[摘 要] 目的：探讨透明质酸介导运动受体（HMMR）在食管鳞状细胞癌（ESCC）细胞恶性进展中的作用及其潜在的分子机制。方法：收集2018年1月至2020年12月期间在河北医科大学第四医院手术切除的8例ESCC组织及癌旁组织标本，以及ESCC细胞KYSE-30和KYSE-150。利用WB法和免疫组化（IHC）法检测HMMR在ESCC组织中的表达情况。采用RNA干扰技术，在KYSE-30和KYSE-150细胞中敲低HMMR表达，qPCR法和WB法检测敲低效果，通过CCK-8实验和Transwell实验分别检测敲低HMMR对ESCC细胞增殖和侵袭能力的影响。4-硝基喹啉1-氧化物（4NQO）诱导小鼠致癌建立ESCC模型，H-E染色观察食管的形态变化，IHC法分析HMMR、序列相似性家族83成员D（FAM83D）、上皮钙黏素（E-cadherin）和神经钙黏素（N-cadherin）在小鼠不同癌变程度组织中的表达情况。结果：人ESCC组织中HMMR表达水平显著高于癌旁组织（均P < 0.05）。敲低HMMR后，KYSE-30和KYSE-150细胞的增殖和侵袭能力均显著降低（P < 0.05或P < 0.01），同时降低了FAM83D的表达水平（均P < 0.01）。裸鼠成瘤实验中，4NQO组小鼠体质量均低于对照组（均P < 0.05）；IHC法染色结果显示，肿瘤组织中HMMR呈高表达（P < 0.05），其中在高级别上皮内瘤变（HGIN）组织中的表达显著高于低级别上皮内瘤变（LGIN）组织（P < 0.001）。HMMR与FAM83D、N-cadherin表达呈显著正相关（r = 0.724、0.870，均P < 0.001），与E-cadherin表达呈显著负相关（r = -0.714，P < 0.001）。结论：HMMR在ESCC组织中呈高表达，其可能通过上调FAM83D表达水平促进ESCC的进展。

Plateau refractory wounds are affected by adverse conditions such as hypoxia, strong ultraviolet rays, and frigid, which can cause serious cell function damage, hinder re-epithelialization, and delay or even stop the healing of wounds. Conventional debridement and drainage, functional dressings and other traditional treatments have poor efficacy on this type of wound. Not only do patients have to endure long hospital stays, but they may also suffer from other complications due to long-term non-healing of wounds. In this paper, we report a patient with a plateau refractory wound that had not healed for 2 months. After two applications of platelet lysate gel treatment, the wound healed completely. This treatment method provides a new treatment approach for patients with plateau refractory wounds, which is worthy of clinical reference.

AIM: To observe the changes of corneal densitometry(CD)in patients with keratoconus after corneal cross-linking(CXL).METHODS: Retrospective study. A total of 32 patients(43 eyes)with keratoconus in Ningxia Eye Hospital from April 2020 to April 2022 were selected. Pentacam analysis system divided the cornea into three layers: anterior 120 μm, middle layer and posterior 60 μm, and divides it into five regions with diameters of 0-2, 2-6, 6-10, 10-12 mm and full diameter according to the diameter, and measures the CD in different ranges. The changes of CD were compared before operation and at 1, 3 and 6 mo after operation.RESULTS: There were differences in uncorrected visual acuity, best corrected visual acuity and intraocular pressure before and 6 mo after operation(all P<0.05), and there was no difference in corneal endothelial cells(P=0.477). CD reached its peak at 1 mo after operation, and decreased at 3 mo and 6 mo after operation, but it was still higher than that before operation. There is a significant positive correlation between CD and Kmax in the anterior layer and the whole layer(r=0.164, P=0.016; r=0.152, P=0.023).CONCLUSION: The values of CD peaked at 1 mo after CXL, then it gradually decreased, tending to become stable at 6 mo postoperatively.

Plateau refractory wounds are affected by adverse conditions such as hypoxia, strong ultraviolet rays, and frigid, which can cause serious cell function damage, hinder re-epithelialization, and delay or even stop the healing of wounds. Conventional debridement and drainage, functional dressings and other traditional treatments have poor efficacy on this type of wound. Not only do patients have to endure long hospital stays, but they may also suffer from other complications due to long-term non-healing of wounds. In this paper, we report a patient with a plateau refractory wound that had not healed for 2 months. After two applications of platelet lysate gel treatment, the wound healed completely. This treatment method provides a new treatment approach for patients with plateau refractory wounds, which is worthy of clinical reference.

Small for gestational age (SGA) infants are more likely to experience neurocognitive impairments compared to appropriate for gestational age (AGA) infants. This paper reviews recent research on the neurocognitive development of SGA children. SGA can lead to a "brain-sparing effect" due to growth restriction, which may affect cerebral blood flow and brain structure. However, this does not guarantee normal brain development. Restrictive blood flow can result in changes in brain structure, such as reduced total white matter and gray matter volume in various brain regions, including the cerebral cortex, hippocampus and cerebellum, ultimately leading to decreased head circumference. SGA children also exhibit lower scores in all neurocognitive domains, including intelligence, attention, memory, and executive function. This may result in poor academic performance and an increased risk of social, behavioral, and neurological problems, such as cerebral palsy, epilepsy, visual and hearing impairments, as well as comorbidities like attention deficit hyperactivity disorder(ADHD), autism spectrum disorder(ASD), anxiety, depression, and schizophrenia. Several risk factors for SGA-related neurocognitive impairments have been identified, including gestational hypertension, abnormal gestational weight, smoking, and catch-up growth. Studies have shown that the best interventions to improve cognitive dysplasia include nutrient supplementation, continued breastfeeding, high-quality education, and appropriate early intervention (responsive parenting) are effective in improving cognitive outcomes for SGA children.

Objective:To explore the application effect of key node advanced nursing mode in the treatment of patients with acute myocardial infarction.Methods:In October 2020, the hospital established a Critical Control Point rescue mode management team.122 patients with acute myocardial infarction admitted to emergency department of the hospital were enrolled as the objects between October 2020 and October 2021. The healthcare failure mode and effect analysis model was applied to analyze the shortcomings of emergency process, so as to construct critical control point rescue mode in the treatment of patients with acute myocardial infarction and apply it to the clinic in November 2021. After clinical application, emergency nursing and cardiac function recovery were compared between the two groups. The mortality rate within 30 d after surgery and occurrence of complications during hospitalization were recorded.Results:The first medical contact to balloon time dropped from (81.9±6.54) min to (56.2±4.23)min. The time from first medical contact to diagnosis of acute myocardial infarction dropped from (47.3±5.68) min to (30.69±5.21) min, the door-balloon dilation time dropped from (49.79±13.84) min to (28.63±15.71) min, producing results time of myocardial injury markers dropped from (28.38±3.79)min to (19.26±2.17) min, reporting time of electrocardiogram dropped from (5.82±2.01) min to (5.14±1.89)min, and hospitalization time dropped from (7.25±2.18) min to (6.14±1.27) min, and the differences were statistically significant ( P<0.05). After treatment, left ventricular ejection fraction in observation group was higher than that in control group, left ventricular end-diastolic diameter and cardiac troponin were lower than those in control group ( P<0.05). The incidence of hypotension and malignant arrhythmia in observation group was lower than that in control group ( P<0.05). Conclusions:The critical control point rescue mode can shorten treatment time and hospitalization time in acute myocardial infarction patients, improve cardiac function, and reduce the risk of complications during hospitalization.

As medical advances and surgical techniques have improved the survival rates of children with congenital heart disease (CHD), more and more studies have begun to focus on the quality of survival and long-term development of children with CHD. Cognitive and psychological developmental deficits in children with CHD have been well documented. With the development of brain function assessment and neuroimaging techniques in recent years, it has become possible to elucidate the mechanisms of neurocognitive impairment in patients with CHD from a brain science perspective. Providing targeted early follow-up interventions for the population with CHD and promoting their social adaptation have a great clinical significance. This review summarized recent research findings on neurocognitive developmental outcomes in children with CHD from the perspective of behavioral medicine and brain science. This paper focuses on reviewing the mechanisms of brain microstructure damage and brain network dysfunction which may explain neurocognitive impairment in children with CHD, and further explores the early monitoring and intervention programs suitable for clinical development, aiming to suggest possible directions for improving long-term neurocognitive developmental outcomes for CHD population.

Immunoadsorption can selectively remove pathogenic antibodies and has recently achieved good results in neuroimmune diseases. The type and titer of pathogenic antibodies play an important role in the clinical symptoms and severity of patients with autoimmune encephalitis. First-line immunotherapy for autoimmune encephalitis includes steroids, intravenous immunoglobulin, plasma exchange or immunoadsorption. Immunoadsorption selectively and rapidly eliminates autoantibodies and can be an effective therapeutic option as part of multimodal immunotherapy.

Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.

Objective To investigate treatment of caesarean scar pregnancy (CSP) and associated problem.Methods From January 2011 to January 2013,57 cases with CSP undergoing treatment in Affiliated Hospital of Hebei University were studied retrospectively.Among 57 patients,it was divided into 12 cases treated by curettage (curettage group) ;22 cases treated by uterine artery embolization(embolization group) ;8 cases treated by laparotomy(laparotomy group) and 15 cases treated by transvaginal debridement (transvaginal group).Results (1) Successful rate of curettage group,embolization group,laparotomy group and transvaginal group were 12/12,86％ (19/22),7/8,13/15.(2) The intraoperative blood loss and the hospital stay were 20 (17-28) ml,(5.1 ± 1.9) days in curettage group,10 (5-15) ml,(10.2 ± 3.2) days in embolization group,200 (80-300) ml,(11.3 ± 3.3) days in laparotomy group,50 (45-100) ml,(6.8 ± 1.2) days in transvaginal group.There was statistically different between curettage group and embolization group (P ＜ 0.05).There was statistically different between laparotomy group and transvaginal group (P ＜ 0.05).Conclusions Curettage,uterine artery embolization,abdominal and transvaginal scar debridement surgery can be used in treatment of the CSP.It should be carefully chosen with surgical intervention,if myometrium was implanted greater than 1/2,or near to serosa.It should be carefully chosen with vaginal surgery,if the blood flow signals was rich around the lesion.