Objective To evaluate the value of miniprobe endoscopic ultrasound(EUS)in guiding endoscopic treatment of small-diameter(maximum diameter less than 1 cm)and low-grade(G1 grade)rectum neuroendocrine neoplasm(R-NEN),and to provide evidence and clues for its clinical application and further research.Methods The clinical data of 85 cases of low-grade(G1 grade)R-NEN with a maximum diameter of less than 1 cm who underwent endoscopic treatment in our center from January 2014 to December 2020 were retrospectively analyzed.The patients were divided into the EUS group(37 cases)and control group(48 cases)according to whether EUS was performed before endoscopic treatment.The positive rate of incision margin,the incidence of complications,the recurrence rate,the hospital stay,the cost of hospitalization and endoscopic therapy were compared between the two groups.Results The positive rate of incision margin in the EUS group was significantly lower than that in control group(P<0.05).There was no significant difference in the incidence of complications,tumor recurrence rate,hospital stay or hospital costs between the two groups(P>0.05).There was statistically significant difference in the endoscopic therapy between the two groups(P<0.05).Conclusion Evaluating the lesion depth of small-diameter and low-grade(G1 grade)R-NEN before surgery by miniprobe EUS and selecting endoscopic surgery according to its results of can significantly reduce the residual risk of resection margin tumors.

Objective To explore the clinical characteristics of patients with alcoholic liver disease(ALD)of various traditional Chinese medicine(TCM)syndrome types.Methods A retrospective analysis was conducted in 129 patients with alcoholic liver disease who met the inclusion and exclusion criteria in Foshan Hospital of Traditional Chinese Medicine from 2018 to 2022.The general data of the patients as well as their TCM syndrome types and clinical information of liver and kidney function,blood lipid,liver transient elastography during the hospital visit were collected.The distribution of TCM syndrome types in ALD patients was analyzed,and the clinical characteristics of the ALD patients with various TCM syndrome types were explored.Results(1)Of the 129 patients,128(99.22%)were male and only one(0.78%)was female,the average age was(48.71±11.50)years old,and the average body mass index(BMI)was(23.82±3.98)kg·m-2.(2)Damp-heat accumulation syndrome was most common syndrome type in ALD patients,with a total of 70 cases(54.26%),and then came liver depression and spleen deficiency syndrome(24 cases,18.60%),internal obstruction of phlegm-damp syndrome(22 cases,17.05%),liver-kidney sufficiency syndrome(7 cases,5.43%),phlegm interweaved with blood stasis syndrome(3 cases,2.33%),and internal accumulation of blood stasis syndrome(3 cases,2.33%).(3)The analysis of clinical characteristics by non-parametric rank sum test showed that there were no statistically significant differences in BMI,alcohol consumption,aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),total bilirubin(TBIL),alkaline phosphatase(ALP),triglyceride(TG),liver stiffness measurement(LSM),and controlled attenuation parameter(CAP)which reflects the fat content of liver in ALD patients with various TCM syndrome types(P＜0.05 or P＜0.01).The prominent features were as follows:patients with the 4 types of liver depression and spleen deficiency,internal obstruction of phlegm-damp,phlegm interweaved with blood stasis,and internal accumulation of blood stasis had a BMI exceeding the standard(＞24 kg·m-2),whereas patients with damp-heat accumulation syndrome and liver-kidney deficiency syndrome,which accounted for 54.26%of the sample size,had a BMI within the normal range(23.03 kg·m-2 and 21.42 kg·m-2,respectively),and the BMI of these two types differed from that(26.44 kg·m-2)of the internal obstruction of phlegm-damp syndrome(P＜0.01),suggesting that more than half of the ALD patients had the normal BMI;moreover,the patients with internal obstruction of phlegm-damp also had the highest values of serum TG(2.69 mmol/L)and CAP(292 db/m)except for the highest BMI,indicating that patients with internal obstruction of phlegm-damp syndrome had a more serious degree of obesity and hepatic fat infiltration than those with other syndrome types;the levels of AST and GGT,which separately reflect the chronic inflammatory injury of liver and bile duct cell injury,were significantly increased in the patients with damp-heat accumulation syndrome and liver-kidney deficiency syndrome,and the LSM value of these two types of patients was also the highest in all of the syndrome types,the differences being all statistically significant(P＜0.05 or P＜0.01).Conclusion Damp-heat accumulation syndrome is the main TCM syndrome type of ALD patients,the degree of fatty infiltration of the liver and overweight of ALD patients are not corresponded to the severity of illness,and there are some differences in the clinical indicators of ALD patients with various TCM syndrome types.However,with cross reference to the data of the four diagnostic examinations of TCM and the clinical indicators,the accuracy of the TCM diagnosis of ALD is expected to be increased.

Objective To observe the influence of nintedanib ethanesulfonate soft capsules combined with tetrandrine tablets on pulmonary function and dyspnea symptoms in patients with connective tissue disease-related pulmonary interstitial fibrosis.Methods Patients with connective tissue disease-related pulmonary interstitial fibrosis were divided into treatment group and control group by cohort method.The control group was given basic treatment such as glucocorticoids and immunosuppressants according to the patient's condition;the treatment group was given ethanesulfonate nintedanib soft capsules(100 mg,bid)and tetrandrine tablets(40 mg,tid)on the basis of the control group,and the treatment course was 3 months.The clinical efficacy,severity of dyspnea[modified British Medical Research Council Dyspnea Scale(mMRC)and St.George's Respiratory Questionnaire(SGRQ)],pulmonary function indicators,pulmonary fibrosis score,and blood gas analysis indicators were compared between the two groups,and the safety was assessed.Results A total of 42 cases were included in the treatment group and the control group,respectively.The total effective rates of the treatment group and the control group were 92.86％(39 cases/42 cases)and 76.19％(32 cases/42 cases)respectively(P＜0.05).After treatment,the mMRC scores of the treatment group and the control group were(1.43±0.27)and(1.69±0.31)points;the SGRQ scores were(46.51±4.39)and(51.08±4.76)points;the forced expiratory volume in one second(FEV1)values were(64.96±6.55)％and(58.67±5.01)％;the fibrosis scores were(1.12±0.14)and(1.26±0.18)points;the partial pressure of arterial oxygen values were(80.31±7.03)and(75.02±6.94)mmHg.The above indexes of the treatment group were compared with those of the control group,and the differences were statistically significant(all P＜0.05).There were no adverse drug reactions in the treatment group,and the main adverse drug reactions in the control group were gastrointestinal discomfort.The total incidence rates of adverse drug reactions in the treatment group and the control group were 0 and 2.38％,respectively(P＞0.05).Conclusion Compared with basic treatment,nintedanib ethanesulfonate soft capsules combined with tetrandrine tablets can better improve the pulmonary fibrosis degree and dyspnea degree in patients with connective tissue disease-related pulmonary interstitial fibrosis,and delay the decline of pulmonary function of patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

AIM To investigate the renoprotective effects and mechanism of Caragana sinica roots,Astragali Radix and their combination use on the rat model of diabetic kidney disease(DKD).METHODS Sixty SD rats were randomly divided into the normal group,the model group,the Empagliflozin group(10 mg/kg),the C.sinica roots group(3.1 g/kg),the Astragali Radix group(3.1 g/kg),and the C.sinica roots plus Astragali Radix group(6.2 g/kg).In contrast to the intact rats of the normal group,rats of the other groups underwent left nephrectomy and intraperitoneal injection of streptozotocin(STZ)followed by 8-week intragastric gavage of the corresponding agent,during which their levels of FBG and 24 h urinary microprotein(24 h U-mAlb)were detected regularly.The rats killed at the end of the trial had their levels of Scr,BUN and Cystatin C detected;their renal pathological changes observed by HE,PAS and Masson stainings;their expressions of macrophage marker proteins CD68 and iNOS detected by immunohistochemistry;their expressions of renal JNK/SAPK pathway proteins such as JNK,p-JNK,TNF-α,IL-1β and ICAM-1 detected by Western blot;and their serum levels of TNF-α,IL-1β and ICAM-1 detected by ELISA as well.RESULTS Compared with the normal group,the model group displayed increased levels of FBG,24 h U-mAlb,BUN,Scr and Cystatin C(P＜0.01);more renal pathological damage,and increased levels of TNF-α,IL-1β and ICAM-1 in the renal tissue and serum(P＜0.01);and increased renal protein expressions of JNK and p-JNK(P＜0.01).Compared with the model group,all of the groups intervened with an agent shared decreased levels of FBG,24 h U-mAlb,BUN,Scr and Cystatin C(P＜0.05,P＜0.01);alleviated renal pathological damage,and decreased levels of TNF-α,IL-1β and ICAM-1 in renal tissue and serum(P＜0.01).There existed no group difference between the Astragali Radix group and the C.sinica roots group in terms of all indices levels(P＞0.05).The C.sinica roots plus Astragali Radix group demonstrated its superiority over either C.sinica roots group or Astragali Radix group in terms of all the indices levels(P＜0.05,P＜0.01).CONCLUSION C.sinica roots,Astragali Radix or their combination use can alleviate the renal pathological damage and improve the renal function of DKD rats through inhibiting the M1 macrophages,reducing the secretion of inflammatory factors,whose mechanism may lie in the inhibition of JNK/SAPK signal pathway activation.A better effect can be anticipated by the combination use of C.sinica roots and Astragali Radix.

AIM To investigate the impact of the combination use of Caragana sinica Radix and Astragali Radix on a rat model of diabetic kidney disease(DKD).METHODS The SD rats were randomly divided into the normal group,the model group,the Engelgin group,the Caragana sinica Radix group,the Astragali Radix group and the Caragana sinica Radix-Astragali Radix compatibility group,with 10 rats in each group.Following the successful establishment of a DKD model by unilateral amputate renal combined with intraperitoneal injection of streptozotocin(STZ),the corresponding gastric gavage of drugs were administered for 8 weeks.The rats had their 24 h urinary microalbumin(24 h U-mALB)detected at 0,4 and 8 weeks;their levels of Scr,BUN,CysC,MDA and SOD activity detected by ELISA;their renal ROS expression detected by fluorescence probe method;their renal pathological changes observed by HE,PAS,Masson and PASM-Masson staining;their renal expressions of NOX4,Drp1,MFN2 and P62 detected by immunohistochemistry;and their renal expressions of PINK1,MFN2,Parkin,LC3-Ⅱ/Ⅰ,P62 and p-Drp1 proteins detected by Western blot.RESULTS Compared with the model group,each treatment group displayed lower contents of 24 h U-mALB,BUN,Scr and CysC in the serum of rats(P＜0.01);reduced pathological structure damage of the renal tissue;decreased MDA level in serum and kidney(P＜0.01);increased SOD activity(P＜0.01);increased renal protein expressions of PINK1,MFN2,Parkin and LC3-Ⅱ/Ⅰ(P＜0.05,P＜0.01);and decreased protein expressions of p-Drp1 and P62(P＜0.01).And the Astragali Radix group and the Caragana sinica Radix-Astragali Radix compatibility group took the lead(P＜0.05,P＜0.01).CONCLUSION Upon the rat model of DKD,the compatibility of Caragana sinica Radix and Astragali Radix may alleviate their renal pathological damage and improve their renal function by activating the mitochondrial autophagy to improve mitochondrial dynamics and inhibit their oxidative stress via PINK1/MFN2/Parkin pathway.

Myocardial fibrosis is a key link in the occurrence and development of diabetic cardiomyopathy. Its etiology is complex, and the effect of drugs is not good.Cardiomyocyte apoptosis is an important cause of myocardial fibrosis. The purpose of this study was to investigate the effect of gaseous signal molecule sulfur dioxide (SO2 ) on diabetic myocardial fibrosis and its internal regulatory mechanism. Masson and TUNEL staining, Western-blot, transmission electron microscopy, RT-qPCR, immunofluorescence staining, and flow cytometry were used in the study, and the interstitial collagen deposition, autophagy, apoptosis, and changes in phosphatidylinositol 3-kinase (PI3K)/AKT pathways were evaluated from in vivo and in vitro experiments. The results showed that diabetic myocardial fibrosis was accompanied by cardiomyocyte apoptosis and down-regulation of endogenous SO2 -producing enzyme aspartate aminotransferase (AAT)1/2 . However, exogenous SO2 donors could up-regulate AAT1/2 , reduce apoptosis of cardiomyocytes induced by diabetic rats or high glucose, inhibit phosphorylation of PI3K/AKT protein, up-regulate autophagy, and reduce interstitial collagen deposition. In conclusion, the results of this study suggest that the gaseous signal molecule SO2 can inhibit the PI3K/AKT pathway to promote cytoprotective autophagy and inhibit cardiomyocyte apoptosis to improve myocardial fibrosis in diabetic rats. The results of this study are expected to provide new targets and intervention strategies for the prevention and treatment of diabetic cardiomyopathy.

This article reports a patient with extensive high-pressure injection injury of the hand caused by mistaken injection of polyurethane material into the index finger, who was diagnosed and treated in the Department of Orthopedics of Huzhou Central Hospital in 2019. Both the digital artery and digital nerve were involved, and the polyurethane involved the right palm along the flexor tendon sheath of the index finger and wrist. Due to the lack of X-ray development, the scope of the first debridement was small, and the blood supply to the fingertip was poor. Finally, the patient's right index finger was amputated due to infection and necrosis. MR or B-ultrasound should be perfected before operation to clarify the extent of polyurethane involvement. The initial thorough debridement or multiple debridements are necessary to improve the prognosis. If the blood supply of the fingers is poor, the blood supply can be reconstructed by skin flap transplantation.
Finger Injuries/surgery* ; Humans ; Polyurethanes/adverse effects* ; Plastic Surgery Procedures ; Skin Transplantation ; Surgical Flaps/surgery* ; Treatment Outcome

Objective: To investigate and monitor the occupational hazards in the Teaching and Research Laboratory (hereinafter referred to as the place) of a university, so as to provide basis for the occupational health work in the university. Methods: November 2014, 46 places in a university were selected by stratified random sampling, and the occupational health risk factors were investigated. Results: Indoor temperature, humidity, sulfur dioxide, nitrogen dioxide, carbon monoxide and carbon dioxide were detected in 21 sites, xylene and hydrofluoric acid were detected in 6 sites, and colony count was detected in 18 sites, the power frequency electric field intensity was measured in 23 places, and the x-ray radiation dose was measured in 4 places. Noise was measured at 21 sites, with 7 sites exceeding the standards accounting for 33.3% (7/21) ; 21 sites were detected for illumination and 10 sites for nonconformity accounting for 47.6% (10/21) ; 10 sites for Microwave Radiation and 3 sites exceeding the standards accounting for 30% (3/10) ; and 25 sites were detected for outdoor air volume and air velocity, the percentage of unqualified was 72% (18/25) in 18 sites, among which the wind velocity was statistically significant in teaching, research and experimental sites (P=0.010) . Conclusion: The occupational hazards in the teaching and research places of a university should be paid attention to, and the engineering protection and personal protection should be strengthened in the experiment.
Air Pollution, Indoor/analysis* ; Humans ; Humidity ; Nitrogen Dioxide/analysis* ; Occupational Exposure ; Occupational Health ; Universities

BACKGROUND: The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images. METHODS: Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists. RESULTS: The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%). CONCLUSIONS: The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists. TRIAL REGISTRATION Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.
Area Under Curve ; Breast/diagnostic imaging* ; Breast Neoplasms/diagnostic imaging* ; China ; Deep Learning ; Humans ; ROC Curve ; Sensitivity and Specificity