Objective To investigate the risk factors that may affect postoperative complications in patients with meningiomas. Methods Of all 300 patients with diagnosed pathologically intracranial meningiomas undergoing resection were retrospectively ana-lyzed in terms of clinical datas and radiological features of preoperative MRI.These patients were divided into two groups according to whether postoperative complications occurred after tumor resection.Both univariate and multivariate regression models were used to analyze the effect of patient age and several MRI characteristics on postoperative complications.Results There were several signif-icant differences between the two groups in patient age,tumor location,tumor size,shape of tumor,wrapping around nerves and blood vessels,and tumor enhancement (P <0.05).According to the results of multivariate Logistic regression analysis,tumor loca-tion,tumor size,wrapping around nerves and blood vessels,and tumor enhancement were independently identified risk factors in the prediction of postoperative complications associated with meningioma resection.Conclusion The features of preoperative MRI may be useful for clinicians in predicting postoperative complications of intracranial meningiomas,and can provide imaging evdience for effective treatment and prognostic assessment in patients with meningiomas.

Objective To investigate the radiation dose delivered to the patients with dense breasts and the influence of photographic conditions on image quality in full field digital mammography (FFDM).Methods (1) Clinical test:we analyzed the compression thickness of breasts,Target-filter(T-F),voltage current (kV),tube current (mAs),average glandular dose (AGD) and entrance surface dose (ESE) of 100 patients (a total of 370 images,277 images of Molybdenum-Rhodium(Mo-Rh)and 93 images of Wolfram-Rhodium (W-Rh)) who underwent examinations in mode of automatic exposure by FFDM with dense breasts.(2) Phantom experiments:placed the Aluminium plate on different thickness of polymethyl methacrylate (PMMA) plates to simulate the dense breasts.68 mm phantom was used to simulate photographic condition of W-Rh and 58 mm to Mo-Rh.The two groups of dense phantom were exposed automatically and manually.The parameters were recorded for each exposure including the compression thickness of breasts,T-F,kV,mAs,AGD,ESE,the calculation of the ratio between ESE and AGD (ESE/AGD).The image quality figure inverse (IQFInv) was obtained by software.To the clinical test,used multiple factors of variance to analyze the influence of compression thickness and mAs on AGD and ESE,Pearson correlation and regression to analyze the influence of compression thickness on ESE/AGD.To the phantom experiments,used Pearson correlation to analyze the influence of kV and mAs on AGD,ESE and ESE/AGD,single factor of variance to analyze the influence of kV and mAs on IQFInv.Results (1) Clinical test:to Mo-Rh and W-Rh,with the increase of compression thickness,ESE/AGD was increased significantly.Compression thickness had linear relationship with ESE/AGD.Pearson correlation coefficients of W-Rh and Mo-Rh were 0.956 and 0.980,respectively(P＜0.01).The effects of compression thickness and mAs on AGD and ESE were statistically significant (P＜0.05) in the two groups.(2)Phantom experiments:adjusted exposure parameters to the two dense phantoms of W-Rh and Mo-Rh.With the increase of mAs and kV,IQFInv was increased in W-Rh and Mo-Rh.Different mAs and kV were statistically significant (P＜0.05) on IQFInv,mAs and kV had positive correlation with ESE and AGD (P＜0.05),mAs and kV had different correlation with ESE/AGD in the two dense phantoms.Conclusions In mode of automatic exposure by FFDM,choosing W-Rh can achieve relatively high image quality and lower radiation dose.According to the results of phantom experiments,adjusting kV and mAs properly in manual exposure can reduce AGD and ESE effectively and ensure the quality of the image.

Objective To evaluate the effects of traditional monitoring and self-monitoring in patients who take the oral anticoagulation medicine after mechanical valve replacement surgical operations.Methods A great number of Chinese and English literatures about this subject were investigated in detail,and these literatures were selected from the Cochrane Central Register of Controlled Trials,EMBase,MEDLINE,Web of Knowledge,CNKI,CNKI,VIP,and WanFang Data.It should be noted that all of the literatures were published before October,2015.Based on the results of the literature investigation,several studies were selected as the candidates.Moreover,many aspects about these candidates such as the experimental designs,characteristics of the objects of the studies and the results of the studies were filtered and recorded by two researchers independently.Furthermore,RevMan 5.3 were employed to analyze the data of the candidates.Results Eight randomized controlled trials were studied,which included 1 262 cases in self-monitoring group and 1 198 cases in traditional monitoring group.The results of metaanalysis indicated that compared with the traditional monitoring group,lower incidence of thromboembolism (Z =3.50,P =0.000) and lower mortality (Z =4.64,P =0.000) were observed,and the bleeding difference (Z =0.07,P =0.940) had no significant statistical meaning.Moreover,compared with the traditional monitoring,the international normalized ratio (INR) of the patients who were controlled in the range of treatment of the self-monitoring increased from 6％ to 20.9％,and the total number of the INR tests was increased by 2.1 to 4.98 times.Conclusions Self-monitoring could obviously reduce the possibilities of the thromboembolism and death of the patients who took the oral anticoagulation medicine after mechanical valve replacement surgical operations.Furthermore,self-monitoring could not only control the INR in the range of treatment but also increase the total number of the INR tests.In short,self-monitoring has practical value of clinical application.

Objective:Exploration of epidermal growth factor receptor (EGFR) expression and its clinical significance in pancreatic adenosquamous carcinoma (PASC).Methods:A total of 60 pancreatic cancer tissue samples and 8 normal pancreatic tissue samples were obtained from patients who were surgically treated at Beijing Chao-Yang Hospital, Capital Medical University from January 2016 to December 2021. A retrospective analysis of the clinical and pathological data of these 60 patients was conducted, including 23 males and 37 females with an age of (62.7±10.2) years. Among them, 20 cases were pathologically diagnosed as PASC, and 40 contemporaneous cases of pancreatic ductal adenocarcinoma (PDAC) were selected through propensity score matching. Immunohistochemistry (IHC) staining was used to measure the integrated optical density (IOD) of EGFR expression, and quantitative polymerase chain reaction (qPCR) was employed to detect the expression differences of EGFR mRNA. Based on the median IOD value of EGFR, the 20 PASC samples were divided into two groups, high and low expression groups. Kaplan-Meier survival analysis was performed to compare the impact of EGFR expression on the prognosis of PASC patients.Results:The IOD value of EGFR in PASC group (29.2 [25.7, 35.1]) was significantly higher than that in the PDAC group [9.5 (5.5, 13.0)] and they both exceeded the value in normal tissues [2.4 (1.7, 3.1)], with statistical significances ( all P<0.001 ). The level of EGFR mRNA expression in the PASC group was higher than that in the PDAC group [3.0 (1.8, 3.5) vs 1.2 (0.8, 1.2)], showing statistically significant difference ( P=0.0079). Patients with high EGFR expression had shorter overall survival compared with patients with low expression ( P=0.002). The incidence of vascular invasion in the PASC group [40.0% (8/20)] was higher than that in the PDAC group [17.5% (7/40)], with a significant difference ( P=0.002). The median survival time for the PASC group was 16.00 (9.25, 25.25) months, which was shorter than that of the PDAC group 21.50 (11.25, 40.75) months, showing a statistically significant difference ( P=0.033). The overall survival rate of the PASC group was lower than PDAC group ( P=0.028). Conclusion:EGFR expression is significantly elevated in PASC tissues and PASC patients have poor prognosis.

Objective To evaluate the effects of traditional monitoring and self-monitoring in patients who take the oral anticoagulation medicine after mechanical valve replacement surgical operations.Methods A great number of Chinese and English literatures about this subject were investigated in detail,and these literatures were selected from the Cochrane Central Register of Controlled Trials,EMBase,MEDLINE,Web of Knowledge,CNKI,CNKI,VIP,and WanFang Data.It should be noted that all of the literatures were published before October,2015.Based on the results of the literature investigation,several studies were selected as the candidates.Moreover,many aspects about these candidates such as the experimental designs,characteristics of the objects of the studies and the results of the studies were filtered and recorded by two researchers independently.Furthermore,RevMan 5.3 were employed to analyze the data of the candidates.Results Eight randomized controlled trials were studied,which included 1 262 cases in self-monitoring group and 1 198 cases in traditional monitoring group.The results of metaanalysis indicated that compared with the traditional monitoring group,lower incidence of thromboembolism (Z =3.50,P =0.000) and lower mortality (Z =4.64,P =0.000) were observed,and the bleeding difference (Z =0.07,P =0.940) had no significant statistical meaning.Moreover,compared with the traditional monitoring,the international normalized ratio (INR) of the patients who were controlled in the range of treatment of the self-monitoring increased from 6％ to 20.9％,and the total number of the INR tests was increased by 2.1 to 4.98 times.Conclusions Self-monitoring could obviously reduce the possibilities of the thromboembolism and death of the patients who took the oral anticoagulation medicine after mechanical valve replacement surgical operations.Furthermore,self-monitoring could not only control the INR in the range of treatment but also increase the total number of the INR tests.In short,self-monitoring has practical value of clinical application.

Objective To construct a cardiovascular surgery nursing service action plan system based on patient's demand so as to provide a reference for nurse specialisms of cardiovascular surgery to provide good service for patients.Methods From January 2017 to June 2017, patients of cardiovascular surgery of a ClassⅢ Grade A hospital were investigated with the self-designed patients' demand for nursing service questionnaire according to literature analysis and interview results of patients. Weights of the primary index and secondary index were calculated by analytic hierarchy process so as to construct a cardiovascular surgery nursing service action plan system based on patient's demand.Results The cardiovascular surgery nursing service action plan system based on patient's demand included 5 primary indexes and 78 secondary indexes. The Cronbach's α of patients' demand for nursing service questionnaire was 0.974 with a good internal consistency. Kaiser-Meyer-Olkin (KMO) was 0.843, andP value of Bartlett sphericity test was less than 0.001 with a good construct validity. The normalized weight coefficients of 5 primary indexes (physiological needs, safety needs, belongingness and love needs, self-esteem needs and self-actualization needs) were 0.2205, 0.4798, 0.0771, 0.1339 and 0.0887 respectively with 0.0488 for the consistency ratio (CR). TheCR of 21 secondary indexes of physiological needs, 19 secondary indexes of safety needs, 11 secondary indexes of belongingness and love needs, 20 secondary indexes of self-esteem needs and 7 secondary indexes of self-actualization needs was 0.0488, 0.0508, 0.0823, 0.0877 and 0.0746 respectively. TheCR was all less than 0.1 showed a satisfactory consistency in the results of hierarchy sequencing.Conclusions The construction of cardiovascular surgerynursing service action plan system based on patient's demand with the strict scientific method improves patient satisfaction. It is worth to be a reference for nursing peers and managers of cardiovascular surgery.

Objective To explore the value of dual?energy CT?based volumetric iodine?uptake (VIU) in the evaluation of chemotherapy efficacy in advanced gastric cancer. Methods Inclusion criteria of subjects: (1) without previous systematic therapy; (2) with complete clinical information before and after chemotherapy; (3) without contraindications of chemotherapy. Exclusion criteria of subjects: (1) unfinished duration and times of chemotherapy; (2) unmeasurable primary lesions; (3) poor imaging quality or poor gastric filling. Clinical and image data of 52 patients with advanced gastric cancer who were diagnosed by pathology from gastroscopic biopsy, and needed chemotherapy evaluated by imaging and clinical information in the First Affiliated Hospital of Wenzhou Medical University from February 2017 to February 2018 were collected and analyzed. Of 52 patients, 38 were male and 14 were female with the median age of 65 (31?88) years old. All the patients underwent a dual?energy, dual phase?enhanced CT scanning before chemotherapy and after the third chemotherapy session. The parameters of the lesions measured before and after chemotherapy in portal vein phase were as follows: the maximum diameter (the largest diameter among those measured in the cross?sectional, coronal, and sagittal planes), average CT value (the regions of interest were manually pinpointed under cross?sectional planes with largest diameter of the tumor, which did not include regions less than 2 mm to the edge of the tumor) and VIU (lesion volume × iodine concentration). The change rates of maximum lesion diameter, average CT value and VIU before and after chemotherapy were calculated [(post?chemotherapy parameters-pre?chemotherapy parameters) / pre?chemotherapy parameters]. The efficacy of chemotherapy was evaluated by RECIST 1.1 (the change of maximum tumor diameter after chemotherapy), Choi (the change of average CT value after chemotherapy) and VIU (the change of VIU after chemotherapy), respectively, which was categorized by complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients with CR, PR, and SD were assigned to the effective group, while those with PD were classified as the ineffective group. Paired t?test or Wilcoxon signed ranks test was used to compare the changes of parameters before and after chemotherapy, whereas Spearman correlation analysis and Kappa test were used for the correlation analysis and the consistency test between the three evaluation criteria ( Kappa≥0.75 indicated good consistency). Results After chemotherapy, the average CT value [(74.01±16.75) HU vs. (81.06±15.87) HU, t=2.202, P=0.030] and median VIU (668.53×102 μg vs. 272.52×102 μg, Z=4.761, P<0.001) decreased significantly, while the difference of the maximum diameter was not statistically significant [(66.71±34.49) mm vs. (78.45±35.62) mm, t=1.708, P=0.091]. The median change rate of VIU (–53.33%) was greater than that of CT values (–5.75%) with significant difference (Z=-5.408, P<0.001). According to the RECIST 1.1 criteria, 47 patients (90.4%, including 19 with PR and 28 with SD) were effective and 5 patients (9.6%) were ineffective. According to the Choi criteria, 45 patients (86.5%, including 37 with PR and 8 with SD) were effective and 7 patients (13.5%) were ineffective. According to the VIU criteria, 46 patients (88.5%, including 41 with PR and 5 with SD) were effective and 6 patients (11.5%) were ineffective. Efficacy comparison among these three criteria showed no significant difference (χ2=0.377, P=0.828). As compared to RECIST 1.1 evaluation, the proportion of PR evaluated by Choi and VIU was significantly higher (χ2=16.861, P<0.001), whereas the proportion of SD was significantly lower (χ2=24.089, P<0.001). There was no significant difference in the proportions of PR and SD between VIU and Choi criteria (χ2=0.887, P=0.346). Consistency and correlation analysis showed that the VIU and Choi evaluation criteria presented the highest consistency and correlation ( Kappa=0.912, P<0.001; r=0.916, P<0.001). Conclusion VIU is a feasible parameter for the evaluation of chemotherapy efficacy in advanced gastric cancer, and may be more sensitive than the evaluation criteria based on maximum diameter or change of CT value in the tumor.

Objective To explore the value of dual?energy CT?based volumetric iodine?uptake (VIU) in the evaluation of chemotherapy efficacy in advanced gastric cancer. Methods Inclusion criteria of subjects: (1) without previous systematic therapy; (2) with complete clinical information before and after chemotherapy; (3) without contraindications of chemotherapy. Exclusion criteria of subjects: (1) unfinished duration and times of chemotherapy; (2) unmeasurable primary lesions; (3) poor imaging quality or poor gastric filling. Clinical and image data of 52 patients with advanced gastric cancer who were diagnosed by pathology from gastroscopic biopsy, and needed chemotherapy evaluated by imaging and clinical information in the First Affiliated Hospital of Wenzhou Medical University from February 2017 to February 2018 were collected and analyzed. Of 52 patients, 38 were male and 14 were female with the median age of 65 (31?88) years old. All the patients underwent a dual?energy, dual phase?enhanced CT scanning before chemotherapy and after the third chemotherapy session. The parameters of the lesions measured before and after chemotherapy in portal vein phase were as follows: the maximum diameter (the largest diameter among those measured in the cross?sectional, coronal, and sagittal planes), average CT value (the regions of interest were manually pinpointed under cross?sectional planes with largest diameter of the tumor, which did not include regions less than 2 mm to the edge of the tumor) and VIU (lesion volume × iodine concentration). The change rates of maximum lesion diameter, average CT value and VIU before and after chemotherapy were calculated [(post?chemotherapy parameters-pre?chemotherapy parameters) / pre?chemotherapy parameters]. The efficacy of chemotherapy was evaluated by RECIST 1.1 (the change of maximum tumor diameter after chemotherapy), Choi (the change of average CT value after chemotherapy) and VIU (the change of VIU after chemotherapy), respectively, which was categorized by complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients with CR, PR, and SD were assigned to the effective group, while those with PD were classified as the ineffective group. Paired t?test or Wilcoxon signed ranks test was used to compare the changes of parameters before and after chemotherapy, whereas Spearman correlation analysis and Kappa test were used for the correlation analysis and the consistency test between the three evaluation criteria ( Kappa≥0.75 indicated good consistency). Results After chemotherapy, the average CT value [(74.01±16.75) HU vs. (81.06±15.87) HU, t=2.202, P=0.030] and median VIU (668.53×102 μg vs. 272.52×102 μg, Z=4.761, P<0.001) decreased significantly, while the difference of the maximum diameter was not statistically significant [(66.71±34.49) mm vs. (78.45±35.62) mm, t=1.708, P=0.091]. The median change rate of VIU (–53.33%) was greater than that of CT values (–5.75%) with significant difference (Z=-5.408, P<0.001). According to the RECIST 1.1 criteria, 47 patients (90.4%, including 19 with PR and 28 with SD) were effective and 5 patients (9.6%) were ineffective. According to the Choi criteria, 45 patients (86.5%, including 37 with PR and 8 with SD) were effective and 7 patients (13.5%) were ineffective. According to the VIU criteria, 46 patients (88.5%, including 41 with PR and 5 with SD) were effective and 6 patients (11.5%) were ineffective. Efficacy comparison among these three criteria showed no significant difference (χ2=0.377, P=0.828). As compared to RECIST 1.1 evaluation, the proportion of PR evaluated by Choi and VIU was significantly higher (χ2=16.861, P<0.001), whereas the proportion of SD was significantly lower (χ2=24.089, P<0.001). There was no significant difference in the proportions of PR and SD between VIU and Choi criteria (χ2=0.887, P=0.346). Consistency and correlation analysis showed that the VIU and Choi evaluation criteria presented the highest consistency and correlation ( Kappa=0.912, P<0.001; r=0.916, P<0.001). Conclusion VIU is a feasible parameter for the evaluation of chemotherapy efficacy in advanced gastric cancer, and may be more sensitive than the evaluation criteria based on maximum diameter or change of CT value in the tumor.

BACKGROUND:Mesenchymal stem cell-derived exosomes may play a crucial role in tissue damage repair,and miRNA is an important component of exosomes for therapeutic effects.Among them,miR-29b-3p has the effect of reducing cell apoptosis,promoting axonal regeneration,and angiogenesis. OBJECTIVE:To study the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on a neural cell injury model simulated by H2O2-treated PC12 cells,and explore the relevant mechanisms. METHODS:(1)First,the collagenase digestion method was used to extract rat adipose-derived mesenchymal stem cells.Adipose-derived mesenchymal stem cells were transfected with miR-29b-3p mimics and inhibitors.Exosomes were extracted from the culture supernatant by ultracentrifugation and identified so as to construct adipose-derived mesenchymal stem cell-derived exosomes with high expression and knockdown miR-29b-3p.(2)By constructing a neural cell injury model simulated by PC12 cells treated with H2O2,the relevant mechanisms of the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on the simulated neuronal cell injury model were studied. RESULTS AND CONCLUSION:(1)Adipose-derived mesenchymal stem cell-derived exosome had a typical cup-shaped shape and a diameter distribution in the range of 50-140 nm,expressed membrane proteins Alix,CD63,and TSG101,which were specific markers on the surface of exosomes,and could be successfully ingested by PC12 cells.(2)Adipose-derived mesenchymal stem cell-derived exosome pretreatment could reduce cell apoptosis induced by H2O2 treatment in PC12 cells,and this protective effect was enhanced with the increase of miR-29b-3p expression in the exosomes and weakened with the decrease of miR-29b-3p expression in the exosomes.The mechanism of its effect was related to adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p promoting the expression of anti-apoptotic protein Bcl-2 and inhibiting the expression of apoptotic protein Bax.