ObjectiveTo evaluate the therapeutic effect of combined portoazygous devascularization and shunt on portal hypertension. MethodsThe data of 56 cases of portal hypertension treated with portoazygous devascularization and shunt from April 1987 to April 1999 was summarized. ResultsThere was no death in 54 patients receiving selective operation;of 2 cases receiving emergency operation, one died. Among 49 followed-up cases, there was one rebleeding,2 hepatic encephalopathy, and one died of liver failure 4 years after opeation. The mean portal pressure before and after operation was(3.42±0.46) kPa and (2.50±0.35) kPa, respectively. ConclusionCombined portoazygons devascularization and shunt not only decreases portal pressure but preserve hepatic blood flow to some extent.

Objective To evaluate the effect of combined therapy for inflammatory cancer of breast (ICB). Methods A retrospective analysis was made on the clinical manifestation, pathological type and treatment modalities of 25 patients with ICB from 1985 to 2000.Results All of the 25 patients were treated with mastectomy, including typical Halsted mastectomy in 12 cases, typical Halsted mastectomy with reconstruction of latissimus dorsi flap in 4, and palliative mastectomy in 9. Of the 21 patients 20 received preoperative chemotherapy; and all the 21 patients received postoperative chemotherpyl; while hormonal therapy was used in 11 cases. A mean survival was 23 months (0.5～5years) in 14 followed up patients; and now 5 patieats remain alive (2months～5 years). Conclusions A combined therapy consisting of chemotherapy, surgery and hormonal therapy may improve the prognosis of ICB.

Objective:To explore the construction and implementation effect of clinical-thinking patterned curriculum for parallel graduate students with "running through clinical diagnosis and treatment process."Methods:In this study, 94 Batch 2016-2017 graduate students with clinical medical professional degree in Shanxi Provincial People's Hospital were selected as the research subjects. Among them, 48 Batch 2017 parallel graduate students were selected as the experimental group. The curriculum of clinical-thinking patterned training of "running through the clinical diagnosis and treatment process" was used. In addition to participating in the degree courses and residency courses, a series of training to improve the clinical-thinking ability were introduced. And 46 Batch 2016 parallel graduate students were divided in the control group, using a traditional curriculum and only participating in degree courses and residency courses. The differences among mini-clinical evaluation exercise (Mini-CEX) scores, direct observation of procedural skills (DOPS) scores, objective structured clinical examination (OSCE) scores and students' satisfaction were compared by t test, chi-square test and repeated measures analysis of variance. Results:The Mini-CEX scores showed the average scores of other aspects except humanistic care were higher than those of the control group, and the score of communication skills was significantly higher than that of the control group [(6.55±0.98) vs. (5.77 ±1.12)], with significant differences ( t=3.62, P<0.001). In the DOPS scores, except for the skills of communication with patients, ability to consider patient's feelings and practice of occupational literacy, the average scores of other aspects of the experimental group were higher than those of the control group, and the real operation-ability score of clinical skills was significantly higher than that of the control group [(6.38 ± 1.38) vs. (5.53±1.23)], with a significant difference ( t=3.12, P=0.002). In terms of the outpatient receiving station, the emergency treatment station, the clinical thinking station①, the clinical thinking station②, the specialist skill station, the auxiliary examination station and the case writing station, their OSCE scores at different stages in the experimental group were higher than those in the control group, and in terms of clinical thinking station①, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( F=6.51, P=0.012). The satisfaction rate of the experimental group in terms of curriculum was higher than that in the control group except for the future career development, and in improving logical-thinking ability, the score of the experimental group was significantly higher than that of the control group, with a significant difference ( χ2=19.18, P<0.001). Conclusion:The curriculum of clinical-thinking ability with "running through the clinical diagnosis and treatment process" can enhance the clinical practical ability of parallel graduate students, making them meet the residential academic standards as soon as possible and effectively promoting the training quality of the students.

Objective:To investigate the correlation between heart rate variability (HRV) and the progression of Parkinson's disease (PD).Methods:A total of 78 patients with PD who received treatment at the Second People's Hospital of Lianyungang from January 2020 to May 2022 were included in this study. According to Hoehn-Yahr (H&Y) staging, patients with PD were divided into three subgroups: mild PD group (H&Y stage < 2), moderate PD group (2 ≤ H&Y < 3), and advanced PD group (H&Y ≥ 3). Another 66 healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. A dynamic electrocardiogram examination was performed in each group for HRV analysis. The Spearman test was used to analyze the correlation between HRV parameters, disease course, and H&Y staging.Results:Standard deviation of all sinus R-R intervals during 24 hours (SDNN), root mean square of successive RR interval differences during 24 hours (RMSSD), percentage normal-to-normal interval deviation greater than 50 ms (PNN50%) during 24 hours, high frequency component (HF), and low frequency component (LF) in the PD group were (94.76 ± 21.65), (23.41 ± 8.67), (3.50 ± 4.32), (96.57 ± 53.84), and (124.92 ± 82.43), respectively, which were significantly lower than (115.65 ± 13.31), (32.48 ± 8.08), (5.61 ± 5.25), (109.11 ± 39.51), and (143.95 ± 72.77) in the control group ( Z = -6.17, -6.22, -3.90, -2.14, -2.53, all P < 0.05). Disease duration, H&Y staging, and the LED level in the mild PD, moderate PD, and advanced PD groups showed an upward trend (all P < 0.05). The Mini-Mental State Examination (MMSE) score in the advanced PD group was significantly higher than that in the mild PD group ( P < 0.05). There was no significant difference in MMSE score between the mild and moderate stages and between moderate and advanced stages ( P > 0.05). Both SDNN and LF in the mild PD group were (110.61 ± 18.53) and (192.02 ± 95.98), respectively, which were significantly lower than (91.97 ± 15.23) and (113.29 ± 56.71) in the moderate PD group ( t = 4.18, 3.55, both P < 0.01). SDNN and LF in the advanced PD group were (80.90 ± 21.03) and (68.10 ± 44.86) respectively, which were significantly lower than those in the moderate PD and advanced PD groups ( t = 4.88, 2.23, 5.54, 3.26, all P < 0.05). There were no significant differences in RMSSD, PNN50%, and HF among the mild PD, moderate PD, and advanced PD groups (all P > 0.05). SDNN and LF were negatively correlated with PD course ( r = -0.36, -0.37, both P < 0.05) and H&Y staging ( r = -0.46, -0.49, both P < 0.05). Conclusion:Sympathetic dysfunction in PD patients is closely related to the onset and progression of PD, and it can reflect the severity of the disease.

Objective: To investigate the application of single-molecule PCR (SM-PCR) in the detection of plasma ctDNA for the treat-ment of patients with advanced lung adenocarcinoma. Methods: In total, 30 patients diagnosed with advanced lung adenocarcinoma were enrolled between June 2017 and May 2018. ctDNA fragments of the target genes (EGFR, KRAS, BRAF, ALK, HER2, and TP53) from the blood samples were enriched by SM-PCR, and DNA libraries were prepared. Finally, a high-throughput sequencing was performed. The EGFR detection of tumor tissue samples was performed using real-time fluorescence PCR based on the amplification refractory mutation system (ARMS) and consistency in the results of EGFR mutation detection in the plasma and tissue was compared. Results:The results of both the methods were consistent (Kappa=0.867, P<0.001). The McNemar's test also indicated that the results are not statistically different (P=0.500). Conclusions: SM-PCR can be used for the detection of plasma EGFR mutations. The target detection sites are more comprehensive and multiple mutations can be detected at the same time. Results of the analysis are more precise and can be absolutely quantified.

Objective: To understand smoking behavior and related factors among college and middle school students in Inner Mongolia Autonomous Region, so as to provide a technical basis for targeted tobacco control interventions. Methods: In September 2023, a total of 93 647 students in Inner Mongolia Autonomous Region were randomly selected by stratified cluster sampling from 12 league cities and 103 banner counties (cities districts) to conduct a questionnaire survey. The χ2 test and binary Logistic regression analyses were used to explore the current situation of adolescent smoking and its related factors. Results: The prevalence of college and middle school students who tried smoking was 10.2%, and the prevalence of current smokers was 4.4%. The binary Logistic regression model showed that students in high school, vocational high school, university, males, those from unstable family, boarders, individuals who sew someone smoking at home, at school, in public places, drinking alcohol, inhaling volatile solvents for pleasure, using cough suppressant except for coughing, using sedative without a doctors permission, being scolded by parents, experiencing school bullying, being addicted to the Internet, having depressive symptoms, anxiety symptoms, and low selfesteem were more likely to attempt smoking and currently smoke (attempt smoking:OR=1.38, 2.59, 1.75, 3.24, 1.18, 1.43, 1.25, 1.43, 1.43, 0.79, 9.18, 1.42, 1.17, 1.65, 1.52, 1.31, 1.58, 1.41, 1.11, 1.17； current smoking:OR=1.61, 4.76, 3.76, 4.45, 1.17, 1.44, 1.27, 1.58, 1.69, 0.68, 7.99, 1.64, 1.12, 2.31, 1.48, 1.37, 1.26, 1.31, 1.35, P<0.05). Teenagers with parents who had graduated from high school and eat breakfast every day had a relatively low risk of trying and current smoking (OR=0.78, 0.83, 0.79, 0.84, 0.78, 0.68, P<0.05). Conclusions Adolescent smoking behaviours in Inner Mongolia Autonomous Region exhibit obvious clustering pattern in the school setting. Associated factors includes demographic characteristics, secondhand smoke exposure, daily behaviours and substance abuse, and psychological behaviours. Schools, families and society should work together to create a smokefree environment to protect adolescents from the harms of tobacco.

Objective To explore the value of diffusion-tensor imaging(DTI)of different gray matter nuclei in the diagnosis and assessment of prodromal Parkinson's disease(pPD)under logistic regression model.Methods A total of 20 patients with pPD were collected as case group and 28 healthy people as control group(HC group).All patients were examined by MRI plain scan and DTI.DSI studio was used to post-process the DTI images of all patients.Parameters(FA,MD,AD,RD)of basal ganglia,midbrain and brainstem of patients with pPD and HC group were automatically extracted and statistically analyzed.Logistic regression analysis was used to draw the Receiver Operating Characteristic(ROC)curve to analyze and compare the diagnostic efficacy of individual diagnosis and combined diagnosis of each parameter.And the correlation between the parameters of each group and MMSE score was analyzed.Results There were statistical differences in basal ganglia,midbrain and brain stem in PPD and HC group(P<0.05).Under Logistic regression equation model,when the optimal threshold was 0.63,the AUC of PPD was 0.964.The sensitivity and specificity of differential diagnosis were 85.0%and 100%respectively(P<0.001).There was correlation between DTI parameters and MMSE score in locus coeruleus in PPD group(P<0.05),and the correlation coefficient of FA value in locus coeruleus(r =-0.646,P = 0.002)was the highest.Conclusions The lesions of basal ganglia,midbrain and brainstem correlated gray matter nuclei in pPD were extensive and differ-ent in degree.AD value of locus coeruleus was valuable for quantitative diagnosis of pPD,FA value of locus coeruleus could be used as a characteristic sensitive index for recognition of the severity of dysfunction in pPD patients.Multi-parameter combined diagnosis of DTI under Logistic regression model could effectively improve the diagnostic efficiency,and provide valuable reference for early diagnosis and intervention of pPD.