Objective To investigate the value of 18 F-fluorodeoxyglucose (18 FDG)positron emission tomography and computer tomography (PET/CT)in the diagnosis and localization of ectopic ACTH syndrome (EAS)induced by lung cancer,and to increase the accuracy rate of diagnosis of EAS.Methods 8 patients were histopathologically proven to be lung cancer.18 FDG PET/CT wholebody and brain scan were performed;magnetic resonance imaging (MRI),99m Tc-octreotide (OCT)imaging and inferior petrosal sinus sampling (IPSS)were done in all patients.On 18 FDG PET/CT images,the SUVmax values of lesions and the SUVmax ratio of lesion tissue to normal lung tissue were calculated.Results ① 8 patients with EAS included 2 cases of carciniod,4 cases of atypical carciniod,and 2 cases of small cell lung cancer.The ACTH levels in inferior petrosal sinus and peripheral veins of 8 patients had no difference.②The chest CT showed there were pulmonary nodules in 6 cases (75%),among them 2 cases were atypical lesions.5 cases of pituitary adenomas were found by MRI (25%),and OCT imaging was positive in 2 cases (25%).③The 18 FDG PET/CT showed nodular,mass like or patch samples with high metabolic activity in 8 cases (100%)of pulmonary lesions.The SUVmax of tumor was 0.72 to 14.05 (3.67±4.68),and the ratio of SUVmax of lesion tissue to normal lung tissue was 1.69 to 27.54 (8.14 ± 9.63).18 FDG hypermetabolism was found in 8 cases of bilateral adrenal hyperplasia,while 4 cases showed pituitary tumor.Conclusion Lung cancer is a common source of EAS,especially carcinoid.18 FDG PET may show lower glucose metabolism.18 FDG PET/CT should be used as an assisted method to diagnose EAS.

group was (1.20 ± 1.09),(1.09 ± 1.04), (0.86 ± 0.42), (1.89 ± 1.30) and that of the control group was (2.40 ± 1.87), (2.34 ± 1.71), (1.60 ± 1.33),(3.49 ± 1.72) respectively, which had statistical significance between the two groups (t=3.139-4.390, P<0.01). the Blood CRP values and CRP positive rate in the observation group, were (6.34±2.74) and 17.14%(6/35) respectively and which of the control group were (10.35±7.37) and 42.86%(15/35), the difference of the two groups was statistically significant (t=2.881, P<0.01 andχ2= 5.250, P < 0.05). Conclusions Topical treatment of acute cellulitis with honey can effectively improve the clinical symptoms, reduce the level of c-reactive protein, which is better than magnesium sulfate wet compress.

Objective To investigate the risk factors and establish the Cox's regression model and the personal prognosis index for the recurrence of ischemic stroke in 3-year follow-up.methods 1058 patients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013.Cases were followed up since the onset of ischemic stroke.The follow-up was finished in January 1,2016.Kaplan-Meier methods were used for recurrence rate description.Monovariant and multivariate Cox's proportional hazard regression model were used to analyze risk factors associated with recurrence.Thus,a recurrence model was set up.Result sDuring the period of follow-up,184 cases relapsed.The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,3-year recurrence rate was 52.7 person-year.Monovariant and multivariant Cox's proportional hazard regression model showed that the independent risk factors associated with recurrence were age(X1)(RR=1.303;95%CI:1.019~1.666)history of heart disease(X2)(RR=1.788;95%CI:1.127~2.836),hypertension(X3)(RR=1.897;95%CI:1.097~3.280),diabetes(X4)(RR=1.674;95%CI:1.015~2.760),total cholesterol(X5)(RR=2.136;95%CI:1.396~3.266).The personal prognosis index(PI)of recurrence model was as the following: PI=0.265X1+0.581X2+0.640X3+0.515X4+0.759X5.Conclusion sAge,history of heart disease,hypertension,disease progression,and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke.The recurrence model and the personal prognosis index equation are successful constructed.

Objective To explore the effects of humanistic care on preoperative negative emotions in patients undergoing eye surgery, so as to alleviate the negative emotion and promote the rehabilitation process of the operation. Methods From October 2016 to February 2017, totals of 120 patients who were undergoing eye surgery from each of the 2 wards of the ophthalmology department in the First Affiliated Hospital of Zhengzhou University were recruited in the research. All the patients were randomly divided into control group and observation group by coin tossing method. Routine nursing was applied in the control group, while on the basis of the control group, humanistic care was given to the observation group. The intervention effects were evaluated by the general information questionnaire, the Self-Perceived Burden Scale (SPBS), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Results There was no statistical difference in negative emotions between the two groups before intervention (P>0.05). The scores of negative emotions all had a certain decrease after intervention. The scores of SPBS, SAS and SDS were (28.49±5.92), (45.49±6.49) and (41.22±5.62) in the observation group after intervention respectively; while those scores were (34.95±6.56), (58.57±8.56) and (54.53±6.45) in the control group respectively. The scores of the observation group were all lower than those of the control group, and the differences were statistically significant (t=10.49, 6.45, 7.34; P< 0.01). Conclusions Humanistic care can obviously reduce patients' self-perceived burden, anxiety, depression and improve patients negative emotions.

Objective To investigate the efficacy of Saccharomyces boulardii combined with ursodeoxycholic acid in the treating rectal ulcerative colitis (UC) and its influence on intestinal mucosal barrier function. Methods A total of 88 patients with rectal UC were randomly divided into observation group and control group, with 44 cases in each group. The scores of main symptoms (abdominal pain, diarrhea, purulent stool), score of the Inflammatory Bowel Disease Questionnaire (IBDQ), levels of inflammatory factor indicators [interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α)] and levels of intestinal mucosal barrier function indicators [the ratio of urinary lactolic acid to mannitol (L/M), serum D-lactic acid (D-LA), serum diamine oxidase (DAO), and serum lipopolysaccharide (LPS)] were compared between the two groups before and after treatment. The incidence of adverse reactions were compared between two groups. Results After treatment, the scores of abdominal pain, diarrhea and purulent stool in both groups were significantly lower than those before treatment, while the IBDQ score was significantly higher than that before treatment, and the scores of abdominal pain, diarrhea and purulent stool in the observation group were significantly lower than those in the control group, while the IBDQ score was significantly higher than that in the control group (P < 0.05). After treatment, the levels of serum D-LA, DAO, LPS and urinary L/M in both groups reduced significantly, and the levels of these indicators in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of serum IL-6, TNF-α and IL-1β in both groups reduced significantly, and the levels of these indicators in the observation group were significantly lower than those in the control group (P < 0.05). The total effective rate inthe observation group was 86.36%, which was significantly higher than 68.18% in the control group (P < 0.05). There were no significant differences in incidence rates of adverse reactions such as lower abdominal pain, allergies and refractory constipation between two groups (P>0.05). Conclusion Saccharomyces boulardii combined with ursodeoxycholic acid is effective in the treatment of patients with rectal UC, which can effectively improve symptoms such as abdominal pain, diarrhea and purulent stool, inhibit the inflammatory response of the body, and alleviate damage to the intestinal mucosal barrier.

Objective:To optimize the alcohol extraction process of herbal pair puerarin-berberine.Methods:Based on the etha-nol reflux extraction,the extraction quantity of total flavonoids,total alkaloid,puerarin and berberine hydrochloride were used as the e-valuation index,and the independent variables included the drug particle,ratio of solid to liquid, ethanol concentration, reflux dura-tion and reflux times. Significance analysis was evaluated by Plackett-Burman design,and then the extraction process was optimized by Box-Behnken response surface methodology.Results:The optimal extraction conditions of drug pair puerarin-berberine were as follows:the drug particle was 80 mesh,the ratio of solid to liquid was 1:13,the ethanol concentration was 75%,the reflux time was 60 min, and the reflux times was 4. Under the above conditions, the extraction quantity of total flavonoids, alkaloid, puerarin and berberine hydrochloride was 120.34,56.99,109.63 and 39.26 mg ·ml-1, respectively.Conclusion: The extraction process of herbal pair puerarin-berberine is reasonable and feasible optimized by Plackett-Burman design and Box-Behnken response surface methodology.

Objective To explore the correlation between depressive symptoms and frailty,in order to provide evidence for prevention and relief of depressive symptoms in elderly inpatients.Methods A cross-sectional survey and comprehensive geriatric assessment(CGA)were conducted with 248 eligible elderly inpatients from December 2015 to February 2017 in our hospital.Depressive symptoms were assessed by the 5-Item Geriatric Depression Scale(GDS-5),and frailty was identified by the frailty phenotype method.Results In all respondents,50 (20.2 ％)patients showed depressive symptoms,93(37.5 ％)patients had pre-frailty and 39 (15.7 ％)patients had frailty.Correlation analysis showed that frailty degree,low grip strength,slow gait speed,low physical activity,fatigue,and weakness were all positively correlated with depressive symptoms in elderly inpatients (r =0.441,0.315,0.426,0.316,0.395 and 0.151,respectively,P ＜ 0.05).Logistic regression analysis showed that patients who had more severe frailty faced a much higher risk of developing depressive symptoms (OR=2.608,P＜0.05).Of the 5 indicators of frailty,slow gait speed and frailty also increased the risk of having depressive symptoms (OR =2.801 and 3.484,P ＜ 0.05).Conclusions Frailty degree,gait speed and fatigue are associated with increased risk of depression in the elderly.Depressive symptoms can be reduced in elderly inpatients with prevention and intervention of pre-frailty and frailty.

Purpose: This study was performed to investigate the association of Glasgow prognostic score (GPS), combined positive score (CPS), and clinicopathological characteristics of locally advanced rectal cancer. Methods: Between February 2012 and February 2018, 103 patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and total mesorectal excision (TME) were retrospectively evaluated. Results: According to the classification of the GPS, 85 (82.5%), 13 (12.6%), and 5 patients (4.9%) were classified as a score of 0, 1, and 2, respectively. Patients were classified into the GPS-low group (GPS of 0, n = 85) and GPS-high group (GPS of 1 or 2, n = 18) with an area under the curve of 0.582 for overall survival (OS). The mean programmed death-ligand 1 (PD-L1) CPS of the whole group was 2.24 (range, 0–70). The PD-L1 CPS of the GPS-high group was higher than the GPS-low group (P < 0.001). Multivariate analysis by Cox proportional hazards model indicated that GPS was associated with OS and diseasefree survival (DFS). Furthermore, PD-L1 CPS was associated with DFS (hazard ratio, 1.050; 95% confidence interval, 1.017– 1.083; P = 0.003). Conclusion Elevated GPS was related to the PD-L1 CPS. GPS and PD-L1 CPS were associated with the prognosis of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by TME.

Medical Physics is an interdiscipline which is formed by applying the basic principles, methods, and techniques of physics to clinical medical research such as prevention, diagnosis, and treatment of human diseases, and it is a compulsory professional basic course for medical students. However, there are many medical students reflect that the content of this course is obscure and difficult to understand. Teaching effect is not ideal. The main reasons are that the teaching method is single and the reference materials are few. Based on the actual situation of the course, Hebei Medical University, China promotes formative evaluation from the content of teaching materials, teaching means, and other aspects. At the same time, by combining with the Internet, the digital construction has been realized, deepening the reform of the Medical Physics curriculum, and remarkable results have been achieved.

Objective:To establish a rapid quantitative PCR (qPCR) technique for Mycobacterium marinum skin infections, and to analyze its clinical diagnostic efficiency. Methods:DNA was extracted from Mycobacterium marinum colonies and serially diluted (10 -1 to 10 -8). Twelve pairs of previously reported primers and probes, as well as 6 pairs of newly designed primers and probes in this study, were used for qPCR amplification to identify the most sensitive primers and probes for the detection of Mycobacterium marinum. Skin lesion tissues were collected from 72 patients with confirmed Mycobacterium marinum infections (experimental group) and 68 with other mycobacterial infections (control group) at Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences in 2021. These skin tissues were subjected to qPCR amplification, interferon-gamma release assay (IGRA), acid-fast staining, and tissue culture to evaluate the diagnostic efficacy. Results:The newly designed primers and probes targeting the mycobacterial enhanced infection locus 2 (Mel2) demonstrated the highest sensitivity, with a detection limit of 0.86 copies/μl (cycle threshold value = 37) ; the qPCR amplification with the Mel2 primers/probes did not yield positive results when used for the detection of other mycobacteria (including Mycobacterium leprae and Staphylococcus spp) . Among the 72 patients in the experimental group, 44 were positive for qPCR with a sensitivity of 61.1% (95% CI: 49.6% - 71.5%), and 47 were positive for culture with a sensitivity of 65.2% (95% CI: 53.8% - 75.3%) ; all the 68 controls were negative for both qPCR and culture, with their specificities both being 100%. Among 65 patients subjected to IGRA, 31 were positive with a sensitivity of 47.7% (95% CI: 36.0% - 59.6%), while 16 out of 25 controls were negative for IGRA with a specificity of 64.0% (95% CI: 44.5% - 79.8%). Among 58 patients subjected to acid-fast staining, 37 were positive with a sensitivity of 63.8% (95% CI: 50.9% - 74.9%), and 52 out of 66 controls were negative for acid-fast staining with a specificity of 78.8% (95% CI: 67.5% - 86.9%). The combination of qPCR and culture resulted in a sensitivity of 93% and a specificity of 100% for the detection of Mycobacterium marinum. Conclusion:In this study, a highly sensitive qPCR assay was developed for the detection of Mycobacterium marinum, and its combination with culture could further improve the detection sensitivity.