0.05 ), the postoperative complication and mortality rate of PG group were 13.7% and 6.8%, of TG group was all 6%.Conclusions:Proximal and total gastrectomy treatment does not significantly influence the prognosis of patients with cardia and esophgogastric junction cancer in progressive stage.

Background Juvenile Graves ophthalmopathy has a low prevalence and few relevant studies.Analyzing and reviewing the clinical features and therapeutic effectiveness of juvenile Graves ophthalmopathy is helpful to its diagnosis and management.Objective This study was to evaluate the clinical characteristics of Graves ophthalmopathy and its management in children and adolescents.Methods The clinical data of 54 eyes from 29 patients with Graves ophthalmopathy who were diagnosed in Shanghai Changzheng Hospital from January 2007 to December 2012 were retrospectively analyzed.The ocular manifestations,thyroid function,CT or MRI testing results were collected,and the activity of Graves ophthalmopathy was scored based on the criteria of CAS.Artificial tears was topically administered in 44 eyes with CAS ≤ 2.In the eyes with CAS ≥ 3,corticosteroids drug was systemically used in 3 patients,and orbital decompression surgery and excision of Müller muscle were performed in 3 eyes of 2 patients respectively.The follow-up was carried out for 1.5-6 years.The treatment outcomes were evaluated according to the reduction of exophthalnos and the improvement of upper eyelid retraction.Results The patients were 5-18 years old with an average age of 12.9 years old.Out of 29 Graves ophthalmopathy patients,5 males and 24 females were included.The initial clinical manifestations were proptosis,eyelid retraction and swelling,and accompanied by conjunctival congestion and hypophasis.The best corrected visual acuity (BCVA) was ≥ 0.8 in all the eyes.CAS scores wcre 0-2 in 48 eyes of 26 patients and ≥ 3 (active Graves ophthalmopathy) in 6 eyes of 3 patients.The increase of orbital adipose volume was exhibited in all the eyes and the enlargement of extraocular muscle was revealed in parts of eyes by CT/MRI.Laboratory examination showed normal thyroid function in 12 patients (41.4％),hyperthyreosis in 15 patients (51.7％) and hypothyroidism in 2 patients (6.9％).The ocular symptom was improved in 20 eyes of 11 patients (37.9％),stabilized in 29 eyes of 16 patients (55.2％) and worsen in4 eyes of 2 patients (6.9％) in following-up duration.Conclusions Graves ophthalmopathy occurs much more in female than in male.The clinical manifestations are mild,with low activity and good prognosis in children and adolescents Graves ophthalmopathy.

Objective To investigate the serum concentration of soluble klotho (s-kl) in systemic lupus erythematosus (SLE) and lupus nephritis (LN) ,and elucidate its role in SLE and LN .Methods A total of 34 patients ,definitely diagnosis as SLE with un-treatment firstly ,were enrolled in this study .The patient were divided into two groups ,those who complicated with LN were assigned to LN group (15 cases) ,the others were distributed to SLE group (19 cases) .At the same time ,17 cases of routine physical examination people were take as control group .24 hours urine of all the cases was collected for examining urinary protein (Upro) .Routine hemocyte analysis ,serum biochemical parameters and ANA and dsDNA were measured by routine method .ELISA was used to detect s-kl ,25-hydroxy vitamin D (25-OH-D) and fibroblast grow th factor-23 (FGF-23) .Systemic lupus erythematosus disease activity index (SLEDAI) was performed in SLE and LN group ,and the creatinine clearance rate(CCr)was calculated accord-ing to the Cockcroft-Gault formula .Pearson′s and linear regression were applied to analyisis the correlation of relevant parameters . Results As compared with the control group ,there were statistically significant differences in mean arterial pressure ,blood rou-tine ,creatine kinase (CK) and lactate dehydrogenase (LDH ) ,complement (C3 and C4 ) and dsDNA in SLE and LN group (P <0 .05) .The level of Upro/24 h ,lipids (CHOL and TG) and creatinine (Scr) in LN group was significantly higher ,while serum al-bumin (ALB) and CCr were obviously lower than those in SLE group and control goup(P< 0 .05) .Difference of s-kl ,25-OH-D and FGF-23 in serum were not observed between SLE and control gropu(P> 0 .05) ,but the serum level of s-kl ,25-OH-D and FGF-23 in LN group were showed a statistical significance when compared with SLE or control group(P< 0 .05) .Meanwhile ,the SLEDAI score was higher in LN than in SLE group(P< 0 .05) .Correlation analysis indicted that s-kl exhibited a positive relationship with 25-OH-D ,C3 and C4 ,while showed a negative correlation with FGF-23 ,SLEDAI and dsDNA(all P< 0 .05) .However ,no any corre-lationt was revealed in regression analysis between the s-kl ,25-OH-D ,FGF-23 and the lupus activity .Conclusion The decrease of s-kl maybe one of the pivotal factors that up-regulated the level of FGF-23 in SLE and LN patients ,thus lead to the deficiency of vi-tamin D and lupus activity .

In order to establish the minipig model of chronic myocardial ischemia and apply non-invasive telemetry technique, the minipig model of chronic myocardial ischemia was made induced by Vitamin D3, isoproterenol and combined with high fat diet, and the non-invasive telemetry technique was used to detect and evaluate the symptoms of minipig model of chronic myocardial ischemia.Moreover, the effects of transport stress and the risk factors of atherosclerosis (AS) induced by high fat diet among Wuzhishan minipigs, Bama minipigs and Tibetan minipigs were also evaluated.Our study has successful established the Bama minipig model of chronic myocardial ischemia and the technical specification for evaluation,.The non-invasive telemetry technique can be used to detect and evaluate the symptoms of chronic myocardial ischemia model, and defines minipigs at least need to keep for more than 4 weeks after transport stress to adaptive recovery period.In addition, the different characteristics of AS risk factors such as hyperlipidemia, hypertension and hyperinsulinemia were observed in Wuzhishan minipigs, Bama minipigs and Tibetan minipigs in high fat environment, and this provides a reference for the selection and application of minipigs in the research of cardiovascular diseases.

Objective To investigate the efficacy of different treatments for breast ductal carcinoma in situ. Methods From January 2010 to March 2015,a total of seventy-eight patients with intraductal carcinoma in Shanghai First People's Hospital Baoshan Branch were enrolled in the study. According to the different treatment methods,the patients were divided into the experimental group (33 cases) and control group (45 cases). The experimental group was given breast conserving surgery plus adjuvant radiotherapy,while the control group was treated with modified radical operation. The operative time, intraoperative blood loss, drainage volume and hospital stay were compared between the two groups. The survival and adverse events of the two groups were analyzed. Results The hospitalization time (( 8. 13 ± 3. 43) d), operation time (( 108. 56 ± 22. 27) min), intraoperative blood loss ((78. 72±30. 74) ml) and drainage ((259. 68±35. 95) ml) in observation group were significantly shorter than those in the control group ((15. 56±2. 73)d,(148. 62±23. 85) min,(169. 28±26. 33) ml,(553. 37 ± 45. 64) ml) The difference between the two groups was statistically significant ( t＝12. 160, 9. 378,17. 304,38. 265,P＜0. 05). Log-rank test showed that the good prognosis rate of two groups in 24 months was 90. 32% and 88. 64% respectively,the difference was not statistically significant ( x 2＝1. 246,P＞0. 05) . Conclusion Breast conserving surgery plus adjuvant radiotherapy is the first choice for the treatment of breast ductal carcinoma in situ.

Objective:To understand the symptom perception and coping experience of postoperative delirium in patients with Stanford type A aortic dissection (TAAD) .Methods:Using the purposive sampling method, a total of 13 patients with delirium after Stanford type A aortic dissection who were admitted to Department of Cardiovascular Surgery of Henan Provincial Chest Hospital from July 2020 to July 2021 were selected as the research objects. Semi-structured interviews were conducted with patients using the phenomenological research method and the interview data were analyzed using the Colaizzi 7-step analysis method.Results:Postoperative delirium in patients with TAAD was classified into four sub-themes, such as confusion, physical and mental discomfort, cognitive disturbance and death perception. The coping experience was classified into three sub-themes, such as communication barriers, lack of encouragement and support and need for safe companionship.Conclusions:Patient with delirium after TAAD have many uncomfortable symptoms and long for support and help.

Objective To evaluate the effects of group medical visits and peer education on the compliance behaviors of patients with acne vulgaris,and to explore the effective health education approaches for patients with acne vulgaris.Methods A total of 80 patients with acne vulgaris were enrolled from Hospital of Dermatology,Chinese Academy of Medical Sciences during December 2016.They were randomly and equally divided into 2 groups:intervention group receiving conventional health education combined with group medical visits and peer education,and control group receiving conventional health education alone.At week 1,2 and 4 after the intervention,the compliance behaviors were compared between the 2 groups.Results Totally,18 patients were lost to the follow-up due to refusals and non-response,and 32 patients in the intervention group and 30 patients in the control group finally completed the study.At week 1,2 and 4 after the intervention,the scores of compliance behaviors were significantly higher in the intervention group (83.6 ± 9.3,85.9 ± 9.1,91.2 ± 8.4 respectively) than in the control group (77.1 ± 7.3,77.1 ± 8.6,79.1 ± 10.2 respectively;all P ＜ 0.05).Moreover,the scores of compliance behaviors significantly increased over time (P ＜ 0.05),and there was a significant interaction effect between the intervention methods and treatment duration (P ＜ 0.05).Conclusion Health education approaches including group medical visits and peer education can improve the compliance behaviors of patients with acne vulgaris.

Objective:To explore the trans-membrane signaling mechanism of interleukin-6 (IL-6)-induced osteogenic differentiation and calcification of human umbilical artery smooth muscle cells (HUASMCs).Methods:HUASMCs were primarily cultured in vitro and were stimulated with IL-6, IL-6+solutable IL-6 receptor (sIL-6R), IL-6+sIL-6R+solutable gp130 (sgp130), or vehicle (blank control). Alizarin red and Von Kossa staining were used for detecting cell calcification, Western blot was used to test the protein expression of tissue-nonspecific alkaline phosphatase (TNAP), osteopontin (OPN), bone morphogenetic protein-2 (BMP-2) and Runt related transcription factor 2 (Runx2), and immunofluorescence was used to examine the mIL-6R expression of HUASMCs. The comparison of measurement date between the two groups was conducted by t-test. The comparison of measurement date between multiple groups was conducted by one-way analysis of variance (ANOVA). Results:The intensity severity of calcification stain was IL-6+sIL-6R group >IL-6+sIL-6R+sgp130 group>IL-6 group=blank control. After stimulated for 12 hours, the TNAP expression in blank control, IL-6 group, IL-6+sIL-6R group, IL-6+sIL-6R+sgp130 group were (0.44±0.08), (0.52±0.14), (0.84±0.16) and (0.55±0.10) respectively ( F=290.96, P<0.001). After stimulated for 3 days, the OPN expression in blank control, IL-6 group, IL-6+sIL-6R group, IL-6+sIL-6R+sgp130 group were (0.61±0.84), (0.95±0.16), (1.65±0.24) and (0.99±0.10) respectively ( F=507.72, P<0.001). After stimulated for 12 hours, the BMP-2 expression in blank control, IL-6 group, IL-6+sIL-6R group, IL-6+sIL-6R+sgp130 group were (0.77±0.05), (1.69±0.16), (2.81±0.26) and (0.57±0.12) respectively ( F=959.09, P<0.001). After stimulated for 3 days, the Runx2 expression in blank control, IL-6 group, IL-6+sIL-6R group,IL-6+sIL-6R+sgp130 group were (0.57±0.03) , (0.92±0.10), (1.31±0.13) and (0.66±0.06) respectively ( F=1141.27, P<0.001). Comparing with Jurkat cells (positive control) and CEM cells (negative control), HUASMCs limited expressed mIL-6R. Conclusion:IL-6 may induce HUASMCs osteogenic differentiation and calcification mainly via the sIL-6R-mediated trans-signaling pathway.

Objective:To analyze the effect of Croton leaf on ERK1/2 pathway in hippocampal of rats with cerebral ischemia-reperfusion.Methods:A total of 216 SD male rats were divided into sham operation group, model group, nimodipine group, low-dose, medium-dose and high-dose groups of croton leaf according to random nubmer table method, with 36 rats in each group. The MACO model of rats was prepared by the method of wire embolization. The high, medium and low dose groups were intragastrated with the water decoction 0.06 g/ml, 0.12 g/ml and 0.18 g/ml of Croton leaf; nimodipine group was intragastrated with nimodipine suspension 1.08 g/L; sham operation group and model group were intragastrated with equal volume of normal saline. Garcia JH score was used to conduct neurological function score, and HE staining was used to observe the morphology of hippocampal neurons after 7 days of continuous administration. Apoptosis of hippocampal CA3/DG region was detected by TUNEL assay. Western Blot was used to detect the expression of ERK1/2 and p-ERK1/2 proteins.Results:Compared with the model group at simultaneous point, the neurological function scores of low-dose, medium-dose and high-dose groups of Croton leaf increased ( P<0.01), the number of apoptotic cells decreased ( P<0.01), the expression of p-ERK1/2 / ERK1/2 [1 d: (0.22±0.03, 0.34±0.02, 0.46±0.01 vs. 0.19±0.02); 3 d: (0.38±0.02, 0.50±0.02, 0.68±0.02 vs. 0.27±0.02); 7 d: (0.29±0.03, 0.43±0.02, 0.59±0.02 vs. 0.21±0.03)] in hippocampus of the low-dose, medium-dose and high-dose groups of Croton leaf significantly increased ( P<0.01). Conclusion:Croton leaf could regulate the expression of ERK1/2 pathway protein upward, effectively improve the neural function and resist the apoptosis of hippocampal CA3/DG area of rats with cerebral ischemia-reperfusion injury.

Objective:To systematically review research on the association between vitamin K and type 2 diabetes and diabetes-related biomarkers in humans, and evaluate the role of vitamin K in the prevention of type 2 diabetes.Methods:"Vitamin K", "type 2 diabetes" and related terms were searched in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang Med Online up to November 2018.Results:A total of 1 Chinese and 12 English articles were included. Among 6 observational studies, 5 of them showed that higher dietary vitamin K intake and plasma vitamin K level were associated with the decrease of the risk of type 2 diabetes. Among 6 clinical intervention studies, 5 of them indicated that the supplementation of vitamin K 1 or K2 could have positive influence on insulin metabolism. One Mendelian randomization study showed higher circulation vitamin K level might reduce the risk of type 2 diabetes. Conclusion:Vitamin K plays an important role in the prevention and control of type 2 diabetes, which may be related to the improvement of insulin metabolism and blood glucose level.