Objective To evaluate the impact of heart rate(HR)on the image quality of one-stop computed tomography angiogra-phy(CTA)of the head and neck,aorta and coronary artery with dual-source CT ECG-gated high-pitch.Methods A total of 172 patients underwent dual-source CT one-stop scan were continuously selected.The subjective image quality was graded on a 4-point scale by two radiologists blinded.Receiver operating characteristic(ROC)curve was performed to analyze the impact of HR on image quality.The patients were divided into high HR group(group A)and low HR group(group B)according to HR.The objective image quality was evaluated by CT value,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)in region of interest(ROI).Results HR≤64 beats/min coronary artery image quality were qualified.The aortic root score in group A was lower than that in group B(P＜0.05).The left cir-cumflex SNR in group B was higher than that in group A,but the difference was not statistically significant(P=0.05).The enhancement degree,SNR and CNR of all branches of residual coronary artery in group B were higher than those in group A,and the difference was statistically significant(P＜0.05).The attenuation of aortic root and carotid artery in group B was higher than that in group A,and the difference was statistically significant(P＜0.05).Conclusion One-stop CTA of the head and neck,aorta and coronary artery with dual-source CT ECG-gated high-pitch is feasible.To improve image quality,the patient's HR should be routinely controlled below 64 beats/min.

Pancreatic cancer is a disease with a high fatality rate， with a five-year survival rate of no more than 10% and a significantly increasing annual mortality rate. The common pathogenesis factors of pancreatic cancer are family inheritance， diet， pancreatitis， obesity， etc.， among which， family inheritance of pancreatic cancer is the main reason， and about 7%-10% of patients have family inheritance. Surgery is an effective way to treat pancreatic cancer in patients and improve their survival， but most people are diagnosed with pancreatic cancer at intermediate and advanced stages and lose the opportunity for surgical treatment. Therefore， radiotherapy， interventional therapy， supportive treatment， immunotherapy， and other treatments are used clinically to relieve symptoms and prolong the survival of patients. The commonly used clinical drug is gemcitabine. Although it can inhibit tumor growth and improve the condition， it can bring side effects such as bone marrow suppression， rash， digestive tract side effects， and drug resistance. The damage of these side effects to the human body is systemic. Chinese medicine can be used alone or in combination with other treatment methods to reduce the toxic and side effects of chemotherapy， restore the physical energy of patients， and reduce its related complications. Chinese medicine contains a large number of active ingredients， including alkaloids， flavonoids， saponins， phenolic acids， and organic acids， with anti-inflammatory， anti-viral， anti-tumor， and other curative effects. Many clinical studies of traditional Chinese medicine （TCM） on cancers have verified that TCM plays a positive role in tumor prevention and treatment， especially in improving and controlling clinical symptoms， and also plays a good detoxification effect on radiotherapy and chemotherapy， with good results achieved in improving bone marrow suppression， improving immunity， improving quality of life， and prolonging survival. This paper reviewed the anti-pancreatic cancer mechanism of Chinese medicine monomers based on literature in China and abroad， aiming to provide new potential drug candidates for the treatment of pancreatic cancer.

The symptoms of pulmonary nodules are insidious,with inflammatory nodules,inflammatory granuloma,early invasive cancer and lung cancer,and the clinical differential diagnosis is still difficult.Regular CT follow-up observation of most pulmonary nodules provides a"window period"for TCM Intervention in pulmonary nodules.From the aspects of external cold attacking the lung,dense cold and humid geographical environment,cold diet,summer air conditioning,etc.,this paper considers that the soaking of cold pathogenic factors is the basic cause of the formation of pulmonary nodules,and cold phlegm are the basic pathogenesis of pulmonary nodules.The clinical manifestations of cold phlegm in pulmonary nodules are summarized from the two actual situations that can be distinguished from clinical symptoms and no symptoms.It is proposed that Mahuang Fuzi Xixin Decoction and Sanzi Yangqin decoction are the basic formulas,Discussion on the treatment of pulmonary nodules by warming yang and dispelling cold to cure the root cause,eliminating phlegm and softening hard mass to treat the symptoms;Improve the ability of TCM diagnosis and treatment of pulmonary nodules.

ObjectiveTo explore the meridian tropism of components in Bupleuri Radix （Chaihu， CH） based on the model of nonalcoholic steatohepatitis （NASH） and clarify the substance basis of the meridian tropism of CH in Xiaoyaosan （XYS） by means of principal component analysis. MethodEighty SPF male C57BL/6 mice were randomly assigned into 8 groups， with 10 mice in each group. Except that the blank group was fed with the methionine choline-sufficient （MCS） diet， the other mice were fed with methionine choline-deficient （MCD） diet for 4 weeks to establish the nonalcoholic steatohepatitis （NASH） model. After the established model was confirmed by hematoxylin-eosin （HE） staining， the mice were administrated with corresponding drugs by gavage once a day for 4 weeks. Specifically， the 8 groups were XYS group （2.874 g·kg^-1）， XYS-CH group （2.445 g·kg^-1）， XYS-CH+volatile oils （Vol， 0.163 mg·kg^-1） group， XYS-CH+polysaccharides （Pol， 24.067 mg·kg^-1） group， XYS-CH+flavones （Fla， 2.241 mg·kg^-1） group， and XYS-CH+saponins （Sap， 2.746 mg·kg^-1） group. The model group and the blank group were administrated with the same volume of normal saline. After the last administration， the mice were sacrificed for the collection of blood and liver tissue. The pathological changes of liver were observed by HE staining and oil red O staining. Enzyme linked immunosorbent assay （ELISA） kits were used to determine the levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， triglyceride （TG）， total cholesterol （TC）， high-density lipoprotein （HDL）， and low-density lipoprotein （LDL） in serum as well as malondialdehyde （MDA）， superoxide dismutase （SOD）， catalase （CAT）， and glutathione peroxidase （GSH-Px） in liver. SPSS Statistics 23 was used for principal component analysis and comprehensive evaluation to determine the substance basis of the meridian tropism of CH in NASH mice. ResultCompared with the blank control group， the modeling led to hepatocyte swelling， increased fat vacuoles， and appearance of inflammatory cells. Further， the modeling elevated the levels of ALT， AST， TG， TC， and LDL and lowered the HDL level in serum， and it increased the MDA level and decreased the SOD， CAT， and GSH-Px levels in liver. Compared with the model group， the administration of XYS and XYS-CH in combination with the components of CH alleviated the oxidative damage in liver （P<0.05）. The comprehensive score of the pharmacological efficacy was in a descending order as follows： XYS > XYS-CH+Sap > XYS-CH+Fla > XYS-CH+Pol > XYS-CH+Vol > XYS-CH. Among the chemical components of CH， Sap had the best effect. ConclusionSap lowers the blood lipid level， regulates the abnormal lipid metabolism， and alleviates the oxidative damage of liver， which is the substance basis for CH to exert the meridian tropism in liver.

N ⁶-methyladenosine (m⁶A) modification is critical for mRNA splicing, nuclear export, stability and translation. Fat mass and obesity-associated protein (FTO), the first identified m⁶A demethylase, is critical for cancer progression. Herein, we developed small-molecule inhibitors of FTO by virtual screening, structural optimization, and bioassay. As a result, two FTO inhibitors namely 18077 and 18097 were identified, which can selectively inhibit demethylase activity of FTO. Specifically, 18097 bound to the active site of FTO and then inhibited cell cycle process and migration of cancer cells. In addition, 18097 reprogrammed the epi-transcriptome of breast cancer cells, particularly for genes related to P53 pathway. 18097 increased the abundance of m⁶A modification of suppressor of cytokine signaling 1 (SOCS1) mRNA, which recruited IGF2BP1 to increase mRNA stability of SOCS1 and subsequently activated the P53 signaling pathway. Further, 18097 suppressed cellular lipogenesis via downregulation of peroxisome proliferator-activated receptor gamma (PPARγ), CCAAT/enhancer-binding protein alpha (C/EBPα), and C/EBPβ. Animal studies confirmed that 18097 can significantly suppress in vivo growth and lung colonization of breast cancer cells. Collectively, we identified that FTO can work as a potential drug target and the small-molecule inhibitor 18097 can serve as a potential agent against breast cancer.

Objective To study the effect of multi-disciplinary team (MDT) management on the outcome in neonates with omphalocele.Method A retrospective non-randomized controlled clinical study was conducted.Neonates who were diagnosed as omphalocele and admitted to the surgical neonatal intensive care unit of the Guangzhou Women and Children Medical Center from December 2010 to December 2017 were collected.Because MDT was established in December 2014,infants were assigned into non-MDT group and MDT group according to their dates of admission.The characteristics and outcomes between non-MDT group and MDT group were compared using x2,t-test or rank-sum test.Multivariate analysis was performed by Logistic regression.Result A total of 91 neonates were included in the study,50 were in non-MDT group and 41 were in MDT group.The mortality in MDT group (2.4％,1/41) was lower than that in non-MDT group (18.0％,9/50),the difference was statistically significant (P ＜ 0.05).The median time of mechanical ventilation of giant omphalocele in non-MDT group (18.3 hours) was longer than that in MDT group (41.7 hours),the difference was also statistically significant (P ＜ 0.05).After adjusting for the associated confounding risk factors,the risk of death in non-MDT group was 54 times higher than that in MDTgroup (OR=54.19,95％CI2.64 ～1 113.49,P＜0.05).Conclusion There was significant association between the MDT management and the decreased risk of death of omphalocele.

Objective:To explore the current cognition of sustained-released (SR) and controlled-release (CR) oral drugs in patients with type 2 diabetes mellitus (T2DM) who have been contracted with general practitioners, analyze the problems and causes in the patients' drug use, and put forward suggestions and countermeasures.Methods:Totally 400 T2DM patients using SR and CR oral drugs, who have been contracted with general practitioners from Yuetan Community Healthcare Center in Xicheng District and Xinhua Community Healthcare Center in Tongzhou District of Beijing were selected by convenient sampling in May 2019, and investigated with the self-designed SR and CR cognition questionnaire for T2DM patients. The patients' cognition and influencing factors of drug use were analyzed.Results:The correct answer rate of the six items in the SR and CR oral drug questionnaire among the 400 patients was 55.3%-59.3%. The correct answer rate of patients aged 41-60 years was higher than that of patients aged over 60 years; the correct answer rate of patients with higher educational levels was higher than that of patients with lower educational levels; and the correct rate of patients who met blood glucose standards was higher than that of patients who did not meet blood glucose standards, and the differences were statistically significant ( P < 0.01) . Conclusions:Diabetic patients contracted with general practitioners have a low level of understanding of SR and CR oral drugs. Individualized guidance based on the patients' own conditions is conducive to their cognition and correct use rate of SR and CR drugs.

Objective To investigate the effects of single i.v. subanesthetic dose of ketamine on heart rate, blood pressure and oxygen saturation for antidepressant treatment. Methods Patients with severe depressive disorder were randomized to ketamine group (n=13) and control group (n=14). Ketamine group received ketamine (0.5mg/kg) single injection whereas control group received saline single injection. Escitalopram (10 mg/d) were orally administered for 4 weeks simultaneously. Comparisons were made on the heart rate, blood pressure and oxygen saturation at baseline, 40 min, 100 min, and 280 min after injection between the two groups. Results The main effects of time but not group were significant for all parameters including heart rate, systolic blood pressure and diastolic blood pressure, (P＜0.05). Interaction of time×group was significant (P＜0.05). All parameters including heart rate (F=16.85, P＜0.01), systolic blood pressure (F=15.82, P＜0.01) and diastolic blood pressure (F=8.63, P＜0.01) with time were significant in ketamine group. The heart rate, systolic blood pressure and diastolic blood pressure in ketamine group were significantly higher at 40 min than at other time points (P＜0.05), while were no significant difference among other time points (P＞0.05). There was no statistical significance of main effect of time, group and interaction of time×group in oxygen saturation between the two groups (P＞0.05). Conclusion Single subanesthetic dose ketamine intravenous drip for antidepressant therapy may cause a transient increase in heart rate and blood pressure.

Objective To explore the classification of collateral blood compensation pathways and collateral blood compensation characteristics in patients with common carotid artery occlusive disease.Methods The hemodynamie and imaging data of 20 patients with common carotid artery occlusive disease,admitted to our hospital from May 2016 to September 2018,were collected.The patients were classified according to whether they had internal carotid artery stealing and collateral circulation compensating for collateral flow.Results Internal carotid artery hematoma was found in 11 of the 20 patients;there was collateral circulation in 17 patients,including 10 branches of the anterior communicating artery,9 branches of the posterior communicating artery,11 branches of the posterior cerebral artery-middle cerebral arterial pia anastomosis,and 8 branches of the ocular artery.There were three types of collateral blood compensation pathways to be discovered in the 20 patients with common carotid artery occlusive disease;type Ⅰ (n=3) was the collateral blood compensation pathway with simple internal carotid artery stealing,type Ⅱ (n=8) was the collateral blood compensation pathway with internal carotid artery stealing and collateral circulation,and type Ⅲ (n=9) was the collateral blood compensation pathways with simple collateral circulation.Conclusion In some patients with common carotid artery occlusion,the internal carotid artery stealing route exists in the collateral flow compensation.

Objective To investigate the application value of low dose high pitch dual source CT angiography technique in diagno-sis of acute aortic dissection.Methods 21 cases of critically ill patients with suspected aortic dissection underwent total aortic angiog-raphy without using ECG by adopting the second generation dual source CT Flash Technology (pitch 3 .2 ,1 0 0 kV and 1 0 0 mAs), using a lower contrast dose (60 mL).Results All subjects accepted as low as possible radiation doses and iodine intake;at the same time,accurate information including aortic intimal tear position,intimal flap,true and false lumen,and lesions involving the range vessel signs and anatomic relationship were received,2 cases of Stanford type A,type B 1 9 cases (2 cases of aortic rupture).Average scan time 2.6 s,average effective radiation dose cm 270 mGy·cm.Conclusion High quality images by using high pitch dual source CT low dose angiography with lower contrast dose provide safe,reliable,real-time screening method for critically ill patients with aor-tic dissection caused by systemic severe compound injury.