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:To investigate the effect of high-dose vitamin B6 on stress-induced liver cell death in rats with severe trauma and its possible mechanism.Methods:Thirty-two male SD rats were selected and divided into sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group by using a random number table, with 8 rats in each group. Rat models of severe trauma were established by inducing abdominal wall injury, bilateral femoral fractures, unilateral cranial injury, and withdrawal of 4 ml blood from the femoral artery. The sham surgery+B6 group and trauma+B6 group were treated with saline solution plus high-dose vitamin B6, while the sham surgery group and trauma group with infusion of saline solution only. At 36 hours after injury, rat liver tissues were collected for the following experiments: (1) the genes differentially expressed in the liver tissues of the rats of the trauma group and the trauma+B6 group were screened with next-generation sequencing, followed by an analysis of the possible involvement of cell death pathways; (2) validation was conducted to ascertain whether high-dose vitamin B6 could influence various cell death pathways in the liver cells in the sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group: apoptosis was confirmed through terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining; necroptosis was verified by mixed lineage kinase domain-like protein (MLKL) immunohistochemical staining; autophagy was examined via transmission electron microscopy; ferroptosis was confirmed by detecting oxidative malondialdehyde (MDA) levels, oxidized glutathione levels, Prussian blue staining with diaminobenzidine (DAB) enhancement, transmission electron microscopy, and immunohistochemical staining for acyl-CoA synthetase long-chain family member 4 (ACSL4); (3) Biological information analyses [Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Enrichment analysis (GSEA)] were performed for biological processes and signaling pathways represented by liver tissue sequencing results of rats between the trauma group and the trauma+B6 group.Results:(1) In the liver tissues of rats, there were 344 significantly differentially expressed genes between the trauma group and trauma+B6 group, comprising 137 upregulated genes and 207 downregulated genes, of which 18 genes were associated with apoptosis, autophagy, necroptosis, ferroptosis, and pyroptosis. (2) No significant differences were found in TUNEL staining among the sham surgery group, sham surgery+B6 group, trauma group or trauma+B6 group; MLKL protein expression levels in the liver tissues after trauma were improved, of which the trauma+B6 group was lower than that of the trauma group; Electron microscopy showed that autophagic activity in the liver cells were significantly increased after trauma, which was significantly lower of the trauma+B6 group than that of the trauma group; MDA levels in the rat liver tissues were (0.20±0.05)nmol/mg, (0.17±0.07)nmol/mg, (0.69±0.11)nmol/mg and (0.52±0.07)nmol/mg in the sham surgery group, sham surgery+B6 group, trauma group, and trauma+B6 group respectively ( P<0.01), with the trauma group having the highest MDA levels and trauma+B6 group having lower MDA levels than the trauma group; Oxidized glutathione levels in the liver tissues of the four groups were (11.75±2.09)μmol/g, (11.69±1.66)μmol/g, (19.75±3.40)μmol/g, and (14.51±1.46)μmol/g respectively ( P<0.01), with the trauma group having the highest levels and trauma+B6 group having lower levels than the trauma group; Significantly increased iron deposition was observed in the liver tissues after trauma, with lower iron deposition in trauma+B6 group than the trauma group; Electron microscopy revealed significantly lower mitochondrial membrane density in the trauma+B6 group compared to the trauma group. ACSL4 protein expression level was lower in the trauma+B6 group compared to the trauma group; (3) GO, KEGG and GSEA enrichment analyses suggested that high-dose vitamin B6 may enhance cholesterol synthesis metabolism in the liver cells and alleviate oxidative stress to reduce liver cell damage and restore normal liver cell function after trauma. Conclusions:High-dose vitamin B6 attenuates stress-induced liver injury in rats with severe trauma by inhibiting the progression of necroptosis, autophagy and ferroptosis. Its molecular mechanism may be associated with enhanced hepatic cholesterol synthesis metabolism and alleviation of oxidative stress in the liver cells.

Objective To analyze the evaluation indicators of pre-hospital first aid for adult patients with acute severe trauma to provide the evidence-based basis for the initiation of "zero channel" in first aid work.Methods The literatures such as expert consensus,clinical research,guideline and systematic review were retrieved from PubMed,Medline,Embase,Cochrane Central Register of Controlled Trials,and China Knowledge Network by computer.The retrieval time was from January 2013 to November 2023.After screen-ing the literatures according to the standard,the quality evaluation and evidence grading were conducted by a-dopting different tools.Results A total of 8 literatures were included,including 4 clinical studies,2 expert consensus and 2 systematic reviews.Finally,10 evidence-based evidences for the initiation of "zero channel" in adult patients with acute severe trauma were summarized.Conclusion This study summarizes the relevant in-dicators of "zero channel" initiation in the adult patients with acute severe trauma,which is helpful for clinical medical staff to start the first aid "zero channel" in time and increase the success rate of rescue.

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.