Objective:To investigate key differential expressed genes(DEGs),enriched biological functions and signaling pathways in exosomes derived from angiosarcoma cells ISOHAS and angiosarcoma stem-like cells Sphere by bioinformatics analysis,to provide new therapeutic targets for angiosarcoma.Methods:Transcriptome sequencing of exosomes derived from ISOHAS and Sphere were performed to screen for DEGs by|log2FC|>2 and FDR<0.05 as criteria.Bioinformatics analysis was used to enrich GO and KEGG pathways of DEGs to identify biological functions and signaling pathways of enriched DEGs.STRING database was used to screen key DEGs,and iPath was used to visualize to identify metabolic pathways enriched by DEGs.Results:Transcriptome sequencing results showed that 91 DEGs were identified in exosomes derived from ISOHAS and Sphere.GO and KEGG pathway enrichment analysis demonstrated that main biological functions and signaling pathways enriched by DEGs were response to glucocorticoid and TNF signaling pathway,respectively.STRING database demonstrated that TNF and IL-6 were key DEGs.iPath metabolic network analysis demonstrated that DEGs were mainly identified in lipid metabolism and nucleotide metabolism.Conclusion:Sphere-derived exosomes may influence occurrence and development of angiosarcoma by carrying key genes TNF and IL-6 to interfere with glucocorticoid response,TNF signaling pathway,lipid metabolism,nucleotide metabolism and other biological functions and signaling pathways,providing new ideas for therapeutic targets for angiosarcoma.

Objective To explore the effect and mechanism of dexmedetomidine(DEX)on myocardial injury and inflammation of rats with diabetic myocardial ischemia-reperfusion(MI/R).Methods The rats were divided into sham group,model grousp[The type 2 diabetes mellitus(T2DM)model was replicated by feeding high-fat and high-sugar combined with streptozotocin injection;MI/R injury model was replicated by coronary artery ligation],DEX group(T2DM model rats were injected with 10 μg/kg DEX through tail vein),antagomir NC group(T2DM model rats were injected with 10 μg/kg DEX and antagomir NC through tail vein),miR-490-3p antagomir group(T2DM model rats were injected with 10 μg/kg DEX and miR-490-3p antagomir via tail vein).RT-qPCR was applied to detect the expression of miR-490-3p and forkhead box O1(FOXO1)mRNA;Blood glucose meter was applied to measure fasting blood glucose(FBG)in rats;The level of fasting insulin(FINS),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)and inflammatory factors interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)was measured by ELISA;HE staining microscopy was applied to observe pathological damage of myocar-dial tissue;TTC staining microscopy was applied to determine the size of myocardial infarction;Dual luciferase assay was applied to verify the relationship between miR-490-3p and FOXO1;Western blot was applied to detect the ex-pression of FOXO1 protein in myocardial tissue.Results Compared with the sham group,the FBG,FINS,CK-MB,LDH,IL-1β,TNF-α,myocardial infarction area,FOXO1 mRNA and protein expression in model group were all in-creased,while miR-490-3p expression decreased(P＜0.05);Compared with the model group,the FBG,FINS,CK-MB,LDH,IL-1β,TNF-α,myocardial infarction area,FOXO1 mRNA and protein expression in rats from DEX group decreased,the miR-490-3p expression increased(P＜0.05);Down regulation of miR-490-3p was able to signifi-cantly baffle the improvement of DEX on myocardial injury and inflammation in diabetes MI/R rats(P＜0.05);FOXO1 had a target-specific regulatory relationship with miR-490-3p.Conclusions DEX may inhibit inflammation and alleviate myocardial injury induced by MI/R in diabetic rat models by regulating the miR-490-3p/FOXO1 axis.

Objective:To analyze the research hot points and trend of general practice in China.Methods:It was a bibliometric analysis. Research papers presentated on Chinese Society of General Practice from 2014 to 2022 were collected. The distribution and its trend were analysed in terms of titles, submission time, research topics, methods and contents as well as authors′ affilation.Results:A total of 944 research papers were included in the analysis. The results showed a general increasing trend in number of research papers presented on annual conferences from 2014 to 2022 with some fluctuation. The papers covered 28 research dimensions; the highest number of papers was on the development of general practice system, the training and education system for general practitioners, and the construction of information technology (576 papers, 61.0%). The most common topic was on primary health services (230 papers, 24.4%), followed by education and training (225, 23.8%) and chronic disease management (212, 22.5%); while fewer papers were dealing with community-based care (39, 4.1%) and rational medication (7, 0.7%). In terms of the affiliation of the first author, 437 papers (46.3%) were from affiliated hospitals of medical universities/colleges, 223 (23.6%) from community health service institutions, 132 (14.0%) from higher education institutions, 118 (12.5%) from non-affiliated hospitals, and 35 (3.7%) were from administration institutions. In terms of regions, it covered all provinces (municipalities/autonomous regions) (including Hong Kong and Taiwan) with few overseas. Shanghai and Beijing contributed more papers than other regions. In terms of research methodology, most papers used quantitative studies (882, 93.7%), less used qualitative studies (39, 4.1%) or mixed studies (23, 2.4%).Conclusion:The analysis indicates that a wide range of contents are involved in general practice research in China, and more high-quality studies are from medical colleges/universities and their affiliated general hospitals, and most papers use quantitative studies.

Objective:To explore the feasibility of contrast-enhanced ultrasound in assessing the degree of transplant renal artery stenosis(TRAS)and evaluate its diagnostic efficacy of severe TRAS.Methods:From February 2013 to February 2022, clinical and follow-up data are retrospectively reviewed for 23 TRAS recipients.A definite diagnosis is made by magnetic resonance angiography (MRA, 2 cases)or digital subtraction angiography(DSA, 21 cases). They are assigned into two groups of mild-moderate stenosis(5 cases)and severe stenosis(18 cases)according to the diameter reduction rate of transplanted renal artery detected by DSA/MRA.Another 32 recipients of stable renal function are selected as controls.All contrast-enhanced ultrasonic images are quantitatively processed with SonoLiver.The following quantitative parameters are obtained, including rising time of interlobular artery(RTi), rising time of cortex(RTc), rising time of medulla(RTm), time to peak of interlobular artery(TTPi), time to peak of cortex(TTPc)and time to peak of medulla(TTPm). The differences of contrast-enhanced ultrasonic quantitative parameters are compared among three groups.And their diagnostic efficacies are calculated in the diagnosis of severe TRAS.Results:As compared with those in normal group, RTi, RTc, TTPi and TTPc are significantly longer in mild-moderate stenosis group(all P<0.05); Meanwhile, RTi, RTc, RTm, TTPi, TTPc and TTPm are significantly longer in severe stenosis group than those in normal group(all P<0.05); Comparing mild-moderate stenosis and severe stenosis groups, only RTm is significantly different between two groups( P<0.05). Among all the above parameters, RTc has the highest diagnostic efficacy in the diagnosis of severe TRAS(AUC=0.848)with a sensitivity of 72.22%, a specificity of 86.49% and an accuracy of 81.82%. Conclusions:The quantitative parameters of contrast-enhanced ultrasound offer aid in assessing the degree of TRAS.And RTc is the most valuable in the diagnosis of severe TRAS.

Objective:To compile the post quality standard scale for wound, ostomy and continence nurses in China and to test the reliability and validity of the scale.Methods:The first draft of the scale was formed through literature review, semi-structured interview and Delphi expert letter consultation. Using the purposive sampling method, a total of 796 wound, ostomy and continence nurses from 31 provinces, municipalities and autonomous regions of China were selected from April to May 2019 to test the reliability and validity of the scale. A total of 796 questionnaires were sent out and 693 were effectively received, with effective recovery of 87.1%.Results:The post quality standard scale for wound, ostomy and continence nurses included 3 first-level items and 77 second-level items. Three common factors were extracted from exploratory factor analysis and the cumulative variance contribution rate was 72.466%. The correlation coefficient between the first-level items was 0.709-0.898 and the correlation coefficient between the first-level item and the total scale was 0.859-0.937. The Cronbach's α coefficient of the total amount table was 0.992 and the half-fold reliability coefficient was 0.917 ( P<0.01) . Conclusions:The post quality standard scale for wound, ostomy and continence nurses has good reliability and validity, which can be used to evaluate the post quality of wound, ostomy and continence nurses.

Objective:To explore the risk factors of recurrence after laparoscopic myomectomy and provide references for clinical prevention and treatment.Methods:The clinical data of 216 patients who underwent laparoscopic myomectomy in Ningjin County People′s Hospital from June 2016 to December 2018 were analyzed retrospectively. The recurrence rate at 12 months after the operation was followed up, and the risk factors influencing the recurrence after laparoscopic myomectomy were screened by univariate analysis and multivariate Logistic regression model.Results:After followed up for 12 months after the operation, 24 cases had recurrence, with a recurrence rate of 11.11%(24/216). Univariate analysis showed that the recurrence after laparoscopic myomectomy was significantly correlated with surgical age, age at menarche, number of fibroids, uterine size, and gonadrotropin releasing hormone agonist (GnRH-a) treatment after the operation ( P<0.05), but was not significantly correlated with body mass index, fibroid size, fibroid type, and pregnancy after the operation ( P>0.05). Multivariate Logistic regression analysis showed that surgical age ≥ 35 years old ( OR=1.289, 95% CI 1.013-1.641), age at menarche <13 years old ( OR=1.765, 95% CI 1.167 - 2.669), and number of fibroids ≥ 2 ( OR=2.487, 95% CI 1.442 - 4.288) were independent risk factors for recurrence after laparoscopic myomectomy ( P<0.05), while GnRH-a treatment after the operation ( OR = 0.696, 95% CI 0.510-0.951) was its protective factor ( P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of surgical age ≥ 35 years old, menarche age <13 years old, and number of fibroids ≥ 2 for predicting recurrence after laparoscopic myomectomy was 0.641 (95% CI 0.573 - 0.705), 0.719 (95% CI 0.654 - 0.778) and 0.622 (95% CI 0.554 - 0.687), and age at menarche had the greatest diagnostic efficiency. Conclusions:Surgical age ≥ 35 years old, age at menarche <13 years old, and number of fibroids ≥ 2 are independent risk factors for recurrence after laparoscopic myomectomy. Intraoperative ultrasound and postoperative GnRH-a treatment can help reduce the risk of postoperative recurrence.

Objective:To evaluate the value of shear wave dispersion imaging in identifying inflammatory reaction zone after liver ablation in rabbits.Methods:The animal model was made by laser ablation of rabbit liver, and then shear wave dispersion imaging and strain elastography imaging were performed on the ablation area at 3 d, 7 d, and 14 d after ablation. The shear wave dispersion values, elastic value and strain ratio measured by shear wave elastography, shear wave dispersion and strain elastography in different regions such as central necrotic tissue, surrounding inflammatory reaction zone and normal liver tissue after ablation were analyzed.Results:The shear wave dispersion values of inflammatory reaction zone around ablation site, necrotic tissue in the center of ablation site and normal liver tissue in rabbits were (26.07±4.55)m·s -1·kHz -1, (21.97±10.53)m·s -1·kHz -1and (15.45±3.94)m·s -1·kHz -1, respectively, the differences were statistically significant (all P<0.05). Compared with the three time points of 3 d, 7 d and 14 d after ablation, the shear wave dispersion value of the inflammatory zone was the highest on the 7th day after ablation ( P<0.05), while the elastic value and strain ratio in this region did not change significantly among these three time points ( P>0.05). Conclusions:Shear wave dispersion imaging can simultaneously measure tissue elasticity and viscosity, which has certain application value in identifying the inflammatory reaction zone around the ablation site in rabbit liver.

Objective:To investigate the clinical efficacy of early pancreatic duct stenting in the treatment of acute pancreatitis.Methods:The retrospective and descriptive study was conducted. The clinical data of 201 patients with acute pancreatitis who were admitted to General Hospital of Ningxia Medical University from October 2011 to December 2017 were collected. There were 106 males and 95 females, aged from 18 to 90 years, with a median age of 62 years. Of 201 patients, there were 178 cases with moderate severe acute pancreatitis and 23 cases with serious severe acute pancreatitis. Patients were treated with pancreatic duct stenting within 48 hours after admission. Observation indicators: (1) treatment; (2) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect recurrence of acute pancreatitis after surgery up to June 2019. Measurement data with normal distribution were represented by Mean± SD, and the independent sample t test was used for comparison between groups, and the matched samples t test was used for comparison between before and after. Measurement data with skewed distribution were represented by M( P25 ,P75) or M(range), and the Mann-Whitney U test was used for comparison between groups, and the Wilcoxon signed rank sum test was used for comparison between before and after. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test . Results:(1) Treatment: 201 patients received pancreatic duct stenting successfully, 63 of which were detected pancreatic obstruction with white-floc. The interval time from admission to surgery , operation time, time for initial oral intake, duration of hospital stay and hospital expenses of 201 patients were 10 hours(4 hours,22 hours), (35±15)minutes, 3 days(2 days,5 days), 6 days(5 days,10 days) and 3.8×10 4 yuan (3.0×10 4 yuan,4.9×10 4 yuan). Of 201 patients, 22 patients were transferred to intensive care unit, including 1 case with serious severe underwent inhospital death and 1 case with moderate severe and 7 cases with serious severe underwent auto-discharge from hospital. There were 25 cases with local complications, including 17 cases with pancreatic infectious necrosis, 7 cases with pancreatic walled-off necrosis and 1 case with spleen infarction. All 25 patients were cured after surgical inter-vention or conservative treatment. Further analysis showed that cases being transferred to intensive care unit, cases undergoing surgical treatment, the time for initial oral intake, duration of hospital stay and cases undergoing auto-discharge from hospital were 6, 11, 3 days(2 days,5 days), 6 days(5 days,10 days) and 1 for the 178 moderate severe cases, versus 16, 5, 7 days(4 days,9 days), 9 days (7 days,17 days) and 7 for the 23 serious severe cases, showing significant differences ( χ2=91.561, 6.730, Z=6.485, 5.463, χ2=47.561, P<0.05). The white blood cell count, serum amylase indexes and chronic health evaluation Ⅱ score of 201 patients were (14±6)×10 9/L, 928 U/L(411 U/L,1 588 U/L), 9±5 before admission, versus (10±4)×10 9/L, 132 U/L(72 U/L,275 U/L), 6±4 at 48 hours after admission, respectively, showing significant differences ( t=12.219, Z=11.639, t=16.016, P<0.05). (2) Follow-up: of 201 patients, 153 cases were followed up for 40 months (27 months,55 months). During the follow-up, 32 of the 153 cases had recurrence of acute pancreatitis. Conclusion:Early pancreatic duct stenting is safe and feasible in the treatment of acute pancreatitis.

Objective:To estimate the predictive value of heart rate (HR)-blood pressure (BP) products of multiplication for compensated shock in children.Methods:The study population consisted of 99 children with shock who had lactate measured before receiving vasopressor agents in Department of Critical Care Medicine of Children′s Hospital, Capital Institute of Pediatrics from October 2015 to March 2021. The clinical data including the HR, BP, HR to BP ratio, HR-BP product and lactate at admission and after the correction of shock, as well as the 28-day mortality were collected. According to the outcome at the 28 th day, the patients were divided into survival group and non-survival group. Comparisons between groups were performed with unpaired Student t test, or Mann-Whitney U test, or chi-square test. Pearson correlation analysis was used to analyze the correlations between lactate and HR, BP, HR to BP ratio and HR-BP product, respectively. Receiver operating characteristic (ROC) curve was analyzed to evaluate the predictive values of HR, BP, HR to BP ratio and HR-BP product for lactate greater than 2 mmol/L. Results:In these 99 children, 49 were males, and the median age was 3.8 (0.7-6.0) years. The most common type of shock was septic shock (61 cases, 62%), followed by cardiogenic shock (12 cases, 12%), hemorrhagic shock (12 cases, 12%), Kawasaki disease shock syndrome (8 cases, 8%) and anaphylactic shock (6 cases, 6%). Sixty-six patients (67%) survived, and 33 patients (33%) died. ROC curve showed that the area under curves (AUC) of lactate (optimal cutoff value 3.15 mmol/L, sensitivity 96.0%, specificity 54.4%, P<0.01) and HR to systolic blood pressure ratio (HR/SBP) (optimal cutoff value 2.0 times/(min·mmHg), sensitivity 62.5%, specificity 69.0%, P = 0.03) for predicting adverse outcome were 0.769 and 0.649, respectively. There were significant correlations between lactate and HR to diastolic blood pressure (DBP) ratio, HR to mean blood pressure (MBP) ratio, SBP, HR/SBP, MBP, DBP and HR ( r= 0.476, 0.452, -0.444, 0.425,-0.410, -0.364, 0.177, all P<0.01), while no significant correlation was found between lactate and the products of HR and BP(all P>0.05). HR/SBP performed better than the other six parameters for predicting lactate>2 mmol/L, with the AUC of 0.872 and the optimal cutoff value of 1.4 bpm/mmHg (sensitivity 92.1%, specificity 70.9%, P<0.01). When MBP was greater than or equal to 65 mmHg, MBP × HR, DBP × HR, SBP × HR, HR, HR/SBP, HR/MBP and HR/DBP were significantly correlated with lactate ( r= 0.706, 0.705, 0.669, 0.626, 0.555, 0.502, 0.446, all P<0.01). And MBP × HR performed better for predicting lactate>2 mmol/L than the other six parameters, with the AUC of 0.974 and the optimal cutoff value of 9446 bpm × mmHg (sensitivity 100.0%, specificity 90.9%, P<0.01). Conclusions:The product of HR and BP, especially the MBP × HR, shows higher predictive values for abnormally elevated lactate in children with compensated shock than the HR/SBP does. It is worth recommending for early identification of compensated shock in children.

To investigate the effects of clinical P-glycoprotein inhibitors on oral bioavailability and brain penetration of gefitinib, 16 inhibitors and gefitinib were co-administered orally to ICR mice. The suspension of gefitinib and CMC-Na were co-administered to the control group. The suspension of gefitinib and clinical P-glycoprotein inhibitors were co-administered to the control group. Blood samples and brain homogenate samples were extracted by protein precipitation with acetonitrile and determinated by LC-MS/MS. It was found that ritonavir can significantly increase the oral bioavailability of gefitinib, and the area under the plasma concentration-time curves(AUC)of gefitinib was increased by 2 times; while brain exposure was increased, there was no increment in brain penetration. Some other drugs can also increase the plasma AUC of gefitinib, but can not enhance the brain penetration; After we corrected brain concentration with fraction of unbound drug in brain, it was found that the brain concentration of gefitinib in both control group and ritonavir group did not achieve the in vitro IC50 of inhibiting non-small cell lung cancer(NSCLC)cell growth. Our results suggest that clinical doses of the 16 clinical P-glycoprotein inhibitors can not specifically increase brain tissue exposure, more specific and safer P-gp inhibitors are required. After we corrected brain concentrations with fraction of unbound drug in brain, our preclinical studies found that insufficient brain exposure may be one of the reasons for the unsatisfactory efficacy of gefitinib in the treatment of brain metastases.