Objective To investigate the effects of dilute concentration and acting time of pronase on quality of gastroscopy.Methods A total of 448 patients were randomly divided into two groups : sodium bicarbonate group and pronase with sodium bicarbonate group.Pronase was diluted into 50 ml (400 U/ml)and 100 ml (200 U/ml) using sodium bicarbonate.The patients were pretreated by pronase of different concentrations 10 min, 20 min, 30 min, 60 min and 120 min before gastroscopy.Diluent of same quantity were taken by the control group.Visibility of gastroscopy, procedure times and positive rates of lesions were compared.Results Pretreatment of pronase significantly improved visibility of gastroscopy, raised positive rates of lesions, and reduced procedure times of gastroscopy, compared with the control group (each P ＜ 0.05).The visibility of gastroscopy were over 80％ 20,30, and 60 minutes before the examination with no significant difference(P ＞ 0.05).The visibility of gastroscopy decreased sharply 30 minutes after taking pronase, especially after 60 minutes.There was no significant difference in the quality of gastroscopy between the 200 U/ml and 400 U/ml group 20-60 minutes before gastroscopy (P =0.640).Conclusion Pronase (200 U/ml-400 U/ml) significantly improves visibility of gastroscopy, raises positive detection rates of lesions, and reduces procedure time of gastroscopy 20-60 minutes before pretreatment.

Objective To investigate cerebrospinal fluid characteristics and clinical features in children with severe hand,foot and mouth disease (HFMD) induced by enterovirus 71 (EV71) infection.Methods A total of 114 children with severe HFMD,in whom EV71 was detected by reverse transcription polymerase chain reaction (RT-PCR),were admitted in Hangzhou Children's Hospital during May and August 2013.Seventy-eight children with severe HFMD induced by other enteroviruses admitted at the same period served as controls.The results of cerebrospinal fluids (CSF) routine examination and biochemical tests,and the clinical symptoms were compared between two groups.Differences in enumeration data were compared with x2 test,and measurement data were compared with Mann-Whitney U test.Results The incidences of vomiting and limb shaking in EV71 infection group were 35.1％ and 50.9％,which were higher than those in control group (x2 =7.864 and 19.682,P ＜ 0.05).The incidence of limb shaking in children with nucleated cells count ≥ 100 × 106/L in EV71 group was higher than that with nucleated cells count ＜ 100 × 106/L (72.3％ vs.35.8％,x2 =14.740,P =0.000).The nucleated cells count,protein quantity and their positive rates in EVT1 infected group were higher than those in control group (Z =-9.458 and-6.591,P=0.000; x2=105.421 and 10.932,P =0.000 and 0.001).Conclusion The symptoms of nervous system damage and abnormal CSF examination were more serious in HFMD induced by EV71 infection,and in EV71 infected patients the incidence of limb shaking is correlated with nucleated cell count in CSF.

AIM:To observe the Toll-like receptor 9 (TLR9) activation in microglia BV-2 cells after oxygen-glucose deprivation and reoxygenation ( OGDR) , and its effects on neuronal apoptosis.METHODS:The BV-2 cell super-natants were collected after the corresponding treatment and added to mouse primary cortical neurons after OGDR for 4 h, followed by normal culture for 24 h.The cells were divided into normal BV-2 group, NC-siRNA group, TLR9-siRNA group, OGDR group, OGDR+NC-siRNA group, OGDR+TLR9-siRNA group and control group (without adding BV-2 cell supernatant) .The changes of the neuronal morphology were observed under an inverted phase-contrast microscope, and the neuronal apoptosis was detected by TUNEL.The protein expression of cleaved caspase-3 was detected by Western blot-ting.RESULTS:After OGDR, the axon turned thin, twisted and broken, and neuronal swelling, decrease in refraction and vacuolar degeneration were observed.The green-stained apoptotic bodies in the neurons in all groups were positive. Compared with control group, the caspase-3 protein levels in other groups were increased.Compared with the normal BV-2 group, the caspase-3 protein in OGDR group and TLR9-siRNA group was increased.Compared with OGDR+TLR9-siRNA group, the caspase-3 protein in TLR9-siRNA group and OGDR group was decreased.CONCLUSION: After OGDR, TLR9 activation in BV-2 cells induces neuronal apoptosis with the increase in caspase-3 protein level.Inhibition of TLR9 expression reduces neuronal damage.

Objective To investigate the expression and clinical significance of apoptosis inhibitory protein, Livin and Smac,in pancreatic carcinoma. Methods The expressions of Livin and Smac protein in 46 cases of pancreatic carcinoma tissues and 15 cases of insulinoma tissues and 14 cases of normal pancreatic tissues were examined by using immunohistochemical SP staining, and its relationship with clinicopathological parameters was analyzed. Results The positive expression rates of Llivin protein were 73.9％ ( 34/46),73.3％ (11/15) and 14.3％ (2/14) in pancreatic carcinoma, insulinoma and normal pancreatic tissue. Livin was highly expressed in pancreatic carcinoma and insulinoma, but there was no significant difference between the two groups, however, both were significantly higher than that in normal pancreatic tissues group ( P ＜ 0.05 ). The expression of Livin was significantly correlated with lymph node metastasis, histopathological grading and clinical staging (P ＜ 0.05 or P ＜0.01 ). The positive expression rates of Smac protein were 39.1％ (18/46), 100％ ( 15/15 ) and 92.9％ (13/14) in pancreatic carcinoma, insulinoma and normal pancreatic tissue. Smac was highly expressed in normal pancreatic tissues and insulinoma, but there was no significant difference between the two groups, however, both were significantly higher than that in pancreatic cancer group (P ＜ 0.05 ). The expression rote of Smac protein was significantly correlated with lymph node metastasis, histopathological grading, chnical staging and patients' age (P ＜0.05 or P ＜0.01 ).Conclusions Livin protein may play an important role in genesis and development of pancreatic carcinoma,but Smac protein may play a role in preventing the development of pancreatic carcinoma.

Objective To explore the clinical application value of serum amyloid A (SAA),C-reactive protein (CRP) and SAA/CRP in early diagnosis of hand-foot-mouth disease (HFMD).Methods The serum levels of SAA and CRP were detected in 873 children with HFMD who were admitted in Hangzhou Children's Hospital from April to December in 2015.And 487 healthy children were enrolled as healthy control group.SAA was measured by nephelometry assay,and CRP was measured by immunoturbidimetry.Variables were compared using Mann-Whitney U test and diagnostic value was measured by using receiver operating characteristic (ROC) curve.Results The median levels of SAA in HFMD group and control group were 330.5 and 4.0 mg/L,respectively,which was statistically different (Z=-29.02,P＜0.01);the median levels of CRP were 10.0 and 1.0 mg/L,respectively,with statistical difference (Z =23.79,P＜ 0.01);and the median SAA/CRP were 23.06 and 2.40,respectively,with statistical difference (Z=-24.79,P＜0.01).In ROC curve comparison,the area under the curve of SAA (0.980) was higher than those of SAA/CRP ratio (0.911) and CRP (0.899) for diagnosing HFMD.When using 10.30 mg/L as the cut off value for SAA according to the ROC curve,the sensitivity was 91.6％ and the specificity was 96.6％.Conclusions Joint detection of SAA and CRP can improve the efficiency in the early diagnosis of HFMD.SAA can provide useful auxiliary information for the diagnosis of HFMD,which is worthy of extensive clinical application.

Objective To preliminarily explore the expresssion of the Hedgehog signaling pathway (HH) after different liver trauma, and provide basis for the blockaded effection of HH and the potentiality of new traditional Chinese medicine exploition. Methods After adaptive breeding for one week, a cohort of 140 male SPF Fisher 344 rats were randomly divided into Retrorsine injection (R) indicated the toxical of chemical damage of liver, partial hepatectomy (PH) indicated the acute liver trauma, retrorsine/partial hepatectomy (R/PH) for the hepatic stem cells regeneration, and normal control (N) groups. The administering of retrorsine or placebo, and PH or sham operation were performed as Gordon’s matheds. RT-PCR, real-time PCR and immunohistochemistry were performed to detect the expression of the constituents related to HH after liver damage. Results RT-PCR demonstrated that the mRNA expression of IHH, PTCH, Smo, Gli1, Gli2, Gli3 were all activated in primary liver cells after different kinds of liver damage. The results of real-time PCR analysis indicated an interaction effect existing between the treatment and the time in 3 Hedgehog-related constituents (signaling molecule IHH, indicators of the HH activation Ptc, Gli1) (all P<0.001). The protein expression of PTCH in liver tissue section was confirmed by immunohistochemistry, which differed in the duration in PH and R/PH groups. Conclusion The HH was abnormally activated during the different liver trauma. It’s maybe an important signaling pathway during the liver’s reaction after damage.

Objective To investigate the effect of micro-incision phacoemul-sification on cataract patients and its effect on interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and epidermal growth factor (EGF) expressions in cataract patients.Methods With forward-looking research, 284 cataract patients were randomly included in the control (coaxial conventional incision phacoemulsification) or observation (coaxial micro-incision phacoemulsification) groups, with 142 cases per group.The effective phacoemulsification time and mean ultrasonic energy difference were compared between two groups, and the uncorrected vision recovery, Ocular Surface Disease Index (OSDI), tear break-up time (BUT), schirmer I test (SIt), corneal fluorescence stain (FL), and the expressionsIL-6, TNF-α and EGF were measured in two groups on preoperative (T0), 1 week after operation (T1), 2 weeks after operation (T2), 4 weeks after operation (T3), and the above indicators of Spearman correlation analysis.Results There was no significant difference in effective phacoemulsification time and mean ultrasonic energy between two groups (P ＞ 0.05).The improvement of uncorrected visual acuity in observation group was significantly better than that in the control group (F=6.116, P =0.032).In addition, OSDI, FL,IL-6,TNF-α, and EGF showed the first increase and then decreased at different time points, and the observation group was superior to the control group with statistically significant difference.At the same time, BUT and SIt showed a trend of increasing first and then decreased, and the observation group was superior to the control group with statistically significant difference.In addition, IL-6, TNF-α, and EGF expressions were positively correlated with OSDI and FL scores (P ＞ 0.05).Conclusions Micro-incision phacoemulsification can help reduce the expressions of IL-6 and TNF-α, improve the expression levels of EGF in cataract patients, and reduce the incidence of adverse symptoms such as dry eye after operation.It might improve the clinical therapeutic effect.

Objective:To compare the efficacy and safety of azacitidine alone or combined with half-course CAG (arorubicin + cytarabine + granulocyte colony stimulating factor) regimen and azacitidine combined with full-course CAG regimen in treatment of patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS).Methods:The clinical data of 51 patients with AML and MDS admitted to Datong Fifth People's Hospital from September 2019 to March 2022 were retrospectively analyzed. Among them, 17 patients received azacitidine alone 7-day regimen, 17 patients received azacitidine combined with half-course CAG regimen and 17 patients received azacitidine combined with full-course CAG regimen. The remission rate, adverse reaction rate and supportive treatment were compared among the three groups.Results:The objective remission rate (ORR) was 58.8% (10/17), 64.7% (11/17) and 70.6% (12/17) in azacitidine alone group, azacitidine combined with half course CAG group, and azacitidine combined with full course CAG group, respectively, and the difference was not statistically significant among the above groups ( P = 0.773). The main adverse reaction after treatment with azacitidine was bone marrow suppression,and 32 patients had grade 3-4 hematological side effects. The average time of agranulocytopenia was (15±5) d, 23 patients had infection and 11 cases had hemorrhage. There were no significant differences of the three groups in the hemorrhage incidence, the infection, incidence, agranulocytosis time, the amount of red blood cell infusion and the amount of platelet infusion (all P > 0.05). Except 1 patient died of acute left ventricular dysfunction after chemotherapy in the first cycle and 1 patient died of cerebral hemorrhage after chemotherapy in the third cycle, all the patients successfully completed the chemotherapy after active symptomatic support treatment and safely passed the bone marrow suppression period. Conclusions:Azacitidine alone, azacitidine combined with half-course CAG, azacitidine combined with full-course CAG regimens in the treatment of AML/MDS all show good curative effects, and their adverse reactions are similar to supportive treatment. Azacitidine combined with full-course CAG regimen has a relatively high effective rate.

Objective:To clarify the transitional components in the blood of compound Banlangen Granules; To explore the mechanism of drugs in the treatment of epidemic encephalitis B, hepatitis and parotitis.Methods:The transitional components in blood of compound Banlangen Granules were analyzed by ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS/MS). The regulatory targets and pathways of compound Banlangen Granules in the treatment of epidemic encephalitis B, hepatitis and parotitis were analyzed based on UPLC-MS/MS and network pharmacology.Results:A total of 9 blood components were identified, of which 8 were prototype components, including sucrose, o-aminobenzoic acid, uridine, adenosine, guanosine, indole-3-acetonitrile-2 murine-S-β-D-glucopyranoside and salicylic acid. Through network pharmacological analysis, it was concluded that compound Banlangen Granules may treat epidemic encephalitis B, hepatitis and parotitis by regulating lipid and atherosclerosis, insulin resistance, IL-17 and other signal pathways.Conclusion:The 9 blood components of compound Banlangen Granules may treat epidemic encephalitis B, hepatitis and parotitis by regulating lipid and atherosclerosis, insulin resistance, IL-17 and other signal pathways.

Objective:To evaluate the clinical outcomes of patients with borderline developmental dysplasia of the hip (BDDH) and cam-type femoroacetabular impingement syndrome (FAIS) after hip arthroscopy.Methods:Data were retrospectively reviewed for patients with BDDH and cam-type FAIS who underwent hip arthroscopy surgery from June 2017 to December 2019. A total of 32 patients were enrolled, with a mean age of 36.13±8.67 years (range, 20-50 years), including 15 males and 17 females. The preoperative lateral center-edge angle was 22.3°±1.6° (range 20.1°-24.7°), while the preoperative α angle was 64.1°±4.6° (range, 56.0°-69.8°). All patients were treated with arthroscopic limited acetabular plasty, labral repair, femoral osteoplasty, and capsular plication after excluding from external hip diseases by ultrasound-guided hip blocking test. The visual analogue scale (VAS), modified Harris Hip Scores (mHHS) and International Hip Outcome Tool-12 (iHOT-12) scores were used to evaluate the clinical effects.Results:All patients were followed up, and the mean follow-up time was 2.5±0.8 years (range, 2.0-4.7 years). The VAS score decreased from 6.07±1.56 to 1.96±0.92 at 1 year and to 1.86±1.01 at 2 years after operation ( F=112.64, P<0.001); the mHHS score increased from 53.87±13.04 to 86.12±8.64 at 1 year and to 88.71±8.15 at 2 years after operation ( F=101.70, P<0.001); the iHOT-12 score was improved from 40.00±7.33 to 76.27±9.50 at 1 year and to 78.67±10.31 at 2 years after operation ( F=134.91, P<0.001). The α angle improved to 40.27°±4.52° (range, 34.8°-49.7°) with significant difference ( t=9.24, P<0.001). Conclusion:Hip arthroscopy can achieve satisfied short-term outcomes in treating BDDH and cam-type FAIS with few complications and less trauma.