Objective:To evaluate the predictive value of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio(TAPSE/sPAP) in identifying precapillary pulmonary hypertension(pcPH) patients requiring repeat balloon pulmonary angioplasty(BPA) within 3 months after initial intervention, and to determine independent risk factors associated with postoperative reintervention.Methods:We retrospectively collected clinical data from 215 consecutive patients with pcPH undergoing BPA. After applying exclusion criteria, 200 patients were ultimately included in the analysis. The predictive value of the TAPSE/sPAP for short-term BPA reintervention was assessed using receiver operating characteristic( ROC) curve analysis and multivariable logistic regression. Internal validation was performed through bootstrap resampling with 1 000 iterations to evaluate model stability. Results:A risk model for echocardiography was constructed using multiple logistic regression, and the results showed that systolic pulmonary artery pressure(sPAP), peak tricuspid regurgitation velocity(TRV), tricuspid regurgitation pressure gradient(PGTR), and TAPSE/sPAP ratio were predictive factors for BPA surgery in patients with pulmonary hypertension within 3 months. Multivariate regression analysis suggests that the TAPSE/sPAP ratio is an independent influencing factor for BPA after 3 months( OR=0.023, P<0.05). The predicted area under the ROC curve( AUC) for BPA after 3 months is 0.62(95% CI: 0.530-0.648), P<0.01, which is better than other cardiac ultrasound indicators. At the same time, internal bootstrap method was used for internal self-validation, and the AUC of the internal self-validation set was 0.67. Conclusion:The TAPSE/sPAP ratio serves as an independent predictor for requiring repeat BPA within 3 months postoperatively in patients with pcPH.

Objective:To evaluate the predictive value of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio(TAPSE/sPAP) in identifying precapillary pulmonary hypertension(pcPH) patients requiring repeat balloon pulmonary angioplasty(BPA) within 3 months after initial intervention, and to determine independent risk factors associated with postoperative reintervention.Methods:We retrospectively collected clinical data from 215 consecutive patients with pcPH undergoing BPA. After applying exclusion criteria, 200 patients were ultimately included in the analysis. The predictive value of the TAPSE/sPAP for short-term BPA reintervention was assessed using receiver operating characteristic( ROC) curve analysis and multivariable logistic regression. Internal validation was performed through bootstrap resampling with 1 000 iterations to evaluate model stability. Results:A risk model for echocardiography was constructed using multiple logistic regression, and the results showed that systolic pulmonary artery pressure(sPAP), peak tricuspid regurgitation velocity(TRV), tricuspid regurgitation pressure gradient(PGTR), and TAPSE/sPAP ratio were predictive factors for BPA surgery in patients with pulmonary hypertension within 3 months. Multivariate regression analysis suggests that the TAPSE/sPAP ratio is an independent influencing factor for BPA after 3 months( OR=0.023, P<0.05). The predicted area under the ROC curve( AUC) for BPA after 3 months is 0.62(95% CI: 0.530-0.648), P<0.01, which is better than other cardiac ultrasound indicators. At the same time, internal bootstrap method was used for internal self-validation, and the AUC of the internal self-validation set was 0.67. Conclusion:The TAPSE/sPAP ratio serves as an independent predictor for requiring repeat BPA within 3 months postoperatively in patients with pcPH.

ObjectiveTo investigate the mechanism of salvianolic acid F （Sal F） in repairing the high glucose-induced injury in human kidney-2 （HK-2） cells via the B-cell lymphoma-2 （Bcl-2）-associated X protein （Bax）/cysteinyl aspartate-specific proteinase 3 （Caspase-3）/gasdermin-E （GSDME） pathway. MethodThe cell counting kit-8 （CCK-8） was used to measure the relative viability of HK-2 cells exposed to high glucose and different concentrations （2.5， 5， 10， 20 μmol·L^-1） of Sal F and the relative viability of HK-2 cells treated with Sal F for different time periods. The levels of lactate dehydrogenase （LDH） and interleukin-1β （IL-1β） in the supernatant of the cell culture were measured by the LDH assay kit and enzyme-linked immunosorbent assay （ELISA） kit， respectively. Flow cytometry combined with Annexin V-FITC/propidium iodide （PI） and Hoechst 33342/PI staining was employed to reveal the proportion of PI-positive HK-2 cells exposed to high glucose. Western blotting was employed to determine the protein levels of Bax， Bcl-2， cytochrome C， cysteinyl aspartate-specific proteinase （Caspase）-9， Caspase-3， and GSDME in the HK-2 cells exposed to high glucose and treated with Sal F. The 2，7-dichlorodihydrofluorescein diacetate fluorescence probe （DCFH-DA） and mitochondrial membrane potential assay kit （JC-1） were used to determine the production of reactive oxygen species （ROS） and the mitochondrial membrane potential in the HK-2 cells exposed to high glucose and treated with Sal F. ResultCompared with the blank group， the model group showed decreased cell viability （P<0.01）， elevated levels LDH and IL-1β， increased proportion of PI-positive cells （P<0.01）， up-regulated protein levels of Bax， cytochrome C， Caspase-9， Caspase-3， and GSDME （P<0.01）， down-regulated protein level of Bcl-2 （P<0.01）， decreased mitochondrial membrane potential， and excessive ROS accumulation. Compared with the model group， Sal F repaired the high glucose-induced injury in HK-2 cells （P<0.05）， lowered the levels of LDH and IL-1β （P<0.05， P<0.01）， and decreased the proportion of PI-positive cells （P<0.01）. In addition， Sal F down-regulated the protein levels of Bax， cytochrome C， Caspase-9， Caspase-3， and GSDME and up-regulated the protein level of Bcl-2 （P<0.05， P<0.01）， increased the mitochondrial membrane potential， and decreased the accumulation of ROS in HK-2 cells. ConclusionSal F can reduce the production of ROS， restore the balance of mitochondrial membrane potential， and inhibit pyroptosis via the Bax/Caspase-3/GSDME signaling pathway to repair the high glucose-induced injury in HK-2 cells.

Objective To explore the impact of δ-catenin expression level on resting-state brain function in breast cancer patients.Methods Totally 104 female breast cancer patients were prospectively enrolled and divided into δ-catenin high expression group(DH group,n=51)and δ-catenin low expression group(DL group,n=53)according to δ-catenin expression level,while 36 female healthy volunteers were selected as controls(control group).Neuropsychological tests were performed,and resting-state functional MRI(rs-fMRI)were acquired,then parameters of brain function,including amplitude of low frequency fluctuation(ALFF),fractional ALFF(fALFF),regional homogeneity(ReHo)and functional connectivity strength(FCS)of brain regions with differences among groups were obtained.Spearman correlation analysis was used to evaluate the correlations of function parameters of brain regions with general data and neuropsychological test scores.Results Significant differences of fALFF,ReHo and FCS values were found among 3 groups(familywise error rate[FWE]correction,all P＜0.05).fALFF value of left inferior temporal gyrus in DH and DL groups were both higher than that in control group(FWE correction,both P＜0.05),ReHo value of right inferior temporal gyrus in DH group,as well as of right middle temporal gyrus,right inferior temporal gyrus and right fusiform gyrus in DL group were all lower than that in control group(FWE correction,all P＜0.05),FSC value of left lenticular nucleus,left putamen,left fusiform gyrus,left calcarine fissure surrounding cortex and left inferior temporal gyrus in DH group were all higher than that in DL group(FWE correction,all P＜0.05),FSC value of left lenticular nucleus,left putamen,left fusiform gyrus and left calcarine fissure surrounding cortex in DH group were all higher than that in control group(FWE correction,all P＜0.05),while FSC value of left lingual gyrus,left lenticular nucleus and left putamen were both higher than that in control group(FWE correction,both P＜0.05).In brain regions with different fMRI indexes between DH group and DL group,FSC values were lowly positively correlated with CogPCA results(r=0.313,P＜0.05).In brain regions with different fMRI indexes between DH group and control group,fALFF value were lowly positively correlated with trail making test A(TMT A)and trail making test B(TMT B)(r=0.301,0.310,both P＜0.05),ReHo values were lowly negatively correlated with TMT B(r=-0.307,P＜0.05),FCS values were weakly/lowly positively correlated with TMT A and TMT B(r=0.282,0.309,both P＜0.05)and lowly negatively correlated with results of digital symbol substitution test(DSST)(r=-0.363,P＜0.05).In brain regions with different fMRI indexes between DL group and control group,fALFF values were weakly/lowly negatively correlated with results of mini mental state examination(MMSE),Montreal cognitive assessment(MoCA),auditory verbal learning test(AVLT)short-term memory and DSST(r=-0.399,-0.362,-0.344,-0.288,all P＜0.05).Conclusion The expression level of δ-catenin had certain impact on brain function of breast cancer patients,resulted in asymmetry changes of brain network in bilateral hemispheres,as well as memory loss through affecting left inferior temporal gyrus,left lenticular nucleus,left putamen and left fusiform gyrus.

Objective:To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+ LC) with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+ LC) in elderly patients with concomitant gallbladder and common bile duct (CBD) stones.Methods:This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January, 2014 and December, 2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University. There were 254 males and 238 females, aged (83.9±3.0) years. These patients were divided into two groups based on their operative methods: the one-stage group (LCBDE+ LC, n=186) and the two-stage group (ERCP+ LC, n=306). Differences in surgery, stones and hospitalization costs were compared between the two groups. Results:When compared with the ERCP+ LC group, the LCBDE+ LC group had significantly higher incidences of previous gastrectomy [21.5%(40/186) vs 4.2%(13/306)], multiple stones [77.4%(144/186) vs 49.3%(151/306)], larger stone diameter [13.7(6.4, 18.6)mm vs 10.9(5.7, 16.1) mm], and increased hospitalization expenditure [(2.37±0.31) Wanyuan vs (3.26±0.44) Wanyuan] (all P<0.05). However, the rates of residual stone [2.7%(5/186) vs 1.3%(4/306)], stone recurrence [2.2%(4/186) vs 5.2%(16/306)], postoperatively overall complications [3.2%(6/186) vs 1.3%(4/306)], and total hospital stay [(10.7±6.2) d vs (11.3±5.4) d] were not significantly different between the two groups (all P>0.05). Conclusions:Allowing for the similar safety and effectiveness, and lower hospitalization expenditure, LCBDE+ LC was a preferred choice for patients aged over 80 year, especially in patients who had previous gastrectomy, multiple large CBD stones, or who could not accept endoscopic procedures for treatment of CBD stones.

ObjectiveTo develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods? Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results? The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947(95%CI 0.930-0.964), which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P＜0.05). After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002). Conclusions? The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability.

Objective To investigate genotyps of Treponema pallidum (Tp) in several cities in Guangxi province. Methods A total of 300 patients with suspected early syphilis were enrolled from STD clinics in Guangxi between January 2012 and July 2016, and tissue fluid samples were collected from skin lesions. Silver staining was performed to detect Tp, and PCR to amplify the Tp polA gene for the diagnosis of early syphilis. Positive samples were subjected to PCR amplification of a 60-bp tandem repeat region within the arp gene, restriction fragment length polymorphism(RFLP)analysis of the tpr Ⅱgene after digestion with Mse Ⅰ enzyme and tp0548 genotyping. Results Finally, 215 patients were diagnosed with early syphilis, including 210(97.7%)patients positive for PCR and 105(48.8%)patients positive for silver staining, and the positive rate significantly differed between the two methods (χ2 = 103.01, P < 0.05). Among the PCR-positive samples, 190 could be genotyped by analysis of three target genes, and 17 genotypes were identified. The genotype 14d/f was predominant (45.3%, 86/190), followed by 15d/f (13.7%, 26/190), 16d/f(11.6%, 22/190), 17d/f(7.4%, 14/190), 13d/f(6.8%, 13/190), 10d/f(4.2%, 8/190), 18d/f(1.6%, 3/190), 16a/f(1.6%, 3/190), 5d/f(1.1%, 2/190), 7d/f(1.1%, 2/190), 12d/f(1.1%, 2/190), 16d/e(1.1%, 2/190), 14a/f(1.1%, 2/190), 9h/c(1.1%, 2/190), 15l/f(0.5%, 1/190), 25a/e(0.5%, 1/190), 15i/f(0.5%, 1/190). Conclusion Tp genotypes are diversified in patients with early syphilis in Guangxi, and the genotype 14 d/f is predominant.

Objective To observe the application value of PET glucose metabolic imaging and MR structural imaging in diagnosis of Alzheimer disease (AD) and mild cognitive impairment (MCI).Methods Totally 18 patients with AD (AD group),6 patients with MCI (MCI group) and 10 healthy volunteers (HC group) were enrolled.There were 11 cases of moderate or severe AD and 7 cases of mild AD in AD group.PET and structural MR imaging of the brain were performed.The radioactivity distribution in the brain and the hippocampal atrophy were observed through visually evaluation and quantitative analysis.Results The glucose metabolism reduced in certain regions of the brain in all AD patients (18/18,100％).Among them,11 patients with moderate or severe AD accompanied hippocampal atrophy,while 3 of 7 patients with mild AD showed hippocampal atrophy.No hippocampal atrophy was found in 5 patients with MCI (5/6,83.33 ％),but 2 of them showed decreased radioactivity in the brain.The symmetric mild diminution of radioactivity distribution without hippocampal atrophy was found in all subjects in HC group (10/10,100％).Two cases in HC group showed mild encephalanalosis.Conclusion Both of PET glucose metabolic imaging and MR structural imaging can be used to diagnose AD or MCI with different focus.Combination of these two techniques is helpful to improving diagnostic accuracy.

Tissue factor pathway inhibitor (TFPI) is the main inhibitor of tissue factor-mediated coagulation.TFPI is expressed by endothelial and smooth muscle celis in the vasculature.Endothelium-derived TFPI has been reported to play a regulatory role in arterial thrombosis.However,the role of endogenous TFPI in vascular smooth muscle cells (VSMCs) in thrombosis and vascular disease development has yet to be elucidated.In this TFPIFlox mice crossbred with Sma-Cre mice were utilized to establish TFPI conditional knockout mice and to examine the effects of VSMC-directed TFPI deletion on development,hemostasis,and thrombosis.The mice with deleted TFPI in VSMCs (TFPIsma) reproduced viable offspring.Plasma TFPI concentration was reduced 7.2％ in the TFPIsma mice compared with TFPFlox littermate controls.Plasma TFPI concentration was also detected in the TFPITie2 (mice deleted TFPI in endothelial cells and cells of hematopoietic origin) mice.Plasma TFPI concentration of the TFPITie2 mice was 80.4％ lower (P ＜ 0.001) than that of the TFPIFlox mice.No difference in hemostatic measures (PT,APTT,and tail bleeding) was observed between TFPIsma and TFPIFlox mice.However,TFPIsma mice had increased ferric chloride-induced arterial thrombosis compared with TFPIFlox littermate controls.Taken together,these data indicated that endogenous TFPI from VSMCs inhibited ferric chloride-induced arterial thrombosis without causing hemostatic effects.

OBJECTIVE:To investigate the composition and medication regularities of prescriptions for Treatise on Febrile Dis-eases. METHODS:The prescriptions included in Treatise on Febrile Diseases were collected and inputted into TCM inheritance platform system(V2.5)software,and prescription database was established. The medication and the compatibility regularity of pre-scriptions were excavated using the function of software integration. RESULTS & CONCLUSIONS:83 kinds of TCM involved in 112 prescriptions ranked by frequency,among which 24 ingredients were used more than 4 times. Commonly used TCM groups were summarized to evolve 16 key groups and 8 new prescriptions. Four properties of TCM are mainly the property of“Wen and Han”,and five tastes mostly are“Sweet,Bitter,Spicy”. TCM with the property of“Wen and Sweet”taste are more than those with the property of“Wen and Spicy”,and TCM acting on spleen are more than those acting on lung.