Objective:To establish the quality standard for Qiyeling granules. Methods:Astragali Radix and naringin were identi-fied by TLC. The content of astragaloside A was determined by HPLC. Results:The qualitative identification was with high resolution and without interference from the negative substances. The linear range of astragaloside A was 0. 166-1. 104 μg(r=0. 999 1), and the average recovery was 97. 27%(RSD=1. 3%,n=6). Conclusion:The method can be used in the quality control of Qiyeling granules.

Objective To investigate the expression of muhidrug resistance-related protein 1 (MRP1),lung resistance-related protein(LfuP)and glutathione S-transferase-π(GST-π)in carcinoma of the gallbladder and cholangiocarcinoma. Methoils MRP1,LRP,GST-πwere measured in experimental group(18 cases of carcinoma of the gallbladder,36 CSSeS Of cholangiocarcinoma)and control group(13cases of cholecystitis and cholangeitis)by immunohistochemistry.Statistical analysis used chi-square test and spearman test. Results The positive rate of MRP1,LRP,GST-π in carcinoma of the gallbladder and eholangiocarcinoma were 72%(13/18),78%(14/18),61%(11/18)and 86%(31/36),75%(27/36),69%(25/36),respectively,significantly higher than those of 23%(3/13),23%(3/13),23%(3/13)(X2=4.5,P＜0.05)in control group.The expression of LRP[93%(13/14)]in pafients＞60 years old was significantly higher than 64%(14/22)in patients younger than 60 yrs old(x2=3.9,P ＜0.05).In addition,their expression was not related to gender,age,staging,tumor differentiation and lymph node metastasis(P＞0.05).The expression of MRP1 was related with tllose Of GST-π,Spearman correlation coefficient=0.569(P＜0.05).Conclusions MRP1,LRP,GsT-π were over expressed in various degrees in carcinoma Of the gallbladder and cholangiocarcinoma witllout chemotherapy.and related to the primary muhidrug resistance Of cholangiocarcinoma and carcinoma of the gallbladder.

Objective: To observe the effect of a novel targeted agent enzastaurin alone or in combination with gefitinib on ge-fitinib-resistant human non-small cell lung cancer cells to explore the rational drug combination. Methods: CCK-8 assay was used to measure the cell proliferation. Combination index ( CI) was calculated by Chou-Talalay method to assess the efficacy of the combination therapy. The flow cytometry (FCM) was used to analyze the change in the cell cycle. Results:In 72h, the IC50 value of gefitinib and enzastaurin for the lung cancer NCI-H460 cells was 6. 99μmol·L-1 (95%CI:3. 55-13. 79μmol·L-1 ) and 7. 25μmol·L-1 (95%CI:4. 77-1. 02 μmol·L-1), respectively. The inhibition effect on the cell proliferation was stronger in the combination treatment than that in the monotherapy (P<0. 05), and the simultaneous treatment showed the most significant inhibition effect (P<0. 01). The IC50 value of gefitinib for H460 cells in the simultaneous administration group, the sequential administration group with gefitinib used first and the sequential administration group with enzastaurin used first was 0.006 μmol·L-1(95%CI:0.002-0.020μmol·L-1), 0.02μmol·L-1(95%CI:0.011-0.037 μmol·L-1) and 0.085 μmol·L-1(95% CI:0.042-0.170μmol·L-1, respectively. The CI of the simultaneous administration group was lower than one when the gefitinib concentration was above 0. 05μmol·L-1 . The cell cycle distribution result indicated that the simultaneous administration group had significantly increased G0/G1 proportion (P<0. 05) and induced cell cycle arrest at G1 phase. Conclusion:Protein kinase C inhibitor enzastaurin combined with EGFR inhibitor gefitinib shows a synergistic effect, suggesting that the combination treatment of the two drugs might be a new strategy for the follow-up therapy of gefitinib-resistant non-small cell lung cancer.

Objective To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia.Methods A total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups,group A (traditional stents) and group B (modified stents)(n =15 in each group).Two days after stent implantation at the cardia by endoscopy,stents were withdrawn with endoscope guided by X-ray.LES Pressure,X-ray images ( including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment.The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared.The side effects and complications during the treatment were recorded.Results All thirty stents were successfully implanted and removed.Stent dislocation occured in 2 cases in group A,but none in group B.Dysphagia had significant improvement after the treatment in both groups ( P ＜ 0.05 ),but the recurrence rate of group A ( 26.7％ ) was significantly higher than group B (6.67％ ) in 6 months ( P ＜ 0.05 ).LES pressure and X-ray images of both groups significantly improved after treatment ( P ＜ 0.001 ),and those of group B were superior to group A ( P ＜ 0.05 ).There was no difference in adverse reaction between the two groups.No perforation occured in any group.Conclusion Self-expanding metallic stents is safe for patients with cardia achalasia,with implantation convenience,symptomatic improvement,low recurrence,and few complications or dislocation.

Objective To evaluate the clinical efficacy and safety of endoscopic mucosal resection (EMR) assisted with magnifying chromoendoscopy in treatment of colorectal neoplasms. Methods Patients who met criteria for EMR including appropriate flat or depressed type and sessile lesions were enrolled. The association of morphology of colorectal lesions with histopathology was observed and the accuracy of estimation of invasive depth by magnifying chromoendoscopy was evaluated. Results Ninety lesions of 81 patients were reseeted by EMR (25 being sessile and 65 being flat or depressed). The histological results revealed low-grade dysplasia (LGD) in 58 lesions, high-grade dysplasia (HGD) in 20 lesions, and adenocarcinoma in 12 lesions. The average size of lesions was (1.4±0.5) cm in HGD, (1.6±0.5) cm in cancer and (1.0±0.4) cm in LGD with no significant difference (P> 0.05). It was shown that the flat and depressed lesions were more likely to be HGD or cancer as compared to sessile lesions, but with no statistical difference [41.5 % (27/65)vs. 20.0% (5/25), P= 0.084]. Moreover, the lesion with central depression was more likely to be HGD or cancer as compared to those without depressed surface [51.0% (25/49) vs. 17.1 % (7/41), P<0.01)]. The accuracy of estimating invasive depth by magnifying chromoendoscopy was 97.8% (86/90). Complete resection was confirmed histologically in 95.8% (88/90) of all lesions. Conclusions Colorectal lesions of depressed and flat types with central depression are more likely to be malignant. Estimation of invasive depth of colorectal neoplasia by magnifying chromoendoscopy in EMR treatment makes it more effective and safer.

Objective To evaluate the accuracy of preoperative three-dimensional endoscopic ultra-sonography (3D-EUS) in tumor invasion depth (T-staging) of rectal cancer. Methods From May 2007 to November 2007, 21 patients with rectal cancer diagnosed by eolonoscopy and biopsy, underwent 3D-EUS, 2D-EUS and MRI before surgery to predict T-staging. The results were assessed according to post-surgical pathological findings. Results The accuracy of 3D-EUS in T-staging was 85.71%, which was significantly higher than that of MRI (57.14%, P<0.05), and similar with that of 2D-EUS (76.19%, P>0.05). Conclusion More accurate T-staging could be achieved by 3D-EUS, which could be combined with MRI to detect lymph node metastasis, and provide more information for therapy decision in rectal cancer.

Pathology rotation is an important part in resident standardization training. Impor-tance should be attached to the residents' learning during the standardization training in Pathology De-partment, such as standardizing training and strict departmental rotation examination, developing the residents' thinking ability of the relationship between clinical and pathology with the main line of spe-cialty pathology learning , and improving clinical research capacity through pathology technical methods and principles, and training pathology literacy from pathology requisition filled to interpreta-tion of the pathology report, which will also help to improve the medical service quality of the hospital.

Objective:To explore the predictive value of renal resistive index (RRI) joint with semiquantitative power Doppler ultrasound (PDU) score to acute kidney injury (AKI) in non-septic critically ill patients.Methods:This prospective observational study enrolled non-septic critically ill patients admitted to the Emergency Intensive Care Unit of Cangzhou Central Hospital from January 2018 to August 2019. In addition to general data, RRI and PDU scores were measured with medical ultrasonic instrument within 6 h after admission. Renal function was assessed on the 5th day in accordance with kidney disease: Improving Global Outcomes criteria. The patients who progressed to AKI stage 3 within 5 days after admission were classified into the AKI 3 group, and the rest were classified into the AKI 0-2 group. The difference of each index was compared between the two groups in non-septic critically ill patients and patients with acute heart failure (AHF). Normal distributed continuous variables were compared using independent sample t-tests, whereas Mann-Whitney U tests were used to examine the differences in variables without a normal distribution. Categorical data were compared with the Chi-square test. Receiver operator characteristic curves were plotted to examine the values of RRI, PDU score, RRI-RDU/10 (subtraction of RRI and 1/10 of PDU score), RRI/PDU (the ratio of RRI to PDU score), and RRI+PDU (the prediction probability of the combination of RRI and PDU score for AKI stage 3 obtained by logistic regression analysis) in predicting AKI 3. Delong's test was used to compare the area under the curve (AUC) between predictors. Results:A total of 110 non-septic critically ill patients (51 patients with no AKI, 21 with AKI stage 1, 11 with AKI stage 2, and 27 with AKI stage 3) were recruited. Among them, there were 63 patients with AHF (21 patients with no AKI, 15 with AKI stage 1, 7 with AKI stage 2, and 20 with AKI stage 3). Among the non-septic critically ill patients as well as its subgroup of AHF, compared with the AKI 0-2 group, acute physiology and chronic health evaluation-Ⅱ score, sequential organ failure assessment score, arterial lactate concentration, mechanical ventilation rate, proportion of vasoactive drugs, 28-day mortality, serum creatinine, RRI, RRI-RDU/10, RRI/PDU, RRI+PDU, and rate of continuous renal replacement therapy were higher in the AKI 3 group, and urine output and PDU score were lower ( all P<0.05). As for non-septic critically ill patients, RRI/PDU [AUC=0.915, 95% confidence interval ( CI): 0.846-0.959, P<0.01] and RRI+PDU (AUC=0.914, 95% CI: 0.845-0.959, P<0.01) performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.804, 95% CI: 0.718-0.874, P<0.01) and PDU score (AUC=0.868, 95% CI: 0.791-0.925, P<0.01). The optimal cutoff for RRI/PDU was > 0.355 (sensitivity 92.6%, specificity 81.9%, Youden index 0.745). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.899, 95% CI: 0.827-0.948, P<0.01) was also better than RRI and PDU scores, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). As for patients with AHF, RRI/PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) and RRI+PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) also performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.845, 95% CI: 0.731-0.924, P<0.01) and PDU score (AUC=0.913, 95% CI: 0.814-0.969, P<0.01) with statistically differences (all P<0.05). The optimal cutoff for RRI/PDU was > 0.360 (sensitivity 95.0%, specificity 90.7%, Youden index 0.857). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.950, 95% CI: 0.864-0.989, P<0.01) was also better than RRI and PDU score, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). Conclusions:The combination of RRI and PDU score could effectively predict AKI 3 in non-septic critically ill patients, especially in patients with AHF. The ratio of RRI to PDU score is recommended for clinical application because of its excellent predictive value for AKI and its practicability.

Objective To investigate the nutritional status of the pupils with cerebral palsy and the factors related with nutrition. Methods The height and weight of 139 cerebral palsy pupil (6~18 years old) were measured. The rate of stunting, wasting, overweight and obesity were calculated, and compared with the norm, and among the subjects with different cerebral palsy type, grade of Gross Motor Function Classification System (GMFCS), famiy background (urban or rural), age, etc. Results The rate of stunting and wasting was more than the norm, and the obesity was less. The rate of stunting negatively correlated with the grade of GMFCS. The rate of wasting negatively correlated with the age. Conclusion It is important to focus on the physical development delay and malnutrition of children with cerebral palsy.

Objective To evaluate the metabolite pattern and the severity in patients with spinocerebellar ataxia type 3/ Machado-Joseph disease (SCA3/MJD) by 1H magnetic resonance spectroscopy (1H-MRS) on different cerebellar regions, including cerebellar vermis, cerebellar peduncles, cerebellar cortex, and dentatum. Methods Thirty-six SCA3/MJD patients, and 27 sex, age-matched healthy controls were scanned with 1H-MRS for N-acetylaspartate (NAA), choline (Cho) and creatine (Cr). We made cerebellar vermis, cerebellar peduncles, cerebellar cortex, and dentatum as the region of interests (ROI), and finally got access to NAA/Cr, Cho/Cr, and NAA/Cho ratios. We also examined the CAG repeat numbers of MJD1 gene, scored the 36 patients by the scale for the assessment and rating of ataxia (SARA), analyzed the differences in ratios between SCA3/MJD patients and the control group, and explored whether relevance existed between these ratios and duration of the disease, age of onset, CAG repeat times, and SARA scores respectively. Results The ratio of NAA/Cr in SCA3/MJD patients showed a significant reduction in the cerebellar cortex, dentatum, cerebellar vermis and medipeduncle (P<0.01) compared with the controls. The ratio of NAA/Cho also showed significant reduction in the dentatum and cerebellar vermis (P<0.01). A number of correlations were found between the metabolite ratios of 1H-MRS and duration of the disease, age of onset, expanded CAG and SARA score in SCA3/MJD patients. Conclusion 1H-MRS, which shows the neural metabolic changes in the cerebella of SCA3/MJD patients, provides useful information about the severity of SCA3/MJD.