Background:With the development of endoscopic techniques,the incidence of rectal neuroendocrine neoplasms(R-NEN)is increasing year by year,and its atypical symptoms and risk of metastasis make early and accurate localization of its primary site essential for its diagnosis and treatment.Aims:To explore the endoscopic ultrasonographic manifestations of R-NEN,compare the consistency between endoscopic ultrasonography(EUS)and pathological diagnosis,and analyze the reasons for these differences.Methods:Patients with pathologically confirmed R-NEN from January 2016 to December 2023 at Renmin Hospital of Wuhan University were recruited retrospectively in this study.The clinical characteristics and the microscopic manifestations of the lesions were analyzed,the diagnostic ability of EUS and postoperative pathology on the infiltration depth of the lesions were compared,and the factors affecting the diagnostic accuracy of EUS were analyzed.Results:A total of 127 patients with R-NEN were included in this study,54.3%(69/127)were male patients,with an average age of(51.00±12.30)years old.Most of the lesions seen microscopically were smooth spherical or hemispherical elevations located in the mucosal-submucosal layer of the rectum,with an average size of(0.77±0.62)cm,and a distance of(6.58±2.51)cm from the anal verge.The diagnostic compliance rate of EUS for lesions involving the submucosa was 98.3%(116/118),and the diagnostic accuracy for the intrinsic muscular layer and above was 55.6%(5/9).The difference of Kappa's consistency test between the two was statistically significant(P<0.05).The diagnostic accuracy of EUS for lesions of 10-20 mm(OR=5.068,95%CI:1.34-19.12,P=0.017)was acceptable,whereas lesions located in the upper rectum(OR=0.05,95%CI:0.01-0.75,P=0.031)and involving to the intrinsic muscular layer of the intestinal wall and above(OR=0.05,95%CI:0.01-0.59,P=0.017)could negatively affect its diagnostic accuracy.Conclusions:EUS has a high localization accuracy for R-NEN lesions,and can be used as a key method for the initial diagnosis of suspected R-NEN.For lesions located in the upper rectum and with deeper infiltration levels,a more standardized operation with more detailed analysis are recommended.

Background:With the development of endoscopic techniques,the incidence of rectal neuroendocrine neoplasms(R-NEN)is increasing year by year,and its atypical symptoms and risk of metastasis make early and accurate localization of its primary site essential for its diagnosis and treatment.Aims:To explore the endoscopic ultrasonographic manifestations of R-NEN,compare the consistency between endoscopic ultrasonography(EUS)and pathological diagnosis,and analyze the reasons for these differences.Methods:Patients with pathologically confirmed R-NEN from January 2016 to December 2023 at Renmin Hospital of Wuhan University were recruited retrospectively in this study.The clinical characteristics and the microscopic manifestations of the lesions were analyzed,the diagnostic ability of EUS and postoperative pathology on the infiltration depth of the lesions were compared,and the factors affecting the diagnostic accuracy of EUS were analyzed.Results:A total of 127 patients with R-NEN were included in this study,54.3%(69/127)were male patients,with an average age of(51.00±12.30)years old.Most of the lesions seen microscopically were smooth spherical or hemispherical elevations located in the mucosal-submucosal layer of the rectum,with an average size of(0.77±0.62)cm,and a distance of(6.58±2.51)cm from the anal verge.The diagnostic compliance rate of EUS for lesions involving the submucosa was 98.3%(116/118),and the diagnostic accuracy for the intrinsic muscular layer and above was 55.6%(5/9).The difference of Kappa's consistency test between the two was statistically significant(P<0.05).The diagnostic accuracy of EUS for lesions of 10-20 mm(OR=5.068,95%CI:1.34-19.12,P=0.017)was acceptable,whereas lesions located in the upper rectum(OR=0.05,95%CI:0.01-0.75,P=0.031)and involving to the intrinsic muscular layer of the intestinal wall and above(OR=0.05,95%CI:0.01-0.59,P=0.017)could negatively affect its diagnostic accuracy.Conclusions:EUS has a high localization accuracy for R-NEN lesions,and can be used as a key method for the initial diagnosis of suspected R-NEN.For lesions located in the upper rectum and with deeper infiltration levels,a more standardized operation with more detailed analysis are recommended.

Background: The terminology of nonalcoholic fatty liver disease (NAFLD) was changed to metabolic dysfunction ⁃ associated fatty liver disease (MAFLD) in 2020. NAFLD has been confirmed to be a risk factor for colorectal neoplasms, but the association between MAFLD and colorectal neoplasms is conflicting. Aims: To investigate the correlation of MAFLD with colorectal adenoma and early colorectal cancer. Methods: The clinical information of 701 patients who met the criteria and were admitted to Renmin Hospital of Wuhan University from January 2021 to August 2021 was collected retrospectively. Among them, 274 colorectal adenoma patients with low ⁃ grade intraepithelial neoplasia or without intraepithelial neoplasia were classified as adenoma group, 21 patients with high ⁃ grade intraepithelial neoplasia, intramucosal carcinoma, and submucosal carcinoma were classified as early cancer group, and 406 patients with normal colonoscopy or non⁃adenomatous polyps were served as control group. The general information and prevalence of MAFLD between these groups were compared. Furthermore, the correlation of MAFLD with colorectal adenoma and early colorectal cancer, and the gender difference of these correlations were analyzed by Logistic regression models. Subgroup analysis was performed based on the clinicopathological characteristics of colorectal adenoma. Results: When adjusting the confounding variables including gender, age, smoking, alcohol drinking, diabetes, hypertension, and serum creatinine, MAFLD was significantly associated with the prevalence of colorectal adenoma (OR=1.83, 95% CI: 1.04 ⁃ 3.22, P=0.037) and early colorectal cancer (OR=3.91, 95% CI: 1.14⁃13.42, P=0.031). When stratified as gender, the significant association remained in females (OR=4.04, 95% CI: 1.56 ⁃ 10.47, P=0.004), but not in males. In addition, no correlation was found between MAFLD and the location, size, number, and advanced histology of colorectal adenoma (all P>0.05). Conclusions: MAFLD is an independent risk factor for colorectal adenoma and early colorectal cancer. MAFLD is specifically associated with increased risk of colorectal adenoma in females but not in males.

Objective To explore the clinical efficacy and safety of modified PPH combined with partial internal anal sphincterotomy in the treatment of circular mixed hemorrhoids.Methods Patients with annular mixed hemorrhoids were divided into two groups by a completely randomized controlled method.54 patients in the experimental group were treated with modified PPH combined with partial internal anal sphincterotomy,while 51 patients in the control group were treated with conventional PPH.The postoperative indicators,perioperative and long-term complication rates of the two groups were compared,and the clinical efficacy and safety were observed.Results The operation time in the experimental group was(48.35±4.37)minutes,which was higher than that in the control group(36.42 ±6.21)minutes(P＜0.05).The incidence of postoperative anastomotic stenosis in the experimental group was 1.9％,lower than 15.6％ in the control group(P＜0.05).Anal pain,urinary retention,first defecation time,long-term anal distention,the experimental group was significantly better than the control group,the difference was statistically significant(P＜0.05);The hospitalization time in the experimental group(4.8±0.62)days was not significantly different from that in the control group(5.1±0.54)days(P＞0.05).The amount of intraoperative bleeding and anastomotic bleeding in the experimental group[(17.28±2.22)ml,3.7％]were not significantly different from those in the control group[(16.75± 2.13)ml,3.9％](P＞0.05).Conclusion Compared with conventional PPH,the modified PPH combined with partial internal anal sphincterotomy slightly increases the operation time,but does not increase the risk of anastomotic bleeding,the incidence of rectal fistula,the amount of surgical bleeding,and the length of hospital stay.It can significantly improve postoperative anal pain,urinary retention,long-term distention symptoms,shorten the time of first defecation,ease the difficulty of defecation,and significantly reduce postoperative anastomotic stenosis,The long-term efficacy and safety are good.

ObjectiveTo explore the protective effect of modified Shengmaisan on cardiac function in elderly patients with myocardial infarction based on the nuclear factor-κB/induction nitric oxide synthase/nitric oxide （NF-κB/iNOS/NO） signaling pathway. MethodA total of 136 elderly patients with myocardial infarction treated in Qinghai Hospital of Traditional Chinese Medicine from december 2019 to december 2021 were included. They were randomly divided into an observation group and a control group， with 68 cases in each group. The control group was treated with conventional western medicine， and the observation group was treated with conventional western medicine + modified Shengmaisan. Both groups were treated with percutaneous coronary intervention for revascularization. The indexes related to cardiac function and levels of serum interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and matrix metalloproteinase-9 （MMP-9） were analyzed and compared between the two groups. The echocardiographic index， cardiac function classification， changes in the NF-κB/iNOS/NO signaling pathway， oxidative stress indexes， and major adverse cardiovascular events （MACE） of the two groups were compared. ResultCompared with those before treatment， the levels of N-terminal B-type natriuretic peptide （NT-pro BNP）， serum inflammatory indexes， left ventricular end systolic volume （LVESV）， left ventricular end diastolic volume （LVEDV）， NO， iNOS， NF-κB p65， and methane dicarboxylic aldehyde （MDA） were significantly reduced （P<0.05，P<0.01）， and the left ventricular ejection fraction （LVEF） and superoxide dismutase (SOD） were significantly increased （P<0.05）. After treatment， as compared with the control group， the levels of NT-pro BNP， serum inflammatory indexes， LVESV， LVEDV， NO， iNOS， NF-κB p65， and MDA in the observation group were significantly reduced （P<0.05）， and those of LVEF and SOD were significantly increased （P<0.05）. There was no significant difference in the New York Heart Association (NYHA) cardiac function classification between two groups. The incidence of MACE in the observation group was significantly lower than that in the control group （P<0.05）. ConclusionModified Shengmaisan can significantly reduce NT-pro BNP and levels of serum inflammatory indexes in elderly patients with myocardial infarction， improve echocardiographic indexes， regulate the NF-κB/iNOS/NO signaling pathway， and reduce the oxidative stress index and the incidence of MACE， which has a good protective effect on cardiac function.

Objective:To investigate the role of Caveolin (Cav-3)/extracellular signal-regulated kinase (ERK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in rats with chronic heart failure.Methods:Clean-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, were used in this study.Chronic heart failure was induced by ligating the left anterior descending coronary artery for 6 weeks.Thirty-six Langendorff-perfused hearts with chronic heart failure were divided into 4 groups ( n=9 each) by a random number table method: myocardial I/R group (group IR), morphine preconditioning group (group MP), morphine preconditioning plus methyl-β-cyclodextrin group (group MP+ MβCD), and methyl-β-cyclodextrin group (group MβCD). Global myocardial I/R was induced by 30 min ischemia followed by 120 min reperfusion.In group MP, after 15 min of equilibration, hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing 1 μmol/L morphine for preconditioning followed by 5 min perfusion with K-H solution, 30 min in total, and after the end of treatment, hearts were subjected to 30 min ischemia followed by 120 min reperfusion.In group MP+ MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 10 min before preconditioning with morphine, and the other treatments were similar to those previously described in group MP.In group MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 40 min before ischemia, and the other treatments were similar to those previously described in group IR.At the end of 15 min of equilibration (T 0) and 5 and 10 min of reperfusion (T 1, 2), coronary outflow was collected for determination of actate dehydrogenase (LDH) activity by chemical colorimetry.Myocardial infarct size (IS) and area at risk (AAR) were measured, and IS/AAR was calculated at the end of 120 min reperfusion.Myocardial tissues of left ventricle were taken to detect the expression of Cav-3, ERK1/2 and phosphorylated ERK1/2 (p-ERK1/2) by Western blot, and p-ERK1/2/ERK1/2 ratio was calculated. Results:Compared with group IR, IS, IS/AAR and LDH activity in coronary outflow were significantly decreased, the expression of Cav-3 was up-regulated, and p-ERK1/2/ERK1/2 ratio was increased in group MP ( P<0.05). Compared with group MP, IS, IS/AAR and LDH activity in coronary outflow were significantly increased, the expression of Cav-3 was down-regulated, and p-ERK1/2/ERK1/2 ratio was decreased in group MP+ MβCD ( P<0.05). Conclusions:The mechanism by which morphine preconditioning reduces I/R injury may be related to activation of Cav-3/ERK signaling pathway in rats with chronic heart failure.

Objective: To learn the prevalence and influencing factors of dyslipidemia among the residents aged 35-75 years in Zhejiang Province, so as to provide basis for prevention and control of dyslipidemia. Methods: Based on the national high-risk early screening and comprehensive intervention program for cardiovascular disease, multi-stage stratified cluster sampling method was adopted to select 35-75 year-old permanent residents from six cities （counties or districts） in Zhejiang Province. A questionnaire survey was used to collect demographic data;physical examination and laboratory test were carried out. A multivariate logistic regression model was used to analyze the influencing factors for dyslipidemia. Results : A total of 44 440 residents were investigated and 40 751 residents responded,accounting for 91.70%. The crude prevalence rate of dyslipidemia was 36.88% （15 027 cases） and the age-standardized one was 34.58%. The crude prevalence rates of hypercholesterolemia, hypertriglyceridemia and high low density lipoprotein-cholesterol were 18.10%, 14.05%, 10.57% and 15.78%, respectively,the age-standardized ones were 16.11%, 13.76% and 14.53%, respectively.The results of multivariate logistic regression analysis showed that age （OR=1.006, 95%CI:1.004-1.008）,urban residence （OR=1.139, 95%CI: 1.087-1.194）,smoking （OR=1.099, 95%CI: 1.033-1.170）,drinking （OR=0.915,95%CI: 0.863-0.970）,underweight （OR=0.623, 95%CI: 0.528-0.735）, overweight （OR=1.624,95%CI: 1.552-1.699）, obesity （OR=2.128, 95%CI: 1.985-2.281）, diabetes （OR=1.600, 95%CI: 1.493-1.715）, hypertension （OR=1.218, 95%CI: 1.165-1.273） and hyperurcemia （OR=1.789, 95%CI: 1.679-1.905） were associated with dyslipidemia. Conclusions The age-standardized prevalence rate of dyslipidemia among the residents aged 35-75 years in Zhejiang Province was lower than that in the whole country,but the prevalence rates of hypercholesterolemia,hypertriglyceridemia and high low density lipoprotein-cholesterol were relatively high.

Objective: To evaluate the effects of office blood pressure(OBP)combined with ambulatory blood pressure monitoring(ABPM)on the diagnosis of hypertension. Methods: The residents aged 35-79 years without hypertension history,whose casual OBP were 120~159 mm Hg/80~99 mm Hg,were enrolled from 4 communities of Hangzhou and Zhuji from 2015 to 2018. They were performed OBP measurements on other two days in 4 weeks and ABPM in a week. There were 2 criteria of OBP as elevated OBP on the first day or in 3 different days,and 4 criteria of ABPM as elevated mean BP in 24 hours, daytime, nighttime and either of the above time. Receiver operating characteristic(ROC)curve was employed to evaluate the effects of different OBP criteria combined with ABPM criteria on the diagnosis of masked hypertension(MH)and white-coat hypertension(WCH). Results: Taking 3-day-OBP as a golden standard,the 1-day-OBP with 4 ABPM criteria had the areas under the ROC curve(AUC)of 0.79-0.81,sensitivity of 57.58%-62.77% and specificity of 100.00% in MH;had the AUC of 0.95-0.98,sensitivity of 100.00% and specificity of 88.96%-96.80% in WCH. The Kappa values were all less than 0.6,known as low consistency. Taking either time of ABPM as a golden standard,24 hours,daytime and nighttime ABPM criteria with OBP had the AUC of 0.90-0.92,sensitivity of 79.17%-83.90% and specificity of 100.00% in MH(all Kappa>0.6),when with 1-day-OBP,the Kappa values were all more than 0.8,known as high consistency;had the AUC of 0.95-1.00,sensitivity of 100.00% and specificity of 89.54%-99.37% in WCH,the Kappa values of daytime ABPM were all more than 0.6,known as high consistency. Conclusions If limited by options, 1-day-OBP could be used instead of 3-day-OBP for detection of WCH or exclusion of MH yet with less accuracy; 24 hours or daytime ABPM instead of either time of ABPM was reliable.

Objective To assess the screening and intervention techniques for resistant hypertension in the community.Methods Random sampling method was used to recruit 1 171 hypertensive patients from two communities in Hangzhou and Zhuji cities of Zhejiang province form October 2015 to september 2016.Among them,97 patients with resistant hypertension were identified with the Three-steps-flow screening method and the individualized intervention was given.The standardized treatment and lifestyle changes were compared before and after intervention.Results Among 97 patients with resistant hypertension,7 cases of pseudo resistant hypertension were detected;there were 2 cases with thyroid disease history,48 cases with snoring history and 1 case with sleep apnea syndrome.The life style intervention and standardized medication guidance were given to 90 patients with resistant hypertension according to the individual risk factors.After one year of intervention,the results showed that the rate of normalized blood pressure was 83.5％ (75/90) and the rate of standardized medication increased from 14.4％(13/90) to 90.0％ (81/90),the rate of medication compliance increased from 46.7％(42/90) to 95.6％(86/90),the blood pressure control rate increased from 12.2％(11/90) to 77.8％(70/90),and the average systolic blood pressure and diastolic blood pressure levels were decreased by 20.4 mmHg (1 mmHg=0.133 kPa) and 15.5 mmHg.The life style of patients with resistant hypertension was remarkably changed,56.7％(51/90) of patients took exercise regularly,high salt/high calorie diet decreased from 37.8％(34/90) to 11.1％(10/90),the proportion of the obese went down to 16.7％(15/90).Conclusion With the application of resistant hypertension screening and intervention,there are remarkable improvement in blood pressure control and life style changes for patients with resistant hypertension in the community.

Objective To analyze risk factors and complication characteristics of healthcare-associated infection (HAI)in patients with lung cancer,and provide evidence for the formulation of HAI management strategy. Methods HAI-related articles were retrieved from China Biology Medicine (CBM),China National Knowledge Infrastructure (CNKI),Wanfang database,Vip database,PubMed,and Embase,all data were conducted Meta-analysis.Results A total of 19 articles involving 8 069 hospitalized patients with lung cancer (1 280 had HAI)were included.Meta-analysis on combined values of medical factors for HAI were as follows:OR(95%CI )of anti-tumor therapy(radiotherapy and chemotherapy),number of chemotherapy (≥ 2 times ),antimicrobial prophylaxis, immunosuppressant therapy,and invasive operation were 3.13 (1 .82,5.39),9.20 (3.04,27.87),3.23 (1 .77, 5.91),2.00(1 .56,2.57),and 2.28(1 .81 ,2.88),respectively;Meta-analysis on combined values of complication factors for HAI were as follows:OR (95% CI )of pulmonary diseases,chronic obstructive pulmonary disease (COPD),diabetes,renal dysfunction,malnutrition,hypoalbuminemia,neutropenia,and leukopenia were 2.65 (1 .74,4.02),2.40 (1 .76,3.27),2.25 (1 .85,2.73 ),2.56 (1 .18,5.52),5.51 (1 .70,17.89),2.05 (1 .56, 2.70),3.38(1 .40,8.18),and 2.10 (1 .22,3.62),respectively.Conclusion HAI-related factors of medical treat-ment and complications in patients with lung cancer are diversity,risk factors for HAI in patients with lung cancer are anti-tumor therapy,immunosuppressant therapy,antimicrobial prophylaxis,invasive operation,pulmonary dis-eases,COPD,diabetes,renal dysfunction,malnutrition,hypoalbuminemia,neutropenia,and leucopenia.