Objective:To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with vimentin (VIM) and carbohydrate antigen 19-9 (CA19-9) for hilar cholangiocarcinoma (HCCA).Methods:A retrospective analysis was conducted on the case data of patients with HCCA and inflammatory pseudotumor of the liver admitted to Liaocheng People′s Hospital from June 2019 to June 2022. Among them, 68 patients with HCCA who underwent radical surgical resection were the observation group, and 60 patients with inflammatory pseudotumor of the liver were the control group. All patients underwent CEUS examination before the operation. The results of ultrasound manifestations were analyzed, and the levels of tissue VIM and serum CA19-9 in the two groups were compared. The relationship between tissue VIM, serum CA19-9 levels and the clinicopathological characteristics of patients with HCCA was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of CEUS parameters, tissue VIM and serum CA19-9 levels in the diagnosis of HCCA.Results:Among the 68 patients with HCCA, " fast in and fast out" was presented in CEUS. The numbers of cases with high enhancement, equal enhancement and low enhancement in the arterial phase were 47(69.12%), 16(23.53%) and 5(7.35%), respectively. The numbers of cases with low enhancement and equal enhancement in the portal vein stage were 53 cases (77.94%) and 15 cases (22.06%), respectively. All 68 cases (100%) in the delay period were of low enhancement. The proportions of patients with peripheral annular enhancement, overall heterogeneous enhancement and overall uniform enhancement in 60 cases of liver inflammatory pseudotumor were 20.00%(12/60), 40.00%(24/60) and 40.00%(24/60), respectively. There was no statistically significant difference in the time of initial enhancement between the two groups ( P>0.05). The peak time, isoenhancement time and the time of initial regression in the observation group were all longer than those in the control group (all P<0.05). The positive rate of VIM and the level of serum CA19-9 in the observation group were both higher than those in the control group (all P<0.05). The expression of VIM in the tissues of HCCA patients was related to tumor size, degree of differentiation, vascular invasion, lymph node metastasis and tumor node metastasis (TNM) stage (all P<0.05), but not related to nerve invasion ( P>0.05). The level of serum CA19-9 was related to tumor size, degree of differentiation, vascular invasion, nerve invasion, lymph node metastasis and TNM stage (all P<0.05). The results of the ROC curve showed that the combined detection of each parameter of CEUS (time to peak, time to start fading, time to equal enhancement) with VIM expression and serum CA19-9 level had a higher diagnostic efficacy for HCCA than the individual detection of each index. Conclusions:CEUS parameters, tissue VIM expression and serum CA19-9 all have certain diagnostic values for HCCA, and the combined detection has higher diagnostic efficacy.

Objective:To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with vimentin (VIM) and carbohydrate antigen 19-9 (CA19-9) for hilar cholangiocarcinoma (HCCA).Methods:A retrospective analysis was conducted on the case data of patients with HCCA and inflammatory pseudotumor of the liver admitted to Liaocheng People′s Hospital from June 2019 to June 2022. Among them, 68 patients with HCCA who underwent radical surgical resection were the observation group, and 60 patients with inflammatory pseudotumor of the liver were the control group. All patients underwent CEUS examination before the operation. The results of ultrasound manifestations were analyzed, and the levels of tissue VIM and serum CA19-9 in the two groups were compared. The relationship between tissue VIM, serum CA19-9 levels and the clinicopathological characteristics of patients with HCCA was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of CEUS parameters, tissue VIM and serum CA19-9 levels in the diagnosis of HCCA.Results:Among the 68 patients with HCCA, " fast in and fast out" was presented in CEUS. The numbers of cases with high enhancement, equal enhancement and low enhancement in the arterial phase were 47(69.12%), 16(23.53%) and 5(7.35%), respectively. The numbers of cases with low enhancement and equal enhancement in the portal vein stage were 53 cases (77.94%) and 15 cases (22.06%), respectively. All 68 cases (100%) in the delay period were of low enhancement. The proportions of patients with peripheral annular enhancement, overall heterogeneous enhancement and overall uniform enhancement in 60 cases of liver inflammatory pseudotumor were 20.00%(12/60), 40.00%(24/60) and 40.00%(24/60), respectively. There was no statistically significant difference in the time of initial enhancement between the two groups ( P>0.05). The peak time, isoenhancement time and the time of initial regression in the observation group were all longer than those in the control group (all P<0.05). The positive rate of VIM and the level of serum CA19-9 in the observation group were both higher than those in the control group (all P<0.05). The expression of VIM in the tissues of HCCA patients was related to tumor size, degree of differentiation, vascular invasion, lymph node metastasis and tumor node metastasis (TNM) stage (all P<0.05), but not related to nerve invasion ( P>0.05). The level of serum CA19-9 was related to tumor size, degree of differentiation, vascular invasion, nerve invasion, lymph node metastasis and TNM stage (all P<0.05). The results of the ROC curve showed that the combined detection of each parameter of CEUS (time to peak, time to start fading, time to equal enhancement) with VIM expression and serum CA19-9 level had a higher diagnostic efficacy for HCCA than the individual detection of each index. Conclusions:CEUS parameters, tissue VIM expression and serum CA19-9 all have certain diagnostic values for HCCA, and the combined detection has higher diagnostic efficacy.

Objective　To analyze the current situation and influencing factors of health-care seeking delay among pulmonary tuberculosis patients in Qingpu District of Shanghai from 2011 to 2022, and to provide a scientific basis for tuberculosis prevention and control. Methods　The data of pulmonary tuberculosis patients in Qingpu District of Shanghai from 2011 to 2022 was collected through the China Tuberculosis Information Management System to describe the distribution and change trend of the delay in health-care seeking. Univariate analysiswas performed using the chi-square (χ²) test, and the time trend of rates was tested with the trend chi-square (trend χ²) test. Multivariate logistic regression model analyzed the influencing factors of the delay in health-care seeking. Results　From 2011 to 2022, there were 3 488 cases of pulmonary tuberculosis in Qingpu District, with 1 438 patients experiencing health-care seeking delay. The median (quartile) number of days of delay was M (P25, P75) = 10 (2, 24) days, and the rate of health-care seeking delay was 41.23%. The annual rate of health-care seeking delay fluctuated between 33.88% and 50.45% from 2011 to 2022, with statistically significant differences between different years (χ²=38.355, P<0.001), and an upward trend in the health-care seeking delay rate was observed from 2020 to 2022 (χtrend²=13.290, P<0.001). Multivariate logistic regression analysis showed that compared to male, those under 25 years old, with local household registration, and detected through health check-ups, females (OR=1.21, 95%CI:1.04-1.41), those aged 45 to <65 (OR=1.36, 95%CI:1.06-1.75), intra-city migrants (OR=1.35, 95%CI:1.09-1.68), inter-provincial/overseas migrants (OR=1.50, 95%CI:1.23-1.83), and patients who directly sought medical care (OR=3.52, 95%CI:2.27-5.47), transfer treatment (OR=2.07,95%CI：1.31-3.25), referral (OR=2.16, 95%CI:1.36-3.44), follow-up (OR=3.07, 95%CI:1.74-5.44) patients with pulmonary tuberculosis were more likely to delay health-care, and the differences were statistically significant (P<0.05). Compared to sputum-positive patients, those with sputum-negative tests (OR=0.76, 95%CI: 0.59-0.97) were less likely to experience delayed health-care, and the difference was statistically significant (P<0.05). Conclusions　Health-care seeking delay of pulmonary tuberculosis patients is relatively common in Qingpu District of Shanghai. Corresponding intervention measures should be adopted for risk factors and key populations to further improve the health-care seeking delay.

Objective To study the hemodynamic effects of enhanced external counter pulsation(EECP)on typical coronary artery disease and microcirculation angina.Methods A physiological model of the right dominant coronary artery,including the coronary conduit arteries and coronary microcirculation,was established using lumped parameter models.Pathological conditions,such as one-vessel lesions,three-vessel lesions,and microcirculation angina,were simulated.EECP intervention models were established,and the hemodynamic effects of EECP on pathological models was simulated.Results The simulation results of the coronary physiological model,pathological models,and EECP intervention model established in this study were consistent with experimental data in related literature.EECP improved coronary blood flow in all three pathological conditions.For one-vessel lesions,EECP could not recover the blood flow of left main coronary artery to a normal level after the stenosis rate reached 80%-85%.For three-vessel lesions,EECP treatment could not be used if the stenosis rate in one of the three vessels exceeded 90%.For microcirculation angina,EECP was effective when critical condition myocardial blood flow was>1.03 mL/min·g and coronary flow reserve was>1.64.Conclusions The model of coronary disease under EECP interference established in this study meets expectations,and the obtained simulation data have certain reference values for the clinical application of EECP.

Objective:To study on the effect of "stomach ten acupuncture" combined with domperidone tablets on clinical symptoms and sleep quality of gastrointestinal neurosis patients with insomnia based on the theory of "stomach harmonious leading to restless".Methods:Randomized controlled trial. From March 2020 to March 2021, 98 patients with gastrointestinal neurosis and insomnia in our hospital who met the inclusion criteria were randomly divided into two groups, with 49 patients in each group. The control group took domperidone tablets orally, and the observation group was treated with "stomach ten acupuncture" on the basis of the control group. Both groups were treated for 8 weeks. Before and after treatment, TCM syndromes were scored, the severity of gastrointestinal symptoms was assessed with Gastrointestinal Symptom Rating Scale (GSRS), anxiety and depression were assessed with Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), and sleep quality was assessed with Pittsburgh Sleep Quality Index Scale (PSQI).Results:After treatment, the scores and total scores of epigastric pain, belching, abdominal distension, anorexia, noisy acid regurgitation, tiredness and asthenia, constipation and loose stools in the observation group were significantly lower than those in the control group ( t values were 19.61, 19.30, 23.10, 22.05, 20.43, 21.81, 20.51, 16.38, respectively, P<0.01); the scores and total scores of typical symptoms, abdominal pain symptoms, reflux symptoms, diarrhea symptoms, constipation symptoms were significantly lower than those in the control group ( t values were 10.10, 11.14, 11.04, 9.31, 11.24, 5.30, respectively, P<0.01); HAMA and HAMD scores were significantly lower than those in the control group ( t values were 6.96 and 6.85, respectively, P<0.01). The scores of time to fall asleep (1.15 ± 0.56 vs. 2.11 ± 0.75, t=7.18), time to sleep (0.92 ± 0.63 vs. 1.52 ± 1.12, t=3.27), sleep quality (1.02 ± 0.66 vs. 1.96 ± 0.80, t=6.35), sleep efficiency (0.86 ± 0.62 vs. 1.68 ± 0.85, t=5.46), sleep disorders (0.92 ± 0.36 vs. 1.48 ± 0.55, t=5.96), daytime dysfunction (0.96 ± 0.42 vs. 1.97 ± 0.87, t=7.32), hypnotics (0.98 ± 0.45 vs. 1.81 ± 0.62, t=7.58) and total scores (6.85 ± 1.47 vs. 12.73 ± 2.95, t=12.49) were significantly lower than those in the control group ( P<0.01). Conclusion:The "stomach ten acupuncture" combined with domperidone tablets can improve the clinical symptoms and sleep quality of gastrointestinal neurosis patients with insomnia.

Objective:To explore the effect of "ten needles in the stomach" on sleep perception of patients with spleen-gastric damp-heat insomnia based on the theory of "stomach discord, then sleep restlessness", to provide references for clinical diagnosis and treatment.Methods:The study subjects were 300 patients with insomnia from the sleep department and outpatient department of Shijiazhuang Traditional Chinese Medicine Hospital. According to the random number method, they were divided into the stomach ten needle group, the diazepam group, and the stomach ten needle plus diazepam group, with 100 in each group. Among them, the stomach ten needles group received "stomach ten needles" acupuncture treatment, the diazepam group was given diazepam therapy, and the stomach ten needles plus diazepam group was given diazepam combined with "stomach ten needles" acupuncture treatment. The Pittsburgh Sleep Quality Index (PSQI) scores, the self-rating disease symptom scale (SCL-90) scores, nighttime polysomnography (PSG) monitoring indicators, and the mean sleep latency (MSL) values were compared before and after treatment in the three groups. The difference in clinical efficacy between the two groups were observed.Results:The total effective rate was 94.0% (94/100) in the combined group, 77.0% (77/100) in the diazepam group, and 85.0% (85/100) in the stomach ten needle group. There were significant differences among the three groups ( χ2=11.56, P<0.01). After treatment, the daytime dysfunction, hypnotic drugs, sleep disturbance, sleep efficiency, sleep time, sleep time, sleep quality score and total score of the combined group were significantly lower than those in the diazepam group and the stomach ten needle group ( F=5.70, 3.65, 5.23, 6.37, 3.66, 6.19, 7.54, 6.40, all Ps<0.01); The scores of SCL-90 and MSL were significantly lower than those in the diazepam group and stomach ten needle group ( F=8.97, 7.53, all Ps<0.01). In the combined group, NWAK [(1.36 ± 0.87) times vs. (2.69 ± 1.15) times, (2.11 ± 1.05) times, F=5.88], SOL [(13.62 ± 5.85) min vs. (25.06 ± 9.42) min, (19.78 ± 7.63) min, F=6.49], N1/TST [(5.69 ± 1.09)% vs. (12.65 ± 2.58)%, (8.49 ± 2.45)%, F=5.13], N2/TST [(51.07 ± 10 2.06)% vs. (58.36 ± 2.18)%, (55.61 ± 2.04)%, F=9.86] were significantly lower than those in the diazepam group and stomach ten needle group ( P<0.01), SE [(90.33 ± 2.89)% vs. (85.39 ± 2.75)%, (87.53 ± 2.69)%, F=8.36], TST [(449.32 ± 23.65) min vs. (421.66 ± 25.33) min, (431.26 ± 25.98) min, F=8.26], REM/TST [(23.87 ± 4.52)% vs. (14.52 ± 3.87)%, (18.36 ± 3.25)%, F=5.34], N3/TST [(18.69 ± 2.02)% vs. (10.31 ± 1.64)%, (14.89 ± 1.74)%, F=7.69] were significantly higher than those in the diazepam group and stomach ten needle group ( P<0.01). Conclusion:Based on the "stomach discord, sleep restlessness" theory, the ten needles on the stomach can treat insomnia and improve psychological state and sleep quality, with the functions of clearing the damp and heat of the middle joker, regulating the lifting and lowering of qi in the middle.

The data of a child with early-onset epileptic encephalopathy in Qilu Children′s Hospital of Shandong University in February 2020 were analyzed retrospectively.The child was a 4-month-old girl, who was admitted to the hospital because of " repeated convulsions for 4 months and feeding difficulty for 1 month" at the age of 4 months.The patient suffered from epilepsy 1 day after birth, and the epilepsy type was tonic seizures.Severe developmental retardation was observed in the patient.Electroencephalogram showed multifocal discharge, which then turned to hypsarrhythmia.The cranial imaging was negative.Feeding difficulty occurred at the age of 3 months.The genetic testing revealed a de novo heterozygous missense mutation in the FGF12 gene (Arg114His). Various antiepileptic drugs and ketogenic diet were ineffective.There was no attack in 2 months after adding Phenytoin.The child could eat on her own after seizure control, but there was no progress in intellectual and motor development.Mutations in the FGF12 gene lead to poor prognosis of early-onset epileptic encephalopathy, and the seizures are difficult to control.Sodium ion channel blockers such as Phenytoin should be used as soon as possible.

Objective To establish the method of thin layer identification of Phellodendri Chinensis Cortex and solid phase extraction - high performance liquid chromatography (SPE-HPLC) determination of the content of phellodendrine in Leshu Lotion. Methods Thin layer chromatography (TLC) was used for qualitative identification of Phellodendri Chinensis Cortex in Leshu Lotion and the Bond Elutplexa PCX strong cation-exchange solid phase was used for extraction small column purification. Platisil-NH2 column was as chromatographic column; column temperature was 30 ℃; triethylamine pH 3.82 (phosphoric acid), tetrahydrofuran, acetonitrile was 18:12:70, isocratic elution; flow rate was 1.0 mL/min; detection wavelength was 286 nm. Results TLC could obviously identify active ingredients of phellodendrine in Phellodendri Chinensis Cortex. The phellodendrine had good linear relationship between concentration and peak area within the scope of 1.22–12.2 μg (r=0.9999); the average recovery rate of phellodendrine was 101.18%, RSD was 1.71%. Conclusion This method is simple to operate, with accuracy and repeatability, and can be used for quality control of Leshu Lotion.

Objective To study the expression and significance of monocyte chemotactic protein 1 (MCP-1) in the process of early radiation-induced lung injury in mice.Methods 40 mice were randomly divided into control group (10 cases) and post-irradiation group (30 cases).A large dose (15 Gy) irradiation on chest was performed in post-irradiation group.Every 10 mice in this group were killed on the 1st day (RT1d),the 10th day (RT10d),the 30th day (RT30d),respectively,and the specimens were collected.The expression of MCP-1 mRNA was detected by quantitative real-time PCR (RT-PCR),and MCP-1 and IL-6 proteins in BALF were detected by ELISA.The pathological changes of lung tissue were observed with HE staining.Results Under the microscope,lung tissue began to show inflammation on the 10th day and was more seriousness on the 30th day in post-irradiation group.Immunohistochemistry staining showed that the expression of MCP-1 in lung tissue irradiated was increased.RT-PCR results showed that the relative expressions of MCP-1 mRNA in control group,RT1d group,RT10d group and RT30d group were 7.63±0.77,6.81±0.75,5.75±0.73 and 4.61±0.75,respectively.The differences between RT1d group and control group,RT10d and RT1d group,and RT30d and RT10d were significantly different (all P ＜ 0.05).ELISA results showed that the levels of MCP-1 and IL-6 proteins in post-irradiation group were significantly higher than those in the control group (P ＜ 0.05).Conclusion The expression of MCP-1 in mice after irradiation is abnormal,and MCP-1 may participate in early radiation-induced lung injury.

This article was aimed to study the correlation among traditional Chinese medicine (TCM) syndrome elements in the first year after ischemic stroke. Data of TCM four examinations were collected among subjects all over China by cross-sectional study, using the same observing rating scale. The results showed that internal-heat, internal-wind and phlegm-damp syndrome were risk factors with obvious positive correlation. On the contrary, blood-stasis, internal-heat and qi-deficiency syndrome were in obvious negative correlation. But syndrome of yin-deficiency had no significant correlation with other syndrome elements. It was concluded that there were remarkable positive correlations on excess syndromes, such as wind, fire and phlegm. The syndromes of excess in the branch are easily to be combined.