Objective To study the effect of antipsychotic drugs combined with psychological intervention on the elderly patients with acute mental disorders after surgery operation.Methods 100 cases of elderly male patients undergoing surgery in our hospital from January 2015 to December 2016 as the object of study in the course of the study,were randomly divided into control group and experimental group,with 50 cases in each group.The control group received routine care,antipsychotic drug combined with psychological nursing intervention for patients in the experimental group,focusing on the psychological status of patients,strengthen exchanges and communication with patients,patients with heart to eliminate negative emotions,help patients recover as soon as possible.The anxiety and depression of the experimental group and the control group were compared and analyzed.Results After the corresponding nursing,the experimental group of patients with anxiety self rating scale and self rating Depression Scale score was significantly better than before nursing, the difference was statistically significant(P<0.05).The self rating depression scale of the experimental group was(44.23±3.78),and the self rating Anxiety Scale score was(42.35±5.98).In the control group,the depression score was(48.73±2.53),and the anxiety score was(45.94±4.92).The anxiety score and depression score of the experimental group were significantly better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion Antipsychotic drugs combined with psychological intervention can help the elderly male surgical acute mental disorders recovered to a certain extent,ease the patients with depression and anxiety,with further clinical promotion and application significance.

Objective To investigate the effects of Rho GTPase expression,actin cytoskeleton re- organization and cell migration in hepatic stellate cells after transform growth factor(TGF)?_1 stimulated. Methods Primary rat hepatic stellate cells were isolated and cultured.A Transwell Chamber system was used to observe the changes of serum starved HSCs haptotactic migration (direct stimulation) and chem- otactie migration(indirect stimulation) after different concentration of TGF?_1 treatment.Changes in ac- tin cytoskeletal organization were visualized by fluorescence staining using FITC labeled phalloidin and fluorescence images were recorded using confocal microscopy.The activation of GTP-loaded GTPases were evaluated by GST pull-down assays with GST-fusion proteins of GTPase hinging domains of differ- ent effectors for Rho GTPases.Results TGF?_1 treatment of hepatic stellate cells resulted in the en- hancement of migration in response to haptotactic and chemotactic stimuli,especially after 5ng/ml TGF?_1 stimulation(haptotactic migration cells :130.90?7.64 vs 102.93?1.01,P＜0.05;chemotactie migration cells:205.17?10.78 vs 102.93?1.01,P＜0.05).Serum-starved,untreated cells had a rounded-up morphology.Stimulation of hepatic stellate cells with 5 ng/ml TGF?_1 induced a rapid mor- phological change concomitant with a robust reorganization of actin cytoskeleton.Five minutes after TGF?_1 stimulation,the cells flattened out and the formation of lamellipodia occurred.Five minutes after TGF?_1 was added,stress fibers became visible,and after 15-30 minutes,the cells became well spread with fully developed stress fibers.TGF?_1 stimulation did not alter the amount of GTP-bound Racl.In contrast,Cdc42 and RhoA GTPase activity was significantly augmented after more than 5ng/ml TGF?_1 stimulation(GTP-Cdc42:0.273?0.024 vs 0.176?0.001,P＜0.05;GTP-RhoA:0.176?0.005 vs 0.096?0.004,P＜0.05).Conclusion The stimulation of TGF?_1 can induce the actin cytoskeleton re- organization,which appears to be mediated through the activity of the Rho GTPases signaling pathway. The ability of TGF?_1 to trigger activation of Cdc42 and RhoA GTPase along with actin cytoskeleton reor- ganization might well play a crucial role in hepatic stellate cells migration.

Objective To study the influence of serum containing Fuzheng Toudu Qudu Recipe, a Chinese formula with the actions of supporting healthy qi to expel and remove toxicity, on serum levels of interleukin 2 (IL-2) and soluble interleukin 2 receptor (sIL-2R) at different stages of CD34+derived dendritic cells (DC) of patients with minimal residual disease of myelogenous leukemia ( MRD-L) , and to explore the biological mechanism of Fuzheng Toudu Qudu Recipe in promoting CD34+ to transform into DC in MRD-L patients. Methods Bone marrow mononuclear cells ( BMMC) were separated from the bone marrow of acute myeloid leukemia patients at complete remission stage by using Ficoll centrifugation. CD34+ cells were isolated by using immuno-magnetic mircobeads method, and then were cultured with various concentrations of Chinese medicine medicated serum and cytokines in vitro for the induction of DC. The morphologic characteristics of DC were observed with the inverted phase contrast microscope, and the expression levels of DC surface molecules such as CD83, CD80, CD86, CD1a and HLA-DR were detected by using flow cytometry. On culturing day 0, 6 and 9, serum levels of IL-2 and sIL-2R of each group were measured by enzyme-linked immunosorbent assay ( ELISA). Results ( 1) Chinese medicine medicated serum combined with cytokines was effective on promoting CD34+ to differentiate into DC with typical morphology, and inducing DC to have high expression of CD80, CD83, CD86 and HLA-DR, which differed from those in fetal calf serum (FCS) group and blank rabbit serum group (P<0.01). Middle- and low-dose combination groups increased expression of CD1a, which differed from high-dose combination group and cytokines group ( P<0.01). ( 2) Content of IL-2 in combination groups was higher than that in blank rabbit serum group on culturing day 0. In the combination groups, IL-2 was higher on culturing day 6 and 9 than that on culturing day 0. Middle and high-dose combination groups had higher IL-2 content on culturing day 9 than on culturing day 6 ( P<0.05 or P<0.01). At the same time point, combination groups had higher IL-2 content than the blank rabbit serum group (P<0.05 or P<0.01). (3) Content of sIL-2R in the combination groups was lower than that in blank rabbit serum group on culturing day 0. In the combination groups, sIL-2R was lower on culturing day 9 than that on culturing day 0 and 6 ( P<0.01) . High-dose combination group had lower sIL-2R content on culturing day 6 than that on culturing day 0 (P<0.05), and the difference of sIL-2R in other groups was insignicant between on culturing day 6 and on culturing day 0 ( P>0.05) . At the same time point, combination groups had lower IL-2 content than the blank rabbit serum group (P<0.05 or P<0.01). Conclusion Fuzheng Toudu Qudu Recipe is effective on increasing serum content of IL-2 and reducing sIL-2R content, and the changes of cytokine contents are more obvious along with the maturity of DC, which indicates that the recipe plays positive effect in the process of promoting CD34+cells to differentiate into DC.

Background and Objectives: Stroke mimics are medical conditions producing stroke-like symptoms but eventually get diagnosed as non-stroke diseases. Epileptic seizure is a common type of stroke mimic. The purpose of this study is to investigate the application of emergency multimodal computed tomography (CT) in the diagnosis of epileptic seizure. Methods: We retrospectively reviewed the case group of patients with suspected stroke in the emergency stroke care service of the First Affiliated Hospital of Suzhou University from September 2017 to October 2019. We included those who underwent multimodal CT, including non-contrasted cranial CT, CT perfusion with CT angiography, and were ultimately diagnosed as epileptic seizures. Ten patients with acute anterior circulation ischemic stroke were assigned as controls. Results: A total of five cases met the inclusion criteria. Multimodal CT was completed within 2.25 to 3.50h from symptom onset. On CT perfusion, hyperperfusion was shown in four cases and slightly increased perfusion in one case with epileptic seizures. Cerebral blood flow and cerebral blood volume were significantly increased, while time to peak and mean transit time decreased in the regions of interest of the epileptic hemisphere when compared to either the non-affected hemisphere or the ischemic area in the control group (P<0.05). The abnormal perfusion areas did not follow vascular territory supply and CT angiography did not show vessel occlusion in the case group. Conclusion: Emergency multimodal CT could be used effectively to differentiate epileptic seizure from stroke.

Objective To investigate the expression of glucagon-like peptide-1 receptor (GLP-1R) of skeletal muscle cells and the changes of skeletal muscle microstructure of diabetic rats, and to explore the relationship between the expressions of GLP-1R and insulin resistance in skeletal muscle. Methods Male Wistar rats were divided into two groups, normal glucose tolerance ( NT, n =25 ) , diabetes group ( DM group, n=30), the methods of creating diabetes model were used high-sugar high-fat diet and low-dose in-traperitoneal injection of streptozotocin. Immunohistochemical methods was used to detect the expression of GLP-1R in the muscle cells. The number of GLP-1R positive cells in the muscle of two groups was observed and compared. The relationship was analyzed between the homeostasis model assessment insulin resistance (HOMA-IR) and the number of GLP-1R positive cells. Results ⑴Compared to the NT group, the num-ber of GLP-1R positive cells in muscle of DM group was decreased (P<0. 05); ⑵ Compared to the NT group, HOMA-IR was increased in DM group (P<0. 05);⑶ Pearson correlation analysis showed that the percentage of GLP-1R positive cells expressed in rat skeletal muscle was negatively correlated with HOMA-IR (r= -0. 538, P<0. 01). Conclusions The expression of GLP-1R positive cells was decreased in the skeletal muscle of diabetic rats, insulin resistance increased. Therefore, the expression of GLP-1R on skele-tal muscle cells may promote the development of insulin resistance and diabetes mellitus.

Objective: To establish the Wistar rat model of acute diquat poisoning and observe the pathological damage of main target organs. Methods: Thirty-six Wistar rats were randomly divided into six groups (n=6) , including one normal saline control group and five treatment groups which were separately given single-dose of intragastric administration at the doses of 46.2 mg/kg, 77.0 mg/kg, 115.5 mg/kg, 231.0 mg/kg and 346.5 mg/kg. The pathological changes of lung, liver and kidney were observed by hematoxylin and eosin (HE) and Masson staining. The optimal dose was determined according to the general situation and pathological changes. Thirty-six Wistar rats were randomly divided into five treatment groups and one normal saline control group. Treatment groups were given single-dose of intragastric administration according to the optimal dose. The rats were sacrificed at 1st, 3rd, 7th, 11th and 14th day after exposed, respectively. The activity of serum glutamic-pyruvic transaminase (ALT) and glutamic-oxalacetic transaminase (AST) were measured by chemical colorimetry. The pathological changes of lung, liver and kidney were observed by HE and Masson staining. Results: According to 14 d survival rate, the toxic symptoms and pathological changes, 115.50 mg/kg was determined the best dose. Given single-dose of intragastric administration at the doses of 115.50 mg/kg, it was found that the serum AST and ALT activity of rats on the first and third day of exposure was significant higher than those in control group. The results of pathological examination exhibited that in 115.50 mg/kg group, the pathological changes of lung, liver and kidney began to appear on the first day of exposure, the pathological changes were the most serious on the third day, and then gradually alleviated. On the 14th day, the alveolar septum was slightly widened, with inflammatory cell infiltration, local alveolar cavity became narrow, atrophy, peripheral alveolar compensation, bronchi and alveolar septum collagen fiber proliferation; The local renal tubular epithelial cells were enlarged and necrotic; the central vein surrounding hepatic cells showed vacuolar degeneration with punctate necrosis. Conclusion The rat model of acute diquat poisoning can be successfully induced by single-dose of intragastric administration. The condition of wistar rats and the pathological damage of the main target organs could be observed during the whole course of 115.50 mg/kg administration.

Objective:To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer.Methods:Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including "pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy" in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95% CI were used for estimating the overall survival time. The R 0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95% CI. The heterogeneity of the studies was analyzed using the I2 test. Results:A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival ( HR=0.76, 95% CI: 0.60-0.97, P=0.03) and higher R 0 resection rate ( RR=1.72, 95% CI: 1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications ( RR=1.02, 95% CI: 0.73-1.43, P=0.90) and mortality rate throughout treatment ( RR=1.19, 95% CI: 0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions:During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.

Objective:To investigate the effects of diquat (DQ) on the expression of intestinal pyroptosis-related proteins and tight junction proteins in rats, and to analyze the role of pyroptosis in the intestinal injury of rats with acute DQ poisoning.Methods:A total of 36 Wistar male rats were randomly divided into control group, and 3 hours, 12 hours, 36 hours and 3 days exposure groups, with 6 rats in each group. Each exposure group was given 1/2 median lethal dose (LD50) of 115.5 mg/kg DQ by one-time gavage. The control group was given the same amount of normal saline by gavage. The control group was anesthetized at 3 hours after DQ gavage to take jejunal tissues; each exposure group was anesthetized at 3 hours, 12 hours, 36 hours, and 3 days after DQ gavage to take jejunal tissues, respectively. The general conditions of the rats were recorded. The pathological changes of jejunum tissue were observed by hematoxylin-eosin (HE) staining. The expression of intestinal pyroptosis-related proteins [NOD-like receptor protein 3 (NLRP3), cysteine aspartate-specific protease 1 (caspase-1), Gasdemin D (GSDMD)] in the intestinal tissues was observed by immunohistochemical staining. Western blotting was used to detect the expression of intestinal pyroptosis-related proteins and intestinal tight junction proteins (Occludin and Claudin-1).Results:Light microscopy showed that pathological changes occurred in jejunum tissue at the early stage of exposure (3 hours), and the injury was the most serious in the 12 hours exposure group, with a large number of inflammatory cells infiltrating in the tissue, and the damage was significantly reduced after 3 days exposure. Immunohistochemical results showed that NLRP3, caspase-1 and GSDMD were expressed in the jejunal mucosa of the control group and the exposure groups, and the positive cells in the control group were less expressed with light staining. The expression of the above proteins in the exposed group was increased significantly and the staining was deep. Western blotting results showed that compared with the control group, the expression of NLRP3 protein in jejunum tissues of all groups was increased, with the most significant increase in the 36 hours group (NLRP3/β-actin: 1.47±0.06 vs. 0.43±0.14, P < 0.01). Compared with the control group, the expression of GSDMD protein in the 3 hours, 12 hours and 36 hours exposure groups increased, and the expression of GSDMD protein in the 3 hours and 12 hours exposure groups increased significantly (GSDMD/β-actin: 1.04±0.40, 1.25±0.15 vs. 0.65±0.25, both P < 0.05). The expression of caspase-1 protein was increased in 36 hours exposure group compared with the control group (caspase-1/β-actin: 1.44±0.34 vs. 0.98±0.19, P > 0.05). Compared with the control group, the expression of Occludin and Claudin-1 proteins in each exposure group decreased, and the expression of Occludin proteins was significantly decreased in the 3 hours, 12 hours, and 36 hours exposure groups decreased significantly (Occludin/β-actin: 0.74±0.17, 0.91±0.20, 0.79±0.23 vs. 1.41±0.08, all P < 0.05). Although the protein expression of Claudin-1 decreased in each exposure group, the difference was not statistically significant. Conclusion:The intestinal injury caused by acute DQ poisoning may be related to the activation of pyroptosis pathway of small intestinal cells and the reduction of the density of intercellular junctions.

Objective:To explore the clinical features of acute diquat (DQ) poisoning, and further improve the awareness of acute DQ poisoning.Methods:A retrospective analysis was performed on the clinical data of patients with acute DQ poisoning diagnosed in the emergency department of the Second Hospital of Hebei Medical University from January 1, 2019 to December 31, 2021. The clinical data included age, gender, exposure routes, presence of pesticides (drugs) mixture poisoning, dosage of poison, the time from taking poisoning to admitting in the emergency department, clinical manifestations, laboratory data, treatment, hospital days, prognosis and survival days.Results:The number of cases who firstly complained of acute DQ poisoning in the past three years were 19 cases in 2019, 28 cases in 2020, and 51 cases in 2021. A total of 12 patients were excluded due to being diagnosed paraquat (PQ) poisoning by toxicology detection. Finally, 86 cases of acute DQ poisoning were included, including 80 cases of oral DQ poisoning, 1 case of intramuscular injection, 1 case of binocular contact and 4 cases of dermal exposure. In 80 cases of oral DQ poisoning, there were 70 cases of diquat poisoning alone (42 cases survived, 28 cases died) and 10 cases of pesticide mixture poisoning (6 cases survived, 4 cases died). The time from oral poisoning to admitting in the emergency department was 0.5-96.0 hours, with an average of (8.6±5.8) hours. The time of intramuscular injection poisoning to admitting in the emergency department was 3 hours. The time of dermal exposure to admitting in the emergency department was relatively long, with an average of 66.1 hours. The time from oral simple DQ poisoning to death was 12.0-108.0 hours, and the time from oral mixed DQ poisoning to death was 24.0-576.0 hours. A total of 70 patients with oral diquat poisoning alone presented various degrees of multiple organ injuries. All patients presented gastrointestinal symptoms such as nausea and vomiting. Renal injury and central nervous system injury were the most significant and closely related to the prognosis.Conclusions:Acute oral DQ poisoning can cause to multiple organ injuries, and the clinical manifestations are related to the dose of the poison. In severe cases, acute renal failure and refractory circulatory failure occur within 24 hours after poisoning, and severe central nervous system injury with disturbance of consciousness as the primary manifestation occurs within 36 hours, followed by multiple organ failure until death.