Objective To observe conventional color Doppler ultrasound(CDU)and contrast-enhanced ultrasound(CEUS)manifestations of solitary abdominal mass-forming lymphoma.Methods Thirty-two patients with solitary abdominal mass-forming lymphoma confirmed by pathology who underwent CDU examination were retrospectively included,among them 28 patients also received CEUS.CDU manifestations of lesions were observed,including the size,echogenicity,shape,margin,posterior acoustic features,blood flow,as well as presence of cord-like and reticular high echogenicity and vascular encasement or not.The enhancement distribution,degree and pattern of lesion during CEUS were recorded.Results CDU showed that solitary abdominal mass-forming lymphomas lesions mainly appeared as hypoechoic masses with heterogeneous internal echogenicity(24/32,75.00%),irregular shape(28/32,87.50%),clear margin(26/32,81.25%)and posterior acoustic enhancement(28/32,87.50%),with rich blood flow(Adler gradeⅡ—Ⅲ in 24 of 32,75.00%).Vascular encasement and reticular septation were noticed each in 8 cases(8/32,25.00%).During CEUS,peak intensity of contrast agents appeared rapidly in arterial phase,with common high enhancement(26/28,92.86%),which then washed out quickly after the peak or decreased slowly in arterial phase and low enhancement in venous phase.Diffuse distribution(26/28,92.86%),uniform enhancement pattern(20/28,71.43%)and absence of liquefied necrotic area inside(22/28,78.57%)were common findings.Conclusion CDU and CEUS manifestations of solitary abdominal mass-forming lymphoma had characteristics to a certain degree,which might be helpful to early diagnosis.

Objective To observe conventional color Doppler ultrasound(CDU)and contrast-enhanced ultrasound(CEUS)manifestations of solitary abdominal mass-forming lymphoma.Methods Thirty-two patients with solitary abdominal mass-forming lymphoma confirmed by pathology who underwent CDU examination were retrospectively included,among them 28 patients also received CEUS.CDU manifestations of lesions were observed,including the size,echogenicity,shape,margin,posterior acoustic features,blood flow,as well as presence of cord-like and reticular high echogenicity and vascular encasement or not.The enhancement distribution,degree and pattern of lesion during CEUS were recorded.Results CDU showed that solitary abdominal mass-forming lymphomas lesions mainly appeared as hypoechoic masses with heterogeneous internal echogenicity(24/32,75.00%),irregular shape(28/32,87.50%),clear margin(26/32,81.25%)and posterior acoustic enhancement(28/32,87.50%),with rich blood flow(Adler gradeⅡ—Ⅲ in 24 of 32,75.00%).Vascular encasement and reticular septation were noticed each in 8 cases(8/32,25.00%).During CEUS,peak intensity of contrast agents appeared rapidly in arterial phase,with common high enhancement(26/28,92.86%),which then washed out quickly after the peak or decreased slowly in arterial phase and low enhancement in venous phase.Diffuse distribution(26/28,92.86%),uniform enhancement pattern(20/28,71.43%)and absence of liquefied necrotic area inside(22/28,78.57%)were common findings.Conclusion CDU and CEUS manifestations of solitary abdominal mass-forming lymphoma had characteristics to a certain degree,which might be helpful to early diagnosis.

Objective We aimed to study the protective effect of total glucosides of paeony (TGP) on chemical liver injury with pattern of liver yin deficiency in rats and determine whether it exerts these effects through the phosphoinositide 3-kinase(PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway.Methods Forty male Sprague-Dawley rats were randomly divided into the following four groups: (i) the blank group, (ii) the model group, (iii) the Yiguan Jian group, and (iv) the TGP group (10 rats per group). For 6 weeks, rats in all groups except for the blank group were injected intraperitoneally with 20％ carbon tetrachloride olive oil solution and were given thyroid tablets (30mg/kg) by gavage in order to establish the model of chemical liver injury with pattern of liver yin deficiency. During the modeling period, rats in the blank and model groups were gavaged daily with distilled water, while rats in the Yiguan Jian group and the TGP group were gavaged with 635mg/kg of Yiguan Jian decoction and 50mg/kg of TGP suspension, respectively. During the administration period, the body weight and rectal temperature of rats were measured every 2 weeks. After the administration, 24-hour food intake, 24-hour water intake, and moisture capacity in tongue surface were recorded. Serum cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), and interleukin-1 receptor antagonist (IL-1Ra) contents were measured by ELISA and the cAMP/cGMP ratio was calculated. Changes in the serum levels of alanine aminotransferase (ALT), alanine transaminase (AST), gamma-glutamyl transpeptidase (γ-GT), alkaline phosphatase (ALP), total bilirubin (TBIL), and total bile acids (TBA) were detected using colorimetric method. Masson staining was performed to observe the degree of liver fibrosis and to calculate the relative collagen area. Real-time PCR and Western blotting were conducted to determine the PI3K, AKT, and mTOR mRNA and protein expression levels in rat liver.Results Compared with the blank group, rats in the model group had a lower body weight at weeks 2, 4, and 6, a higher rectal temperature at weeks 2, 4, and 6, and a higher 24-hour food intake; the cAMP level was elevated, the cGMP level was decreased, and the cAMP/cGMP ratio was elevated; the contents of IL-1, IL-6, and TNF-α were elevated, and the contents of IL-10 and IL-1Ra were decreased; ALT, AST, γ-GT, ALP, TBIL, and TBA levels were elevated; the percentage of collagen area in the liver was increased; and the mRNA and protein phosphorylation levels of PI3K, AKT, and mTOR were elevated ( P<0.05). Compared with the model group, rats in the TGP group showed a decrease in rectal temperature at weeks 2, 4, and 6, a decrease in 24-hour food intake and water intake, and an increase in the moisture capacity in tongue surface; rats in the Yiguan Jian and TGP groups showed a decrease in cAMP, an increase in cGMP, and a decrease in the cAMP/cGMP, the contents of IL-1, IL-6, and TNF-α were decreased and the content of IL-10 was increased, the percentage of collagen area in the liver was decreased; ALT, AST, γ-GT, ALP, and TBIL levels were decreased in the TGP group, and PI3K, AKT, and mTOR were downregulated at the mRNA and protein levels(P<0.05).Conclusion TGP has a good protective effect on chemical liver injury with pattern of liver yin deficiency in rats. TGP may regulate the balance of yin and yang by inhibiting the PI3K/AKT/mTOR pathway, reducing the secretion of pro-inflammatory cytokines, and increasing the release of anti-inflammatory cytokines.

Sepsis-associated encephalopathy (SAE) is the most common neurological complication of sepsis, with an incidence of up to 70% in sepsis, and contributes to the increased mortality and disability in sepsis. To date, the exact pathogenesis of SAE is not clear. Most of current researches indicated that blood-brain barrier (BBB) dysfunction, active neuroinflammation, glial cell over activation as well as cerebral microcirculation dysfunction contributed to the pathophysiology of SAE. BBB, as a complex cellular structure between the central nervous system and the peripheral system, strictly controls the entrance and discharge of substances and plays an important role in maintaining the balance between biochemical system and immune system of central system. During the progress of sepsis, inflammatory cytokines and reactive oxygen species resulting from peripheral system directly or indirectly resulted in the damage to the integrity and structure of BBB, which helped above species easily enter into the central system. Above these damages caused glial cell activation (microglia and astrocyte), the imbalance of neurotransmitters, mitochondrial dysfunction and neural apoptosis, which also reversely contributed to the damage to the integrity and permeability of BBB via decreasing the expression of tight junctional protein between cells. Therefore, this review focuses on the structural and functional changes of BBB in SAE, and how these changes lead to the development of SAE, in order to seek a BBB-targeted therapy for SAE.

Malnutrition is highly prevalent in patients with inflammatory bowel disease, which can be life-threatening when refeeding syndrome occurs. This article reports a patient with Crohn′s disease admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine who developed refeeding syndrome due to long-term malnutrition and complicating lymph node tuberculosis. After the discussion, diagnosis and treatment of multidisciplinary team including Departments of Gastroenterology, Nutrition, Colorectal Surgery and Oncology, and Pathology, the patient was improved significantly.

Malnutrition is highly prevalent in patients with inflammatory bowel disease, which can be life-threatening when refeeding syndrome occurs. This article reports a patient with Crohn′s disease admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine who developed refeeding syndrome due to long-term malnutrition and complicating lymph node tuberculosis. After the discussion, diagnosis and treatment of multidisciplinary team including Departments of Gastroenterology, Nutrition, Colorectal Surgery and Oncology, and Pathology, the patient was improved significantly.

Objective To investigate the role of the Janus tyrosine kinase (JAK)- signal transducer and activators of transcription (STAT) signaling pathway in thrombosis formation after splenectomy in cirrhotic patients with portal hypertension. Methods A total of 198 liver cirrhosis patients with portal hypertension who underwent splenectomy and devascularization were recruited from March 2018 to April 2020 and then divided into thrombosis ( n =41) and non-thrombosis groups ( n =157) according to whether portal vein thrombosis occurred 3 months after surgery. mRNA levels of JAK2 and STAT3 in peripheral blood mononuclear cells (PBMCs) were assessed. Comparison of continuous data between groups was performed using t test, while comparison of categorial data between group was performed using chi square test. Clinicopathological data from patients were collected and analyzed for the potential risk factors of portal vein thrombosis by using univariate and multivariate Logistic regression analyses. The prediction values of JAK2 and STAT3 mRNA for portal vein thrombosis were evaluated by area under the receiver operating curve ( AUC ). Results The diameter of portal vein, the diameter of portal vein, the velocity difference of portal vein and the volume of spleen in the thrombus group were significantly higher than those in the non-thrombus group ( t =4.718, 3.945, 8.671, and 2.006 respectively; P < 0.05).The relative mRNA levels of JAK2 and STAT3 in PBMCs of the two groups were significantly increased after surgery ( t =12.933, 15.442, 14.386, 10.896; P < 0.05), and their levels were also much higher in the thrombosis group than in the non-thrombosis group of patients ( P < 0.05). Multivariate Logistic regression analytic data showed that the portal vein diameter, the velocity difference of portal vein and mRNA level of JAK2 and STAT3 were all predictors for thrombosis in these patients ( P < 0.05). The AUC of JAK2 and STAT3 mRNAs was 0.850 and 0.787, respectively in diagnosis of thrombosis in these patients. Conclusion The JAK / STAT signaling was activated in the process of thrombosis after splenectomy in cirrhotic patients with portal hypertension, which may be one of the important mechanisms of postoperative portal vein thrombosis, and may become a potential target for the prevention and treatment of postoperative portal vein thrombosis.

Overweight and obesity are main risk factors for chronic metabolic diseases, and are strongly associated with the increased risk of premature death. Low carbohydrate diet (LCD) has been proven to effectively control body weight and fat mass in overweight and obese patients by short-term (≤6 months) dietary intervention studies. The mechanisms include regulation of energy metabolism, anti-inflammatory, antioxidant, alteration in expression of lipid metabolic-related genes and modulation of intestinal flora. However, the conclusions are inconsistent on whether LCD can cause durable weight loss and reduce the risk of overweight and obesity. This review summarizes the current research progress on the mechanisms, epidemiological studies, intervention studies and potential risks of LCD in controlling overweight and obesity, providing a reference for the future research and clinical application.

Objective: To explore the effect of obesity on the treatment for femoral neck fracture in patients with SuperPATH hip replacement. Methods: Seventy patients who were treated with SuperPATH hip replacement in the Second People's Hospital of Wuxi from January 2014 to January 2017 were selected in the study.Based on their body mass index(BMI), the patients were divided into obesity group(BMI≥30kg/m²) (23 cases), overweight group(BMI: 25-30kg/m²) (22 cases), and normal group(BMI: 18.5-25kg/m²)(25 cases). The incision length, operation time, blood loss, blood transfusion rate, pain score, hip joint function score, imaging measurement results and postoperative complications were compared among the three groups. Results: All 70 patients received the operation successfully.The incision length of the obesity group was (7.4±0.2)cm, which of the overweight group was (7.2±0.1)cm, which of the normal group was (7.1±0.8)cm, the difference among the three groups was statistically significant (F=24.671, P<0.001). The patients were followed up for 9-13 months.The acetabular anteversion angle, acetabular abduction angle, pain score, mobility of hip joint, walking ability score in the obesity group were (17.8±1.2)°, (40.9±3.4)°, (1.26±0.61)points, (95.43±7.89)°, (8.10±0.27)points, respectively, which in the overweight group were (16.7±3.3)°, (42.9±2.9)°, (1.23±0.58)points, (96.78±3.22)°, (8.20±0.92) points, respectively, which in the normal group were (15.8±2.7)°, (43.9±5.1)°, (1.24±0.78)points, (97.12±6.44)°, (8.20±0.48)points, respectively.The difference of acetabular abduction angle among the three groups was statistically significant (F=9.803, P=0.002). In the obesity group, there were two cases of incision infection, two cases of deep venous thrombosis and one case of pulmonary complication, the incidence rate of complications was 5%.In the overweight group, there was one case of superficial incision infection, and one case of deep vein thrombosis, the incidence rate of complications was 2%.In the normal group, there was one case of deep venous thrombosis, the incidence rate of complications was 1%.The difference of incidence rate of complications among the three groups was statistically significant(χ²=15.31, P<0.01). Conclusion Obesity increases the surgical risk of SuperPATH total hip replacement, and more attention should be attached to perioperative and post-operative treatment for such patients.

Objective To investigate the effect of Buyang-Huanwu decoction on left ventricular diastolic function in DHF rats.Methods Thirty male Sprague-Dawley rats were randomly divided into the normal group (n=10),the Chinese medicine group (n=6),the western medicine group (n=6) and the model group (n=6).Except for the normal group,the other groups got abdominal aorta stenosis.After 12 weeks,The Chinese medicine group was given Buyang-Huanwu decoction 12.72 g/(kg·d),and the western medicine group was given metoprolo 1 0.004 5 g/(kg·d),and the normal group and the model control group were given water.After once daily for 8 weeks,echocardiography was used to measure EF,E/A ratio and e/a ratio.The heart rate,left ventricular diastolic pressure,left ventricular end-diastolic pressure,tension and maximal change in pressure of left ventricular were measured by Langendorff.Results Compared with the model group,the e/a value (1.11 ± 0.28 vs.0.67 ± 0.20) of the Chinese medicine group significantly increased (P＜0.05),and the ventricular muscle tension (0.86 ± 0.64 g vs.1.01 ± 0.33 g) significantly decreased (P＜0.05).Conclusions Buyang-Huanwu decoction could improve cardiac relaxation by reducing ventricular muscle tension,thus improving diastolic function of diastolic heart failure rats.