Objective To evaluate the security of catheter-based renal denervation by two dimensional speckle tracking imaging.Methods 20 dogs was ablated,whose indicies of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views as well as the parasternal short-axis views at the level of the mitral valve and papillary muscles.The time to peak-systolic strain of each segment in the level of the mitral valve and papillary muscles,the standard deviation of the time to peak-systolic strain,the peak strain of the longitudinal 12-segment were recorded.Parameters were compared among the before and after ablation.Results Compared with before ablation of renal sympathetic nerve,the systolic pressure and diastolic pressure didn't reduced significantly after the ablation of renal sympathetic nerve (P ＞ 0.05),while there were no significant difference in the peak strain of the longitudinal 12-segment,the dyssychrony parameters and the size of the heart cavity before and after ablation(P ＞0.05).Conclusions The pressure had no change after the ablation of renal sympathetic nerve while without harmful effect on the the size of the heart cavity,the function of the myocardial contraction and the dyssychrony parameters.The ablation of renal sympathetic nerve can' t lower the normal blood pressure and be safe for heart at the same time.

Objective To evaluate the synchrony of heart after catheter-based renal denervation by two dimensional speckle tracking imaging.Methods Each renal sympathetic nerve of 20 dogs were ablated,and the index of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views.The times from QRS onset to peak-systolic strain rate and to peak-diastolic strain rate were measured for the longitudinal 16-segments in Qlab software,and the standard deviation were calculated.The time to peak longitudinal strain rate and time to peak contraction strain rate of left atrium were measured for each segment contained septal,latera,anterior and posterior in the level of the basal segments,middle sections and apical in Qlab software,and the standard deviation were calculated.Parameters were compared among the before and after of the ablation.Results The systolic pressure and diastolic pressure had no changes after the ablation of renal sympathetic nerve (P ＞ 0.05).The R-R showed a increasing trend,but no significant differences(P ＞0.05).The peak time of LV systolic and diastolic strain rate had a extended trendency too,but no differences(P ＞0.05),and standard deviations of the peak times had no significant differences(P ＞0.05).The peak time of LA longitudinal strain rate and contraction strain rate had a extended trendency,but no obvious change (P ＞0.05),and the standard deviations of the peak times had no significant differences (P ＞0.05).The size of the heart cavity had no differences(P ＞0.05).Conclusions The systolic pressure and diastolic pressure have no changes after the ablation of renal sympathetic nerve,and the synchrony parameters of LV and LA have no significant differences,demonstrate that the synchrony of heart is not affected by the renal sympathetic denervation.

Objective:It analyzed the population aggregation characteristics of the treatment costs for Traditional Chinese Medi-cine(TCM)dominant diseases,and make targeted recommendations for relevant health policies.Methods:A total of 205 medical insti-tutions were obtained through stratified whole-cluster sampling to analyze the composition of the beneficiary population based on Sys-tem of Health Accounts 2011 for the treatment costs of TCM dominant diseases for local residents in Beijing in 2019.Results:The treatment costs of Beijing's TCM dominant diseases are dominated by diseases that include basic western medicine treatment,with male patients'costs accounting for a higher proportion than those of females,and the trend of younger patients in types of diseases treated by TCM and the costs have mainly flowed to females,with more than 50%of the treatment costs being consumed by patients aged 60 years old and above.Conclusion:It is needed to pay attention to male and child patients aged 0～14 years and their priority diseases,strengthen the construction of Chinese medicine geriatric health services,and adopt differentiated strategies for different groups of people so as to maximize the advantages of Chinese medicine.

Objective:To investigate the current status of psychosomatic medical service competence and training needs among general practice resident physicians.Methods:An online questionnaire survey was conducted from August to September 2021, among general practice resident physicians selected by cluster sampling from 4 affiliated hospitals of Tongji University. The questionnaire contained the basic information, the self-assessment and training needs of psychosomatic medical service competence of participants, and psychosomatic medical service requirements of patients in the community.Results:A total of 159 questionnaires were distributed, and 140 were collected (88.1%). The survey showed that 25.7% (36/140) of participants believed that 50% or more patients had physical symptoms accompanied by emotional problems; 29.3% (41/140) thought that 50% or more patients had sleep problems, but 60.0% (84/140) of them failed to provide appropriate treatment. The rate of "core knowledge and concepts of psychosomatic medicine" was 47.5% (665/1 400) and the correct rate of "common psychosomatic diseases" was (64.6±23.4)%. Merely 21.4% (30/140) participants reported satisfaction with the psychosomatic medical service competence; 62.8% (88/140) respondents believed that the coverage rate of the above-mentioned competence training in the current general practice residential training program was less than 50%, and 66.4% (93/140) supported that more psychosomatic training was "necessary". The acceptance rate of online training, workshops, MDT, and clinical practice ranged from 56.4% (79/140) to 63.4% (89/140).Conclusions:The survey indicates that there are large needs for psychosomatic medical services among patients in community, but the competence and confidence of general practice resident physicians to provide the service are significantly insufficient. Therefore, it is suggested to strengthen the training of psychosomatic medical service competence in the general practice residency training program.

Objective:To investigate the current status of social support, readiness for discharge, and loneliness in elderly patients with diabetes mellitus type 2 (T2DM) and the relationship among them.Methods:A total of 230 elderly T2DM patients treated in the Endocrinology Department of the First Affiliated Hospital of Anhui Medical University from April to October 2022 were selected as research objects by the convenient sampling method. Patients were surveyed using a general information questionnaire, Readiness for Discharge Scale, Perceived Social Support Scale and UCLA Loneliness Scale. The Spearman correlation analysis was used to investigate the correlation between social support, loneliness and discharge readiness in elderly T2DM patients. Model 4 in SPSS Process 4.0 software was used to examine the mediating effects of discharge readiness, social support and loneliness in elderly patients with T2DM. A total of 230 questionnaires were sent out and 222 were effectively received, with effective recovery of 96.5% (222/230) .Results:The total scores of Readiness for Discharge Scale, Perceived Social Support Scale and UCLA Loneliness Scale in 222 elderly T2DM patients were 104.00 (91.00, 113.00), 65.00 (57.50, 72.00) and 36.50 (26.00, 44.25), respectively. Spearman correlation analysis showed that social support was positively correlated with discharge readiness ( r=0.448, P<0.05), and loneliness was negatively correlated with social support and readiness for discharge ( r=-0.563, -0.512, P<0.05). The mediating effect analysis showed that loneliness played a partial mediating role between social support and hospital readiness, with an effect ratio of 42.8%. Conclusions:Clinical medical staff should pay attention to the psychological state of patients, alleviate the loneliness of elderly T2DM patients, improve the level of social support, so as to improve the readiness of patients for discharge and increase the self-management ability of elderly diabetes mellitus type 2 patients after discharge.

Objective:To evaluate the preoperative localization value of endoscopic ultrasound guided fine needle tattooing (EUS-FNT) for laparoscopic distal pancreatectomy in pancreatic lesions with a maximum diameter ≤3 cm.Methods:From November 2017 to October 2022, at the Second Affiliated Hospital of Soochow University, the data of patients with pancreatic lesions ≤3 cm who underwent laparoscopic distal pancreatectomy were retrospectively analyzed. Eight patients who underwent EUS-FNT assisted laparoscopic distal pancreatectomy were included in the fine needle tattooing (FNT) combined laparoscopic group. And 14 patients who underwent simple laparoscopic distal pancreatectomy were taken as the simple laparoscopic group. The success rate and complications of EUS-FNT were observed. The differences in operation time, surgery-related complications and complete resection rate of lesions between the two groups were compared. Mann-Whitney U test and descriptive analysis were used for statistical analysis. Results:In the FNT combined laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 4 cases in the pancreatic tail. In the simple laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 10 cases in the pancreatic tail. There was a significant difference in lesion size between the two groups (14.5 mm (10.8 mm, 16.5 mm) vs. 27.0 mm (23.5 mm, 30.0 mm), Z=-3.09, P=0.001). In the FNT combined laparoscopic group, EUS-FNT was successfully performed in all 8 patients. The average time of laparoscopy after EUS-FNT was (98.4±8.8) min. The marks were clearly visible under the laparoscopic field of view, and no complications such as abdominal hemorrhage and hematoma were observed. Laparoscopic pancreaticocaudectomy was performed in 5 cases and pancreaticocaudectomy plus splenectomy in 3 cases. The median operation time was 192.5 min (176.3 min, 203.8 min). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. The lesions were one-time completely resected in all 8 patients. The postoperative pathology were 6 cases of pancreatic neuroendocrine neoplasm, 1 case of intraductal papillary mucinous neoplasm (IPMN), and 1 case of solid pseudopapilloma. In the simple laparoscopic group, laparoscopic pancreaticocaudectomy was performed in 2 cases and pancreaticocaudectomy plus splenectomy in 12 cases. The median operation time was 202.5 min (192.8 min, 235.0 min), which was longer than that of FNT combined laparoscopic group, but the difference was not statistically significant ( P>0.05). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. In 1 patient with pancreatic body lesions, no lesion was found in the specimen examination after the first pancreatectomy, and the lesions were completely resected after the second partial pancreatectomy. Active abdominal hemorrhage occurred in 1 patient on the second day after operation, and underwent interventional embolization for hemostasis. Two weeks after surgery, 1 patient was found to have a encapsulated fluid with a long diameter of 6 cm around the pancreas by computed tomography re-examination 2 weeks after surgery. The postoperative pathology were 5 cases of pancreatic neuroendocrine neoplasm, 2 cases of IPMN, 1 case of solid pseudopapilloma, 1 case of pancreatic cyst with glandular low-grade intraepithelial neoplasia, 1 case of ectopic spleen, and 4 cases of pancreatic ductal adenocarcinoma. Conclusion:EUS-FNT can effectively localize small pancreatic lesions before laparoscopic distal pancreatectomy, shorten the operation time and improve the complete resection rate under laparoscopy.

Objective:To investigate the effect of ubiquitin binding enzyme 2T (UBE2T) on the radiosensitivity of lung adenocarcinoma and unravel its possible mechanism.Methods:A total of 45 patients pathologically diagnosed with different stages of lung adenocarcinoma and treated with radiotherapy in the Second Affiliated Hospital of Zunyi Medical University from March, 2019 to December, 2021 were enrolled, and the efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST1.1). All patients were divided into radiosensitive group ( n=25) and radioresistant group ( n=20). Radiosensitive group was complete remission (CR)+partial remission (PR), and radioresistant group was stable disease (SD) + progression disease (PD). Immunohistochemistry (IHC) was used to calculate the score based on the staining intensity and the number of positive cells. Chi-square test was combined to analyze the correlation between the expression level of UBE2T in paraffin specimens of lung adenocarcinoma patients and the radiosensitivity of patients. Lentivirus UBE2T-interfered (UBE2Tsh) A549 and UBE2T-overexpressed SPC-A-1 lung adenocarcinoma cells and their respective controls were constructed for irradiation and colony formation assay. The survivor fraction curve was fitted by single-hit multi-target model. The DNA double-strand break (DSB) marker γH2AX foci were detected by immunofluorescence (IF). The expression levels of UBE2T, γH 2AX and Rad51 proteins were detected by Western blot. Cell cycle and apoptosis rate of A549 were determined by flow cytometry. Binary variables were statistically analyzed by Fisher's exact probability method and measurement data were assessed by t-test. Results:High-expression level of UBE2T was correlated with the radiosensitivity of lung adenocarcinoma patients ( P<0.05). UBE2Tsh improved the radiosensitivity of A549 lung adenocarcinoma cells, and the sensitizing enhancement ratio (SER) was 1.795. UBE2T overexpression decreased the radiosensitivity of SPC-A-1 lung adenocarcinoma cells with an SER of 0.293. γH2AX foci number per cell were significantly increased in UBE2Tsh A549 cells after irradiation ( P<0.01) . Compared with the control group, the expression level of γH2AX protein was up-regulated ( P<0.01)and that of Rad51 protein was down-regulated in UBE2Tsh A549 cells after radiation ( P<0.001). Compared with the control group, the expression level of γH2AX protein was down-regulated ( P<0.05) and that of Rad51 protein was up-regulated in UBE2T overexpressed SPC-A-1 cells ( P<0.001). The proportion of UBE2Tsh A549 cells in G 2 phase was decreased ( P<0.01) and cell apoptosis was increased ( P<0.001). Conclusions:UBE2T might promote the radioresistance of lung adenocarcinoma cells by enhancing DNA DSB repair induced by radiotherapy, inducing cell cycle G 2 phase arrest, and reducing cell apoptosis.

Objective:Human leukocyte antigen(HLA)B27 is a susceptibility allele of ankylosing spondylitis(AS),and HLA-B27 antigen typing is an important indicator for clinical diagnosis of AS,but current typing methods such as sequence specific primer polymerase chain reaction(PCR-SSP)still possess limitation.Therefore,this study aims to analyze the correlation between B27 subtypes and susceptibility to AS in Hunan Province by applying high-resolution polymerase chain reaction-sequence-based typing(PCR-SBT). Methods:Peripheral blood of 116 patients with suspected AS(suspected AS group)and 121 healthy volunteers(control group)admitted to the Second Xiangya Hospital from January 2020 to December 2020 were collected for HLA-B genotyping by PCR-SBT.Among the patients in the suspected AS group,23 patients were finally diagnosed with AS(confirmed AS group),and the remaining 93 undiagnosed patients served as the non-confirmed AS group.PCR-SBT and PCR-SSP were used to detect HLA-B27 typing in 116 patients with suspected AS,and the results of the 2 methods were compared. Results:The HLA-B27 allele frequency in the suspected AS group was significantly higher than that in the control group[11.63%vs 2.48%;P<0.001,odds ratio(OR)=5.18,95%confidence interval(CI)2.097 to 12.795].B*27:04,B*27:05,B*27:06,and B*27:07 were detected in the suspected AS group and the control group.The frequency of the B*27:04 allele in the suspected AS group was significantly higher than that in the control group(9.48%vs 1.24%;P<0.001,OR=8.346,95%CI 2.463 to 28.282).The positive rate of B27 in the suspected AS group and the confirmed AS group(B27+/+ and B27+/-)was significantly higher than that in the control group(χ2=16.579,P<0.001;χ2=94.582,P<0.001,respectively).Among the confirmed AS group,21 were HLA-B27 carriers,and the B27 positive rate in the confirmed AS group was 91.3%.PCR-SBT could achieve high resolution typing of the HLA-B gene locus,with higher sensitivity,specificity,positive predictive value,negative predictive value,and accuracy than PCR-SSP. Conclusion:PCR-SBT typing analysis shows a strong correlation between HLA-B * 27:04 and AS in Hunan province.The PCR-SBT method can be used as the preferred option for the auxiliary diagnosis of clinical AS.

Objective To optimize the operational steps and processes in mouse cervical heterotopic heart transplantation by modifying the conventional cuff technique for vascular anastomosis and consequently establish a more stable cervical heterotopic heart transplantation model in mice.Methods C57BL/6 male mice (6～8 weeks old,weighing 20～24 g)were categorized into control (conventional cuff technique)and experimental groups (our"Anchoring Node"technique).Time for each surgical step,frequencies of vascular everting and vascular trimming,and the reasons for failure were recorded and compared between the 2 groups. Postoperative survival of heart allograft was determined by daily observation and touching,and the mice with the survival time>48 h were considered as successful model establishment.On the 7th and 14th days after surgery,HE staining was used to observe the pathologic changes in the vascular tissues at anastomosis.The expression of troponin T (cTnT)in the heart on the 7th day was detected with immunofluorescence assay. Results ① In the 25 hearts from each group,2 hearts from the experimental group and 8 from the control group failed,and the survival rate of heart allografts was 92％and 68％,respectively.In the experimental group,arterial and venous everting occurred at an average of 1 .16 times,with an average frequency of trimming of 0.04 times,while in the control group,arterial and venous everting was 2.00 and 2.28 times,respectively,with an average frequency of trimming of 0.21 and 0.46 times,respectively.② Significant differences were observed in the overall duration for cervical heterotopic heart transplantation (77.22±3.82 vs 87.49±8.01 min),vascular separation plus cannulation (30.06±2.68 vs 36.50±6.67 min),and cervical anastomosis (7.31±1 .08 vs 12.34±2.58 min)between the experimental and control groups (all P<0.05).③HE staining displayed that vascular patency was observed in the experimental group on the 7th and 14th days after surgery.④cTnT staining indicated no massive myocardial necrosis was seen in both groups. Conclusion Based on conventional cuff technique for mouse cervical heterotopic heart transplantation,our modified"Anchoring Node"technique ensures the stability and efficiency of one-man microscopic operation with controllable quality,with the advantages of longer postoperative survival of heart allograft,high patency rate of anastomotic vessels,good cardiac function,and fewer postoperative complications.

Objective:To explore the value of a radiomics nomogram based on T 1WI for prediction of the relapse of osteosarcoma after surgery within 1 year from multicenter data. Methods:The imaging and clinical data of 107 patients with pathologica1ly confirmed osteosarcoma who received neoadjuvant chemotherapy before surgery from 6 hospitals from January 2009 to October 2017 were retrospectively analyzed. A training cohort consisted of 75 patients from firstly enrolled 4 hospitals and an independent validation cohort of 32 patients from other 2 hospitals. Pretreatment T 1WI was used to extract radiomics features. Least absolute shrinkage and selection operator (LASSO) regression was applied to reduce the dimension and then the radiomics signature was constructed to predict the relapse of osteosarcoma after surgery within 1 year in training cohort. Independent clinical risk factors were screened using one-way logistic regression, and then a radiomics nomogram incorporated the radiomics signature and MRI characteristics was developed by multivariate logistic regression. The predictive nomogram was evaluated using receiver operating characteristic (ROC) curve in the training cohort, and validated in the independent validation cohort. The calibration curve was used to evaluate the agreement between prediction and actual observation and the decision curve was used to demonstrate the clinical usefulness. Results:Based on T 1WI from multicenter institutions, the radiomics signature was built using 2 valuable selected features that were significantly associated with relapse within 1 year. Two selected features included 1 gray-level co-occurrence matrices (GLCM) feature (L_G_1.0_GLCM_homogeneity1, LASSO coefficient 3.122) and 1 gray-level run length matrix (GLRLM) feature (GLRLM_RP, LASSO coefficient -2.474). The prediction nomogram including radiomics signature and MRI characteristics (joint invasion and perivascular involvement) showed good discrimination with the area under the ROC curve of 0.884 and 0.821 in the training and validation cohorts, respectively. The calibration curve showed that the nomogram achieved good agreement between prediction and actual observation. Decision curve analysis demonstrated that the radiomics nomogram was clinically useful when the threshold probability was greater than 21%. Conclusion:The radiomics nomogram based on T 1WI can be used as a non-invasive quantitative tool to predict relapse of osteosarcoma within 1 year before treatment, which provides support for clinical decision-making in osteosarcoma.