ObjectiveTo investigate the infestation of bedbugs in a staff dormitory in Jiading District, Shanghai, to explore the measures to dispose Cimex lectularius linnaeus, so as to provide a scientific basis for the prevention and control of bedbugs. MethodsThe infestation of bedbugs in the dormitory of the company was determined through field investigation, accompanied by scientific guidance under the comprehensive control measures and an effect evaluation of the control results. ResultsA total of 114 rooms distributed in 3 dormitory buildings were investigated, with an average infestation rate of 42.11%, of which building B has the highest infestation rate of 51.52%. Six bedbug specimens were collected by visual inspection in the room, and all of them were identified as Cimex lectularius linnaeus. After a series of comprehensive control measures including environmental cleanup, aerosol elimination, replacement of wooden beds with iron frame beds, and purchase of all-inclusive mattress, the bedbug infestation rate dropped to 5.26%. ConclusionComprehensive control can effectively prevent the breeding and spread of bedbugs. Dissemination and education effort should be strengthened in case of the occurrence of bedbug infestation, together with an implementation of long-term and continuous surveillance and monitoring.

Objective:To compare the efficacy of amide proton transfer-weighted (APTw) imaging with time-dependent diffusion MRI (td-dMRI) in the diagnosis of malignant breast lesions.Methods:This study was a cross-sectional study. The clinical, pathological and imaging data of patients with breast lesions admitted to the First Affiliated Hospital of Zhengzhou University from March to August 2023 were prospectively analyzed. All patients firstly underwent T 2WI, diffusion-weighted imaging, followed by dynamic contrast-enhanced MRI (DCE-MRI), and finally APTw imaging and td-dMRI were performed for breast lesions using DCE-MRI as reference. Reconstructed images from APTw imaging measured lesions with a frequency shift of 3.5 ppm asymmetric magnetic susceptibility MTR asym(+3.5 ppm). The apparent diffusion coefficient (ADC) values at different oscillating frequency gradients (ADC PGSE, ADC 17 Hz, ADC 33 Hz values) were measured using reconstructed td-dMRI images. Independent sample t-test was used to compare APTw imaging, td-dMRI parameter differences between benign and malignant breast tumors, breast malignant tumors with different molecular types [estrogen receptor (ER) negative and positive, progesterone receptor (PR) negative and positive, human epidermal growth factor receptor (HER-2) negative and positive, proliferation index (Ki-67) low and high expression] and different histological grades (grade Ⅱ and Ⅲ). Receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the efficacy of APTw imaging and td-dMRI parameters in differentiating benign and malignant breast tumors, molecular classification and histological grading of malignant breast lesions. Results:There were 171 lesions in 171 patients, including 103 malignant lesions and 68 benign lesions. Histological grades were grade Ⅱ in 51 cases and grade Ⅲ in 38 cases of 89 cases of invasive carcinoma. Totally 98 cases of malignant lesions were included in molecular typing analysis, 36 cases were ER negative and 62 cases were ER positive. PR was negative in 51 cases and positive in 47 cases. There were 33 negative HER-2 patients, 65 positive HER-2 patients. There were 50 cases of low Ki-67 expression and 48 cases of high Ki-67 expression. The MTR asym(+3.5 ppm) value of malignant breast lesions was higher than that of benign lesions ( t=5.76, P<0.001), and the ADC PGSE, ADC 17 Hz and ADC 33 Hz values were lower than those of benign breast lesions ( t was 4.84, 4.62, 4.01, respectively, all P<0.001). MTR asym(+3.5 ppm) had the highest AUC value (0.83) and the highest specificity (90.38%), and ADC PGSE had the highest sensitivity (85.86%). There were no significant differences in MTR asym(+3.5 ppm), ADC PGSE, ADC 17 Hz and ADC 33 Hz between grade Ⅱ and grade Ⅲ histological grades of malignant breast lesions (all P>0.05). The ADC PGSE value of ER negative was higher than that of ER positive ( t=2.34, P=0.018), and the AUC for distinguishing ER positive from negative was 0.64. The ADC PGSE and ADC 17 Hz values of PR negative were higher than those of PR positive ( t=2.87, 2.81, P=0.004, 0.006, respectively), and their AUCs for identifying PR positive versus negative breast malignant lesions were 0.68 and 0.67, respectively. The ADC 33 Hz value of negative HER-2 was lower than that of positive HER-2 ( t=3.00, P=0.003), and the AUC for distinguishing positive and negative HER-2 was 0.67. There were no significant differences in other parameters among different subtypes of breast malignant lesions (all P>0.05). Conclusion:Compared with td-dMRI, APTw imaging is more effective in differentiating benign and malignant lesions of breast tumors, and ADC values at different gradient oscillation frequencies obtained by td-dMRI show better diagnostic efficacy in differentiating different molecular types of breast malignant lesions.

Objective:To explore the effectiveness and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD).Methods:A retrospective analysis was conducted on data of 16 patients who underwent EUS-PD because of endoscopic retrograde pancreatography (ERP) failure, poor effectiveness or anatomical changes and couldn't undergo the routine ERP in Nanjing Drum Tower Hospital from June 2018 to July 2022. The technical success of EUS-PD, clinical efficacy and post-procedure adverse events were analyzed.Results:In the 16 patients, there were 14 males and 2 females, with age of 50.69±12.95 years. A total of 19 times of EUS-PD operations were included, 3 of them were rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), 15 transgastric or transenteric EUS-guided stent placement and 1 was EUS-guided nasopancreatic duct placement. Technical success was achieved in 84.21% (16/19) patients, and among whom 93.75% (15/16) achieved clinical success. The overall incidence of postoperative adverse events was 52.63% (10/19) including 47.37% (9/19) abdominal pain, 15.79% (3/19) fever and 15.79% (3/19) postoperative pancreatitis. All adverse effects were relieved after general conservative treatment and no primary disease or surgery-related death occurred. The mean follow-up was 17.6 (8.2,22.3) months and 93.75% (15/16) of the patients were followed up. By the time of follow-up, 76.92% (10/13) of the patients who had successfully received EUS-PD had no recurrence of abdominal pain or distension.Conclusion:EUS-PD is a safe and effective alternative therapy for those with pancreatic diseases with ERP failure, poor efficacy or anatomical changes.

[摘 要] 目的：探究小核核糖核蛋白多肽A（SNRPA）在肝细胞癌（HCC）组织和细胞中的表达及其调控HCC细胞HepG2和Hep3B恶性生物学行为的作用及其机制。方法: 数据库分析SNRPA在泛癌组织中的表达及其与病理分期、HCC患者预后的相关性。常规培养HepG2和Hep3B细胞，将si-NC，si-SNRPA#1、si-SNRPA#2转染HepG2和Hep3B细胞，实验分为si-NC组、si-SNRPA#1组和si-SNRPA#2组；将SNRPA-vector和SNRPA-oe载体转染LO2细胞，分为SNRPA-vector组和SNRPA-oe组。qPCR法检测正常肝细胞和肝癌细胞以及转染各组HepG2和Hep3B细胞中SNRPA mRNA的表达，MTT法、Transwell法和WB法分别检测转染后各组HepG2和Hep3B细胞的增殖、迁移和侵袭能力以及EMT相关蛋白表达的变化。结果: 数据库分析显示，SNRPA mRNA在多数肿瘤组织中均呈高表达（均P<0.001）且与病理分期有关联（P<0.05或P<0.01）。SNRPA在HCC组织和细胞中均呈高表达（P<0.05或P<0.01），且与HCC患者的预后有关联（P<0.01）。敲减SNRPA表达明显抑制HepG2和Hep3B细胞增殖（P<0.05或P<0.01）而过表达SNRPA则能促进LO2细胞增殖（P<0.01），敲减SNRPA表达明显抑制HepG2和Hep3B细胞的迁移和侵袭能力（均P<0.01），明显促进E-cadherin的表达上调（P<0.01），而抑制N-cadherin、vimentin的表达（P<0.01）。结论: SNRPA在HCC组织及细胞中呈明显高表达，其可能通过调控上皮间质转化（EMT）进程进而促进HepG2和Hep3B细胞的增殖、迁移和侵袭。

Objective:To investigate the diagnostic value of X-ray mammography, ultrasound and MRI in breast cancer with silicone implants.Methods:The clinical and imaging data of 20 patients with breast cancer in women with silicone implants in the First Affiliated Hospital of Zhengzhou University from March 2014 to October 2021 were analyzed retrospectively. The mammography, ultrasound and MRI findings were analyzed, and the differences in detection rate, diagnostic accuracy and omission diagnostic rate of breast cancer in women with implants were compared among the three imaging methods.Results:Compared with mammography, both ultrasound and MRI were able to display the prosthesis and breast lesions completely. There were significant differences in detection rate, diagnostic accuracy and omission diagnostic rate among mammography, ultrasound and MRI. And the detection rate and diagnostic accuracy of MRI in breast cancer in women with implants were higher than those of mammography, and the omission diagnostic rate was lower.Conclusions:Ultrasound and MRI are superior to mammography in evaluating breast cancer after silicone prosthesis implantation, and MRI has more advantages in guiding clinical diagnosis and treatment.

Objective:To investigate the diagnostic value of three-dimensional amide proton transfer-weighted imaging (APTWI) and its combination with diffusion weighted imaging (DWI) for differentiating breast benign from malignant lesions.Methods:This was a prospective study. From July to December 2020, 226 patients with breast lesions confirmed by surgery or puncture pathology in the First Affiliated Hospital of Zhengzhou University were collected. All patients underwent MR T 1-weighted imaging, T 2-weighted imaging, DWI, APTWI, and dynamic contrast-enhanced MRI, and the apparent diffusion coefficient (ADC) value and the magnetization transfer ratio asymmetry at an offset of 3.5 ppm [MTRasym(3.5 ppm)] were obtained from DWI and APTWI respectively. Mann-Whitney U test was used for the comparison of DWI and APTWI parameters between breast benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to evaluate the differences of diagnostic efficacy between DWI, APTWI, and their combination. Results:There were 226 patients with 226 breast lesions, including 124 malignant and 102 benign lesions. The ADC values of patients with malignant breast lesions [1.03 (0.93, 1.13)×10 -3 mm 2/s] and MTRasym (3.5 ppm) [1.95% (1.10%, 2.88%)] were lower than those of benign breast lesions [1.38 (1.11, 1.55)×10 -3 mm 2/s, 3.30% (2.20%, 4.20%), respectively], and the differences were statistically significant ( Z=-8.19, -6.51, P<0.05). The area under the ROC curves (AUC) of DWI, APTWI, and its combination in the differential diagnosis of benign and malignant breast lesions were 0.817, 0.752, and 0.868, respectively. The AUC of the combination of DWI and APTWI was higher than that of DWI and APTWI ( Z=4.00, 2.93, P<0.05), and there was no significant difference in the AUC between DWI and APTWI diagnoses ( Z=1.58, P>0.05). Taking 1.25×10 -3 mm 2/s as the optimal cut-off value for ADC values, the sensitivity, specificity, and accuracy in differentiating benign from malignant breast lesions were 94.4% (117/124), 62.7% (64/102), and 80.1% (181/226), respectively; Taking 2.70% as the optimal cut-off value for MTRasym (3.5 ppm), the sensitivity, specificity, and accuracy in differentiating benign from malignant breast lesions were 73.4% (91/124), 64.7% (66/102), and 69.5% (157/226), respectively, and the sensitivity, specificity, and accuracy of DWI combined with APTWI in differentiating benign from malignant breast lesions were 82.3% (102/124), 79.4% (81/102), and 81.0% (183/226), respectively. Conclusion:APTWI can be used for the differential diagnosis of benign and malignant breast lesions, and the combination of APTWI and DWI can obtain the better diagnostic performance than the single method.

Objective:To investigate the efficacy and safety of a new China-made direct visualization system of peroral cholangiopancreatography in the diagnosis and treatment of biliopancreatic diseases.Methods:Clinical data of 37 patients who underwent endoscopic examination through the direct visualization system of peroral cholangiopancreatography at Digestive Endoscopy Center of Nanjing Drum Tower Hospital from April 2020 to June 2021 were retrospectively analyzed. Technical success rate and complications were analyzed.Results:The examination was completed in 37 patients through the system. The technical success rate was 100.0%. The nature of biliary stricture was confirmed in 24 cases, presenece or absence of bleeding or residual stones in the bile duct was confirmed in 6 cases, neoplasm or residual stones in the pancreatic duct was determined in 2 cases, biliary stricture was passed assisted with visualized guidewire in 2 cases, and lithotripsy was performed assisted with biliary laser in 3 cases. Nine patients were pathologically diagnosed as having malignant biliary stricture, and 8 of them were confirmed malignant by the system. Drainage was performed in 34 cases after the examination. There were 3 cases of cholangitis, 4 cases of bacteremia and 2 cases of postoperative pancreatitis after the operation, which were relieved in a short time after conservative treatment. Bleeding occurred in 1 case which was improved after two times of endoscopic hemostasis.Conclusion:The new direct visualization system of peroral cholangiopancreatography is safe and effective in the diagnosis and treatment of biliopancreatic diseases.

Objective:To investigate the safety and long-term outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with benign refractory pancreatic stenosis.Methods:Data of 18 patients with benign refractory pancreatic stenosis who underwent endoscopic treatment with FCSEMS in Nanjing Drum Tower Hospital between March 2013 and July 2020 were collected. The technical success, clinical success, adverse events and long-term outcomes were analyzed.Results:FCSEMS placement was successful in all 18 patients, with technical success rate of 100.0% (18/18). After stenting, the visual analogue scale (VAS) significantly decreased [2.00 (1.75, 3.00) VS 6.00 (5.00, 7.00), Z=-3.572, P<0.001]. The VAS decreased by more than 50% in 15 cases, and the clinical success rate was 83.3% (15/18). Stent-related adverse events included intolerable pain in 3 patients, stented-induced de novo stricture in 2 patients, and distal migration of stent in 2 patients. The stents were successfully removed in all patients after 137.5 (59.0, 417.0) days. There was significant reduction in terms of decreased upstream ductal dilatation after stent removal [9.1 (6.7, 14.1) mm VS 11.0 (7.6, 16.2) mm, Z=10.508, P<0.001]. After stent removal, 10 of the 14 patients maintained the response to pancreatic stenting and 4 recurred during the follow-up of 37-1 246 days. Conclusion:FCSEMS placement appears to be safe and effective in the treatment of benign refractory pancreatic stenosis and can provide persistent improvement in the stricture.

Objective:To evaluate the application value of small IT knife pre-cut in assistance to duodenal papillary cannulation compared with conventional guidewire cannulation.Methods:A retrospective analysis was performed on the data of 90 patients with choledocholithiasis including 52 patients with small IT knife pre-cut assisted intubation (small IT knife group) and 38 patients with conventional guidewire intubation (conventional group) in endoscopic retrograde cholangiopancreatography (ERCP) from May 2016 to July 2019 in the digestive endoscopy center of Nanjing Drum Tower Hospital. The basic data, curative effect and complications of the two groups were collected and compared.Results:There was statistically significant difference in gender composition between the small IT knife group and the conventional group ( χ2=5.679, P=0.017), but no significant difference in other baseline data between the two groups (all P>0.05). The median intubation time of the small IT knife group was significantly shorter than that of the conventional group (141.5 s VS 270.0 s, Z=1 268.0, P=0.022). There were no significant differences in the success rate of intubation [98.1% (51/52) VS 94.7% (36/38), χ2=0.760, P=0.571], the incidence of intraoperative bleeding [15.4% (8/52) VS 7.9% (3/38), χ2=1.148, P=0.345], postoperative pancreatitis [5.8% (3/52) VS 7.9% (3/38), χ2=0.159, P=0.694], and postoperative cholangitis [1.9% (1/52) VS 5.3% (2/38), χ2=0.760, P=0.571] between the two groups. No perforation occurred in the two groups. After stratifying according to the operator′s proficiency, the median intubation time was significantly different between the small IT knife expert group and the conventional expert group (116.0 s VS 258.0 s, Z=276.0, P=0.038), while there was no significant difference in the intubation time among other groups (all P>0.05). Conclusion:The small IT knife is safe and effective to pre-cut and assist intubation in ERCP, and it may shorten the intubation time.

Objective:To study LIM kinase 1 (LIMK1) expressional condition, and its regulatory effects on the proliferation and metastasis of hepatocellular carcinoma cells and tissues.Methods:The online database starBase v3.0 and GEPIA were used to analyze the LIMK1 expression in hepatocellular carcinoma cells and normal liver tissues, and then the relevant survival analysis was performed. LIMK1 expression in hepatocellular carcinoma cell line was analyzed by Western blot. Hep3B and Huh7 cells were transiently transfected after LIMK1 protein expression was down-regulated by small interfering RNA (siRNA). LIMK1 effects on the proliferation of Hep3B and Huh7 cells were observed by MTT assay and colony formation assay. Transwell assay was used to detect the change in metastatic ability of hepatocellular carcinoma cell after the down-regulation of LIMK1 expression. Western blot was used to detect the changes of related indexes in the process of epithelial mesenchymal transition after the down-regulation of LIMK1 expression. Data were analyzed by one-way ANOVA.Results:The expression level of LIMK1 in liver cancer tissues was significantly higher than that of normal liver tissues, and was related with prognosis ( P ?< 0.01). Furthermore, LIMK1 expression in HCC cell lines was significantly higher than that of immortalized liver L02 cells ( P < 0.05). Functional correlated experiment showed that the proliferation and metastatic ability of liver cancer cells were significantly inhibited after LIMK1 expression down-regulation ( P < 0.05). Simultaneously, LIMK1 was also involved in the process of epithelial-mesenchymal transition. Conclusion:LIMK1 was overexpressed in HCC tissues and cells, and may regulate the proliferation and metastasis of HCC cells and participate in epithelial-mesenchymal transition process.