially in IRI group (all P<0.01). In normal group, IRI group and IRI-treated group after 24 hours for resuscitation, the cellular apoptosis index of renal tissues was (2.3±0.8)%, (44.0±5.4)% and (13.8±4.3)%; the cellular apoptosis index of intestinal tissues was (2.6±0.9)%, (61.3±10.4)% and (20.8±3.7)%; the rate of iron deposition of renal tissues was (0.6±0.1)%, (3.9±1.0)% and (1.7±0.3)%; the rate of iron deposition of intestinal tissues was (0.8±0.1)%, (4.9±0.9)% and (2.1±0.5)% (all P<0.01). The cellular apoptosis index and rate of iron deposition of both renal and intestinal tissues were the highest in IRI group. The renal-intestinal expression of GPX4 in IRI group and IRI-treated group was lower than that in normal group at 24 hours after resuscitation (all P<0.05), with the lowest in IRI group. The renal-intestinal expression of ACSL4 in IRI group and IRI-treated group was higher than that in normal group at 24 hours after resuscitation (all P< 0.01), with the highest in IRI group. Conclusion:Sodium octanoate can reduce renal-intestinal IRI after resuscitation from traumatic cardiac arrest in pigs, the mechanism for which is probably due to that sodium octanoate can inhibit cellular apoptosis and reduce ferroptosis by regulating the expression levels of GPX4 and ACSL4.