AIM:To study the protective effect and mechanism of Gujingdan(Radix Astragali,Fructus Alpiniae oxyphyllae,Radix et Rhizoma Salviae miltiorrhizae,Herba Epimedii,Semen Euryales,etc.) on the acute renal injury caused by Gentamicin in rats.METHODS:90 rats were randomly divided into normal control group,pathologic model group,preventive group which included high,middle and low dosages of Gujingdan(4 g/kg,2 g/kg,1 g/kg) and positive control group which was treated with Shenkangning(2 g/kg) and treated group which included the same groups as the preventive group.The preventive groups were respectively given Gujingdan and Shenkangning for two weeks and ahead one week.On the seventh day,except the normal group the others were continuously injected gentamicin by abdominal cavity(100 mg/kg/day) seven days.At the same time,the treated group were given Gujingdan and Shenkangning by ig for seven days.When the experiment was over,the content of ?-N-acetyglocosamidase(NAG),serum creatinine(SCR) and blood urea nitrogen(BUN) were examined,and the renal histological changes were observed.RESULTS:NAG,BUN,SCR of the groups which were treated with Gujingdan were remarkly lower than that of the pathologic model group;SOD、ATP were higher and MDA was lower than that of the model group.Histological changes showed that renal tubular epithelial cells of the groups treated with Gujingdan were similar to the changes of normal group and much better than that of positive group and pathologic model group.CONCLUSION:Gujingdan has the protective effect on acute renal injury caused by Gentamicin.The mechanism may be that Gujingdan has the function of inhibiting oxidation,protecting and stabilizing cell membrane.

The research capacity in post-graduate education process is an important content,also an important indicator of educational outcomes.School of Medicine and Health Management of Hangzhou Normal University has done a bold exploration at this area,making the integration and innovation,from the management system to the practical operation,from the school management to the society support.Considering the compound characteristics of Social Medicine and Health Service Management specialty,the school has designed the "ladder" training research capacity programs by playing the school system,teacher roles and social support,and many other forces,in order to ensure and enhance the research capability of post-graduates.

Objective To explore the feasibility ,effectiveness ,recurrence rate and complications ,etc .of endoscopic retrograde stenting in treating acute appendicitis .Methods A retrospective analysis was conducted on seven patients with the clinical diagnosis of acute appendicitis ,complying with the following treatment steps :(1) normal saline for high cleansing enema in 2-3 times ;(2) en-doscopically douching ileocecal junction and observing the opening of appendix ;(3) placing the guide wire into the opening of appen-dix under the guidance of imaging tube ,and then conducting angiography imaging ;(4) repeatedly douching with metronidazole;(5) implant the appendix stent ,draining the inflammatory secretions out and then douching ;(6 ) observing postoperative abdominal pain ,fever ,bowel and other conditions;(7) reviewing with the enteroscopy and removing the stent 2 weeks later .At 2 before the surgery and 48 after it ,all patients were administrated with antibiotics for anti-infective treatment .The follow-up was made from 8-15 months after the surgery .Results Among these 7 patients ,4 patients had successful appendix stenting :the abdominal pain sig-nificantly alleviated after the surgery ;the proportional level of white blood cells(WBC)recovered during 24-48 after the surgery .15 after discharge ,two patients returned to hospital and their appendix stent removal was successful;during the operation ,smooth mu-cosa at the opening of appendix was observed .The stents of two patients spontaneously fell off ,and normal morphology of the ap-pendix opening was observed at review .During the postoperative follow-up of 8-15 months ,one patient relapsed and underwent sur-gical treatment in the general surgery department .The other three patients did not undergo appendix stenting due to the unsuccess-ful intubation .Conclusion The treatment of acute appendicitis with endoscopic stenting has the advantages of little trauma ,high safety and significant efficacy .However ,this method still requires large-scale and multicenter randomized controlled clinical trials to evaluate its feasibility and long-term efficacy .

Objective:To evaluate the effects of pegylated interferon (Peg-IFN) alfa-2b combined with nucleotide analogues (NAs) on the recurrence of hepatitis B-related liver cancer after resection, and to explore the changes of HBsAg and HBV DNA in patients with chronic hepatitis B liver cancer during postoperative treatment.Methods:The prospective study was conducted. Clinical data of 43 patients with hepatitis B-related liver cancer who underwent radical resection treated in 900th Hospital of People′s Liberation Army were prospectively analyzed from January 2020 to December 2021. Among 43 patients, there were 39 males and 4 females, the age was 30-76 years. According to different treatment methods they were divided into two groups, the patients treated by Peg-IFN alfa-2b combined with NAs were devided into the IFN group( n=10), and those treated by NAs alone into the NAs group( n=33). Two-pair semi-quantitative were collected every 3 months after operation. The recurrence-free survival rate, recurrence time after 2 years in the two groups, the clearance rate and the negative rate of HBsAg and HBV DNA in the two groups. Peg-IFN alfa-2b was evaluated in improving the prognosis of hepatitis B-related liver cancer. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Chi-square test was used for comparison between the two groups of count data. Repeated analysis of measurement variance was used for analysis HBsAg and HBV DNA changes of the interferon group overall survival time and recurrence-free surrival time of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. Results:HBsAg and HBV DNA: The HBsAg clearance rate at 24 weeks and that at 48 weeks in the IFN group were 24.6% and 59.0% respectively. The HBsAg negative rate at 48 weeks was 16.7%. The HBV DNA clearance rate at 24 weeks and that at 48 weeks were 33.9% and 53.8% respectively. The HBV DNA negative rate was 0 at 48 weeks. The levels of HBsAg and HBV DNA in the IFN group decreased gradually with time. There were statistically differences between the levels of HBsAg and HBV DNA at 0 weeks, 24 weeks and 48 weeks( P<0.05). The 2-year overall survival rates of IFN group and NAs group were 100% and 90.9% respectively. The 2-year recurrence-free survival rates were 90.0% and 63.6% respectively. There were no significant statistical differences in the overall survival rate and recurrence-free survival rate between the groups ( P>0.05). The postoperative recurrence time of the IFN group and the NAs group were (15.00±7.07) months and (5.78±3.39) months respectively. The difference between the two groups was statistically significant ( t=3.160, P<0.01). Conclusion:Long-term antiviral therapy of Peg-IFN alfa-2b combined with NAs can prolong the recurrence time of liver cancer, reduce the levels of HBsAg and HBV DNA in serum, and potentially improve the survival rate of the patients compared with therapy of NAs alone.

Objective Excimer laser coronary atherecomy ( ELCA) has been recently used for the treatment of complex coronary lesions including calcified stenosis , chronic total occlusions and in-stent restenosis. Such complex lesions are difficult to adequately treat with balloon angioplasty and /or intracoronary stenting.The aim of this study was to introduce our early experiences in using ELCA in China . Methods Fifteen patients were enrolled through our center from March 2015 to April 2016 , and excimer laser coronary angioplasty was performed on 15 lesions.Eleven patients were previously failed cases either from uncrossable balloon ( 9 lesions ) or expandable balloon ( 6 lesions ) . The procedure and clinical endpoints were recorded .Results Laser catheter with 0.9 mm diameters were used in all 15 coronary lesions.All the lesions were successfully crossed with laser catheter and finally dilated with balloon .The procedural success rate was 100%.Drug eluting stents ( DES ) were implanted in 86.7% lesions and 2 cases were treated with drug eluting balloon .Clinical success was obtained in all patients (100%).There was no dissection , major side branch occlusion , spasm, no-reflow phenomenon nor acute vessel closure . Conclusions This study shows that laser-facilitated coronary angioplasty is a simple , safe and effective device for the management of complex coronary lesions .

Purpose: This study compared the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the Risk of Malignancy Index 4 (RMI4), the International Ovarian of Tumor Analysis Logistic Regression Model 2 (IOTA LR2), and the IOTA Simple Rules (IOTA SR) in predicting the malignancy of adnexal masses (AMs). Methods: This retrospective study included 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (group I) and two junior doctors (group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. A receiver operating characteristic curve was used to test the diagnostic performance. The interrater agreement between the two groups was tested using kappa values. Results: Of all 592 AMs, 447 (75.5%) were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68, and 0.77 for the O-RADS, RMI4, IOTA LR2, and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems were 0.90, 0.89, 0.90, and 0.86 for group I and 0.89, 0.87, 0.88, and 0.84 for group II, respectively. The O-RADS had the highest sensitivity (91.0% in group I and 84.8% in group II). Conclusion The four diagnostic systems could compensate for junior doctors’ inexperience in predicting malignant adnexal lesions. The O-RADS performed best and showed the highest sensitivity.

Hilar cholangiocarcinoma(HCCA) is a hotpot and a difficult point in the field of hepatobiliary surgery. HCCA is the most common type of cholangiocarcinoma and is characterized by atypical early clinical manifestations, rapid progression and poor prognosis. There is no specific marker for HCCA and its preoperative diagnosis and evaluation mainly relies on imaging examination. Surgical treatment is still the main treatment, but most patients have lost the opportunity of surgical resection by the time of treatment. In recent years, a large number of studies have been conducted on the diagnosis and treatment of HCCA at home and abroad, and the efficacy of HCCA has been improved. Perioperative management, including the selection of preoperative drainage and perioperative chemoradiotherapy and others, improved postoperative survival. Among them, the application of preoperative radiotherapy and chemotherapy in the field of liver transplantation has achieved quite good results. Targeted therapy and immunotherapy have provided new treatment methods for HCCA. This paper reviews the diagnosis and multimodal treatment of HCCA.

Objective:To study the agreements between transperineal ultrasound (TPUS) and endoanal ultrasound in assessing obstetrics anal sphincter injury (OASI), and to analyse the diagnostic efficacy of OASI in predicting AI relationship between OASI and anal incontinence (AI).Methods:A total of 217 women were prospectively recruited from the clinic in the Second Xiangya Hospital of Central South University from January 2021 to May 2022. Symptoms of AI were determined using the St Mark′s Incontinence Score (SMIS). TPUS and EAUS were performed by the same operator with the same machine on every participant for detecting OASI: OASI grades 3a, 3b, 3c, and 4 were performed according to the extent of the injuries in the anal sphincter complex. The angle of the defect in the external anal sphincter (EAS) was measured. A "significant EAS defect" was diagnosed as a defect affecting at least 2/3 of the length of the EAS with a defect angle of ≥30° in each slice.Ultrasound findings were compared between the two methods. The diagnostic efficacy of "ultrasound OASI" in predicting AI was analysed by logistic regression.Results:Of 217 women, twenty-eight (12.9%) suffered from AI with SMIS ranging from 5~20(11.9±4.5). On TPUS, 79 (36.4%) cases were suspected of OASI, that was 50 OASI 3a, 13 OASI 3b, and 16 OASI 3c/4. On EAUS, 78 (35.9%) cases were suspected of OASI that was 23 OASI 3a, 22 OASI 3b, 15 OASI 3c, and 18 OASI 4. Twenty-four "significant EAS defects" were diagnosed by TPUS and twenty-eight by EAUS, TPUS had excellent agreement with EAUS (weighted Kappa=0.91, P<0.001). Logistic regression analysis showed that "ultrasound OASI" was associated with AI symptoms. ROC curve analysis showed that the area under the curve (AUC) was 0.92, 0.87, 0.89, 0.92 for TPUS OASI 3b+ , EAUS OASI 3b+ , TPUS "Significant EAS defect" , and EAUS "Significant EAS defect" for predicting AI, respectively. Conclusions:TPUS has good agreement with EAUS in detecting OASI. OASI 3b+ and "significant EAS defect" on TPUS and EAUS had good performance in predicting AI symptoms.

Objective:To investigate the effect of different spray-coagulation time of argon plasma coagulation (APC) injury on the Glisson system primary branche(G1) in the hepatic portal of pigs.Methods:Fifty clean healthy domestic pigs (27 females and 23 males, aged 7 to 14 months) were selected, with the body weighted (100.0±9.5) kg. They were randomly divided into five groups (A, B, C, D, and E), with 10 pigs in each group. G1 models were made and sprayed by APC for 1, 2, 3, 4, and 5 seconds. The damage, maximum damage area, maximum damage depth, and damage of the three branches of the Glisson system (the first branches of the portal vein, intrahepatic bile duct, and hepatic artery) were compared among the groups. The pigs were divided into two groups based on whether the three branches were damaged or not: the three-branch damage group ( n=23) and the control group ( n=27). The maximum damage area and maximum damage depth were compared between the two groups. Results:After the APC spraying, circular or elliptical damage appeared on the surface of the G1, with changes such as yellow-brown color, brown color, charred appearance, and defects. Under the microscope, G1 capsule was found to be deficient, the fibrous tissue beneath the capsule was ruptured, and the structures of small blood vessels and small bile ducts were incomplete. " Burn marks" and damage to the three branches of the Glisson system in G1 were also observed, and the damage was more severe at the center of the spray-coagulation. As the spray-coagulation time increased, the maximum damage area of the G1 model also increased, and the two were positively correlated ( r=0.90, P<0.001). The maximum damage depth was also positively correlated with spray-coagulation time ( r=0.97, P<0.001). The numbers of pigs with damage to the three branches of the Glisson system in Groups A-E were 0, 2, 5, 6, and 10, respectively, and the number of pigs with damage increased with the spray-coagulation time. In the three-branch damage group, the spray-coagulation time, maximum damage area, and maximum damage depth were all higher than those in the control group (without three-branch damage), and the differences were statistically significant (all P<0.05). Conclusion:The degree of damage to G1 caused by APC is positively correlated with the spray-coagulation time, and damage to the three branches of the Glisson system in G1 is related to the maximum damage area, maximum damage depth, and APC spray-coagulation time.

Objective To compare the difference of diagnostic ability between ultrasound radiomics ( USR) and different conventional imaging models of central neck ( Ⅵ ) lymph node metastasis in papillary thyroid carcinoma ( PTC) . Methods A training set of 609 cases was set up . USR features were extracted and screened by USR method . A weighted formula was established to calculate the USR score of each patient by ultrasound image . T he USR score of the best diagnostic ability was obtained by statistical method and set as the diagnostic criterion . A test set of 326 cases was established to compare the diagnostic ability of USR score with ultrasound ( US ) ,computed tomography ( CT ) and US combined CT . Results T he accuracy ,sensitivity ,specificity ,area under ROC curve and Youden index of USR score in test set were 0 .804 ,0 .867 ,0 .770 ,0 .766 ,0 .533 ,respectively ,which were significantly higher than the corresponding values of US ,CT and US combined CT ( all P ＝ 0 .000 ) . Conclusions USR score obtained with USR method can effectively predict lymph node metastasis in Ⅵ region of PTC . T he diagnostic efficiency and clinical value of USR score were significantly higher than those of conventional medical imaging models .