Objective To study the function of hypoxia mimics of different exposure time of deferasirox in improving the growth of micrangium in a narrow pedicle flap.Methods Fourty male SD rats were divided into 2 groups:experimental group was fed with deferasirox 100 mg/kg per day from 1d,3d,5d and 7d,respectively,before the surgery of transferring the narrow pedicle flap,while control group just fed with saline.After 7 days,the immunohistochemistry,Western blot and quantitative reverse transcription-PCR (qPCR) were performed to examine the expression of CD34.qPCR was used to examine the expression of HIF-1α,VEGF in order to investigate the regulatory effect of deferasirox in improving the growth of micrangium and the distinction among the different exposed time of deferasirox in the narrow pedicle flap.Results The deferasirox group exhibited a marked improvement in flap healing time,and with the increasing administration time of deferasirox,the expression of MVD,HIF-1α and VEGF was improved in each treated group (P＜0.05).Conclusions Deferasirox can induce HIF-1α secretion and increase CD34 expression,and so deferasirox can protect endothelial cells from hypoxic and ischaemic injury.

Objective To investigate the effect of deferasirox on DLL4 expression and angiogenesis in a narrow pedicle and random flap in rats.Methods Twenty SD rats were randomly divided into the deferagirox group and control group.Rats were subjected to deferagirox of 100 mg · kg-1 · d-1 inthe experimental groups,respectively and the same dose saline in the control group for 1 week. In each group,flap were created in the bilateral back of each rats.Ratio of length to width of tissue in the pedicle portion and the flap portion was 1 cm × 1 cm and 3 cm × 3 cm,respectively.The tissue samples were taken from the pedicle and the middle portions of the flap.The DLL4 and CD105 expression was also detected with immunohistochemistry (SABC).Results Compared with control group,whatever in the pedicle portion or the middle portion,there was a significant increase of microvessels marked by CD105 and a significant decrease of flap microvessels stained by DLL4 in the deferagirox group.In both groups,compared with the pedicle portion,there was a significant increase of microvessels marked by CD105 and DLL4 in the the middle portion.Conclusions Deferasirox can in crease the CD105 expression and angiogenesis of the slender narrow pedicle random flap.This process might be related to the inhibition of DLL4 protein expression,which is significant in the notch signaling pathway.

Objective To determine the characteristics of early cognitive dysfunction and N300 event-related potentials(ERPs)in patients with acute cerebral infarction(ACI).Methods Thirty patients with ACI and thirty normal healthy elderly people were studied.The two groups were examined with a picture recognition test and EEG waveforms were recorded.The ERPs were analysed statistically.The mini-mental state examination(MMSE) was used to evaluate cognitive function,and the results were correlated with the ERPs. Results The average MMSE scores of the ACI and control groups were significantly different.Reaction times(RTs)in the picture recognition test were(798.63±49.32)ms in the ACI group and(765.21±35.67)ms in the control group,a difference significant at the 5% confidence level.The average accuracy rates,(59.75±8.45)%and(65.26±9.28)%,were also significantly different.Average N300 ERPs the in the ACI group were significantly lower than those in the control group,and the average latencies were significantly longer.Both latency and amplitude in the ACI group showed a linear correlation with MMSE scores. Conclusion The ERPs of ACI patients have some clinical significance,and can be used as a scale-based assessment of cognitive function.

Objective To study the preliminary effects of percutaneously looped thread transection on the surgical treatment of carpal tunnel syndrome (CTS). Methods A total of 72 cases (103 sides) were treated from January 2012 to Decem?ber 2014 (27 males and 45 females, aged 22-94 years, with an average of 51.3 years). Among all the cases, 21 cases (30 sides) were treated with open decompression and 51 cases (73 sides) were treated with percutaneously looped thread transection. We did the incision in the ulnaris hypothenar pattern, revealed and cut off the transverse carpal ligament to decompress the carpal tunnel in the open surgery. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse carpal ligament, respectively, forming loops to cut off and decompressed the carpal tunnel. We observed the me?dian nerve aspect ratio (the ratio of length to width of the uncinatum median nerve on transverse section) and swelling ratio (the ra?tio of area of median nerve on transverse section of pisiform and distal radius) under ultrasound before, during and 3 months after operation. Telephone follow?up was conducted in postoperative 3 months according to the Boston Carpal Tunnel Questionnaire (BCTQ) to evaluate the symptoms of carpal tunnel syndrome and wrist joint function. Results There were 11 cases lost in the fol?low?up, and 61 cases were followed up for 3 to 27 months, with an average of 11.6 months. The preoperative BCTQ scores of open decompression group and looped thread transection group were 28.5±4.6 and 29.4±5.3, respectively. There was no statistically sig?nificant difference between two groups (t=1.34, P=0.528). The postoperative 3 months BCTQ scores were 16.3±5.7 and 15.7±4.9. There was no statistically significant difference between two groups (t=1.12, P=0.674). The median nerve aspect ratios measured under ultrasound of open decompression group before and 3 months after operation were 3.8 ± 0.7 and 2.6 ± 0.4, respectively. The swelling ratios were 2.3±0.4 and 1.2±0.3. The difference of preoperative and postoperative changes was statistically significant (P<0.05). The median nerve aspect ratios measured under ultrasound of looped thread transection group before and 3 months after op?eration were 3.9±0.6 and 2.7±0.5, respectively. The swelling ratios were 2.1±0.3 and 1.4±0.4. The difference of preoperative and postoperative changes was statistically significant (P<0.05). There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treat?ment of CTS has less trauma and rapid recovery. It can improve the symptoms of median nerve stimulation, restore the morphology and function of the median nerve and reach the same effects as the open decompression surgery.

International League Against Epilepsy published a unified standard for drug resistant epilepsy by numbers of unsuccessful anti-epileptic drugs, criteria for seizure control and follow-up time in 2009. However, there are still some problems and even some controversies in the clinical application of this standard. To provide references for future clinical application and scientific research, we reconsider the definition of drug resistant epilepsy from its historical definitions, core elements and existing problems, and propose that some drug resistant epilepsy patients are probably more appropriately defined as chronic epilepsy.

Objective:To investigate characteristics of fever and drug-induced liver injury (DILI) in inpatients with severe drug eruptions.Methods:A retrospective analysis was carried out on clinical data collected from 63 inpatients with severe drug eruptions from June 2007 to June 2020, and their characteristics of fever and DILI were investigated. Two-independent-sample t test or Kruskal-Wallis H test was used for intergroup comparison of measurement data, and intergroup comparison of enumeration data was performed using chi-square test or Fisher′s exact test. Results:Among the 63 patients with severe drug eruptions, 54 developed fever; low, moderate and high/ultra-high fever all occurred in about one third of the patients; of 17 patients with high/ultra-high fever, 16 sufferred from Stevens-Johnson syndrome (SJS) , toxic epidermal necrolysis (TEN) or drug hypersensitivity syndrome (DHS) ; 45 had irregular fever; fever duration ranged from 1 to 14 days in 51 patients; there were no significant differences in the fever grade or duration among the patients with different clinical types of drug eruptions ( P = 0.303, 0.719, respectively) ; rashes occurred earlier than or at the same time as fever in 92.59% of the patients. DILI occurred in 11 patients, 8 of whom had hepatocellular injury at admission, including 5 with DHS, 2 with SJS and 1 with TEN; 6 patients were accompanied by low, moderate or high fever, with the fever duration being 7.33 ± 4.97 days, and they all had grade 1 liver injury; liver function retesting at discharge showed complete recovery in 5 patients, improvement in 1, as well as conversion from hepatocellular injury to mixed liver injury in 1, and 1 patient did not undergo the liver function retesting due to against-medical-advice discharge. The other 3 patients had cholestatic liver injury, all of whom were diagnosed with DHS and accompanied by high or ultra-high fever, wtih the fever duration being 8.33 ± 3.51 days, and 1 patient had grade 4 liver injury (acute liver failure) ; liver function was improved in all the 3 patients at discharge. Conclusions:Patients with severe drug eruptions are prone to be accompanied by various types of fever, irregular fever is more common, fever usually lasts 2 weeks, and rashes often occur earlier than or at the same time as fever. DILI can occur in patients with severe drug eruptions, and is usually accompanied by fever; hepatocellular injury is more common, and prone to be improved rapidly; cholestatic liver injury is characterized by severe clinical symptoms and a long disease course, and most frequently occurs in patients with DHS.

Objective:To explore the clinical value of N terminal pro B type natriuretic peptide (NT-proBNP) in diagnosing or predicting heart failure in peridialysis chronic kidney disease (CKD) population.Methods:It was a single-center retrospective study. Patients with peridialysis CKD who visited the Department of Nephrology, First Affiliated Hospital of Zhengzhou University from January 2021 to June 2021 were collected and divided into 4 groups according to the presence or absence of heart failure and the level of left ventricular ejection fraction (LVEF), namely the non-heart failure group, heart failure with reduced ejection fraction (HFrEF) group (LVEF<40%), heart failure with mid-range ejection fraction (HFmrEF) group (40％≤LVEF<50％), and heart failure with preserved ejection fraction (HFpEF) group (LVEF≥50％). The NT-proBNP, echocardiography and other indicators of the 4 groups were compared. The value of plasma NT-proBNP in diagnosing heart failure, HFpEF, HFmrEF and HFrEF was analyzed by drawing receiver operating characteristic curve (ROC curve). Logistic regression analysis was used to analyze the related factors of heart failure in peridialysis CKD patients.Results:A total of 508 patients were included, including 11 cases in the HFrEF group, 29 cases in the HFmrEF group, 152 cases in the HFpEF group, and 316 cases without heart failure. The differences in age, 24-h urine volume, hemodialysis proportion, non-dialysis proportion, serum creatinine, estimated glomerular filtration rate, hemoglobin, serum albumin, C-reactive protein, NT-proBNP, cardiac troponin I, left ventricular internal diameter, LVEF, pulmonary artery systolic pressure, left ventricular end-diastolic volume, E/A value, septal thickness, and left ventricular posterior wall thickness among the four groups were statistically significant ( P < 0.05, respectively). A two-pair comparison (all P values corrected by Bonferroni method) revealed that the 24-h urine volume was higher in the non-heart failure group than in the other three groups (corrected P<0.05, respectively), while the proportion of hemodialysis patients and the levels of NT-proBNP and C-reactive protein were lower in the non-heart failure group than in the other three groups (corrected P<0.001, respectively); the levels of hemoglobin and serum albumin were lower in the HFpEF group than in the non-heart failure group (corrected P<0.001, respectively); troponin I was lower in the non-heart failure group than in the HFpEF group (corrected P<0.001), HFmrEF group (corrected P=0.001) and HFrEF group (corrected P<0.001), and troponin I was lower in the HFpEF group than in the HFrEF group (corrected P=0.008); LVEF was higher in the non-heart failure group than in the other three groups (corrected P<0.001, respectively), and LVEF in the HFpEF group was higher than in the HFmrEF and HFrEF groups (corrected P<0.001, respectively). For patients with peridialysis CKD, the cut-off values of plasma NT-proBNP for diagnosing or predicting heart failure, HFpEF, HFmrEF and HFrEF were 4 943.33 ng/L, 4 976.83 ng/L, 14 964.5 ng/L and 17 847.55 ng/L, respectively. Multivariate logistic regression analysis showed that NT-proBNP (every 500 ng/L increase, OR=1.390, 95% CI 1.287-1.501, P<0.001), LVEF ( OR=0.747, 95% CI 0.656-0.851, P<0.001) and 24-h urine volume (every 100 ml increase, OR=0.842, 95% CI 0.763-0.929, P=0.001) were independently correlated with heart failure. Conclusions:The cut-off value of plasma NT-proBNP for diagnosing or predicting heart failure in peridialysis CKD patients is much higher than that in patients with normal renal function. NT-proBNP, LVEF and 24-h urine volume are independently associated with heart failure in peridialysis CKD patients.

Objective:To compare the cost-effectiveness between open surgery and minimally invasive rotational surgery in patients with benign breast tumor, and to provide a theoretical support for the choice of surgical approach.Methods:The clinical data of 1 389 benign breast tumor patients underwent surgery from January 2017 to January 2020 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Among them, 374 patients were treated with open surgery (open group), and 1 015 patients were treated with minimally invasive rotational surgery (minimally invasive group). The surgery-related and cost-effectiveness analysis indexes were compared between two groups.Results:The operation time, incidence of hematoma/subcutaneous bruising and cosmetic result satisfactory rate in minimally invasive group were significantly higher than those in open group: (37.37 ± 6.66) min vs. (34.58 ± 8.95) min, 10.54% (107/1 015) vs. 5.35% (20/374) and 98.72% (1 002/1 015) vs. 95.99% (359/374); while the incision length, length of hospital stay and pain score were significantly less than those in open group: (5.00 ± 0.00) mm vs. (26.55 ± 4.73) mm, (1.03 ± 0.36) d vs. (2.85 ± 1.99) d, (1.76 ± 1.56) scores vs. (2.72 ± 1.27) scores, and there were statistical differences ( P<0.01). The patients were followed up until May 2022. There were no incision infection, recurrence and residual lesions in the two groups. The total cost and cost-effectiveness ratio in minimally invasive group were significantly lower than those in open group: (6 553 ± 1 150) yuan vs. (7 965 ± 3 323) yuan and 71.10 ± 13.61 vs. 88.96 ± 37.48, the benefit score was significantly higher than that in open group: (96.50 ± 3.89) scores vs. (88.92 ± 6.39) scores, and there were statistical differences ( P<0.01). Conclusions:Compared with open surgery, minimally invasive rotational surgery is less costly and more benefits, so minimally invasive surgery should be the preferred surgical procedure for benign breast tumor.

Objective To explore the relevant protective/risk factors during the development of coronary heart disease blood stasis evidence in the process of pre-existing evidence based on the macro-,meso-,and micro-health state characterization parameter system of Chinese medicine state science.Methods 253 cases of coronary heart disease to be investigated were collected from the outpatient and inpatient departments of the Department of Cardiology in the hospitals affiliated to Hunan University of Traditional Chinese Medicine,and questionnaires were formulated according to the three dimensions of macro,meso,and micro,and the collected parameters were categorized with Python software,and the patients were diagnosed as pre-coronary heart disease blood stasis evidence(150 cases)and coronary heart disease blood stasis evidence(100 cases),and statistical analyses were performed with frequency analysis,χ2 test,and Logistic regression and other methods for statistical analysis.Results ①The results of univariate analysis showed that:age,BMI,history of smoking,history of alcohol consumption,history of hypertension,history of diabetes mellitus,average monthly high temperature,air quality,season,type of occupation,social environment,coronary artery angiographic stenosis,diastolic blood pressure,systolic blood pressure,creatinine,uric acid and total cholesterol differed between patients diagnosed as pre-Coronary artery disease blood stasis evidence and those diagnosed as Coronary artery disease blood stasis evidence,and all the differences were statistically significant(P<0.05).② Binary logistic regression analysis showed that age,BMI,history of alcohol consumption,type of occupation,coronary angiographic stenosis,diastolic blood pressure,creatinine,and dark red tongue were independent risk factors.A prediction model was established:P=1/[1+exp(16.522-1.427×age-0.975×BMI-3.55×drinking history+1.982×monthly average high temperature+0.709×season-1.827×occupational type-1.1×coronary angiographic stenosis-0.072×diastolic blood pressure-0.076×creatinine+2.398×dizziness-4.108×dark red tongue+4.169×pulse asthenia)],the model prediction rate was 90.5%.Conclusion The logistic regression model of coronary heart disease with blood stasis evidence is good with clinical diagnosis,which lays the foundation for the exploration of the state between the already diseased and undiseased of coronary heart disease,and provides important basic data for the theory of subhealth.

Objective It evaluates the high-quality development policies of public hospitals at the provincial level in China,and provides theoretical basis and countermeasures for formulating and optimizing the high-quality develop-ment policies of public hospitals.Methods The ROST CM 6.0 software was used to conduct text mining for 11 sample policies,and the Policy Modeling Consistency(PMC)index model was constructed to evaluate the sample policies quantitatively.Results The average PMC index of 11 sample policies included in the study was 7.16 points,of which 8 were excellent grades and 3 were qualified grades.The first-level variables X5 service system(0.82),X8 Party leadership(0.91)and X6 organization and operation(0.94)scored higher;X2 policy timeliness(0.52),X7 cultural construction(0.68)and X4 service capability(0.71)scored low.Conclusion The content of the high-quality develop-ment policy of public hospitals at the provincial level is basically in line with the national policy,and is relatively excel-lent in the aspects of organization and operation,service system and party leadership,etc.,but there are some weaknesses in the aspects of policy timeliness,cultural construction and service capacity,etc.,which can be op-timized and improved from the aspects of improving service capacity,supplementing long-term policies and strengthening hospital cultural construction.