Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) monoclonal antibody in maintenance therapy for ulcerative colitis (UC) .Methods:A retrospective case control study was conducted, including 84 patients with active UC undergoing VDZ therapy for an average of (22±8) weeks in the Department of Gastroenterology, the Second Affiliated Hospital of Zhejiang University School of Medicine from December 2020 to September 2023. These patients achieved a response or remission by (22±8) weeks and continued follow-up until (54±8) weeks. They were divided into effective and ineffective groups based on whether they achieved clinical remission by (54±8) weeks after using VDZ; those who required optimized treatment with shortened injection intervals were included in the ineffective group. Baseline clinical data, medication history and endoscopic imaging data were recorded. The clinically modified Mayo score, Mayo endoscopic score, and other assessments were used to evaluate UC disease activity. Adverse reactions related to treatment were also recorded to assess the efficacy of VDZ treatment up to (54±8) weeks was assessed and key factors affecting clinical remission of the disease were analyzed.Results:Among the 84 UC patients with followed up to (54±8) weeks, 47 cases (55.95%) achieved clinical remission and were classified as the effective group, while 37 cases (44.05%) did not achieve clinical remission and were classified as the ineffective group. The endoscopic remission rate in the effective group was 68.09% (32/47), and the mucosal healing rate was 36.17% (17/47). Joint pain occurred in 2.38% of patients, hepatic dysfunction in 3.57%, and one patient died from leukemia following a COVID-19 infection during the maintenance therapy period.Conclusion:VDZ has a certain efficacy in the continuous treatment of UC patients and in maintaining clinical and endoscopic remission, with generally high overall safety and a low incidence of adverse reactions.

Objective:To evaluate the efficacy and safety of vedolizumab (VDZ) monoclonal antibody in maintenance therapy for ulcerative colitis (UC) .Methods:A retrospective case control study was conducted, including 84 patients with active UC undergoing VDZ therapy for an average of (22±8) weeks in the Department of Gastroenterology, the Second Affiliated Hospital of Zhejiang University School of Medicine from December 2020 to September 2023. These patients achieved a response or remission by (22±8) weeks and continued follow-up until (54±8) weeks. They were divided into effective and ineffective groups based on whether they achieved clinical remission by (54±8) weeks after using VDZ; those who required optimized treatment with shortened injection intervals were included in the ineffective group. Baseline clinical data, medication history and endoscopic imaging data were recorded. The clinically modified Mayo score, Mayo endoscopic score, and other assessments were used to evaluate UC disease activity. Adverse reactions related to treatment were also recorded to assess the efficacy of VDZ treatment up to (54±8) weeks was assessed and key factors affecting clinical remission of the disease were analyzed.Results:Among the 84 UC patients with followed up to (54±8) weeks, 47 cases (55.95%) achieved clinical remission and were classified as the effective group, while 37 cases (44.05%) did not achieve clinical remission and were classified as the ineffective group. The endoscopic remission rate in the effective group was 68.09% (32/47), and the mucosal healing rate was 36.17% (17/47). Joint pain occurred in 2.38% of patients, hepatic dysfunction in 3.57%, and one patient died from leukemia following a COVID-19 infection during the maintenance therapy period.Conclusion:VDZ has a certain efficacy in the continuous treatment of UC patients and in maintaining clinical and endoscopic remission, with generally high overall safety and a low incidence of adverse reactions.

Objective:To analyze Traditional Chinese Medicine(TCM) prescriptions in COVID-19 patients in Shanghai area.Methods:Two hundred and forty patients were enrolled in the study, including 19 mild cases, 199 moderate cases, 16 severe case and 6 critical cases. The COVID-19 formula in Shanghai area was extracted and input in TCM Inheritance platform. Data association method such as software association rules,improved mutual information method,complex system entropy clustering,unsupervised entropy hierarchical clustering were used to analyze the frequency,herb flavor and meridian, combination rule and core combination of different types of Chinese herbs in the treatment of COVID-19 in Shanghai area.Results:According to the frequency analysis of 240 prescriptions of Chinese medicine,194 herbs were found. The COVID-19 formula herbs were all "cold", the frequency of use in mild, moderate, severe and critical cases was [46.02%(104/226), 46.31%(1 230/2 656), 37.06%(146/394), 39.24%(31/79)]. The flavor was mainly "bitter" and the frequency of use in 4 types of disease were [36.53%(122/332), 37.33%(1 445/3 857), 35.96%(205/564), 33.62%(39/113)]. Scutellaria was the most frequently used TCM of "bitter and cold". The drugs used were mainly lung,stomach and spleen meridians. By comparing the formulas between mild and moderate cases,herb combinations with the highest frequency were all "scutellaria glycyrrhiza" and "tangerine glycyrrhiza". The formulas for 19 mild cases were collected,and 197 drug combinations were counted, and 125 Chinese medicine association rules,including 13 Chinese herbs. The formulas were extracted in 199 moderate cases of COVID-19, a total of 92 drug combinations and 38 Chinese medicine association rules were collected,including 19 Chinese herbs. In 16 severe cases, a total of 62 drug combination models and 46 Chinese medicine association rules were collected,including 17 Chinese herbs. For the 6 critical cases,80 Chinese medicine prescriptions were combined,and 10 Chinese medicine association rules, including 12 Chinese herbs.Conclusions:The herbal prescriptions of COVID-19 in Shanghai are characterized by clearing away heat and resolving dampness. By analyzing prescription rules with complex system entropy clustering, association compatibility ideas of different types of traditional Chinese medicine are found to be different among four types of COVID-19 cases. Analyzing the connection rules in formulas, by using the theory of TCM and pharmacology of traditional Chinese medical formula in different COVID-19 patients may be helpful for general practitioners.

Objective To investigate the association of single nucleotide polymorphism (SNP) rs13333226 in uromodulin (UMOD) gene with diabetic kidney diseases (DKD) in Han population in Tianjin,China.Methods A total of 210 type 2 diabetes (T2DM),90 normal controls (NC) and 280 DKD patients were recruited.According to the level of estimated glomerular filtration rate (eGFR),the DKD subjects were further subdivided into three groups:GFR≥90 ml/min group (n=105),60 ml/mim≤GFR ＜ 90 ml/min group (n=84) and GFR ＜ 60 ml/min group (n=91).Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for UMOD rs13333226C genotyping.Results The frequencies of AA,GA,GG genotype were 27.8％,58.9％,13.3％ in NC group and 41.0％,48.6％,10.5％ in T2DM group and 54.3％,36.1％,9.6％ in DKD group.The frequency of G allele was 42.8％ in NC group,34.8％ in T2DM group and 27.7％ in DKD group.The genotype distribution of UMOD was statistically significant between NC group and DKD group,and between T2DM group and DKD group (P ＜ 0.05).G allele of UMOD was an independent protective gene polymorphism of DKD in Logistic regression (B=-0.248,Wald=8.012,P=0.021,OR=0.780,95％ CI 0.612-0.968).Conclusion The G allele of UMOD gene may be an independent protective factor of DKD in Han population in Tianjin,China.

[Summary] A total of 128 individuals with type 2 diabetes underwent continuous glucose monitoring for 3 consecutive days.The dawn phenomenon was defined by three different parameters according to the previous research:(1)the absolute increase of glucose level from nocturnal nadir to prebreakfast value(?G) above 20 mg/dl;(2)?G above 10 mg/dl;( 3 ) insulin requirement increased at least 20%.The participants were secondarily separated by presence/absence of a dawn phenomenon based on the definitions above.The impact on blood glucose fluctuation of different groups was assessed according to the standard deviation of blood glucose( SDBG) , the area under curve above 10 mmol/L ( AUC ) , and the mean amplitude of glycemic excursions ( MAGE ) , etc.The frequencies of dawn phenomenon were 64.8%(?G≥20mg/dl), 85.2%(?G≥10 mg/dl), and 59.4%(rise in insulin requirement≥20%)respectively.The impacts on SDBG, AUC, MAGE, and MODD were without statistical difference(P>0.05) between the presence and absence of the dawn phenomenon patients when?G≥10 mg/dl.However, the differences reached statistical significance(P<0.05) when ?G≥20 mg/dl and the increase in insulin requirement≥20%. Besides, the incidence of dawn phenomenon was positively correlated with HOMA-IR, HbA1C , and free C-peptide.Dawn phenomenon is a very frequent event in type 2 diabetes and not only impacts the overall glycemic control but also exaggerates glucose fluctuation.To be clinically relevant, ?G≥20mg/dl should be taken as the quantitative criterion of the dawn phenomenon.

[Summary] To investigate the association between sleep disorder and ambulatory blood pressure rhythm in patients with type 2 diabetes. 418 patients with type 2 diabetes were divided into two groups according to Pittsburgh sleep quality index ( PSQI):patients without sleep disorder and patients with sleep disorder. Oral glucose tolerance test, insulin releasing test, and C-peptide releasing test were performed to investigate the differences in the β-cell function, the circadian rhythm of blood pressure, and blood pressure variation between the two groups after fasting and glucose-load. The correlation and regression analysis were performed between PSQI and other indicators. (1)The level of HbA1C , fasting plasma insulin, area under curve of insulin, fasting plasma C-peptide, area under curve of C-peptide, and homeostasis model assessment for insulin resistance ( HOMA-IR) were significantly higher in patients withsleepdisordercomparedtothoseinpatientswithoutsleepdisorder[(8.2±2.1)% vs(7.4±1.8)%,(13.42± 4.55vs11.86±4.52)mU/L,(8.51±0.54vs8.38±0.51)mU·L-1·min,(2.42±1.25vs1.79±0.73)ng/ml, (6.59±0.39vs6.49±0.43)μg·L-1·min,4.63±1.12vs3.86±0.97,allP<0.05]. Insulinsensitivityindex (ISI) was lower in patients with sleep disorder than that in patients without sleep disorder(-4. 26 ± 0. 78 vs-4. 05 ± 0.62,P<0.05). (2)Thelevelof24hmeansystolicanddiastolicbloodpressure,nocturalsystolicanddiastolicblood pressure, and systolic blood pressure during daytime and nighttime were significantly higher in patients with type 2 diabetes who were suffering from sleep disorder. The blood pressure variation was more marked in patients with sleep disorder. (3)Multiple stepwise regression analysis showed that PSQI score was positively related to area under curve of C-peptide, HOMA-IR, 24 h mean systolic blood pressure, and noctural systolic blood pressure (β=0. 242, 0. 293, 0. 352, 0. 413, all P<0. 05), and negatively related to ISI and decreasing ratio of noctural systolic blood pressure (β=-0. 124 and -0. 226, both P<0. 05). Sleep disorder may cause abnormal circadian rhythm of blood pressure through various mechanisms. Improving sleep disorder may help to ameliorate insulin resistance and restore normal circadian rhythm of blood pressure.

Objective:To observe the effect of breathing andDaoyin exercises on the quality of life in patients with stable chronic obstructive pulmonary disease (COPD) due to deficiency of the lung and kidney (grade II-III).
Methods:A total of 60 eligible cases were randomly allocated into a treatment group (n=30) and a control group (n=30) by random number table. Cases in the control group received routine Western medical treatment, whereas cases in the treatment group conducted breathing andDaoyin exercises in addition to routine Western medical treatment. Patients in both groups were treated for a total of 3 months. Then the observation was made on changes in pulmonary ventilation function, major clinical symptoms, modified Medical Research Council scale (mMRC), distance in 6-minute walk test (6-MWT), COPD assessment test (CAT) and efficacy satisfaction questionnaire for COPD (ESQ-COPD) before and after treatment.
Results:After treatment, the total effective rate was 80.0% in the treatment group, versus 66.7% in the control group, showing a statistical difference (P<0.05). Patients in the treatment group obtained more significant improvement in coughing, sputum production, dyspnea and shortness of breath than those in the control group (P<0.05). Patients in the treatment group obtained more significant elevation in the forced expiratory volume in 1 second percentage of predicted value (FEV1%) and peak expiratory flow rate (PEF%) than those in the control group (P<0.05). Patients in the treatment group obtained lower mMRC score than those in the control group (P<0.05). Patients in the treatment group obtained longer 6-MWT distance than those in the control group (P<0.05). Patients in the treatment group obtained lower CAT score (P<0.01) and higher ESQ-COPD score (P<0.05) than those in the control group.
Conclusion:Breathing andDaoyin exercises combined with routine Western medical treatment are effective for stable COPD (grade II-III) due to deficiency of the lung and kidney and can improve the patients’ quality of life.

BACKGROUND:The role of minocycline hydrochloride in adjuvant therapy of chronic periodontitis and
periodontal abscess has been widely reported, but detailed study of minocycline hydrochloride for combined periodontal-endodontic lesions is rare at present.
OBJECTIVE:To investigate the effect of minocycline hydrochloride in the treatment of combined periodontal-endodontic lesions.
METHODS:A total of 68 teeth with combined periodontal-endodontic lesions were treated with periodontal mechanical treatment and root canal therapy. According to the patient’s wiling, 68 patients were divided into experimental group (n=24; local injection of minocycline hydrochloride after periodontal mechanical treatment), positive control group (n=24; local injection of iodine glycerol after periodontal mechanical treatment), and
negative control group (n=20; no injection after periodontal mechanical treatment). These three groups were reviewed 1 month after periodontal mechanical treatment, and the differences before and after treatment were compared, including periodontal probing depth, attachment loss and gingival bleeding index.
RESULTS AND CONCLUSION: Probing depth, attachment loss and gingival bleeding index in three groups were significantly improved after 1 month of periodontal mechanical treatment (P< 0.05); both probing depth and
sulcus bleeding index in experimental group and positive control group were better than that of the negative
control group (P < 0.05), and probing depth and sulcus bleeding index in experimental group were better than that
of positive control group (P < 0.05). Experimental findings indicate that, in the clinical treatment of combined
periodontal-endodontic lesions, in addition to periodontal mechanical treatment and root canal therapy, local application of minocycline hydrochloride can effectively reduce the depth of periodontal pocket, improve gingival inflammatory
conditions and consolidate curative effect.