Objective:To investigate the safety and risk factors of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic lesions.Methods:Five thousand one hundred and sixty patients who underwent EUS-FNA in the Department of Endoscopy, Fudan University Shanghai Cancer Center from January 2012 to December 2022 were retrospectively reviewed. The incidence of adverse events was calculated, and independent risk factors were analyzed by univariate and logistic regression.Results:The incidences of postoperative pancreatitis, intraoperative bleeding and postoperative bleeding were 1.38% (68/4 930), 0.82% (42/5 143) and 0.78% (40/5 143) respectively. No perforation or death occurred. Age >60 years ( OR=0.581, 95% CI: 0.356-0.946, P=0.029), tumor located in the neck, body and tail ( OR=0.355, 95% CI: 0.194-0.652, P=0.001), lesion diameter of >20-40 mm ( OR=0.450, 95% CI: 0.227-0.893, P=0.023), and lesion diameter >40 mm ( OR=0.382, 95% CI: 0.168-0.869, P=0.022) were independent protective factors for postoperative pancreatitis. Transduodenal puncture ( OR=2.435, 95% CI: 1.319-4.496, P=0.005) was an independent risk factor for postoperative pancreatitis. Puncture for 3-4 pass ( OR=0.439,95% CI: 0.235-0.821, P=0.010), lesion diameter of >20-40 mm ( OR=0.154, 95% CI: 0.069-0.341, P<0.001), and lesion diameter >40 mm ( OR=0.326, 95% CI: 0.143-0.743, P=0.008) were independent protective factors for intraoperative bleeding. Fine-needle biopsy (FNB) needle ( OR=2.314, 95% CI: 1.189-4.502, P=0.014) was an independent risk factor for postoperative bleeding. Conclusion:EUS-FNA is a safe procedure with low incidence of adverse events. The occurrence of postoperative pancreatitis and intraoperative bleeding is mainly related to clinical characteristics of the lesion, while postoperative bleeding is related to the type of puncture needle.

OBJECTIVE To explore in vitro dissolution and in vivo pharmacokinetics of Luteolin solid dispersion in Beagle dogs. METHODS The dissolution of Luteolin solid dispersion was investigated according to the second method （paddle method） of the “dissolution determination method” in the 2020 edition of Chinese Pharmacopoeia （Part Ⅳ）. UPLC-MS/MS method was established to determine the concentration of luteolin in the plasma of Beagle dogs. Twelve Beagle dogs were randomly divided into luteolin group and Luteolin solid dispersion group， with 6 dogs in each group. They were given relevant medicine orally at the dose of 10 mg/kg luteolin. Blood was collected before medication （0 h）， at 5， 10， 15， 30， 45 min and 1， 2， 4， 6， 8， 10， 12， 24， 48 h after administration. After protein precipitation with acetonitrile， the blood concentration of luteolin in Beagle dogs was determined by UPLC-MS/MS and the major pharmacokinetic parameters were calculated with non-compartmental models by using DAS 3.2.8 pharmacokinetic software. RESULTS The dissolutions of Luteolin solid dispersion in purified water and 0.1% sodium dodecyl sulfate solution was significantly higher than those of luteolin； the dissolution rate reached 95% in 0.1% sodium dodecyl sulfate solution for 120 minutes. The peak concentration （cmax） of luteolin in the Luteolin solid dispersion group of Beagle dogs was 5.62 times higher than the luteolin group， and the relative bioavailability was 348%. Compared with luteolin group， cmax and the area under the drug time curve of luteolin in the Luteolin solid dispersion group of Beagle dogs were significantly increased， while the apparent distribution volume was significantly reduced （P＜0.05）. CONCLUSIONS Luteolin solid dispersion can improve in vitro dissolution and bioavailability of luteolin in Beagle dogs.

ObjectiveTo investigate the mechanism of acupuncture in the treatment of chemotherapy-related cognitive impairment （CRCI） of breast cancer based on resting-state functional magnetic resonance imaging （rs-fMRI）. MethodTwenty-five patients with CRCI of breast cancer were included and treated with the acupuncture based on the method of regulating qi and blood， nourishing mind and benefiting intelligence； the selected acupoints included Zusanli （ST 36， bilateral）， Xuehai （SP 10， bilateral）， Tanzhong （CV 17）， Zhongwan （CV 12）， Qihai （CV 6）， Baihui （GV 20）， Fengfu （GV 16， bilateral）， Xinshu （BL 15， bilateral）， Tongli （HT 5， bilateral）， Zhaohai （KI 6， bilateral）， Yixi （BL 45， bilateral） twice a week， each time interval of 2-3 days， for 8 weeks. The scores of Montreal Cognitive Assessment （MoCA）， Mini-mental State Examination （MMSE）， European Cancer Research and Treatment Organization Quality of Life Questionnaire （EORTC QLQ-C30） were compared before and after acupuncture， and the effectiveness were evaluated by MoCA scale. The patients received rs-fMRI before and after treatment， and used low-frequency oscillation amplitude and functional connectivity （FC） analysis to extract the mean zALFF values of regions of interest such as bilateral anterior cingulate gyrus， bilateral hippocampus， bilateral amygdala， bilateral temporal pole middle temporal gyrus， and bilateral temporal pole supramarginal gyrus for comparison， and used the brain regions with statistically significant differences in the pre- and post-treatment zALFF values as the seed points for the seed-point-based FC Analysis. Correlation analyses were performed between the imaging metrics and the clinical scales. ResultsTwenty-four patients with CRCI of breast cancer completed treatment and follow-up. The zALFF values of the left hippocampus， left amygdala， and left temporal pole temporal gyrus in patients' rs-fMRI decreased after treatment （P＜0.05 or P＜0.01）， and left temporal pole temporal gyrus and right posterior cerebellar lobe FC were elevated （t = -5.169）， and MoCA scale total scores and visuospatial and executive， naming， and delayed recall cognitive scores， MMSE scale total scores， and EORTC QLQ-C30 scale mood scores were significantly higher （P＜0.05 or P＜0.01）. The total effective rate of MoCA was 58.33%. The difference in zALFF values of the left temporal pole middle temporal gyrus before and after treatment was negatively correlated with the MoCA total score （r= -0.499， P = 0.015）， as well as the difference in abstract function （r = -0.498， P = 0.016）. ConclusionThe acupuncture method of regulating qi and blood， nourishing mind and benefiting intelligence can improve the cognitive function of breast cancer patients with CRCI， and its mechanism may be related to improving the functional activities of hippocampus， amygdala and temporal lobe， as well as the functional connections of left temporal pole-temporal middle gyrus and right posterior cerebellar lobe.

OBJECTIVE To provide reference for improving the construction of China's emergency drugs supply guarantee mechanism. METHODS Based on the 4R model, the literature research method was used to carry out a systematic analysis of the management measures and operation of emergency drugs in China and the United States in four stages: reduction, readiness, response and recovery, and to make a side-by-side comparison. RESULTS The flexibility of the United States in its legal system had contributed to the maturity of strategic national stockpile, with a dedicated Administration for Strategic Preparedness and Response responsible for the implementation and management of the entire supply process, focusing on the development of information systems and the maintenance of physical stockpiles. In contrast, China's national pharmaceutical reserve emphasized its respective roles and responsibilities, with joint management of institutions, and the reserve tasks and transportation and distribution were mainly undertaken by enterprises, which provided more room for operation in the overall supply process, but the regulatory rules for enterprises had yet to be further improved. CONCLUSION It is recommended that China, on the basis of its own national conditions, draw on the characteristics and experience of the United States strategic national stockpile, improve and perfect the relevant laws and regulations as soon as possible, build a management system with an efficient management organization at its core, supplemented by an information management system, and at the same time, assist in promoting the virtuous cycle of rotational stockpiling by enterprises, and actively carry out summary and assessment work, in order to promote the optimization and development of the mechanism of guaranteeing the supply of emergency drugs in the long term.

Objective:To investigate the correlation between cardiac polyps and gastroesophageal flap valve (GEFV).Methods:The clinical, endoscopic and pathological data of 349 patients with cardiac polyps (the cardiac polyp group) visiting Affiliated Hospital of Yangzhou University from January 1, 2016 to December 31, 2021 were retrospectively collected, and the same number of non-cardiac polyp patients (the non-cardiac polyp group) were matched in the same period as control according to the propensity score. The clinical, endoscopic and pathological data of the two groups were compared.Results:After matching with propensity score, there were 296 patients in each group, with no significant differences in smoking, acid reflux, heartburn, Helicobacter pylori infection, bile reflux, reflux esophagitis or pancreatitis between the two groups ( P>0.05). Compared with the non-cardiac polyp group, the risk of cardiac polyps increased in GEFV Ⅱ patients ( OR=3.046, 95%CI: 2.100-4.419, P<0.001) and GEFV Ⅲ patients ( OR=4.202, 95%CI: 2.299-7.681, P<0.001). Compared with the non-cardiac polyp group, the risk of cardiac polyps increased in patients with GEFV abnormalities ( OR=2.822, 95%CI: 1.615-4.931, P<0.001). GEFV abnormalities was associated with the cardiac polyp site ( χ2=22.169, P=0.003) and was not significantly associated with cardiac polyp size, number, morphology, intestinal metaplasia of the surrounding mucosa or intraepithelial neoplasia ( P>0.05). Conclusion:The occurrence of cardiac polyps is related to GEFV, and the patients with GEFV abnormalities are more likely to develop cardiac polyps.

Objective:To explore the effect and mechanism of diosmetin (Dio) on neuronal ferroptosis in rats with bacterial meningitis (BM).Methods:Male SD rats aged 6-7 weeks of SPF grade were selected for the experiment. The BM model was established by injecting group B hemolytic streptococcus into the cisterna magna of cerebellum. Sixty BM model rats were successfully modeled and divided into model group, low-dose Dio group, medium-dose Dio group, high-dose Dio group and inhibitor group according to the random number table method, with 12 rats in each group. Another 12 weight-matched rats were taken as the control group.The rats in the low-dose Dio group, medium-dose Dio group, high-dose Dio group and the inhibitor group were intragastrically administered with Dio at 50 mg/kg, 100 mg/kg, 200 mg/kg and 200 mg/kg, respectively. The rats in the control group were intragastrically administered with an equal volume of 0.9 % sodium chloride solution. On the day of intragastric administration, the rats in the inhibitor group were intraperitoneally injected with SIRT1 pathway inhibitor EX527 (10 mg/kg), and the rats in the other groups were injected with an equal volume of 0.9% sodium chloride solution. The above interventions were performed once a day for 28 consecutive days. Loeffler neurological score was used to evaluate the neurological impairment in rats. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in cerebrospinal fluid of rats were detected by ELISA. The number of white blood cells in cerebrospinal fluid was detected by a blood cell analyzer. Glutathione (GSH) was detected by micro-enzyme labeling method, malondialdehyde (MDA) was detected by thiobarbituric acid colorimetric method, reactive oxygen species(ROS) was detected by colorimetry, and Fe 2+ level was detected by ferrozine method. Hematoxylin-eosin staining, Prussian blue staining and TUNEL staining were used to observe the pathological damage, iron accumulation and apoptosis in the hippocampus, respectively.Western blot was applied to measure the expression of transferrin (Tf), proliferating cell nuclear antigen (PCNA), Bcl-2-associated X protein (Bax), caspase-3 and SIRT1/Nrf2/HO-1/Gpx4 signaling pathway proteins. Graphpad Prism 9.0 was used for data analysis. One-way ANOVA was used for statistical analysis, and SNK- q test was used for further pairwise comparisons. Results:(1) There was a statistically significant difference in neurological function scores among the 6 groups of rats ( F=125.451, P<0.001). The neurological function score of the model group was lower than that of control group, while the neurological function scores of the low-dose Dio group, medium-dose Dio group, and high-dose Dio group were higher than those of the model group (all P<0.05). The neurological function score of the inhibitor group ((2.57±0.26)) was lower than that of high-dose Dio group ((4.34±0.48)) ( P<0.05). (2) There were statistically significant differences in the levels of IL-6, TNF-α and the number of white blood cells in the cerebrospinal fluid of rats among the 6 groups ( F=127.817, 102.413, 180.967, all P<0.001). The levels of IL-6, TNF-α and the number of white blood cells in model group were higher than those of control group(all P<0.05). The levels of IL-6, TNF-α and the number of white blood cells in low-dose Dio group, medium-dose Dio group and high-dose Dio group were lower than those of model group (all P<0.001), and those in inhibitor group were all higher than those in high-dose Dio group(all P<0.001). (3) There were statistically significant differences in iron deposition rate and neuronal apoptosis rate among the 6 groups of rats ( F=90.857, 88.835, both P<0.001). The iron deposition rate ((18.37±3.14)%) and neuronal apoptosis rate ((27.58±2.63)%) in the inhibitor group were higher than those in the high-dose Dio group ((6.35±1.08)%, (14.02±1.87)%) (both P<0.05). (4) The levels of GSH, ROS, MDA, and Fe 2+ in the hippocampus of the 6 groups of rats showed statistically significant differences ( F=54.465, 106.453, 55.969, 105.457, all P<0.001). The GSH content in the inhibitor group ((103.48±8.76) mmol/g) was lower than that in the high-dose Dio group ((133.97±10.54) mmol/g), while the contents of ROS, MDA, Fe 2+ ((225.17±16.32) μmol/mg, (10.73±1.58) μmol/mg, (62.71±5.43) μg/g) were higher than those of the high-dose Dio group ((131.87±11.67) μmol/mg, (4.35±0.87) μmol/mg, (34.86±2.95) μg/g) (all P<0.05). (5)There were statistically significant differences in the protein levels of Tf, PCNA, Bax, caspase-3, SIRT1, Nrf2, HO-1 and Gpx4 in the hippocampus of the 6 groups of rats ( F=120.179, 107.568, 157.265, 98.031, 90.932, 52.283, 59.424, 114.539, all P<0.001). The protein levels of Tf, Bax and caspase-3 in the hippocampus of inhibitor group were higher than those of the high-dose Dio group, while the protein levels of PCNA, SIRT1, Nrf2, HO-1, Gpx4 were lower than those of the high-dose Dio group (all P<0.05). Conclusion:Diosmetin can activate SIRT1/Nrf2/HO-1/Gpx4 signaling pathway, thereby inhibiting neuronal ferroptosis in BM rats.

ObjectiveTo investigate the effect of Zishen Huoxue prescription on promoting neurogenesis in hippocampal CA1 region of vascular dementia （VD） rats by regulating mitophagy. MethodThe 2-VO method was used to establish the VD rat model and 60 SD rats were randomly divided into sham operation group， model group， donepezil hydrochloride group， and Zishen Huoxue prescription low-dose（8.9 g·kg^-1）， medium-dose（17.8 g·kg^-1） and high-dose（35.6 g·kg^-1） groups. Morris water maze test was performed to detect the escape latency and the number of crossing platform in each group. The expression of phosphatase and tensin homology-induced kinase 1 （PINK1） and Parkinson protein （Parkin） mRNA in hippocampal CA1 region was detected by Real-time fluorescent quantitative polymerase chain reaction（Real-time PCR）. Western blot was used to determine the expression of mitochondrial autophagy signaling pathway-related proteins Parkin， prohibitin 2 （PHB2）， mitofusin 2 （Mfn2） and dynamin-related protein 1 （Drp1） in hippocampal CA1 region. The neurogenesis in hippocampal CA1 region was tested by Brdu method. ResultCompared with the conditions in the sham operation group， the learning and spatial memory abilities of the model group were decreased （P<0.05）， with damaged mitochondrial structure and autolysosome formation in the hippocampal CA1 region. The expressions of Parkin， Pink1 mRNA and Parkin， PHB2， and Drp1 proteins were up-regulated （P<0.05）， while the expression of Mfn2 protein and the neuronal regeneration in hippocampal CA1 region were reduced （P<0.05， P<0.05）. Compared with the conditions in the model group， Zishen Huoxue prescription enhanced the learning and spatial memory abilities of VD rats （P<0.05）， increased the number of autophagosomes in hippocampal CA1 region and improved the mitochondrial structure. The expression of Parkin， Pink1 mRNA and Parkin， PHB2， and Drp1 proteins in hippocampal CA1 region was up-regulated （P<0.05， P<0.01）while the expression of Mfn2 protein was down-regulated（P<0.05， P<0.01）. The number of new neurons in hippocampal CA1 region was also increased（P<0.05， P<0.01）. ConclusionThe promoting effect of Zishen Huoxue prescription on the neurogenesis in hippocampal CA1 region of VD rats was related to the mitophagy mediated by Pink1/Parkin signaling pathway.

Objective:To explore the effect of hydrogen sulfide (H 2S) on modulating the subunit Kir6.2 of adenosine triphosphate sensitive potassium channels via the cyclic guanosine monophosphate-dependent protein kinase (cGMP/PKG) signaling pathway in epileptic rat models. Methods:Sixty adult male SD rats were randomly divided into the following six groups (10 rats in each group) by random number table method: control, epileptic, H 2S donor, H 2S donor+epileptic, KT5823 (one inhibitor of the cyclic guanosine monophosphate-dependent protein kinase)+H 2S donor+epileptic, and glibenclamide (one inhibitor of the adenosine triphosphate sensitive potassium channels)+H 2S donor+epileptic groups. Except the control group, SD rats were intraperitoneally injected with plentylenetetrazole to make the kindling models and their behaviours were recorded including the latency period, the grade, and the duration of the first epileptic seizure according to the Racine′s standard. The waveforms of electroencephalogram (EEG) in hippocampus were also recorded during the seizure. The mRNA and protein levels of PKG and Kir6.2 in hippocampus were evaluated by Western blotting and quantitative real-time polymerase chain reaction, and the hippocampal concentrations of cGMP and phosphorylation of cyclic guanosine monophosphate-dependent protein kinase (p-PKG) were detected by enzyme linked immunosorbent assay. Results:Rats in the epileptic group showed Ⅳ-Ⅴ grade of epileptic seizure [4.500 (4.000, 4.875)], short latency period [(10.37±8.21) min] but long duration [(69.50±24.37) s] of seizure. Compared to the epileptic group, rats in the H 2S donor group showed Ⅱ-Ⅲ grade of epileptic seizure ( P=0.004), significantly longer latency period ( P<0.001), and shorter duration of seizure ( P<0.001). Compared to the H 2S donor+epileptic group, rats in the KT5823+H 2S donor+epileptic group showed Ⅲ-Ⅳ grade of epileptic seizures, significantly shorter latency period ( P<0.001), and longer duration of seizure ( P<0.001). The results of EEG showed that the wave patterns in the epileptic group were spike or sharp waves and the amplitudes were largest [(190.570±23.590) μV]. Compared with the epileptic group, amplitudes were reduced ( P<0.001) in the H 2S donor+epileptic group. PKG mRNA and PKG protein were expressed differently among all groups (PKG mRNA: n=5, H=26.714, P<0.001; PKG protein: n=5, F=30.597, P<0.001). Compared with the control group, the expression of both PKG mRNA and PKG protein was decreased (PKG mRNA: 1.000±0.001 vs 0.782±0.064, P=0.023; PKG protein: 0.550±0.037 vs 0.145±0.020, P=0.042) in the epileptic group. Besides, Kir6.2 mRNA and Kir6.2 protein were expressed differently among all groups (Kir6.2 mRNA: n=5, H=27.761, P<0.001; Kir6.2 protein: n=5, F=60.659, P<0.001). Compared with the control group, the expression of both Kir6.2 mRNA and Kir6.2 protein was decreased (Kir6.2 mRNA: 1.000±0.001 vs 0.897±0.033, P=0.004; Kir6.2 protein: 0.384±0.035 vs 0.215±0.016, P=0.024) in the epileptic group. And the concentrations of cGMP and p-PKG were decreased (cGMP: P<0.001; p-PKG: P<0.001) in the epileptic group. The results in the H 2S donor+epileptic group were up-regulated (PKG mRNA: P=0.047; PKG protein: P<0.001; Kir6.2 mRNA: P=0.011; Kir6.2 protein: P<0.001; cGMP: P<0.001; p-PKG: P<0.001) compared with the epileptic group. However, the results in the KT5823+H 2S donor+epileptic group were down-regulated (PKG mRNA: P=0.015; PKG protein: P=0.027; Kir6.2 mRNA: P=0.013; Kir6.2 protein: P=0.017; cGMP: P=0.005; p-PKG: P<0.001) compared with the H 2S donor+epileptic group. Conclusion:A possible mechanism is that H 2S prevents the epileptic seizure from modulating the subunit Kir6.2 of ATP sensitive potassium channels via the cGMP/PKG signaling pathway.

Objective To investigate the neurodevelopmental toxicity of ACR by studying the expression of DCX and GAP-43 in the hippocampal dentate gyrus of rats after maternal exposure to acrylamide. Methods Pregnant rats were randomly divided into low-dose ACR(4.5 mg/kg),medium-dose(9 mg/kg),high dose groups(18 mg/kg)and the control group(0 mg/kg),8 in each group,and were exposed to toxicant from gestation-al day 15 to postnatal day 13. All rats and their pups were killed on postnatal day 14. ABC immunohistochemistry was used to detect the expression of GFAP in the hippocampus of mother rats and offspring. Results Compared with the control group,the expression of DCX and GAP-43 in hippocampus dentate gyrus of the pregnant rats in middle and high dose groups was significantly decreased(P < 0.05). Conclusion ACR may interfere with the growth and development of neurons by reducing the expression of DCX and GAP-43.

Objective To get the knowledge of the diagnosis and treatment of acute pulmonary embolism (APE)in primary hospital.Methods The clinical data of the patients diagnosed with APE were retrospectively reviewed.The patients were clarified into different risk-group by revised Geneva score and Wells score according to the clinical records.Results 17 patients were diagnosed with APE in this time slot,in which male 10 cases and female 7 cases,average age was (51.8 ±18.4)years old,and among them,4 cases with 4 scores of revised Geneva score,9 cases with 4 to 10 scores,4 cases with more than 11,6 cases with less than 4 Wells score,11 cases with more than 4,2 cases with low risk and 15 cases with intermediate risk.The length of hospital stay was (10.9 ±5.4)days in average.In this group,one patient was dead,seven cases improved,six cases remarkably improved and three cases were recued.Fourteen patients received anticoagulation agents and three cases without any.Eleven patients were given thrombolystic therapy,one case was operated and six cases were given interventional treatment.Conclusion Clinicians know APE and keep alert gradually.However,it should be improved in respects of treating and following the APE patients.