The deltoid muscles on both sides of 8 male cadavers were studied within 24 hours after death. According to its fiber architecture, origins and insertions, and nerve distribution, the deltoid muscle was divided into three compartments: an anterior, a middle and a posterior. The muscle samples were taken respectively from the superficial and the deep portion of each compartment of the deltoid muscle. Frozen transverse sections were stained fer myosin ATPase. Muscle fibers were identified as type Ⅰ and type Ⅱ. The proportion of fiber types in each portion was calculated on microscopic photographs and mean cross-sectional areas of both fiber types were measured by imaging analytical system. The results showed that the proportion of type Ⅰ fiber in the superficial and deep portion of the middle compartment is significantly higher than that of the corresponding portion of the anterior and posterior compartments, and the proportion in the deep portion of each compartment is higher than that of the superficial one, however no difference was found between the left and right sides. The fiber size among all portions is not obviously different, but the diameter of type Ⅱ fiber in the deep portion of the middle compartment is significantly smaller than that of other portions. Except the deep portion of the middle compartment, the diameter of both fiber types of the right muscle is larger than those of the left one, although statistical analysis showed that the difference is not significant. The authors suggest that the difference of fiber type distribution within the deltoid muscle is closely related with the functional differentiation of the muscle and the characteristic higher typeⅠ fiber proportion and smaller type Ⅱ fiber diamiter in the deep portion of the middle compartment probably indicate that the main function of this portion is to keep the shoulder joint stability.

Objective To investigate the expression of DNM T1 and PDCD4 in Tongue Squamous cell carcinoma and their signif‐icance to Clinical .Methods The protein expression of DNM T1 and PDCD4 in 40 cases of TSCC tissues and The adjacent no tumor tissues were measured by Elivision Two Step immunohistochemical method(IHC) ,the relationship between DNM T1 ,PDCD4 and clinicopathological parameters were analyzed .Results There was positively over expression of DNM T1 while the expression of PD‐CD4 was at a low lever or lost in TSCC tissues ,the expression of two genes DNM T1 and PDCD4 in the adjacent no tumor tissues were in contrast ;there was a significant negative correlation between DNM T1 and PDCD4 expression in TSCC(r = - 0 .452 ,P<0 .05) .The expression of DNM T1 protein were associated with histopathological differentiation types ,regional lymph node metasta‐sis and TNM staging(P< 0 .05) ,it had nothing to do with age and gender ;the expression of PDCD4 protein were associated with regional lymph node metastasis and TNM staging(P< 0 .05) ,and it had nothing to do with age ,gender ,histopathological differenti‐ation types .Conclusion Implying the abnormal expression of DNM T1 and PDCD4 protein might be closely related to the develop‐ment and progression of TSCC .DNM T1 may be participates in the inactivation of PDCD4 expression ,and led to the development of the cancer at last .

Objective To determine the advantages of laparoscopic cholecystectomy (LC) by establishing pneumoperitoneum under direct vision. Methods A 1cm incision was made just below the umbilicus; lifting and cutting out of the peritoneum at the line alba abdominis with direct vision; then a 10mm trocar was inserted into the pneumoperitoneum cavity.Results There were 107 patients underwent LC.Of them, 93 patients suffered from chronic cholecystitis with gallstone, 6 from acute cholecystitis with gallstone, and 8 from cystopolyps. Among them, 16 patients had previous abdominal operations. Two patients with atrophic cholecystitis converted to open cholecystectomy(OC) owing to the unclear bile duct anatomy. The average operation time was 45min. Postoperative complications included pulmonary infection in 3 patients, bile leakage in 1( due to the titanic clip falling off),but no bile duct injury or other severe complications occurred;and no mortality in this series. Conclusions Establishing pneumoperitoneum under direct vision has following advantages:rapid and safe,and favorable to avoid the severe trocar-related complications.

CRP measurement on automated biochemistry analyzer. The method can be used in clinical diagnosis.

Background Nitrosamines (NAms) are highly carcinogenic and frequently detected in drinking water systems in China, indicating potential human health risk through drinking water. Objective To analyze the distribution of NAms in drinking water in Shanghai and to evaluate relevant human health risk. Methods A total of 94 samples of source water and 120 samples of finished water were collected in February (dry period) and August (wet period) of 2021 from 30 drinking water plants in Shanghai, and eight NAms were quantitatively analyzed by gas chromatography tandem mass spectrometry after solid phase extraction. Cancer risks for different age groups caused by NAms exposure through water were evaluated using Monte Carlo probabilistic method and carcinogens risk assessment model recommended by the United States Environmental Protection Agency. Results The concentrations of total NAms in source and finished water were 12.56-65.86 ng·L⁻¹ and 8.52-57.38 ng·L⁻¹, respectively. The average concentration of total NAms was higher in source water (33.50 ng·L⁻¹) than in finished water (22.07 ng·L⁻¹, P<0.05) during dry season, and lower in source water (16.90 ng·L⁻¹) than in finished water (21.02 ng·L⁻¹, P<0.05) during wet season. The average concentration of total NAms in source water during dry season was twice of that during wet season. The positive rate of N-nitrosodimethylamine (NDMA) was the highest (100%) among the eight NAms. The cancer risk of exposure to NAms in finished water in Shanghai was mainly from the ingestion route, which was mostly caused by NDMA. The cancer risk from exposure to NAms in water for children (median=4.32×10⁻⁵) was slightly higher than that for adults (median=3.34×10⁻⁵) and adolescents (median=2.27×10⁻⁵). The cancer risks of exposure to NAms in water for people of different ages were mainly (80% - 95%) at an acceptable level (1×10⁻⁶ - 1×10⁻⁴). Conclusion NAms contamination is positive in Shanghai’s drinking water and NDMA is the main contaminant. The removal of NAms in water by current water treatment process is season-dependent. The cancer risk of children exposed to NAms in water was slightly higher than that of adults and adolescents, but all at acceptable levels.

Parkinson's disease with depression belongs to the category of "tremor syndrome" and "depression syndrome" of Traditional Chinese Medicine. Its syndrome characteristics and distribution are different from simple tremor syndrome and depression syndrome. Its neuroplastic mechanism involves dopamine, serotonin, norepinephrine and brain-derived neurotrophic factor. Parkinson's disease and depression have common neuro-biological mechanisms. Therefore, Chinese medicine treatment of Parkinson's disease with depression may have a dual regulation effect.

Objective:To explore the expression of long-chain noncoding RNA (lncRNA) and myocardial infarction-associated transcription (MIAT) in Leukocyte differentiation antigen (CD)4+T cells in peripheral blood of gastric cancer patients and its value of clinical application.Methods:Peripheral blood CD4+T cells were collected from 124 patients with gastric cancer, 90 benign gastric diseases patients and 80 healthy controls enrolled in Taizhou People′s Hospital from January 2019 to April 2021. The expression levels of MIAT and N6-methyladenosine(m6A) binding to MIAT promoter in CD4+T cells were detected by real-time fluorescent quantitative polymerase chain reaction (qPCR) and Chromatin immunoprecipitation (ChIP)-qPCR, respectively. Spearman test was used to analyze the correlation between MIAT and clinicopathological features, as well as between MIAT and regulatory T cell levels. The receivor operating characteristic curve (ROC) of the subjects was used to evaluate the MIAT expression level in the auxiliary diagnostic value of gastric cancer.Results:The relative expression levels of MIAT in the gastric cancer patients, the benign gastric diseases patients, and the healthy controls were 2.849 (2.131, 4.062), 1.511 (0.916, 1.855) and 0.963 (0.729, 1.432), respectively. The difference among the three groups was statistically significant ( H=158.25, P<0.001). The relative expression level of MIAT in the gastric cancer patients was significantly higher than the levels in the benign gastric diseases patients and healthy controls. The difference was statistically significant ( Z=100.63, 145.14, P<0.001). The binding activity of m6A to MIAT promoter in patients with early stage (stage Ⅰ and Ⅱ) and end stage (stage Ⅲ and Ⅳ) gastric cancer was 8.590±1.483 and 4.274±0.425, respectively. The difference was statistically significant ( t=6.255, P=0.002). Furthermore, the binding activity of m6A to MIAT promoter in the gastric cancer patients was significantly lower than that in patients with benign gastric diseases (17.267±3.106) and healthy controls (27.637±3.945) ( t=-7.331,-12.832, P<0.001). The relative expression of MIAT in CD4+T cells in peripheral blood of the gastric cancer patients had no significant difference in age(χ2=0.000, P=1.000), gender(χ2=0.000, P=1.000), CEA (χ2=0.648, P=0.421) and CA199(χ2=1.554, P=0.213), but had significant difference with tumor size expression(χ2=9.443, P<0.01), TNM stage(χ2=23.571, P=0.002) and lymph node metastasis (χ2=45.248, P<0.01). In addition, there was a significant positive correlation between the relative expression of MIAT in CD4+T cells and Treg level ( r2=0.76, P<0.001). The diagnostic efficacies of MIAT in CD4+T cells, CEA and CA199 in the gastric cancer patients were analyzed by ROC curve. When compared with patients with benign gastric diseases, the areas under the curve were 0.879, 0.635 and 0.611, respectively. When compared with healthy patients, the areas under the curve were 0.953, 0.784 and 0.598, respectively. Conclusions:The level of MIAT in CD4+T cells in peripheral blood of patients with gastric cancer is significantly higher than the levels in patients with benign gastric diseases and the healthy controls, which may be related with the decreased activity of m6A binding to the promoter of MIAT. The level of MIAT in CD4+T cells may be a relevant biomarker for the diagnosis and prognosis of gastric cancer.

The tiered medical treatment system stands as a cornerstone in the deepening reforms of China′s medical and health sectors, playing a crucial role in building a healthy China. Exploring the harmonious coexistence mechanism of multiple entities on the supply and demand sides of the tiered diagnosis and treatment system, and promoting the formation of a scientific and reasonable tiered diagnosis and treatment order, has become an urgent public proposition that needs to be answered and has significant social impact. Addressing the challenges in China′s tiered medical treatment system, particularly its need for a more systematic, comprehensive, and collaborative approach, this study is informed by a thorough literature review. Based on the harmonious management and symbiosis theories, the authors proposed a theoretical concept and future research path for the formation of a harmonious symbiotic mechanism in the tiered diagnosis and treatment system, in order to pave the way for exploring the harmonious symbiotic mechanism in the tiered diagnosis and treatment system.

Objective To evaluate the efficacy and safety of Carbamazepin (CBZ)compared with Oxcarbazepine (OXC ) therapy for vestibular paroxysmia. Methods Eighty-two patients with vestibular paroxysmia were admitted during June 2013 and June 2017 in this study. According to the agents administered ,all patients were divided into the CBZ group(n＝ 31) ,CBZ+ Betahistine(BMT) group(n＝ 26)and OXC+ BMT group(n＝ 25).The clinical efficacy ,frequency ,vertigo and adverse reactions of three groups were compared after 3 months follow-up. Results In CBZ group ,14 cases were cured ,13 were improved ,and the effective rate was 87.1%.In CBZ+BMT group ,18 cases were cured ,7 were recovered ,and the effective rate was 96.2%.In OXC+BMT group ,15 cases were cured , 8 cases were recovered ,and the effective rate was 92.0% . There was no significantly difference in effective rate among the three groups(χ2＝0.783 ,P＝0.129).Meanwhile ,the CBZ+BMT group had the lowest frequency of vestibular paroxysmia and vertigo degree ,while the CBZ group was the highest ;the difference in the frequency and vertigo degree between groups was statistically significant (P＜ 0.05).Furthermore ,the incidences of side-effects were 51.6%(n＝ 16) ,30.8%(n ＝ 8)and 16.0%(n＝4)in the CBZ group ,CBZ+BMT group and OXC+BMT group ,respectively. Conclusions The effect of Carbamazepine and Oxcarbazepine for vestibular paroxysmia is similar ,and is safely and significantly improved when combined with Betahistine.

Objective:To explore the driving mechanisms of doctors′ collaborative willingness and behavior in the tiered diagnosis and treatment system, in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods:Based on the harmonious management theory, a theoretical framework for the driving mechanisms of doctors′ collaborative behavior in the tiered diagnosis and treatment system was developed. Through random sampling, a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022. The t-test, variance analysis, and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics. The structural equation model and stratified linear regression were used to assess the impact of collaborative factors (professional environment and work expectations) and harmonious factors (perception of policy support and perception of management mechanism) on doctors′ collaboration willingness and behavior. Results:A total of 1 959 doctors participated in the survey. Doctors′ collaborative behavior scored 2.13±1.12, indicating a slightly below-average level, whereas their willingness to collaborate scored 3.88±0.79, falling between neutral and somewhat willing. Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking, age, years of experience, monthly average income, and professional titles ( P<0.05). Both collaborative and harmonious factors directly influenced the doctors′ willingness to collaborate, with standardized path coefficients of 0.428 and 0.139, respectively. Similarly, these factors directly impacted their collaborative behavior, with standardized path coefficients of 0.104 and 0.366. The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′ collaborative willingness and behavior, with effect values of 0.047 and 0.043 respectively ( P<0.05). Conclusions:The collaborative and harmonious elements serve as positive drivers for collaboration among doctors in the tiered diagnosis and treatment system at both the cognitive and behavioral levels. Enhancing and optimizing policy support and management mechanisms can facilitate the transition from intention to actual collaborative actions among doctors from different levels of medical institutions.