Objective:To analyze the clinical characteristics of patients with spontaneous splenorenal shunt (SSRS) in liver cirrhosis, and to compare the effects and prognosis of different treatments.Methods:The data of cirrhotic patients with SSRS at the First Affiliated Hospital of Zhengzhou University between 2016-2022 were retrospectively analyzed.Patients were divided into Group A receiving conservative treatment, Group B by simple embolization, Group C undergoing TIPS combined with embolization, and Group D given liver transplantation. Life status, liver function changes, incidences of adverse events, and survival between groups were compared.Results:SSRS diameter was positively correlated with blood ammonia ( R=0.478) and negatively correlated with portal vein diameter ( R=-0.301). SSRS diameter is a protective factor for gastrointestinal hemorrhage and ascites and a risk factor for hepatic encephalopathy; Blood ammonia decreased and prothrombin time prolonged after treatment in group A ( P<0.05), blood ammonia decreased and albumin increased in group B ( P<0.05). Hemoglobin and bilirubin increased in group C ( P<0.05), blood ammonia and bilirubin decreased and platelets and albumin increased in group D ( P<0.05); Survival analysis showed that the prognosis of groups A and C was related to liver function, and the survival rate of group D was the highest of all ( P<0.05). Conclusions:SSRS embolization is safe and effective, and liver transplantation improves patient survival. Individualized treatment should be selected based on patient symptoms, liver function, and shunt diameter.

Objective:To analyze the clinical features, treatment, pathology and prognosis of retroperitoneal paraganglioma(PGL).Methods:Surgery adopted, pathology and follow-up data of patients with retroperitoneal PGL at the First Affiliated Hospital of Zhengzhou University from Jan 2015 to Jan 2022 were retrospectively analyzed.Results:Compared with non-functional PGL patients, those with functional PGL had higher systolic and diastolic blood pressure (180 mmHg vs. 140 mmHg, Z=-4.807, P<0.001;100 mmHg vs. 82 mmHg, Z=-4.495, P<0.001)at admission, and were more prone to hemodynamic instability during operation ( χ2=8.188, P=0.004). All 65 patients under wentresection,with partial excision and repair of inferior vena cava in 1 patient . Sixty-two patients out of 65 were followed up, and 4 patients died of disease progression. The overall 5-year survival rate was 92%. The prognosis of patients with G3 tumor and distant metastasis was poor , the difference was statistically significant ( χ2=4.259, P=0.039; χ2=13.061, P<0.001). Tumor diameter and tumor functional status were not related to the prognosis, and the difference was not statistically significant ( χ2=0.519, P=0.472; χ2=0.010 P=0.920). Conclusions:Retroperitoneal PGL is less common, and some may encroach abdominal large vessels. The prognosis is good after complete resection of the tumor. Distant metastasis and G3 tumors are associated with poor prognosis .

Objective:To explore the relationship between their proficiency, needle penetration angle and the success rate of puncture by using a self-developed venipuncture angle monitor based on remote sensing technology, and measured the needle penetration angle of people with different venipuncture proficiency levels.Methods:A total of 30 sophomore medical school undergraduates without venipuncture experience and 30 nurses with more than 3 years of clinical experience each were recruited. Volunteers performed punctures on a rubber puncture model of the arm. The result of each puncture, the volunteer′s estimated insertion angle, and the actual insertion angle measured by the monitor were recorded and analyzed.Results:The puncture success rate of the nurse group was 96.7% (58/60), and the puncture success rate of the student group was 51.7% (31/60). The puncture success rate of the nurse group was higher than that of the student group( χ2 value was 29.4, P<0.05); The estimated difference of the average angle of the nurse group was (5.2 ± 1.9) °, and the estimated difference of the average angle of the student group was (8.9 ± 2.6) °. The estimated difference of the nurse group was less than the student group ( Z value was -7.10, P<0.05); the most suitable venipuncture angle range for beginners was (31.6 ± 6.4)°. Conclusions:There is a correlation between the success rate of venipuncture and the puncture angle, and optimum puncture angle for beginners in the controlled model was (31.6±6.4)°. At both skill levels, operator estimates of the puncture angle were commonly larger than the actual angle. The angle monitor based on remote sensing technology makes the precise study of venipuncture possible.

Breast cancer is one of the most common malignant tumors in clinic,and its pathogenesis has been extensively studied by people.miRNA play an important regulatory role in normal breast cell proliferation and apoptosis,they are widely involved in the occurrence and development of breast cancer and are attracting more and more attention as new tumor markers.The Wnt/β-catenin signaling pathways involved in breast cancer and other malignancies have long been confirmed.Recent studies have shown that a variety of important members of the Wnt/β-catenin signaling pathway can be regulated as miRNA target genes,affecting the occurrence and development of breast cancer.At the same time,Wnt/β-catenin signaling pathway changes can also cause the expression of related miRNA changes.Both miRNA and Wnt/ β-catenin signaling pathways play an important regulatory role in the pathogenesis of breast cancer,but the complex regulatory relationship between them has not been elucidated yet.Therefore,in this review,the roles of miRNA and Wnt/β-catenin signaling in breast cancer and its relationship with each other are reviewed in order to gain a deeper understanding of the complex pathogenesis of breast cancer and to explore new diagnostic molecular markers and therapeutic targets for breast cancer,provide a new idea for the diagnosis and treatment of breast cancer.

Objective To evaluate the cardioprotection of electroacupuncture (EA) in the patients undergoing heart surgery with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅲ patients,aged 18-55 yr,of New York Heart Association Ⅱ-Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table:control group (group C) and group EA.In group EA,bilateral Neiguan,Ximen,Shenmen and Baihui acupoints were stimulated with an electrie stimulator with the frequency of 2 Hz from 20 min before anesthesia induction until the end of operation,and the optimal intensity was selected according to the patient's tolerance when awake.Before EA and at 30 min of CPB,30 min,1 h and 2 h after termination of CPB and 6 and 24 h after operation,blood samples were taken from the central vein for determination of concentrations of heart-type fatty acid binding protein and cardiac troponin Ⅰ in plasma (by enzymelinked immunosorbent assay) and concentrations of malondialdehyde (using hydroxylamine method).Cardiac contractility was scored at 1,6 and 24 h after operation,and arrhythmia was scored at 24 h after operation.Results Compared with group C,the plasma concentrations of malondialdehyde at 30 min and 1 and 2 h after termination of CPB and 6 h after operation,plasma concentrations of cardiac troponin Ⅰ at 24 h after operation,and plasma concentrations of heart-type fatty acid binding protein at 30 min of CPB and 24 h after operation were significantly decreased,and the arrhythmia score and cardiac contractility score at 6 and 24 h after operation were decreased in group EA (P＜0.05).Conclusion EA can inhibit lipid peroxidation and exerts cardioprotection in the patients undergoing heart surgery with CPB.

Objective To evaluate the effect of total alkaloids of Sophora alopecuroides L on the nervous behavior and the expression of neurotransmitters in rats. Methods 48 male SD rats were randomly divided into 4 groups:blank group,total alkaloids of Sophora alopecuroides L treatment with 4 mg·kg-1 ·d-1 ( low dose group) ,8 mg·kg-1 ·d-1( medium dose group) and 16 mg·kg-1 ·d-1( high dose group) groups. After successive intragastric administration for 30 days,the locomotor activity was applied to test the nervous behavior and emotional state of rats in each group. After behavioral tests were finished,the contents of trypto-phan (Trp),5-hydroxytryptophan (5-HTP),5-serotonin (5-HT),5-hydroxyindoleacetic acid (5-HIAA), norepinephrine (NE),epinephrine (E) and dopamine (DA) were detected by ELISA in serum and brain. Results In the experiment of locomotor activity,compared with blank group ((95.33±12.75) times),the numbers of horizontal movement of Sophora alopecuroides L in medium and high dose group ( ( 61. 64 ± 5.91),(64.62±5.79)times both P<0.05) were significantly reduced (P<0.05, P<0.01).Compared with the blank group ((4.33±0.66) times),the numbers of vertical motion of Sophora alopecuroides L in medium and high dose group ((3.05±0.09)times,(3.77±0.69)times) were significantly reduced (P<0.05, P<0.01). Compared with blank group ((2.25±0.39) number),the granule number in high dose group ((3.38±0.40) number) were significantly increased (P<0.05, P<0.01),and emotional stress degree increased. Meanwhile,compared with blank group,the content detection of 5-HT,5-HIAA in different dose groups of the total alkaloids of Sophora alopecuroides L was improved obviously(P<0.01),but there was no significant effect on the content of Trp,5-HTP,NE,E,DA(P>0.05). Correlation analysis indicated that the degree of au-tonomic activity in rats with the content of 5-HT,5-HIAA and DA in serum was negatively correlated (P<0.05, P<0.01) ,the degree of emotional stress and the content of 5-HT,5-HIAA in brain was negatively cor-related (P<0.05, P<0.01) . Conclusion The total alkaloids of Sophora alopecuroides L can reduce the ac-tivity of rats and increase the degree of emotional stress. And the mechanism may be correlated with the in-creasing level of 5-HT and 5-HIAA in serum and brain.

Objective To evaluate the effect of isoflurane preconditioning on the expression of hippocampal GluR1 subunits-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate(AMPA)receptors in a rat model of focal cerebral ischemia-reperfusion(I/R).Methods Forty-eight pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups(n=16 each)using a random number table:sham operation group(group S),focal cerebral I/R group(group I/R)and isoflurane preconditioning group(group IPC).Focal cerebral I/R was induced by occlusion of the middle cerebral artery for 2 h followed by reperfusion to induce cognitive decline in I/R and IPC groups. Rats were exposed to 1.5% isoflurane for 1 h every day for 5 consecutive days,and the model was established at 24 h after the last exposure in group IPC. Eight rats in each group were selected to perform Morris water maze test for 6 consecutive days starting from 9 or 23 days after operation. The rats were sacrificed at 14 and 28 days after operation,and the hippocampal tissues were obtained for determination of the expression of GluR1 mRNA(by using real-time polymerase chain reaction)and GluR1 protein(by Western blot).Results Compared with group S,the escape latency was significantly prolonged at each time point after operation,the frequency of crossing the original platform quadrant and percentage of swimming distance at the original platform quadrant were decreased at 14 and 28 days after operation,and the expression of GluR1 protein and mRNA was down-regulated at 14 days after operation in I/R and IPC groups(P<0.05).Compared with group I/R,the escape latency was significantly shortened at 10-13 days after operation,the percentage of swimming distance at the original platform quadrant and frequency of crossing the original platform quadrant were increased at 14 days after the operation,and the expression of GluR1 protein and mRNA was up-regulated at 14 days after operation in group IPC(P<0.05).Conclusion The mechanism by which isoflurane preconditioninig improves the cognitive function is related to up-regulation of the expression of hippocampal GluR1 subunits-containing AMPA receptors in a rat model of focal cerebral I/R.

Objective To evaluate the effect of isoflurane preconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and isoflurane preconditioning group (group IP).Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion followed by 24 reperfusion.Group IP inhaled 1.5％ isoflurane for 1 h per day for 5 consecutive days,the other two groups only inhaled 30％ oxygen,and focal cerebral I/R was induced at 24 h after the last inhalation.At 24 h of reperfusion,neurologic deficit was assessed and scored,the rats were then sacrificed,and brains were removed for determination of cerebral infarct size (using triphenyl tetrazolium chloride staining) and expression of microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 (by Western blot).Results Compared with group S,the neurologic deficit scores and cerebral infarct size were significantly increased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly up-regulated in I/R and IP groups (P＜0.05).Compared with group I/R,the neurologic deficit scores and cerebral infarct size were significantly decreased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly upregulated in group IP (P ＜ 0.05).Conclusion The mechanism by which isoflurane preconditioning ameliorates focal cerebral I/R injury is related to enhancement of autophagy in the rats.

Objective To learn the change of causes sequences, the pattern and dynamic trend of causes of death for the inhabitants in Jiaxing from 2009 to 2014, and to provide a major reference for health decisions and disease control and prevention. Method This study was based on chronic disease surveillance information management data in Zhejiang province from 2009 to 2014. ICD-10 criteria and method was used to classify the causes of death. To evaluate health status of those residents, the relative health indicators such as mortality rate, constituent ratio, PYLL, AYLL, PYLL‰were used. Results The average mortality rate of residents was 691.92/100 000 of Jiaxing from 2009 to 2014, with male 760.73/100 000 and female 624.64/100 000 (the average mortality rate of male was significantly higher than that of female, χ2=455.52, P<0.01). The top five causes of death of local residents were malignant neoplasm, respiratory system diseases, cerebrovascular diseases, injury and poisoning, heart diseases, which accounted for 87.95%of all deaths. The mortality caused by malignant neoplasm was 189.53/100 000, which accounted for 31.90% of five main death causes (the rate of male was significantly higher than that of female, χ2=3767.70, P<0.01). The PYLL of malignant neoplasm were 38 368 years, which was the main reason. The AYLL of injury and poisoning were 9.58 years. Conclusion The average mortality rate of residents has been declining across the Jiaxing, but the mortality rate of malignant neoplasm is increasing year by year. The data suggested that malignant neoplasm, cardiovascular disease, unintentional falls, motor vehicle traffic accidents and pneumonia are major factors affecting the health of the population.

Objective To investigate the effect of isoflurane preconditioning on rat learning and memory in cerebral ischemia-reperfusion injury and its possible mechanism.Methods Thirty-six adult male Sprague-Daw ley rats w ere randomly divided into a sham operation group, a cerebral ischemia-reperfusion group, and an isoflurane preconditioning group (n=12 in each group). A model of middle cerebral artery occlusion and ischemic-reperfusion w as induced by a modified intraluminal suture method. The rats of the isoflurane preconditioning group inhaled 1.5%isoflurane for 1 hour per day for 5 d. At 24 h after the last preconditioning, a model of MCAO w as made. At 24 h after MCAO, the infarct volume w as detected by using 2,3,5 chlorinated diphenyl tetrazolium staining. At day 1, 3, 7, and 14 after MCAO, the modified Neurological Severity Score (mNSS) were performed. At day 9 after MCAO, the Morris w ater maze test w as used to evaluate the learning and memory of rats. At day 14, Western blotting w as used to detect the protein expression level of hippocampal tissue glutamate receptor 1 (GluR1) on the side of ischemia. Results No obvious infarcts w ere observed in the rats of the sham operation group. The infarct volume in the isoflurane preconditioning group w as significantly smal er than that of the cerebral ischemia-reperfusion group (26.383%±3.128%vs.19.107%±1.661%;P<0.05). No neurological deficit w as observed in the sham operation group (score 0). The mNSS scores at day 1, 3, 7, and 14 after MCAO in the isoflurane preconditioning group w ere decreased significantly (day 1:9.000 ±1.195 vs.11.500 ±1.414;day 3:6.6250 ±1.407 vs.6.625 ±1.407vs.6.625 ±1.407; day 7: 5.875 ±0.707 vs.7.375 ±1.407; and day 14:3.375 ±1.187 vs.5.125 ±1.246;al P<0.05). The Morris w ater maze show ed that the escape latencies at day 1-5 after MCAO in the isoflurane preconditioning group w ere al significantly shorter than those in the cerebral ischemia-reperfusion group (day 1: 95.992 ±15.734 s vs.103.008 ±11.654 s; day 2: 70.949 ±14.708 s vs. 94.705 ±14.709 s;day 3:39.660 ±7.413 s vs.65.716 ±10.155 s;day 4:22.692 ±5.778 s vs.35.240 ±8.553 s;day 5: 14.906 ±4.336 s vs.22.890 ±10.381 s; al P<0.05). The numbers of crossing platform (4.556 ± 1.333 vs.2.889 ±1.536 ) and the percentages of time spent in the target quadrant ( 33.014%±5.223%vs. 21.978%±6.697%) in the isoflurane preconditioning group w ere significantly increased than in the cerebral ischemia-reperfusion group (al P<0.01). The levels of hippocampal GluR1 protein on the ischemic sides in the sham operation group, ischemia-reperfusion group, and isoflurane preconditioning group w ere 0.871 ±0.153, 0.456 ±0.130, and 0.689 ±0.126, respectively. There w ere significant differences among the 3 groups ( F=18.329, P<0.001) and the isoflurane preconditioning group w as significantly higher than the ischemia-reperfusion group (P<0.05). Conclusions Isoflurane preconditioning can improve the learning and memory in cerebral ischemia-reperfusion in rats, its mechanism may be associated w ith the uprelagating GluR1 expression in the hippocampus.