Venous system diseases mainly include varicose veins and venous malformations of lower limbs and the genital system. Most of them are chronic diseases that cause serious clinical symptoms to patients and affect their health and quality of life. Sclerotherapy has become the first-line therapy for venous system diseases. However, there are problems such as incomplete fibrosis and vascular recanalization after sclerotherapy, and improper operation will cause serious adverse consequences. Therefore, exploring a safe and effective sclerotherapy strategy is essential for developing clinically successful sclerotherapy. To solve the above problems, we proposed a new sclerotherapy strategy with a dual mechanism of "vascular damage and plasmin (PLA) system inhibition." We intended to construct a novel cationic surfactant (AEO_x-TA) by reacting tranexamic acid (TA), a parent structure, with fatty alcohol polyoxyethylene ether (AEO_x) by ester bonds. AEO_x-TA could damage vascular endothelium and initiate a coagulation cascade effect to induce thrombus. Furthermore, AEO_x-TA could be degraded by esterase and release the parent drug, TA, which could inhibit the PLA system to inhibit the degradation of thrombus and extracellular matrix and promote the process of vascular fibrosis. In addition, such surfactant-based sclerosants have foam-forming properties, and they can be blended with polyvinyl alcohol (PVA) to prepare a highly stable foam formulation (AEO_x-TA/P), which can achieve a precise drug delivery and prolonged drug retention time, thereby improving drug efficacy and reducing the risk of ectopic embolism. Overall, the novel cationic surfactant AEO_x-TA provides a new avenue to resolve the bottleneck: surfactant sclerosants' efficiency is relatively low in the current sclerotherapy.

Objective To investigate the clinical features and maternal and fetal outcomes of acute pancreatitis in pregnancy(APIP)and the risk factors for disease aggravation,and to establish a predictive model.Methods A retrospective analysis was performed for 52 APIP patients who were admitted to Affiliated Hospital of Zunyi Medical University from January 2017 to December 2022,and according to disease severity,they were divided into mild acute pancreatitis(MAP)group with 32 patients,moderate-severe acute pancreatitis(MSAP)group with 8 patients,and severe acute pancreatitis(SAP)group with 12 patients.The logistic regression analysis was performed for the clinical data of each group,and the receiver operating characteristic(ROC)curves were plotted to assess the value of risk factors in predicting the severity of APIP.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparision between two groups.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Wilcoxon rank-sum test was used for further comparision between two groups;the chi-square test was used for comparison of categorical data between groups.Results Of all patients in terms of etiology,26(50%)had hyperlipidemic pancreatitis,20(38.4%)had biliary pancreatitis,and 6(11.5%)had idiopathic pancreatitis.In terms of gestational week,1 patient(1.9%)was in early pregnancy,25(48.1%)were in mid-pregnancy,and 26(50.0%)were in late pregnancy.A total of 10 patients(19.2%)had acute respiratory distress syndrome(ARDS),among whom 9(90%)required respiratory support.There were significant differences between the patients with different severities of APIP in aspartate aminotransferase,alanine aminotransferase,blood urea nitrogen,blood glucose,C-reactive protein(CRP),international normalized ratio(INR),pneumonia,ARDS,sepsis,hepatic insufficiency,and coagulation dysfunction(all P<0.05).The univariate analysis showed that the severity of APIP was associated with blood glucose,blood urea nitrogen,CRP,and pneumonia(all P<0.05),and pneumonia was a risk factor for the aggravation of APIP(odds ratio=18.938,95%confidence interval:1.020—351.747,P=0.048).CRP,blood glucose,blood urea nitrogen,and INR used in combination had a larger area under the ROC curve than each index used alone(0.954 vs 0.778/0.796/0.721/0.801).Conclusion Pneumonia is a risk factor for the aggravation of APIP,and the combination of CRP,blood glucose,blood urea nitrogen,and INR can be used to predict the severity of APIP.

Objective To investigate the predictive value of dynamic diffusion tensor imaging(DTI)in the postoperative efficacy of cervical spondylotic myelopathy(CSM)and to determine whether DTI parameters in different positions can be used as predictors of poor neurological prognosis.Methods A total of 105 CSM patients who underwent cervical spine decompression surgery were included.The modified Japanese Orthopedic Association(mJOA)score was used to assess patients'neurological function before surgery and one year after surgery.Patients were divided into two groups based on the recovery rate:the good prognosis group(recovery rate ≥50％)(44 cases)and the poor prognosis group(recovery rate＜50％)(61 cases).Univariate analysis was performed based on patients'clinical characteristics,imaging features and dynamic DTI parameters.Significant variables were subjected to binary logistic regres-sion analysis to identify risk factors for poor postoperative prognosis in CSM patients.Results Univariate analysis results showed significant differences between the two groups in terms of diabetes,number of compression segments,pre-mJOA score,cross-sectional area of the spinal canal at the narrowest location[Area-N(natu-ral),Area-E(extension),Area-F(flexion)],apparent diffusion coefficient(ADC)(ADC-N,ADC-E,ADC-F)and fractional ani-sotropy(FA)(FA-N,FA-E,FA-F)(P＜0.05).Binary logistic regression analysisrevealed that Area-N[odds ratio(OR)0.226;95％confidence interval(CI)0.069-0.732,P=0.013],FA-N(OR 3.028;95％CI 1.12-8.19,P=0.029),Area-E(OR 0.248;95％CI 0.076-0.814,P=0.021),FA-E(OR 4.793;95％CI 1.737-13.228,P=0.002),Area-F(OR 0.288;95％CI 0.095-0.87,P=0.027),FA-F(OR 2.964;95％CI 1.126-7.801,P=0.028)were independent risk factors for poor prognosis.FA-E had significant predictive value for poor prognosis in CSM patients.Conclusion Dynamic DTI can predict the postoperative outcomes in CSM,and FA-E value can serve as an excellent predictor of poor neurological prognosis.

Objective To discover the existing problems and provide appropriate suggestions and countermeasures through the quality control inspection.MethodsA comprehensive quality control inspection was conducted for the radiotherapy equipment in 45 hospitals in Zhejiang province.The physical,technical,clinical and radiotherapy process and the parameters related to quality control were evaluated.Results As of December 31,2017,a total of 62 linear accelerators from 45 hospitals have been assessed.In the radiotherapy process,multiple quality control problems were identified in terms of radiotherapy equipment configuration,clinical work quality,radiotherapy technology and personnel qualifications.Besides,unreasonable equipment configuration,shortage of radiotherapy staff,clinical work flow and the quality assurance of physical radiotherapy remained to be resolved.Conclusion Regular quality control of radiotherapy plays a pivotal role in ensuring the accuracy,effectiveness and medical safety of radiotherapy.

Objective To investigate the dynamics of white blood cell count (WBC),prealbumin(PA),high sensitive C-reactive protein (hs-CRP),and vascular endothelial growth factor (VEGF) in hand-foot-and-mouth disease (HFMD) complicated with or without encephalitis and in vitro inhibitory effects of artesunate on VEGF secretion of mononuclear cells from HFMD patients.Methods Peripheral blood mononuclear cells from healthy control group,HFMD group and HFMD combined with encephalitis group were isolated by Ficoll density gradient centrifugation and treated with different concentrations of artesunate (25,50,100 mg/L).The expression of VEGF in the supernatant was examined by ELISA double antibody sandwich method.The levels of WBC,PA and hs-CRP in the three groups were also detected.Multiple samples were compared by one-way analysis of variance.Multiple comparison was performed by Dunnett T3 test.Correlation of two variables was analyzed by Spearman correlation test.Results There were significant differences in the levels of WBC,hs-CRP,PA and VEGF between the HFMD combined with or without encephalitis group and health control group (F=172.69,366.02,166.32 and 5 941.89,respectively,all P＜0.01).There were significant differences in the levels of VEGF secreted by mononuclear cells treated with three different concentrations of artesunate between the HFMD combined with or without encephalitis groups and health control group (F =194.265 and 4 750.69,respectively,both P＜0.01).Correlation analysis showed that the VEGF level secretion by mononuclear cells from HFMD patients with or without encephalitis were both negatively correlated with different concentrations of artesunate (r=-0.903 and-0.969,both P＜0.01).Conclusions Compared with HFMD without encephalitis,the secretion of VEGF by mononuclear cells,WBC and hs-CRP levels in HFMD complicated with encephalitis group all increase and PA decrease significantly.Artesunate can inhibit the secretion of VEGF by mononuclear cells of patients with hand-foot-and-mouth disease in a dosedependent manner in vitro.

Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer.Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015.The 80% isodose line covered 95% of the planning target volume,and the 100% isodose line covered 100% of the internal gross tumor volume.The fractional dose was 4.0-18.0 Gy daily or every other day,and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy).Results All patients completed treatment.The follow-up rate was 96.0%.The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group,versus 25%(19/77) and 38%(29/77) for the metastasis group.The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%,respectively.The median follow-up was 14.9 months.The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group,versus 92% and 73% for the metastasis group.The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group,versus 85% and 62% for the metastasis group.Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis,resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.

BACKGROUND:Platelet lysate has been known as a kind of lysate of autologous or alogeneic platelet-rich products. It not only removes the residual cel structure, reduces immunogenicity, but also retains many growth factors. Platelet lysate has been suggested as a substitute for fetal bovine serum to expand mesenchymal stem cels in vitro. OBJECTIVE:To observe the effects of platelet lysate on biological characteristics of human bone marrow mesenchymal stem cels and adipose mesenchymal stem cels, and provide some experimental data for clinical cel therapy and regenerative medicine. METHODS:Platelet lysate was prepared by repeated freezing and thawing from fresh blood. Healthy adult bone marrow and adipose tissue were colected. Human bone marrow mesenchymal stem cels and adipose mesenchymal stem cels were obtained by density gradient centrifugation and type I colagenase digestion. We tested the morphology, cel phenotype, differentiation characteristics, proliferation capacity, colony forming ability and the level of cytokine secretion of bone marrow mesenchymal stem cels and adipose mesenchymal stem cels after cultured with platelet lysis. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cels and adipose mesenchymal stem cels were successfuly cultured in vitro using platelet lysate. There were no significant differences in morphology, cel phenotype, colony forming ability and the level of cytokine secretion, and chondrogenic, osteogenic and adipogenic capacities between bone marrow mesenchymal stem cels and adipose mesenchymal stem cels. Adipose mesenchymal stem cels had a high cumulative population doublings than bone marrow mesenchymal stem cels (P < 0.05). These findings suggest adipose mesenchymal stem cels had a stronger proliferative ability, and are more suitable for large-scale expansionin vitro cultivation system of platelet lysate compared with bone marrow mesenchymal stem cels.

Objective:To describe the current situation in the nursing practice and their turnover intention in township health centers, and to analyze the changing potential influence in the nursing practice scope and workloads on their intention to leave those health centers. Methods:By means of a questionnaire, we conducted a survey on 167 nurses and interviewed 44 of them, all from 45 township hospitals within three provinces in China. Results:Since the healthcare system reform, the nursing workload in the township health centers significantly increased. 62% of the re-spondents considered their workload as heavy. Typically, the nursing work accounted for about 60% and the public health service work accounted for only 21% of the working hours. About 30% of the respondents were intended to leave their current job. The participating public health service was associated with intention to leave the job after con-trolling the province, workload, marital status, formal position, educational level and length of nursing service (P<0. 05). Conclusions:Since the healthcare system reform, the nursing practice scope in township health centers has been expanded and the workload increased considerably. But so far, expanding the scope of the nursing work may have potentials in reducing the intention of nurses to leave their current positions.

Objective:To analyze the job preference of doctors at township health center ( THC) and provide references for formulating effective policy. Methods:238 cases of doctors were sampled from Shandong, Anhui and Shaanxi provinces. Using a discrete choice experiment, we analyzed the data with a conditional logit model. Results:The most important job attribution was salary, followed by education for children, permanent post, work location, training opportunity, and years before promotion. The OR value of the monthly income of 8 000 yuan is 7. 0 compared to 2 000 yuan. Doctors will pay 3 857 yuan and 3 294 yuan respectively for better education for children and perma-nent posts. Monthly income increasing to 8 000 yuan will reduce the quitting rate from 35% to 8%, and providing better education for children and permanent posts will reduce 5%. The permanent posts at township health center and non-permanent posts in county hospital have the same appeal to the doctor. Conclusion:When choosing a job, doc-tors at THCs valued salary the most. Improving the education level for children can be beneficial for attracting and re-taining doctors at THCs. A permanent post is more attractive to doctors than non-permanent posts at THCs.

Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.