Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Peritoneal dialysis, as an important renal replacement therapy for end-stage renal disease patients, can be treated at home. The importance of social support for peritoneal dialysis patients has been widely recognized by researchers. However, due to various reasons, the role of social support has not been fully played. This paper reviews the social support evaluation tools, current situation and influencing factors of peritoneal dialysis patients, summarizes the social support interventions and the existing deficiencies, in order to provide a reference for managers to formulate targeted social support interventions.

Objective: To investigate the endothelial protective effects of simvastatin on the coagulation system in septic rats. Methods: A total of 54 SD male rats were divided into 3 groups. Six healthy rats were intraperitoneally injected with normal salineas control group. Twenty-four rats in septic group were intraperitoneally injected with normal saline followed by lipopolysaccharide 2.5 mg. Study group had 24 rats intraperitoneally injected with simvastatin followed by lipopolysaccharide. Plasma von Willebrand factor (vWF), thrombomodulin (TM), platelet activating factor (PAF) and antithrombin-Ⅲ (AT-Ⅲ) were tested at 1 h, 3 h, 6 h and 12 h after treatment. Scanning electron microscopy and transmission electron microscopy were used to observe the morphology and apoptosis of rat aorta endothelial cells. Results: Compared with healthy control group, vWF [(68.3±4.8) ng/ml, (59.2±5.1) ng/ml, (74.2±20.1) ng/ml, (53.5±4.0)ng/ml, respectively], TM [(1.4±0.3) ng/ml, (1.6±0.4) ng/ml, (2.8±0.9) ng/ml, (1.4±0.5) ng/ml, respectively], PAF [(29.1±6.5) pg/ml, (28.6±1.5) pg/ml, (28.7±2.7) pg/ml, (18.2±4.1) pg/ml, respectively] and AT-Ⅲ [(262.2±38.1)μg/ml, (233.0±70.4) μg/ml, (218.7±54.7) μg/ml, (162.2±37.2) μg/ml, respectively] were significantly increased in the sepsis group at 1 h, 3 h, 6 h and 12 h (P<0.05). Compared with the sepsis group, the plasma levels of PAF in simvastatin intervention group at 1 h [(15.6±2.5) pg/ml, 3 h(10.4±5.3) pg/ml, 6 h (9.3±1.4) pg/ml, 12 h(11.0±2.7) pg/ml] were significantly decreased, so were the TM level at 6 h (1.6±0.9) ng/ml, and the AT-Ⅲ levels at 1 h[(190.3±29.2) μg/ml],6 h [(104.4±33.6) μg/ml] and 12 h [(73.6±39.0) μg/ml, P<0.05]. Conclusion In the condition of sepsis, toxins and over-activated inflammatory factors damage the vascular endothelium. A large amount of circulating vWF, TM, PAF, and AT-Ⅲ cause early hypercoagulability. Simvastatin significantly reduces plasma amount of these procoagulants, suggesting it smodification of coagulopathy and vascular protective effectsin a septic rat model.

Objective:To study the characteristics and influence factors of laboratory test results of confirmed COVID-19 cases in Tianjin.Methods:Sample collection was conducted based on the standard operating procedure. Tianlong automatic magnetic bead nucleic acid extraction reagent was used for RNA extraction. Real-time RT-PCR was performed using four approved COVID-19 nucleic acid detection kits. Related epidemiological data of the cases were collected. One-way analysis of variance and non-parametric test for inter-group differences analysis were conducted using SPSS25.0 software.Results:A total of 162 PCR tests were completed for novel coronavirus nucleic acid detection in 123 confirmed COVID-19 cases. Eleven PCR results were positive for a single target gene and 10 of which were positive for nucleocapsid protein (N) gene. Nineteen cases were tested with two kinds of nucleic acid detection kits and the results of different detection kits were different. Different types of samples were collected form 13 cases for nucleic acid detection and the results showed that the Ct value of sputum sample was lower than that of throat swab sample. No significant difference in Ct values of throat swab samples was observed among patients with different clinical symptoms ( PCt-N=0.797, PCt-ORF1a/b=0.551). The 123 cases were divided into different groups according to the time interval between the onset date and the date of the first positive detection of viral nucleic acid. No significant difference in Ct values of throat swab samples was observed among different time interval groups ( PCt-N=0.373, PCt-ORF1a/b=0.058). Conclusions:Sputum samples were better than upper respiratory tract samples for viral nucleic acid detection. The sensitivity of N gene detection was higher, but re-sampling was needed when the result was positive for the single target N gene. Appropriate detection kits should be selected according to the actual needs, and samples should be collected at multiple time points, in multiple types and form multiple sites for detection.

Objective:To understand the characteristics of clusters of COVID-19 cases in Tianjin, and provide epidemiological evidence for the prevention and control of COVID-19.Methods:The data of all the COVID-19 cluster cases in Tianjin, reported by 22 February 2020, were collected to analyze the characteristics of different types of the clusters.Results:A total of 115 COVID-19 cases were reported in 33 clusters in Tianjin included 28 family clusters (71 cases), 1 work place cluster (10 cases), 3 transport vehicle clusters (8 cases) and 1 public place cluster (26 cases). Family clusters were caused by the cases from the working place or public place clusters. Numbers of secondary cases of family clusters was between 1 to 7, the median number was 2. The interval from onset to diagnosis for the first case was longer than those of other cases in the familial clusters ( Z=-2.406, P=0.016). The median of incubation period of the public place clusters was 2 days. The intervals from onset to diagnosis were significant different among the family, working place and public place clusters ( H=8.843, P=0.012), and also significant differences in onset time among the secondary cases ( H=16.607, P=0.000). Conclusions:In the surveillance of COVID-19 epidemic, special attention should be paid to places where clustering are prone to occur, and the epidemiological investigation should be carried out timely to confirm the cluster. To prevent the transmission of COVID-19, the close contacts of the patients should be transferred to an assigned observation place on time for single room isolation. The awareness of COVID-19 prevention is low in some rural areas, reflected by many mass gathering activities and delayed medical care seeking after onset. It is necessary to strengthen the health education and take control measures in early period of epidemic.

Objective? To explore the application effects of grading nursing plan based on GRACE score for patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Methods? By convenience sampling, 172 patients with NSTE-ACS who were admitted and hospitalized with complete file in the Cardiovascular Department of Fenyang Hospital of Shanxi Province from August 2016 to May 2017 were enrolled. According to the time of admission, they were divided into the control group(n=86) who were admitted into the hospital from August to December of 2016 and the experimental group (n=86) who were admitted into the hospital from January to May in 2017. The routine nursing approach was adopted in the control group , and the grading nursing plan based on GRACE score was used in the experimental group. The two groups were compared in the incidence of adverse cardiac events (MACE), average length of stay and patient satisfaction. Results? The incidence of MACE and length of hospital stay in the experimental group were all lower than the control group with statistical differences (P＜0.05). The satisfaction degree towards the nursing job in the experimental group was higher than the control group with a statistical difference (P＜0.05). Conclusions? Grading nursing plan for NSTE-ACS based on GRACE score can reduce the incidence of MACE for the patients,shortened their hospitalization time and improved patients＇ satisfaction.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

OBJECTIVE: To investigate the effect of vitamin D3 on polarization of monocyte macrophages induced by serum from patients with ankylosing spondylitis (AS). METHODS: Twenty AS naïve patients and 20 healthy controls from Wenzhou People's Hospital during January 2016 and December 2017 were enrolled. The macrophages were differentiated from THP1 cells induced by phorbol 12-myristate 13-acetate (PMA), and then co-cultured with the serum from healthy subjects (control group) or AS patients. Vitamin D3 was added in the medium mixed with serum from AS patients. Flow cytometry was used to analyze the ratio of CD68 and CD206 positive cells, and RT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase(iNOS) and arginase-1(Arg-1). RESULTS: THP1 cells could be polarized into mononuclear-macrophages with the induction of PMA. The proportion of CD206 positive cells in AS-serum group was lower than that in the control group (=9.434, <0.05), while the proportion of CD68 positive cells was higher than that in the control group (=43.920, <0.05). The proportion of CD206 positive cells in vitamin D3 group was higher than that in AS-serum group (=8.895, <0.05), while the proportion of CD68 positive cells was lower than that in AS-serum group (=9.089, <0.05). mRNA expression of Arg-1 in AS-serum group was lower than that in the control group (=8.899, <0.05), while mRNA expression of iNOS was higher than that in the control group (=3.656, <0.05). mRNA expression of Arg-1 in vitamin D3 group was higher than that in AS-serum group (=6.219, <0.05), while mRNA expression of iNOS was lower than that in AS-serum group (=5.876, <0.05). CONCLUSIONS Vitamin D3 can regulate the polarization of mononuclear macrophages for immunoregulation in patients with AS.
Adjuvants, Immunologic ; pharmacology ; Cell Differentiation ; drug effects ; Cholecalciferol ; pharmacology ; Humans ; Monocytes ; drug effects ; Spondylitis, Ankylosing ; blood ; physiopathology

Objective To explore the incidence and risk factors for postoperative delirium patients over 60 years undergoing total knee arthroplasty.Methods Three hundred and sixty-nine patients (73 males,296 females,aged over 60 years,ASA Ⅰ or Ⅱ) undergoing unilateral total knee arthroplasty were chosen.Before induction of anesthesia,femoral nerve block by nerve stimulator was performed for all patients,25 ml of 0.4% ropivacaine was injected to the continuous femoral nerve catheter for postoperative analgesia,all patients received intravenous-inhalation anesthesia during the operative.The confusion assessment method-intensive care unit (CAM-ICU) was used twice a day to evaluate whether the postoperative delirium had happened for patients within 3 days after operation,and record the case of complication besides postoperative delirium.To analysis the perioperative indicators depend on whether the postoperative delirium had happened for patients,then to screen out the probable risk factors for postoperative delirium,which include the kind of intravenous anesthesia drugs during operation,gender,age group,level of education;preoperative hypertension,coronary heart disease,arrhythmia,stroke,respiratory disease,diabetes,abnormal renal function and the ASA grade;the bleeding and blood transfusion volume during operative and the total amount of blood transfusion;degree of postoperative pain and whether used pethidine after operative.Put all observed factors to be analyzed by the Logistic regression model.Results Sixty-two patients (16.8%) had delirium within 3 days after operation.The results of multi-factor Logistic regression analysis indicates that the patients` increasing age (OR=2.116,P=0.035),low level of education (OR=0.091,P<0.001),preoperative chronic obstructive pulmonary diseases (COPD) (OR=12.500,P=0.002),high ASA grade (OR=22.333,P=0.005),increasing total amount of blood transfusion (OR=4.500,P<0.001) and postoperative used pethidine(OR=22.372,P=0.001) were the independent risk factors for postoperative delirium.Conclusion The patients` age,level of education,preoperative COPD,high ASA grade,increasing total amount of blood transfusion and postoperative used pethidine are the independent risk factors for postoperative delirium.

Objective To investigate the effects and probable mechanism ofShenfu injection on the oxidaitve damage of H2O2-induced PC12 cells.Methods PC12 cells were cultured and exposed to 100μmol/L H2O2 for 1 h to establish the oxidative damage model. The protective effect ofShenfu injection was observed by the cell survival rate measured by colorimetric MTT assay, and the leakage rate of lactic dehydrogense (LDH). Western blot methods were used to detect the expression of NF-κB signaling pathway.Results Compared with the model group,Shenfu injection at 5, 10, 20 ml/L could improve the PC12 cells survival rate (83.11% ± 2.59 %, 87.99% ± 0.59%, 85.26% ± 1.07%vs. 73.82% ± 1.82%;P<0.01 orP<0.05), decrease the LDH leakage rate (32.75% ± 4.10%, 28.52% ± 1.14%, 35.79% ± 1.62%vs. 64.34% ± 3.18%;P<0.01 or P<0.05). Western blot results showed thatShenfu injection could protect the PC12 cells from oxidaitve damage by suppressing the p-p65/p65 (1.30 ± 0.10, 1.17 ± 0.06, 1.37 ± 0.15 vs. 1.70 ± 0.10;P<0.01 orP<0.05), p-IκBα/IκBα (1.07 ± 0.12, 1.00 ± 0.10, 1.03 ± 0.06 vs. 1.17 ± 0.06; P<0.01 orP<0.05).ConclusionShenfu injection has a obvious antioxidant effect on PC12 cells in vitro.