Objective:To investigate the application value of dermoscopy and reflectance confocal microscopy (RCM) in identifying field cancerization in actinic keratosis (AK) in the elderly.Methods:A retrospective analysis was conducted on clinical, dermoscopic, and RCM features of elderly (> 60 years old) patients, who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023.Results:A total of 132 elderly patients with AK were included. Dermoscopy showed brownish-gray pseudonetwork pigment patterns, follicular horn plugs, irregular branched vessels, and rosette signs in AK lesions. Histopathological examination in 51 patients revealed that 47 (92.16%) were confirmedly diagnosed with AK. Field cancerization was observed in 106 patients (80.3%), among whom 66 (62.26%) had irregular branched vessels, 88 (83.02%) predominantly exhibited brownish-gray pseudonetwork pigment patterns, and 83 (78.30%) showed scattered brown pigment networks/fingerprint-like patterns. Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy, with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses. RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns, with atypical cells in the AK lesions; in the field cancerization areas of 20 patients, RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern, with some keratinocytes exhibiting mild atypia. Thirty-four AK patients underwent dynamic RCM monitoring before and after 1, 3 and 6 months of ALA-PDT treatment, which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells, as well as reappearance of atypical keratinocytes upon recurrence.Conclusions:The incidence of field cancerization was relatively high in elderly AK patients. Dermoscopy and RCM are helpful for the early identification of AK and field cancerization, especially in patients with multiple lesions and with difficulties in multi-site biopsy.

Objective:To investigate the application value of dermoscopy and reflectance confocal microscopy (RCM) in identifying field cancerization in actinic keratosis (AK) in the elderly.Methods:A retrospective analysis was conducted on clinical, dermoscopic, and RCM features of elderly (> 60 years old) patients, who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023.Results:A total of 132 elderly patients with AK were included. Dermoscopy showed brownish-gray pseudonetwork pigment patterns, follicular horn plugs, irregular branched vessels, and rosette signs in AK lesions. Histopathological examination in 51 patients revealed that 47 (92.16%) were confirmedly diagnosed with AK. Field cancerization was observed in 106 patients (80.3%), among whom 66 (62.26%) had irregular branched vessels, 88 (83.02%) predominantly exhibited brownish-gray pseudonetwork pigment patterns, and 83 (78.30%) showed scattered brown pigment networks/fingerprint-like patterns. Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy, with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses. RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns, with atypical cells in the AK lesions; in the field cancerization areas of 20 patients, RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern, with some keratinocytes exhibiting mild atypia. Thirty-four AK patients underwent dynamic RCM monitoring before and after 1, 3 and 6 months of ALA-PDT treatment, which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells, as well as reappearance of atypical keratinocytes upon recurrence.Conclusions:The incidence of field cancerization was relatively high in elderly AK patients. Dermoscopy and RCM are helpful for the early identification of AK and field cancerization, especially in patients with multiple lesions and with difficulties in multi-site biopsy.

Objective:To investigate Helicobactor pylori (H. pylori) infection status and interfamilial transmission pattern in Zhengzhou area. Methods:A cross-sectional study was conducted from September 2020 to march 2021, among 731 individual from 266 families randomly selected from 9 communities of Zhengzhou area. H. pylori infection status was determined by serum antibody tests, and 13C-urea breath test was performed in the previously eradicated population to clarify the current infection status. The individual and familial infection rate, infection status for couples and children and adolescent were analyzed. Results:Among 731 individuals from 266 families, 397 of them were H. pylori positive. The individual infection rate was 54.31% (397/731); among infected individuals 77.83% (307/397) were infected with type Ⅰ strain, 22.67% (90/397) were infected by type Ⅱ strain. Annual household income ( χ2=0.419, 0.410, 0.213, all P>0.05), smoking history (χ 2=0.071, P>0.05), drinking history ( χ2=0.071, P>0.05), dining place ( χ2=0.009, P>0.05), gastrointestinal symptoms ( χ2=0.047, P>0.05), family history of gastric disease ( χ2=0.069, P>0.05), and history of gastric cancer ( χ2=0.004, P>0.05) had no significant differences between H. pylori-positive and -negative groups, but the infection rate in individuals with higher education level was lower ( χ2=4.449, P<0.05). The infection rate was significantly higher in≥18 age groups compared with<18 age groups ( χ2=6.531, 23.362, 20.671, 24.244, 37.948, 14.597 and 5.170, all P<0.05). The familial H. pylori infection rate was 87.59% (233/266), and in 61 families all member were infected (26.18%, 61/233). The positive rate was 23.08% (6/26) in 50 families with children under 18 years when both parents were infected. Among 231 coupled families, both couples were infected in 78 families (33.76%), one couple was infected in 113 families (48.92%), and both couples were not infected in 40 (17.32%). With the increase of marriage time, the infection rate of both spouses increased significantly ( χ2=7.775, 12.662, 15.487, all P<0.05). Conclusions:The distribution of H. pylori infection presents a family cluster pattern, and intrafamilial infection is an important transmission rout of H. pylori. The type I strain of H. pylori is the dominate strain in this area.

This study conducted a bibliometric analysis of the literature related to the field of hemodialysis arteriovenous fistula from the Web of Science database. The current and future research hotspots and development trends in this field were visualized by sorting and interpreting the research data and drawing a visualization chart. This study suggests that there are certain academic barriers between China and developed countries, and international multicenter clinical trials should be conducted in the future with early identification of arteriovenous fistula dysfunction and emerging diagnostic tools as the academic development direction.

Objective:To screen differential metabolites and metabolic pathways in urine of adult patients with Kashin-Beck disease (KBD), so as to provide scientific basis for finding specific biomarkers and pathogenesis of KBD.Methods:In Yongshou County, the KBD area in Shaanxi Province, adult KBD patients were selected as the case group, and healthy people without clinical symptoms of KBD were selected as the control group in the same disease area. The subjects' fasting mid-morning urine was collected, and liquid chromatography-mass spectrometry (LC-MS) technology was used to detect small-molecule metabolites in the urine. Multivariate statistical analysis [partial least square discriminant analysis (PLS-DA)] and comparison with KEGG and human metabonomics database (HMDB) were used to identify and screen differential metabolites and metabolic pathways in KBD patients.Results:A total of 58 subjects were included, 39 cases in the case group, including 23 males and 16 females; the age was (61.2 ± 7.8) years old; the body mass index was (22.7 ± 6.5) kg/m 2. There were 19 cases in the control group, including 10 males and 9 females; the age was (50.0 ± 9.0) years old; the body mass index was (24.3 ± 5.5) kg/m 2. Three first-order differential metabolites (HT-2 toxin, T-2 tetraol and seleno-adenosine selenomethionine) were identified and screened, which were highly related to the pathogenesis of KBD, and all were down-regulated. There were 38 second-order differential metabolites, among them, 10 were up-regulated and 28 were down-regulated. Nine differential metabolic pathways were screened, mainly involving amino acid metabolism, lipid metabolism and energy metabolism. Conclusions:The urine metabolism profiles of adult KBD patients and healthy people are significantly different, mainly involving amino acid metabolism, lipid metabolism and energy metabolism. The first-order differential metabolites HT-2 toxin, T-2 tetraol and seleno-adenosine selenomethionine are highly correlated with the pathogenesis of KBD.

Objective:To investigate clinical manifestations and dermoscopic characteristics of lichen planus-like keratosis (LPLK) .Methods:Clinical data were collected from 21 patients with LPLK who visited Shanghai Skin Disease Hospital and underwent both dermoscopic and histopathological examinations from January 2017 to September 2019, and clinical and dermoscopic features were retrospectively analyzed.Results:These patients were aged 64.69 ± 13.29 years, and the ratio of males to females was 1∶2. Skin lesions were located on the face of 18 cases and legs of 3 cases, and were red/violaceous in color in 7 cases, reddish-brown in 5, brown/gray in 8, and brown/reddish in 1. There were 3 types of skin lesions, including plaque-like type in 10 cases, flat pigmented patch type in 6, and flat erythema-like type in 5. As dermoscopy showed, 12 cases were non-pigmented LPLK, and 9 were pigmented LPLK. Pigment granules were found in 13 lesions, and there was no significant difference in the prevalence of pigment granules between pigmented and non-pigmented LPLK ( P=0.07) ; pigment granules were often diffusely distributed (9/13) , and the diffuse distribution pattern was common paticularly in pigmented LPLK (8/9) ; locally distributed pigment granules were found in 4 cases of non-pigmented LPLK. Coarse pigment granules were seen in 10 cases (10/13) , including 8 of pigmented LPLK and 2 of non-pigmented LPLK, and the prevalence rate of coarse pigment granules significantly differed between the pigmented LPLK and non-pigmented LPLK groups ( P=0.002) . Moreover, special distribution patterns of pigment granules included the annular granular pattern (8/13) and peppered pattern (7/13) , and no significant difference was observed in the prevalence of the 2 special distribution patterns between the pigmented LPLK and non-pigmented LPLK groups (both P > 0.05) . Scales were seen in 13 cases (13/21) , and vascular structures in 7 (7/21) , and there was no significant difference in the prevalence of the 2 structures between the pigmented and non-pigmented LPLK groups ( P=0.67, 0.16, respectively) . Conclusions:LPLK mostly occurs on the face, and manifests as solitary red, reddish-brown or brownish-gray plaques or patches, whose surfaces may be covered with scales. The characteristic dermoscopic feature of LPLK is the presence of pigment granules, which are coarse, often diffusely distributed, and commonly observed in pigmented LPLK.

Objective:To summarize the early results and follow-up of mitral valve repair for rheumatic heart disease(RHD).Methods:From January 2018 to November 2019, 48 patients with rheumatic heart disease undergoing mitral valve repair in Cardiovascular Surgery Department of GaoZhou People' s Hospital were analyzed retrospectively. Surgical methods: according to the condition of mitral valve disease, the prosthetic mitral annulus was used in rheumatic mitral valve repair by the methods of joint incision, valve thinning, calcification stripping, Chordae tendineae release and papillary muscle splitting. All patients with tricuspid regurgitation were fixed with artificial valve ring(type C ring), and with atrial fibrillation were treated with Maze-IV radiofrequency ablation. Data on extracorporeal circulation time, aortic occlusion time, mechanical ventilation time, ICU stay time, and major postoperative complications were collected. Patients were followed up to assess mitral valve, cardiac function, and cardiac rhythm.Results:According to pathological classification, type Ⅰ were 9 cases, 31 cases as type Ⅱ and 8 cases as type Ⅲ. All patients in type I and type II were repaired successfully, and type III has 1 case who was repaired failed and underwent mitral valve replacement due to moderate regurgitation. Cardiopulmonary bypass(CPB) time was(110.62±27.68) min, Cross-clamp time was(76.63±17.63) min, ICU stay was(46.16±11.37) h, mechanical ventilation was(21.60±10.89) h. All survived at 30 days, 1 case of acute renal failure, 1 case of low cardiac output syndrome, 3 cases of pulmonary infection, no complications such as stroke and malignant Arrhythmia. 47 patients were followed up for(9.86±6.78) months. There were no death, malignant Arrhythmia and reoperation during the follow-up, and the cardiac function was improved significantly( P<0.001). Conclusion:The mitral valve repair of RHD can preserve the intact mitral valve structure, maintain the heart function, and have a good survival and quality of life. On the basis of mastering the repair of heart valve, being familiar with the anatomic features of rheumatic mitral valve disease, strictly grasping the indications, fully evaluating before operation, it is feasible to carry out the repair of rheumatic mitral valve, and the early clinical effect is satisfactory, long-term results recommend long-term follow-up.

AIM: To study the action of Yuyang Powder(Herba Swertiae, Corium Elephantis, Rhizoma Bletillae, etc.) on the experimental gastric ulcer. METHODS: The rat gastric ulcer models were induced by burned acetic acid, irritabillity stimulus, ethanol injure gastric mucosa and pyloric ligation, respectively. The ulcer was obsered and the content of gastric juice, gastric acidity and pepsin were measured. RESULTS: Yuyang Powder could significantly reduce the areas of ulcers, restrain gastric ulcer, promote gastric ulcer heal, reduce gastric juice volume, restrain gastric secretion (in pyloric ligation). CONCLUSION: Yuyang Powder has the preventive and therapeutic in gastric ulcer.

The aortic arch and its ramifications were studied in 76 chinese infant specimens (♂44,♀52)We examined its position,length and circumference and the types of its ramifications. 1.In average,the superior border of infant's aortic arch is situated at the level of the intervertebral disc between the second and third thoracic vertebrae,and the inferior border is situated at the level of the upper one-third of the fourth thoracic vertebra. 2.The medial point between the superior and inferior borders of the aortic arch,in average,is situated at the level of lower one third of the third thoracic vertebra.In the 3 age-groups,1,2 and 3-year old infants,in 76 specimens,we found that the levels of the medial point of aortic arches,corresponding to 6.05,6.10and 6.19 in the 7 th region of the vertebral column respectively,Comparison of this figures with those of the adult revealed that its height in the infant is higher than in the adult. 3.The average lengths of aortic arch of the 3 age-groups of the Chinese infants were 20.6?1.31mm,19.3?0.59mm and 20.8?0.43mm respectively. 4.The circumferences of the aortic arch of the 3 age-groups of the Chinese infants before the aortic arch divided int?the innominate artery,in average,were 35.8?0.86 mm,36.4?1.04 mm and 38.6?0.83 mm respectively,and after dividing into the left subclavian artery,in average,they were 26.1?1.01mm,26.9?1.25 mm and 29.7?0.79 mm respectively. 5.Seven types can be distinguished in the patterns of the ramifications of the aortic arch.One type was not included in the twenty types of the ramification that have been suggested by Chang Wei-lung according to McDdonald and Anson's classification.This new type increases the number of the types of the human aortic arch to twenty one.The seven types viz: Type A:52.infants,68.42?5.33%.Type B:11 infants,14.47?4.03%.Type G: 4 infants,5.26?2.56%.Type D:1 infant,1.32?1.31%.Type F:4 infants,5.26? 2.56%.(One of the four cases is named thyro-thymus trunk).Type BF:1 infant,1.32 ?1.31%.(This type was composed of a common trunk,which consisted of the inno- minate and left common carotid,the left subclavian and the thyroidea ima arising from the common trunk.According to De Garis's classification,we combine type B with type F into type BF).Type J:3 infants,3.95?2.23%.(This type was more common in infants than in adults). 6.By comparing the types of ramification of aortic arch in 76 specimens with those of the adult,it reveals that the types of the ramifications of aortic arches vary with age.

The position,length,size,and the site and pattern of ramification of the innominate arteries and common carotid arteries were studied in 76 specimens(♂44,♀32)of one- year-old to three-year-old Chinese infants. 1.The position relation between the innominate artery and trachea may be divided into three patterns:type Ⅰ:2 infants(2.63?1.8%),type Ⅱ:33 infants(43.42? 5.72%),type Ⅲ:41 infants(53.95?5.71%). 2.In 76 specimens the ramification region of innominate arteries of the Chinese infants were studied,among which in 57 specimens(75.0?4.96%)the site of ramifi- cation of innominate arteries is situated above the upper border of the sternoclavicular joint,and in 19 specimens(25.0?4.96%)behind the sternoclavicular joint.The region of ramification is higher in position in the infant than in the adult. 3.The average length of innominate arteries of all 76 specimens of 3 age groups: one,two,and three years old,is 20.7?0.42mm,19.2?0.56mm and 21.8?0.94mm respectively.The average circumference is 19.8?0.64mm,20.3?0.21mm and 21.0? 0.51mm respectively. 4.In 63 cases(82.9?4.32%)the innominate artery arises from the aortic arch by itself,in the other 13(17.1?4.32%)it arises from a common trunk,which is formed by the union of the innominate artery with the left common carotid artery.Among the 76 specimens,71 cases did not give off branches on its way,but in 4 specimens(5.26? 2.56%)the thyroidea ima is branched off directly from the innominate artery on its way,while in 1 specimen(1.32?1.31%)it arises from the common trunk. 5.The average site of ramification of the common carotid artery of the 76 Chinese infants is situated at the level of npper border of the intervertebral disc between the third and the fourth cervical vertebrae,but it is different on both sides:37 cases(48.7? 5.73%)with a higher level on the left,14 cases(18.4?4.44%)with.a higher level on the right side,25 cases(32.9?5.38%)with both sides on the same level. 6.The ramification angle of the common carotid arteries of the 76 infants fall into three patterns:60 sides(39.5?3.96%)belong to the acute angle pattern,40 sides(26.3? 3.57%)belong to the arcform pattern and 52 sides(34.2?84%)belong to the in- termediate pattern.The acute angle pattern is more common than the arcform pattern in the infants. 7.The average length of common carotid arteries of all 76 specimens of the three age-groups in one-、two-、three-year-old Chinese infants was 42.9?1.55mm,45.7?0.57 mm and 47.8?1.50mm on the right side and 59.0?1.10 mm,56.7?2.99mm and 64.9?1.62mm on the left side respectively,but the average circumference was 14.8 ?0.77mm,16.3?0.14mm and 16.6?0.19mm on the right side and 15.6?0.61 mm, 16.6?0.13mm and 17.3?0.40mm on the left side respectively.