Objective To investigate the high-frequency ultrasonic anatomical features of the adjacent C7 transverse process and its clinical value in stellate ganglion block(SGB).Methods High-frequency ultrasound was applied to obtain ultrasonographic anatomical sonogram features in the plane of bilateral C7 transverse processes in 52 cases(104 sides in total)of healthy adults and then stored for the operator to learn and correctly label each tissue structure.Fifty patients who underwent ultrasound-guided SGB were selected and divided into the BC7 group(25 cases before study)and AC7 group(25 cases after study).The operation time,SGB success rate,number of adjusted needle tips,dosage of anaesthetic and adverse reaction of patients in both group were recorded.Results The main muscles observed in the C7 plane were the longissimus and anterior scalene muscles,the ultrasonographic anatomical relationships of the vagus nerve located in the carotid sheath,the pleura located posterior to the subclavian artery,and the recurrent laryngeal nerve located in the vicinity of the branches of the inferior thyroid artery are described,and the stellate ganglion was illustrated as a flattened hypoechogenic structure visible on the deep surface of the prevertebral fascia in the region of the external cervical longissimus muscle,vertebral artery and vein,and the medial aspect of the anterior oblique muscle,and emanated the sonographic features of several hypoechoic nerve bundles.Ultrasound guided SGB was completed uneventfully in patients of both groups,and all patients developed Horner syndrome,with the SGB success rate of 100%.The operation time[(5.36±1.11)minutes]of patients in the BC7 group was longer than that in the AC7 group[(3.08±0.86)minutes],the number of adjusted needle tips[(4.20±1.00)times]of patients in the BC7 group was more than that in the AC7 group[(2.24±0.87)times],and the dosage of anaesthetic[(1.82±0.28)mL]of patients in the BC7 group was more than that in the AC7 group[(1.64±0.22)mL],all the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reaction between the two groups(P>0.05).Conclusion After ultrasonic learning of adjacent structures through C7 transverse process,SGB is safe and easy to perform.

Objective We aimed to compare the efficacy and prognosis of percutaneous coronary intervention(PCI)in complex and high-risk patients with coronary heart disease(CHD)treated with extracorporeal membrane oxygenation(ECMO)combined with intra-aortic balloon pump(IABP)assistance,and explore the application value of combined use of mechanical circulatory support(MCS)devices in complex PCI.Methods A total of patients who met the inclusion criteria and underwent selective PCI supported by MCS at the Department of Cardiology,the First Affiliated Hospital of the Air Force Medical University from January 2018 to December 2022 were continuously enrolled.According to the mechanical circulatory support method,the patients were divided into ECMO+IABP group and IABP group.Clinical characteristics,angiographic features,in-hospital outcomes,and complications were collected.The intra-hospital outcomes and major adverse cardiovascular events(MACE)at one month and one year after the procedure were observed.The differences and independent risk factors between the two groups in the above indicators were analyzed.Results A total of 218 patients undergoing elective PCI were included,of which 66 patients were in the ECMO+IABP group and 152 patients were in the IABP group.The baseline characteristics of the two groups of patients were generally comparable,but the ECMO+IABP group had more complex lesion characteristics.The proportion of patients with atrial fibrillation(6.1％vs.0.7％,P=0.030),left main disease(43.9％vs.27.0％,P=0.018),triple vessel disease(90.9％vs.75.5％,P=0.009),and RCA chronic total occlusion disease(60.6％vs.35.5％,P＜0.001)was higher in the ECMO+IABP group compared to the IABP group.The proportion of patients with previous PCI history was higher in the IABP group(32.9％vs.16.7％,P=0.014).There was no statistically significant difference in the incidence of in-hospital complications between the two groups(P=0.176),but the incidence of hypotension after PCI was higher in the ECMO+IABP group(19.7％vs.9.2％,P=0.031).The rates of 1-month MACE(4.5％vs.2.6％,P=0.435)and 1-year MACE(7.6％vs.7.9％,P=0.936)were comparable between the two groups.Multivariate analysis showed that in-hospital cardiac arrest(OR 7.17,95％CI 1.27-40.38,P=0.025)and after procedure hypotension(OR 3.60,95％CI 1.10-11.83,P=0.035)were independent risk factors for the occurrence of 1-year MACE.Conclusions Combination use of ECMO+IABP support can provide complex and high-risk coronary heart disease patients with an opportunity to achieve coronary artery revascularization through PCI,and achieve satisfactory long-term prognosis.

Objective:To investigate the expression of NOD-like receptor protein 3(NLRP3)inflammasome and its relation-ship with granulosa cell apoptosis in patients with polycystic ovary syndrome(PCOS).Methods:Follicular fluid and ovarian granulosa cells were collected from 17 PCOS patients(PCOS group)and 20 non-PCOS patients(control group),and the expression levels of pro-inflammatory factor,TNF-α,IL-1β and IL-18 in follicular fluid were detected by ELISA.RT-PCR and Western blot were used to de-tect NLRP3 mRNA and NLRP3 inflammasome associated protein NLRP3,ASC and cleaved caspase-1 and autophagy related protein LC3-Ⅱ/LC3-Ⅰ and p62 expression level in granulosa cells.TUNEL assay was used to detect the apoptotic level of granulosa cells in both groups.NLRP3 silenced siRNA(si-NLRP3)and negative control sequence(si-NC)were transfected into human ovarian cancer granulosa cell line KGN cells by siRNA interference technique in vitro.TNF-α was used to simulate PCOS-related cell damage.KGN cells were divided into 4 groups according to different treatment methods:Ctrl group,TNF-α group,TNF-α+si-NLRP3 group and TNF-α+si-NC group.The levels of DHEA,testosterone,IL-1β and IL-18 in supernatant were detected by ELISA.TUNEL assay was used to detect the apoptosis level of KGN cells.The LC3-Ⅱ/LC3-Ⅰ and p62,NLRP3,ASC and cleaved caspase-1 protein expression levels,and NF-κB p-p65 level(NF-κB p-p65/NF-κB p65)in KGN cells were detected by Western blot.Results:Compared with con-trol group,the concentration of TNF-α,IL-1β,and IL-18 in follicular fluid of PCOS patients,and LC3-Ⅱ/LC3-Ⅰ,NLRP3 mRNA and the protein expression of NLRP3,ASC,and cleaved caspase-1 in granulosa cells of and apoptosis were significantly increased(P<0.05 or P<0.01),while the protein expression of p62 was significantly decreased(P<0.01).Compared with Ctrl group,the levels of DHEA,testosterone,IL-1β and IL-18 in supernatant of TNF-α group,TNF-α+si-NC group,and TNF-α+si-NLRP3 group,and LC3-Ⅱ/LC3-Ⅰ,ASC and cleaved caspase-1 protein expression,and the level of NF-κB p-p65 and apoptosis were significantly increased(P<0.05 or P<0.01),while p62 protein was significantly decreased(P<0.01).NLRP3 was significantly decreased except in TNF-α+si-NLRP3 group(P<0.01),while in the TNF-α group and TNF-α+si-NC group was significantly increased(P<0.01).However,com-pared with TNF-α group,the above indexes in TNF-α+si-NLRP3 group were significantly decreased(P<0.05),and TNF-α+si-NC group had no significant change(P>0.05).Conclusion:The over-activated NLRP3 inflammasome in granulosa cells may promote cell inflammatory injury and autophagy apoptosis in PCOS patients through NF-κB pathway.

This study was aimed at creating an engineered strain of Bacillus subtilis for efficient expression of biologically active type 2 toxin B(TcdB2)derived from a highly virulent strain of Clostridium difficile.The TcdB2 gene was cloned from ST1/RT027 strain genome DNA,incorporated into the PHT01 vector,and then transformed into B.subtilis strain WB800N for prokaryotic expression.Cell toxicity assays revealed that the recombinant TcdB2 exhibited cytotoxic effects in various cells.The engineered B.subtilis strain effectively expressed biologically active TcdB2,thus providing a basis for further exploration of the pathogenic mechanisms of highly virulent strains of C.difficile and establishing a foundation for potential vaccine can-didate targets.

Objective:To investigate the correlation of miR-155 expression with drug sensitivity of FLT3-ITD+acute myeloid leukemia(AML)cell line and its potential regulatory mechanism.Methods:By knocking out miR-155 gene in FLT3-ITD+AML cell line MV411 through CRISPR/Cas9 gene-editing technology,monoclonal cells were screened.The genotype of these monoclonal cells was validated by PCR and Sanger sequencing.The expression of mature miRNA was measured by RT-qPCR.The treatment response of doxorubicin,quizartinib and midostaurin were measured by MTT assay and IC50 of these drugs were calculated to identify the sensitivity.Transcriptome sequencing was used to analyze change of mRNA level in MV411 cells after miR-155 knockout,gene set enrichment analysis to analyze change of signaling pathway,and Western blot to verify expressions of key molecules in signaling pathway.Results:Four heterozygotes with gene knockout and one heterozygote with gene insertion were obtained through PCR screening and Sanger sequencing.RT-qPCR results showed that the expression of mature miR-155 in the monoclonal cells was significantly lower than wild-type clones.MTT results showed that the sensitivity of MV411 cells to various anti FLT3-ITD+AML drugs increased significantly after miR-155 knockout compared with wild-type clones.RNA sequencing showed that the mTOR signaling pathway and Wnt signaling pathway were inhibited after miR-155 knockout.Western blot showed that the expressions of key molecules p-mTOR,Wnt5α and β-catenin in signaling pathway were down-regulated.Conclusion:Drug sensitivity of MV411 cells to doxorubicin,quizartinib and midostaurin can be enhanced significantly after miR-155 knockout,which is related to the inhibition of multiple signaling pathways including mTOR and Wnt signaling pathways.

Objective To explore the impact of inspiratory muscle training(IMT)on enhancing cardio-pulmonary fitness and inspiratory muscle performance among hemiplegic stroke survivors.Methods A total of 58 hemiplegic stroke survivors treated at the Affiliated Jiangning Hospital of Nanjing Medical University between January 2012 and January 2023 were enrolled,and randomly divided into an IMT group and a control group,each of 29.Both groups were given a 12-week health education and rou-tine rehabilitation including physiotherapy and aerobic exercise,while the IMT group was additionally provided with IMT.Before and after intervention,both groups were assessed the maximal inspiratory pressure(MIP)and the inspiratory muscle strength index(IMSI)using the Power breathe K5 system,the 6-minute walk distance(6MWD)using the 6-minute walk test(6MWT),as well as the difference value between baseline and post-intervention 6MWD(6MWDd-value).During the process of 6MWT,gas exchange data were recorded using Cosmed K4b2 wirless telemetry gas analyzer,and the peak oxy-gen uptake(VO2peak)and peak ventilation(VEpeak)were determined.Meanwhile,the cardiopulmonary fit-ness and inspiratory muscle performance were compared,and the correlations of 6MWD to VO2peak and VEpeak were assessed,respectively.Results After intervention,a significant increase was observed in MIP,IMSI,6MWD,VO2peak,and VEpeak in both groups(P<0.05).Moreover,the IMT group demonstrat-ed more significant increases in MIP,IMSI,6MWDd-value,VO2peak,and VEpeak compared to the con-trol group(P<0.05).However,no significant difference was found in 6MWD between the two groups af-ter the intervention(P>0.05).Although 6MWD was positively correlated with VO2peak(r=0.298,P<0.05)and VEpeak(r=0.813,P<0.01),the 6MWDd-value was not significantly correlated with 6MWD,VO2peak or VEpeak(P>0.05).Meanwhile,6MWD and IMT can positively predict VO2peak(6MWD:B=0.023,P<0.01;IMT:B=0.341,P<0.01)and VEpeak(6MWD:B=0.503,P<0.01;IMT:B=7.486,P<0.01).Conclusion IMT can enhance cardiopulmonary fitness and inspiratory muscle performance in stroke sur-vivors with hemiplegia.Consequently,it is suggested that the integration of IMT with conventional stroke rehabilitation strategies may yield beneficial outcomes.Moreover,the six-minute walking test may be used to assess improvements in oxygen uptake and ventilation in stroke patients indirectly.

Objective To explore the current status of H.pylori infection in the natural population of Sanya City,analyze its influencing factors,and provide a reference basis for the prevention and control of H.pylori infection.Methods A total of 677 residents from four districts of Sanya City were selected by overall stratified random sampling method,and were subjected to urea 14C breath test and questionnaire survey to calculate the positive rate of H.pylori in the natural population and analyze the influencing factors of H.pylori infection.Results A total of 606 residents were included,and the number of H.pylori positive detections was 261,with a positive detection rate of 38.5％.Among them,different ethnicity,marital status,smoking,eating vegetables and fruits,and literacy level were associated with H.pylori infection(P＜0.05);gender,age,BMI,alcohol consumption,drinking water source,betel quid chewing,and the number of cohabitants were not significantly associated with H.pylori infection(P＞0.05).Family infection was an independent risk factor for H.pylori infection in the natural population of Sanya City,and Li ethnicity,frequent consumption of fruits and vegetables,and college and higher education level were independent protective factors for H.pylori infection in the natural population of Sanya City.Conclusion The rate of H.pylori infection in the natural population of Sanya City is lower than the national average.Consuming more fruits and vegetables and improving the awareness of hygiene protection are conducive to the prevention of H.pylori infection;and the promotion of the family and related members with the same examination and treatment is important to avoid aggregation of infection within the family.

Objective To explore the relevant risk factors of H.pylori infection,and provide reference for prevention and treatment of H.pylori in this area,and further provide theoretical basis for the prevention and treatment of gastric cancer.Methods A total of 1200 residents in four districts of Haikou city were investigated by questionnaire and urea 14 C breath test by holistic stratified random sampling to calculate the population infection rate and analyze the risk factors of infection.Results The total infection rate was 32.5％,which was lower than the national H.pylori infection rate.No consumption of fruits and vegetables,no habit of washing hands before meals,and people with gastrointestinal symptoms,are independent risk factors of H.pylori infection.No consumption of pickled products is of great significance to prevent H.pylori infection.Conclusion The prevalence of H.pylori infection in the population of Haikou is lower than the national average,and H.pylori infection is closely related to the poor living habits of residents.

Objective:To explore the clinical effect of Triangle hierarchical management in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)after percutaneous coronary intervention(PCI).Methods:A total of 107 NSTEMI patients who underwent PCI in our hospital from Jan 2019 to Dec 2022 were selected.Ac-cording to the random number table method,patients were divided into control group(n=53)and observation group(n=54).Patients in the control group received routine rehabilitation training,while observation group re-ceived Triangle hierarchical management based on control group,both groups were intervened for 6 months.Car-diopulmonary function indexes,scores of myocardial infarction dimensional assessment scale(MIDAS)and general self-efficacy scale(GSES)before and after intervention,and incidence of adverse events during follow-up were compared between two groups.Results:During study period,two cases were lost in the control group and one case withdrew in the observation group,with 51 and 53 cases finally enrolled in each group,respectively.Compared with the control group after intervention,there were significant rise in forced expiratory volume in one second(FEV1)[(2.98±0.27)L vs.(3.30±0.35)L],FEV1/forced vital capacity(FVC)[(72.65±4.31)％vs.(77.06±3.95)％]and GSES score[(18.53±2.63)points vs.(26.89±3.19)points],and significant reduction in MIDAS total score[(65.53±4.86)points vs.(56.26±4.38)points]in observation group(P＜0.001 all).There was no significant difference in the incidence rate of adverse events between control group and observation group during fol-low-up(13.73％vs.7.55％,P=0.306).Conclusion:Triangle hierarchical management may significantly improve lung function,self-efficacy and quality of life with high safety in patients with acute non-ST-segment elevation myocardial infarction after PCI,suggesting that it worths promoting in clinical practice.

Objective To investigate the dosimetric effects of different calculation grid size(CGS)in helical tomotherapy(HT)planning system on stereotactic body radiation therapy(SBRT)for non-small cell lung cancer(NSCLC).Methods Nine NSCLC patients receiving radiation therapy for the first time at some hospital from March 2019 to December 2022 were selected as the subjects.SBRT planning was carried out through the HT system with three different CGS plans(Fine,Normal,and Coarse)and the same pitch,modulation factor(MF)and optimization conditions,and the target area indexes of the three CGS plans were compared including conformity index(CI),homogeneity index(HI),dosimetric parameters of the organ at risk(OAR),point dose verification pass rate,treatment time,number of monitor units and Sinograms.SPSS 22.0 was used for statistical analysis.Results For target area HI,there weres significant differences between CGS Fine plan and Coarse plan and between CGS Normal plan and Coarse plan(P＜0.05),while no statistical differences were found between CGS Fine plan and Normal plan(P＞0.05).For target area CI,there were significant differences between CGS Fine plan and Coarse plan(P＜0.05),while no statistical differences were found between CGS Fine plan and Normal plan and between CGS Normal plan and Coarse plan(P＞0.05).For OAR dosimetric parameters,CGS Fine plan and Coarse plan had significant differences in heart Dmax and Dmean,esophageal Dmax and Dmean,V5,V20,V30 and Dmean of the whole lung and affected lung,V5 and Dmax of the affected lung and heart V10 and V30(P＜0.05),CGS Normal plan and Coarse plan had obvious differences in esophageal Dmax(P＜0.05),and the remained dosimetric parameters were not statistically significant(P＞0.05).Fine,Normal and Coarse plans had the point dose verifica-tion pass rates being 0.96％,1.50％and 1.77％,respectively.In terms of treatment time and number of monitor units,there were significant differences between Fine plan and Coarse plan(P＜0.05)while no statistical differences were found between Fine and Normal plans and between Normal and Coarse plans(P＞0.05).Sinograms analyses showed Fine plan had evenly distributed segment color gradient,Coarse plan had areas of very dark and very light color gradients and Normal plan was somewhere in between.Conclusion Low CGS has to be used as much as possible to obtain accurate dose distribution during SBRT planning for NSCLC patients,which contributes to the execution of the radiation therapy plan and the prevention of ad-verse effects.[Chinese Medical Equipment Journal,2024,45(2):52-57]