ObjectiveTo explore the impacts of material type and loading volume of rigid containers on the hydrogen peroxide low temperature plasma sterilization of thoracoscopic instruments, to identify the best rigid containers and loading volume of thoracoscopic instruments. MethodsThoracoscopic instruments sterilized by STERRAD^® 100NX hydrogen peroxide low temperature plasma in Shanghai Pulmonary Hospital affiliated to Tongji University from August to September 2024 were selected as the research items. According to the material of rigid containers, the instruments were divided into polyethylene case group (A), stainless steel case group (B) and silicone resin case group (C). In terms of the loading volume, the rigid containers were divided into (loading capacity <80%) groups of 8, 10 and 12 instruments. The results of physical monitoring, the first type of chemical indicator card monitoring, and the five types of card luminal chemical process challenge device (PCD) monitoring of the 9 groups of A8, A10, A12, B8, B10, B12, C8, C10 and C12 were compared and evaluated. ResultsCompared to A8, A10 A12, C8, C10 or C12 groups, the thoracoscope instruments in the stainless steel containers in B8, B10 or B12 group had higher hydrogen peroxide concentrations and shorter elapsed time in the pressure check phases 1 and phases 2, with the differences statistically significant (P<0.05), followed by the silicone resin case group and the polyethylene case group. The nine groups of physical parameter monitoring, the first type of chemical indicator monitoring, and the five types of chemical PCD monitoring for lumen sterilization achieved 100% qualification rates, and there were no significant differences in the qualified rates of sterilization among the 9 groups (P>0.05). ConclusionWhen using hydrogen peroxide low temperature plasma to sterilize thoracoscopic instruments, it is recommended to use stainless steel or silicone resin rigid containers with a controlled loading capacity (≤12) to ensure optimal sterilization quality.

ObjectiveTo explore the potential mechanism of Huoxue Xiaoyi Formula （活血消异方， HXF） in treating ovarian endometriosis （OEM） from the perspective of T follicular helper （Tfh） cells and the Janus kinase/signal transducer and activator of transcription （JAK/STAT） signaling pathway. MethodsForty-five female SD rats with normal estrous cycles were randomly divided into three groups， HXF group， model group， and normal group， with 15 rats in each group. A rat model of OEM was established by autologous endometrial tissue implantation. After successful modeling， the treatment group received HXF at 5.85 g/（kg·d） by gavage for 14 consecutive days. The model group and normal group received 1 mL/d of normal saline by gavage. RNA-sequencing data from human proliferative-phase endometriotic and normal endometrial tissues were downloaded from the GEO database. Transcriptomic sequencing was used to analyze gene expression in rat ovarian ectopic tissues and normal uterine tissues， and comparisons were made with human data to verify JAK/STAT pathway activation in proliferative-phase ectopic tissues. Immunohistochemistry was used to detect the positive expression of CXC chemokine receptor 5 （CXCR5） and interleukin-21 （IL-21） in rat ovarian ectopic and normal uterine tissues. Western Blotting was performed to detect the protein levels of IL-21， IL-21 receptor （IL-21R）， Janus kinase 1 （JAK1）， signal transducer and activator of transcription 6 （STAT6）， and B-cell lymphoma 2 （Bcl-2）. Tfh cell infiltration was analyzed using immune cell infiltration methods. ResultsGene set enrichment analysis showed that the JAK/STAT pathway was significantly activated in human proliferative-phase endometriotic tissues compared to normal endometrial tissues. Similarly， the JAK/STAT pathway was markedly activated in rat ovarian ectopic tissues in the model group compared to the normal group， but suppressed in the HXF group compared to the model group. Compared with normal uterine tissues， ovarian ectopic tissues in the model group showed increased Tfh cell infiltration scores， higher CXCR5 and IL-21 expression， and elevated levels of IL-21， IL-21R， JAK1， STAT6， and Bcl-2 proteins. Compared with the model group， HXF group showed reduced CXCR5 and IL-21 expression and decreased protein levels of IL-21， IL-21R， JAK1， STAT6， and Bcl-2. ConclusionHXF may suppress activation of the JAK/STAT signaling pathway in ovarian endometriotic tissues by inhibiting IL-21 secretion from Tfh cells.

Objective To explore the diagnostic significance of fecal calprotectin(FC)in infectious diarrhea in children.Methods A total of 190 children with infectious diarrhea who were hospitalized in Hangzhou Children's Hospital from August 2021 to July 2024 were selected and divided into bacterial group(115 cases)and viral group(75 cases)according to type of pathogen.48 children who underwent health examination in the hospital during the same period were included in control group.The FC,white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of three groups of children were detected.The diagnostic efficacy of FC,WBC,CRP and PCT for bacterial infectious diarrhea was evaluated by using the receiver operating characteristic(ROC)curve.Results The proportions of fever and hematochezia,the highest body temperature,frequency of defecation,and fecal white blood cells in bacterial group were significantly higher than those in viral group,while the proportion of vomiting was significantly lower than that in viral group(P＜0.05).There were statistically significant differences in levels of WBC,CRP,PCT and FC among three groups of children(P＜0.05),and the levels were all in the order of bacterial group＞viral group＞control group.The results of ROC curve showed that area under the curve(AUC)of FC for diagnosing bacterial diarrhea was 0.941,with a sensitivity of 87.0％and a specificity of 85.4％.The AUC,sensitivity and specificity of the diagnosis by FC combined with CRP were 0.987,93.0％and 97.9％respectively.Correlation analysis indicated that FC was positively correlated with WBC and CRP levels(r-0.221,0.159,P＜0.05).Conclusion FC is helpful in differentiating bacterial diarrhea from viral diarrhea,and the combined detection of FC and CRP can effectively improve the effectiveness of differential diagnosis and reduce the misdiagnosis rate.

OBJECTIVE To observe the expression of micro ribonucleic acid-146a(miR-146a)in peripheral blood of the children with hand-foot-mouth disease(HFMD)caused by enterovirus 71(EV71)infection and analyze the clinical significance.METHODS A total of 45 children with HFMD induced by non-EV71 infection who were trea-ted in Hangzhou Children's Hospital from Jul.2023 to Jan.2024 were assigned as the HFMD group,meanwhile,15 healthy children who received physical examination were chosen as the healthy group.The baseline clinical data were compared between the two groups.The expression level of miR-146a in peripheral blood mononuclear cells(PBMCs)was detected by real-time polymerase chain reaction(RT-PCR),the levels of blood routine indexes and relevant biochemical indexes were detected.The association of expression of peripheral blood miR-146a,routine indexes with the HFMD induced by non-EV71 infection was observed.The value of miR-146a in diagnosis of HFMD induced by non-EV71 infection was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The expression level of miR-146a in PBMCs was 0.78(0.69,1.08)in the HFMD group,1.43(1.11,1.62)in the healthy group,and there was significant difference(Z=-3.927,P＜0.001);there were significant difference values in WBC and CRP between the two groups(t=5.188,P＜0.001;Z=-4.986,P＜0.001).Among the children in the HFMD group,the expression level of miR-146a was 0.83(0.70,1.27)in the children with common HFMD,0.73(0.66,0.79)in the children with severe HFMD,and there was significant difference(Z=-2.130,P=0.032).ROC curve analysis showed that the area under the curve(AUC)of the miR-146a was 0.841 in prediction of HFMD caused by non-EV71 infection.CONCLUSIONS The children with HFMD caused by non-EV71 infection show the remarkable decline of miR-146a in PMMCs.The low expression level of miR-146a may be the predictive factor for risk of HFMD caused by non-EV71 infection and severe HFMD,it has certain predictive value and can be used as blood marker for the children with HFMD.

OBJECTIVE To observe the expression of micro ribonucleic acid-146a(miR-146a)in peripheral blood of the children with hand-foot-mouth disease(HFMD)caused by enterovirus 71(EV71)infection and analyze the clinical significance.METHODS A total of 45 children with HFMD induced by non-EV71 infection who were trea-ted in Hangzhou Children's Hospital from Jul.2023 to Jan.2024 were assigned as the HFMD group,meanwhile,15 healthy children who received physical examination were chosen as the healthy group.The baseline clinical data were compared between the two groups.The expression level of miR-146a in peripheral blood mononuclear cells(PBMCs)was detected by real-time polymerase chain reaction(RT-PCR),the levels of blood routine indexes and relevant biochemical indexes were detected.The association of expression of peripheral blood miR-146a,routine indexes with the HFMD induced by non-EV71 infection was observed.The value of miR-146a in diagnosis of HFMD induced by non-EV71 infection was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS The expression level of miR-146a in PBMCs was 0.78(0.69,1.08)in the HFMD group,1.43(1.11,1.62)in the healthy group,and there was significant difference(Z=-3.927,P＜0.001);there were significant difference values in WBC and CRP between the two groups(t=5.188,P＜0.001;Z=-4.986,P＜0.001).Among the children in the HFMD group,the expression level of miR-146a was 0.83(0.70,1.27)in the children with common HFMD,0.73(0.66,0.79)in the children with severe HFMD,and there was significant difference(Z=-2.130,P=0.032).ROC curve analysis showed that the area under the curve(AUC)of the miR-146a was 0.841 in prediction of HFMD caused by non-EV71 infection.CONCLUSIONS The children with HFMD caused by non-EV71 infection show the remarkable decline of miR-146a in PMMCs.The low expression level of miR-146a may be the predictive factor for risk of HFMD caused by non-EV71 infection and severe HFMD,it has certain predictive value and can be used as blood marker for the children with HFMD.

Objective To explore the diagnostic significance of fecal calprotectin(FC)in infectious diarrhea in children.Methods A total of 190 children with infectious diarrhea who were hospitalized in Hangzhou Children's Hospital from August 2021 to July 2024 were selected and divided into bacterial group(115 cases)and viral group(75 cases)according to type of pathogen.48 children who underwent health examination in the hospital during the same period were included in control group.The FC,white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of three groups of children were detected.The diagnostic efficacy of FC,WBC,CRP and PCT for bacterial infectious diarrhea was evaluated by using the receiver operating characteristic(ROC)curve.Results The proportions of fever and hematochezia,the highest body temperature,frequency of defecation,and fecal white blood cells in bacterial group were significantly higher than those in viral group,while the proportion of vomiting was significantly lower than that in viral group(P＜0.05).There were statistically significant differences in levels of WBC,CRP,PCT and FC among three groups of children(P＜0.05),and the levels were all in the order of bacterial group＞viral group＞control group.The results of ROC curve showed that area under the curve(AUC)of FC for diagnosing bacterial diarrhea was 0.941,with a sensitivity of 87.0％and a specificity of 85.4％.The AUC,sensitivity and specificity of the diagnosis by FC combined with CRP were 0.987,93.0％and 97.9％respectively.Correlation analysis indicated that FC was positively correlated with WBC and CRP levels(r-0.221,0.159,P＜0.05).Conclusion FC is helpful in differentiating bacterial diarrhea from viral diarrhea,and the combined detection of FC and CRP can effectively improve the effectiveness of differential diagnosis and reduce the misdiagnosis rate.

Objective:To explore the recurrence pattern and prognosis of cervical cancer after radical chemoradiotherapy.Methods:Clinical and follow-up data of 1 359 patients with stage Ⅰ-ⅣA (International Federation of Gynecology and Obstetrics 2009 staging) who received radical radiotherapy in Zhejiang Cancer Hospital from August 2011 to December 2017 were retrospectively analyzed. The survival and prognostic factors of 249 patients with recurrence / metastasis with detailed data were analyzed. The primary endpoint was post-recurrence / metastasis survival time. Kaplan-Meier method was used to calculate the survival rate, log-rank test was used for single factor analysis, and Cox model was used for multi-factor analysis.Results:The distant metastasis rate of 249 patients was 77.5%, and the local recurrence rate was 36.9%. According to the location of metastasis and recurrence, 56 cases with recurrence in the field of radiotherapy alone were assigned into group A, 157 cases with recurrence outside the radiation field alone were allocated into group B (56 cases with lymph node recurrence in group B1, 78 cases with blood metastasis in group B2, and 23 cases with lymph node and blood metastasis simultaneously in group B3), and 36 cases with combined recurrence and metastasis in and out of the field of radiotherapy were assigned into group C. The median survival time of patients in groups A, B1, B2, B3 and C was 13, 24, 13, 11 and 9 months, respectively (all P<0.001). According to the interval from initial diagnosis to recurrence / metastasis, 110 cases were classified in ≤1 year group, 74 cases in >1-2 years group, and 65 cases in >2 years group. The median survival time of patients in the three groups was 11, 14, and 22 months, respectively (all P<0.001). According to the management of recurrence / metastasis, 138 cases received palliative treatment, 15 cases received local treatment, 45 cases received systemic treatment, and 51 cases received combined treatment. The median survival time of patients among four groups was 9, 37, 20 and 32 months, respectively (all P<0.001). The results of multi-factor analysis showed that age, recurrence / metastatic site, retreatment methods, time interval between initial treatment and recurrence /metastasis were the independent prognostic factors affecting the survival (all P<0.05). Conclusions:Distant metastasis is the main failure pattern after radical radiotherapy. Patients with metastasis out of irradiated regions, especially those with only lymph node metastasis, have good prognosis. Active retreatment and time interval between initial diagnosis and recurrence / metastasis are important prognostic factors.

Objective:To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer.Methods:Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median . Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results:The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions:Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.

Objective:To comparison of three different beta blockers on murine hemangioma (EOMA cells) cells in vitro and in vivo effects.Preliminary study on the therapeutic effect of propranolol on vascular tumor in mice and possible mechanisms , provide a reference for beta blockers in the treatment of infantile hemangioma .Methods: Comparative study on the effects of three kinds of different β-receptor blockers---metoprolol, propranolol and butoxamine , on the proliferation and apoptosis of Mouse Hemangioendothelioma Endothelial cell (EOMA cells) was conducted in vitro.EOMA cells were cultured in vitro,randomly divided into different groups,propranolol and timolol were added into the medium respectively ,after 24 h intervention.MTT assay and acridine orange staining assay were conducted respectively to detect cell viability and apoptosis level .EOMA cells were transplanted into nude mice in vivo.Tumor volume growth to 100 mm3 ,animals were randomly divided into 4 groups respectively ,the control group ,metoprolol group,Bhutto Samin group and propranolol group ,drug group according to 2 mg/( kg? d) oral gavage ,control group were given an equal volume of saline ( NS ) , every two days measurement tumor volume size .Serum levels of tumor necrosis factor alpha ( TNF-α) and vascular endothelial growth factor ( VEGF ) were detected by enzyme linked immunosorbent assay ( ELISA ) in the end of the experiment.Results:For propranolol,after 24 h treatment,significant differences of cell viability and apoptosis were noted (P<0.05) at the concentration of 50 μmol/L,while continuing to increase to 800 μmol/L,the cell survival rate decreased sharply to close to 10%. Acridine orange staining at the 50 μmol/L group after 24 h revealed many apoptotic cells .For metoprolol and butoxa mine ,significant differences of cell viability and apoptosis were noted ( P<0.05 ) at the concentration of 100 μmol/L,while continuing to increase to 800μmol/L,the cell survival rate decreased sharply to close to 20%.It was significantly higher than propranolol group at the same concentration ( P<0.05 ) .It showed a similar trend in acridine orange staining .In vivo experiments showed that the end of the experiment of metoprolol , butoxamine group and propranolol drugs in mice tumor volume , respectively ( 1 642.8 ±89.3 ) , ( 1 529.3 ± 119.1) and (752.7±46.5)mm3,significantly lower than the control group of mice tumor volume of (2 023.3±123.0) mm3(P<0.001).Metoprolol,butoxamine mice and propranolol drugs group ,serum VEGF levels for (606.5±105.8 ) pg/ml,(534.3±243.2 ) pg/ml and (420.1±123.7) pg/ml, significantly lower than the PBS control group [(825.8±145.7) pg/ml,(P<0.05)],the TNF alpha result was followed by(301.3±62.3) pg/ml,(305.1±53.8) pg/ml and (288.8±59.5) pg/ml,significantly lower than the normal control group [(444±100.4) pg/ml,P<0.05].Conclusion:Three kinds of beta-blockers can effectively inhibit EOMA cells proliferation and induce apoptosis in vitro, the role of propranolol more significantly than butoxamine and metoprolol .Three kinds of beta blockers restrain the growth of the hemangioma in vivo ,in which the inhibitory effect of propranolol is stronger than the metoprolol and butoxa mine.Three kinds of beta blockers can lower the levels of VEGF and TNF-αin vivo.Indicating that propranolol on vascular tumor in mice may be one of the mechanisms of β1 and β2 receptor synergy effect and its mechanism in the treatment of hemangioma may be associated with VEGF and TNF-α.