OBJECTIVE To evaluate the clinical efficacy of Baogong zhixue granule combined with medroxyprogesterone acetate （MPA） in the treatment of perimenopausal abnormal uterine bleeding （AUB） （yin deficiency and blood heat syndrome）. METHODS A total of 146 patients with perimenopausal AUB （yin deficiency and blood heat syndrome） admitted to Hainan Modern Women and Children’s Hospital from March 2022 to February 2023 were prospectively enrolled and divided into control group （73 cases） and combined group （73 cases） by random number table method. The control group took MPA orally， 10 mg each time， twice a day； the combined group took Baogong zhixue granule on the basis of the control group， 15 g each time， 3 times a day. Both groups started taking the medicine from the 5th day of menstruation， and took the medicine for 22 days as a treatment cycle. Both groups were treated for 2 consecutive cycles and followed up for 12 months. The bleeding control time， complete hemostasis time， endometrial thickness， total effective rate， recurrence rate， traditional Chinese medicine syndrome score， sex hormone and inflammatory factor levels， and adverse reactions were compared between the two groups. RESULTS The bleeding control time and complete hemostasis time of the combined group after treatment were significantly shorter than those of the control group （P＜0.05）， and the scores of light-color menstrual blood or clots， lower abdominal pain， sallow complexion， and fatigue and shortness of breath were significantly lower than those of the control group （P＜0.05）. The total effective rates of the combined group at 1， 3， 6 and 12 months after treatment were significantly higher than those of the control group （P＜0.05）， and the overall recurrence rate within 12 months was significantly lower than that of the control group （P＜0.05）. Compared with before treatment， the endometrial thickness， the serum sex hormones （follicle stimulating hormone， estradiol， and luteinizing hormone）， and the inflammatory factors （interleukin-6， tumor necrosis factor-α） levels of the two groups after treatment were significantly reduced or decreased （P＜0.05）， and the reduction or decrease in the combined group was greater than the control group （P＜0.05）. There was no significant difference in the incidence of adverse drug reactions between the two groups （P＞0.05）. CONCLUSIONS Baogong zhixue granules combined with MPA are effective in treating perimenopausal AUB （yin deficiency and blood heat syndrome）. They can quickly stop bleeding， inhibit endometrial hyperplasia， and regulate the levels of serum sex hormones and inflammatory factors. They also have a low recurrence rate and high safety.

Objective:To understand the use of post-exposure prophylaxis (PEP) and analyze related factors among men who have sex with men (MSM) in Qingdao, and provide a reference for the AIDS prevention and control in this population.Methods:A cross-sectional survey conducted from April 2022 to February 2023. Relying on MSM social groups in Qingdao, a snowball sampling method was applied to recruit research subjects who met the inclusion criteria of age ≥18 years old, having had homosexual anal or oral sex in the past six months, and HIV-negative or infection status unknown. The sample size was estimated at 566. Data on demographic characteristics, sexual behavior characteristics, PEP use, and others of the research subjects was collected through on-site questionnaires. The logistic regression model was used to analyze the factors associated with using PEP.Results:A total of 811 participants were recruited, mainly aged 25-34 (53.6%, 435/811), unmarried (74.7%, 606/811), with an average monthly income of ≥5 000 yuan (52.2%, 423/811), and having lived in Qingdao for ≥10 years (75.6%, 613/811). The proportion of those who knew the HIV status of their sexual partners in the last six months was 67.1% (544/811), and those with HIV-positive partners were 3.6% (29/811). In the last six months, the proportion of participants who had group sex (86.4%, 701/811), unprotected anal sex (98.2%, 796/811), and use of club drugs (80.3%, 651/811) was high. Moreover, 28.4% (230/811) had used PEP. The multivariate logistic regression analysis showed that the factors related to the use of PEP included divorced or widowed (a OR=5.46,95% CI:1.96-15.17), average monthly income ≥5 000 yuan (a OR=2.04,95% CI:1.44-2.89), same-sex sexual orientation (a OR=0.40,95% CI:0.22-0.71), having HIV-positive sexual partners in the last six months (a OR=2.54,95% CI:1.13-5.71) and having been tested for HIV ≥3 times in the last six months (a OR=1.46,95% CI:1.04-2.06). Conclusions:The prevalence of risk behaviors among MSM in Qingdao was high, and the use of PEP was low. In the future, it is essential to increase HIV/AIDS prevention education among MSM, promote MSM to know the HIV status of their sexual partners, and reduce the prevalence of risk behaviors among this population. Additionally, explore medical insurance reimbursement plans for PEP to reduce utilization costs and promote the use of PEP by MSM after HIV exposure occurs as soon as possible.

Objective To investigate the clinical value of postoperative platelet-to-neutrophil ratio(PNR)in predicting the prognosis of patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.Methods A total of 95 patients with acute anterior circulation cardiogenic large-vessel occlusion stroke,who were admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University of China from January 2019 to January 2022,were enrolled in this study.Venous blood sampling was performed at admission and within 24 hours after thrombectomy,and the PNR,platelet-white blood cell ratio(PWR),platelet-lymphocyte ratio(PLR),and neutrophil-lymphocyte ratio(NLR)were calculated.According to the modified Rankin Scale score at 90 days(mRS-90),the patients were divided into good prognosis group(mRS-90 ≤2 points,n=45)and poor prognosis group(mRS-90 3-6 points,n=50).The clinical data were compared between the two groups.Multivariate logistic regression analysis was used to analyze the predictors of 90-d good prognosis.The area under the receiver operating characteristic curve(AUC)was used to compare the efficacy of PWR,PNR,and NLR in predicting good prognosis.Results Compared with poor prognosis group,in good prognosis group the patients were younger,the NIHSS score at admission was smaller,the incidence of postoperative contrast extravasation was lower,the postoperative 24-hour PWR and PNR values were higher,and the postoperative 24-hour NLR value was lower,the differences in the above indexes between the two groups were statistically significant(all P＜0.05).Multivariate analysis showed that bridging therapy(OR=4.746,P=0.021,95％CI:1.262-17.856),postoperative contrast medium extravasation(OR=0.254,P=0.022,95％CI:0.079-0.824)and postoperative 24-h PNR(OR=1.087,P=0.006,95％CI:1.025-1.153)were the independent predictors for 90-d good prognosis in patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.AUCs of postoperative 24-h PWR,PNR and NLR for predicting a good prognosis after thrombectomy were 0.734,0.736 and 0.704 respectively.PNR had the highest predictive efficacy,with a cutoff value of 25.08,a specificity of 84.00％,and a sensitivity of 67.78％.Conclusion In patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment,a better clinical prognosis can be expected when the patient has a higher postoperative 24-h PNR value.

Objective:To investigate the effect of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) on sizes and components of thrombi in patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT).Methods:Ninety-eight AIS patients accepted MT in Department of Neurology, Huaian First Hospital Affiliated to Nanjing Medical University from June 2018 to June 2022 were enrolled; they were divided into bridging therapy group and direct thrombectomy group according to the treatments. Baseline data, prognoses and thrombus features between the 2 groups were compared.Results:No significant differences were observed between the 2 groups in terms of age, gender, previous medical history, baseline scores, sites and types of vascular occlusion, TOAST causative classifications, time frame, MT frequencies and techniques, successful recanalization, or prognoses 90 d after MT ( P>0.05). Compared with the direct thrombectomy group, the bridging therapy group had significantly reduced thrombus area (37[22, 78] mm 2vs. 27[14, 62] mm 2) and areas of major pathological components [red blood cells: 16.1([9.0, 37.4] mm 2vs. 11.8[6.1, 22.1] mm 2, fibrin/platelets: 19.5[9.5, 26.4] mm 2vs. 10.7[5.0, 22.8] mm 2, white blood cells: 4.0[2.2, 8.0] mm 2vs. 2.4[1.4, 5.7] mm 2, P<0.05); however, no significant differences in proportions of areas of major pathological components were noted between the 2 groups of patients ( P>0.05). Conclusion:The rt-PA intravenous thrombolysis can significantly reduce the thrombi volume and decrease the contents of major thrombus components in AIS patients after MT, but not change the proportions of major pathological components in thrombi.

Objective:To investigate the diagnostic value of integrated 18F-fluorodeoxyglucose (FDG) PET/MRI multimodal imaging in the grading of adult diffuse gliomas. Methods:A retrospective analysis was performed; 29 patients accepted cranial 18F-FDG PET/MRI multimodal imaging and diagnosed as having adult diffuse gliomas in our center from January 2020 to December 2021 were chosen; their clinical and image data were collected. These patients were divided into low-grade group (WHO grading II, n=13) and high-grade group (WHO grading III and IV, n=16) according to the pathological results confirmed by surgery or biopsy. T1WI, T2WI, DWI, arterial spin labeling (ASL), magnetic resonance spectroscopy (MRS) and PET were performed in these patients. Differences in T1WI and T2WI signs between the two groups were compared. Differences in maximum standard uptake value (SUV max), apparent diffusion coefficient (ADC), choline/ N-acetylaspartate (Cho/NAA), NAA/creatine (Cr), Cho/Cr, relative cerebral blood flow (rCBF) between the two groups were compared. The diagnostic efficacies of above parameters in differentiating high-grade from low-grade adult diffuse gliomas were determined by receiver-operating characteristic (ROC) curves. The predictive probabilities for differentiating high-grade from low-grade adult diffuse gliomas using combined parameters were obtained by binary Logistic regression analysis. Results:There were no statistical differences in T1WI and T2WI signs, proportion of adjacent parenchyma edema, proportion of crossing the midline into the contralateral side, proportion of mass effect, proportion of cystic degeneration/necrosis, or site of growth between low-grade and high-grade groups ( P>0.05). The values of SUV max, ADC, Cho/NAA, Cho/Cr and rCBF were statistically different between the two groups, and the order of diagnostic efficiency was SUV max>ADC>Cho/NAA>rCBF>Cho/Cr>NAA/Cr. SUV max had the highest diagnostic efficacy in differentiating high-grade from low-grade adult diffuse gliomas with an area under the curve (AUC) of 0.894, a sensitivity of 75% and a specificity of 100%; the diagnostic efficacy of combined parameters (mean AUC>0.9) was higher than that of single parameter, and the combined parameters of SUV max and Cho/NAA showed the highest diagnostic efficacy with an AUC of 0.933, a sensitivity of 81.3% and a specificity of 92.3%. Conclusion:The 18F-FDG PET/MRI multimodal imaging is helpful in the grading diagnosis of adult diffuse gliomas, and combination of PET and MRS may play a greater role.

Objective:To evaluate the association between thrombus composition and mechanical recanalization,operation procedure and clinical outcome.Methods:One hundred and ninety-two consecutive stroke patients with large-vessel occlusion treated by mechanical thrombectomy using a stent retriever and (or) aspiration catheter in the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University between January 2018 and January 2020 were collected. The retrieved thrombi were quantitatively analyzed for red blood cells, white blood cells, platelets, and fibrin. The patients were divided into two groups, a erythrocyte-rich group and a fibrin-rich group based on the predominant composition in the clot. The clinical prognosis, CT value of thrombus, procedure time,number of recanalization maneuvers, and degree of vascular recanalization were compared between the two groups.Results:The retrieved clot from 138 patients with acute ischemic stroke from internal carotid artery occlusion ( n=56), middle cerebral artery occlusion ( n=62), intracranial segment of vertebral artery or basilar artery occlusion( n=20) were histologically analyzed. Erythrocyte-rich clots were present in 59 cases, while fibrin-rich clots were present in 79 cases. Cardioembolic thrombi had higher proportions of fibrin/platelets [77.2%(61/79)], less erythrocytes than noncardioembolic thrombi [45.8%(27/59), χ2=8.115, P=0.004]. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers [2 (1, 2) vs 3 (2, 4), Z=-7.613, P<0.001], shorter procedure time [45 (30, 60) min vs 80 (60, 90) min, Z=-6.944, P<0.001], higher thrombus CT value [42 (32, 53) vs 36 (31, 41), Z=-2.003, P=0.045], good clinical prognosis (the ratio of modified Rankin Scale score ≤2, 62.7% (37/59) vs 39.2% (31/79), χ2=7.444, P=0.006). There was no significant difference in the location of vascular occlusion between the two groups. Conclusion:For patients whose thrombotic components are mainly red blood cells, the cause of stroke may be non cardiogenic cerebral embolism, the CT value of embolus is relatively high, the embolus is easy to remove, and the clinical prognosis is relatively good.

Objective:To investigate the relations of thrombotic components with cause of stroke, procedure of mechanical thrombectomy, degrees of vascular recanalization and clinical prognoses in patients with large vessel occlusive cerebral infarction.Methods:One hundred and thirty-eight patients with large vessel occlusive cerebral infarction accepted mechanical thrombectomy using stent retriever and/or aspiration catheter in our hospital from January 2018 to January 2020 were chosen. These patients were divided into two groups, a erythrocyte-rich group and a fibrin-rich group, based on the predominant composition in the clots. The baseline clinical data, procedure time, number of recanalization maneuvers, degrees of vascular recanalization and clinical prognoses were compared between the two groups. The relations of infiltration degrees of erythrocytes and fibrin in embolus with procedure time were investigated.Results:The components of thrombus clots were mainly erythrocytes, fibrin, leukocytes, and platelets; erythrocyte-rich clots were presented in 59 patients, and fibrin-rich clots were presented in 79 patients. There was no significant difference in age, gender, preoperative NIHSS scores, proportions of hypertension, proportion of diabetes and proportion of vascular recanalization between the two groups ( P>0.05). As compared with patients from erythrocyterich group, patients in the fibrin-rich group had significantly higher proportion of cardioembolic thrombus (22.8% vs. 77.2%), statically larger number of recanalization maneuvers (2 [1, 2] times vs. 3 [2, 4] times), significantly longer procedure times (45 [30, 60] min vs. 80 [60, 90] min), and significantly lower proportion of patients with modifed Rankin scale (mRS) scores≤2 90 d after surgery (62.7% vs. 39.2%, P<0.05). Procedure time was negatively correlated with erythrocyte infiltration ( r= -0.562, P=0.005) and positively correlated with fibrin infiltration ( r=0.567, P=0.010). Conclusions:Different components of thrombus suggest the etiology of stroke may be different. Thrombus removal is relatively easy in patients with erythrocyte-rich clots, and the clinical prognosis is relatively good.

OBJECTIVE: To establish an ultra-high performance liquid chromatography-tandem mass spectrometry(HPLC-MS) method for simultaneous detection of 12 kinds of rodenticides such as tetramine, warfarin and rodenticide in suspected poisoning patients' residual food, vomit, gastric lavage, serum and urine. METHODS: The residual food, vomit, gastric lavage, serum and urine of patients with suspected rodenticide poisoning were collected. The food, vomit, gastric lavage and urine samples were added with ammonium acetate at a concentration of 2 mol/L, and than were repeatedly extracted twice by ethyl acetate. The serum sample was extracted by adding acetonitrile. After the sample was dried by nitrogen, it was dissolved in methanol ∶ammonium acetate(60 ∶40, V/V), and the supernatant was centrifuged and separated by a C18 column, and quantified by a standard curve method. Samples were detected by HPLC-MS. RESULTS: The linearity of the 12 kinds of rodenticides in the quantitative range of residual food, vomit, gastric lavage, serum and urine in patients with suspected rodenticide poisoning was good, and the correlation coefficient was 0.992 3-0.999 9. The detection limit of food, vomit or gastric lavage was 0.03-0.14 μg/kg, and that in serum and urine were 0.10-0.30 and 0.02-0.04 μg/L, respectively. The standard recovery rate was 84.4%-114.0%, and the within-run and between-run relative standard deviations were 2.7%-6.2% and 2.4%-9.5%, respectively.CONCLUSION: The method has advantages of simple operation, high efficiency and good accuracy. This method is suitable for emergency treatment of poisoning events caused by rodent drugs or poisoning.

Objective To discuss the clinical effects of Zhuang medicine tendons method with Zhuang herbal medicine inunction after ironing therapy in the nursing of knee osteoarthritis. Methods From February 2014 to December 2015, a total of 80 patients from the Orthopaedics Department and the Zhuang Medical Clinic of the First Affiliated Hospital of Guangxi University of Chinese Medicine were selected, and divided into observation group and control group by random number table method, with 40 cases in each group. The patients in the control group received routine Zhuang herbal medicine inunction and ironing therapy, while the patients in observation group received Zhuang medicine tendons method on the basis of the treatment of the control group. The Japanese Orthopedic Association (JOA) scores and the effects of the two groups were compared before and after the intervention. Results After 2 weeks of intervention, the JOA scores of the observation group and the control group were (91.1±4.3) and (63.2±4.2) respectively, and the difference was statistically significant (P< 0.01). Additionally, the effective rates of the observation group and the control group were 100.0% and 87.5% respectively. It was significantly higher in the observation group than in the control group (P< 0.05). Conclusions Zhuang medicine tendons method with Zhuang herbal medicine inunction after ironing therapy can improve the score of clinical symptoms and theraputic effects in knee osteoarthritis patients

AIM:To investigate the effects of p62 on drug resistance of human laryngocarcinoma cell line Hep-2.METHODS:The abundance of p62 in Hep-2/5-FU and Hep-2 cells was measured by RT-qPCR and Western blot.After silencing of p62 with p62 siRNA in the Hep-2/5-FU cells, the cell viability and cell apoptosis were determined by CCK-8 assay and flow cytometry.The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured to reflect the status of oxidative stress in the cells.The protein levels of apoptosis-related molecules Bcl-2, Bax, caspase-8/cleaved caspase-8 and caspase-3/cleaved caspase-3,and the activity of anti-oxidative stress pathway-related proteins Keap1/Nrf2 were measured by Western blot.RESULTS:The expression of p62 at both mRNA and protein levels was significantly up-regulated in the Hep-2/5-FU cells.The expression of p62 and Nrf2 increased in a dose-dependent manner in the Hep-2 cells.Knockdown of p62 inhibited the viability and promoted the apoptosis of the Hep-2/5-FU cells.Increased content of MDA, and suppressed activity of SOD and GSH-Px were also observed.Furthermore, knockdown of p62 up-regulated the protein levels of Bax, cleaved caspase-8, cleaved caspase-3 and Keap1, but down-regulated the protein levels of Bcl-2, Nrf2 and HO-1.CONCLUSION:Knockdown of p62 increases the sensitivity of Hep-2/5-FU cells to 5-FU exposure.The mechanism may be related to the inhibition of Keap1/Nrf2 pathway and the modulation of oxidative stress and cell apoptosis.