Objective:To evaluate the clinical efficacy and safety of endoscopic ultrasound (EUS)-guided coil implantation combined with glue injection for preventing rebleeding of tumorous gastric fundal varices.Methods:A retrospective analysis was performed on the clinical data of patients who underwent EUS-guided coil implantation combined with glue injection due to tumorous gastric fundal variceal bleeding from September 2017 to December 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The basic characteristics and endoscopic manifestations of patients treated with this technique were analyzed, and the success rate of this technique, the usage of tissue glue and coil, the variceal obliteration rate and the incidence of complications such as pulmonary embolism were analyzed. Patients were followed up over a long period of time to obtain data on rebleeding. At the same time, patients were divided into complete obliteration group and incomplete obliteration group according to the endoscopic performance after the treatment, and the rebleeding rate in the two groups was compared.Results:Among the 41 patients included in this study, 18 cases (43.90%) had single isolated gastric varices type 1, and 23 cases (56.10%) had gastroesophageal varices combined. Fourteen cases had signs of recent bleeding such as thrombi and ulcers under endoscopy, and 13 cases had combined portal hypertensive gastropathy. All patients successfully completed the operation of EUS-guided coil implantation combined with glue injection. The technical success rate for the first attempt was 92.68% (38/41). The one-time pre-installation success rate of coils was 95.12% (39/41). The success rate of target vessel aspiration under EUS guidance was 100.00% (41/41). The release success rate of coil was 97.56% (40/41). The number of coils used was 1.12±0.33, and the amount of tissue glue used after inserting the coils was 1.54±0.46 mL. The target vessel obliteration rate after operation was 97.56% (40/41), and the complete gastric fundal variceal obliteration rate was 51.22% (21/41). There were 2 cases (4.88%) of intraoperative bleeding, 1 case stopped spontaneously, and 1 case successfully stopped bleeding after additional injection of tissue glue under direct endoscopic vision. No patient had symptoms of pulmonary embolism such as decreased oxygen saturation during the operation. Postoperative computed tomography angiography of pulmonary artery or lung computed tomography was performed in 24 cases, of which 1 case (4.17%) showed distal pulmonary artery embolism, but there were no relevant clinical manifestations. The patients were followed up for 21.64±16.86 months (1-50 months) after the surgery. There were 13 cases (31.71%) of recurrent gastrointestinal bleeding after the surgery, no rebleeding within 5 days, 2 cases of rebleeding within 3 months, 5 cases from 3 to 12 months, and 6 cases more than 1 year. Among the 13 cases of recurrent bleeding after the surgery, the recurrence rate of bleeding after operation in the complete obliteration group was 23.81% (5/21), which was lower than that in the incomplete obliteration group with 40.00% (8/20), but there was no statistically significant difference ( χ2=1.240, P=0.265). Conclusion:EUS-guided coil implantation combined with glue injection has good secondary prevention value and safety for tumorous gastric fundal variceal bleeding, and is worthy of clinical promotion and application.

Objective:To explore the effect of Zhuyu Xiaozhong Decoction combined with warm acupuncture and moxibustion on rotator cuff injury of qi stagnation and blood stasis type.Methods:A total of 120 patients with rotator cuff injury of qi stagnation and blood stasis type treated at the First Hospital of Hunan University of Chinese Medicine from October 2021 to October 2023 were randomly divided into a control group ( n=60) and an observation group ( n=60) according to the random drawing method. The control group received routine treatment, while the observation group received Zhuyu Xiaozhong Decoction combined with warming acupuncture and moxibustion on this basis. Two groups of treatment effects were compared, including total effective rate, inflammation indicators, pain status, shoulder joint function and range of motion, and quality of life. Visual Analog Scale (VAS), Shoulder Joint Function Rating Scale (CMS), and Quality of Life Comprehensive Assessment Questionnaire (GQOLI-74) were used to evaluate patients′ pain status, shoulder joint function, and quality of life, respectively. Results:After treatment, the total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05); Before treatment, there was no statistically significant difference in the levels of serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) between the two groups (all P>0.05); After treatment, the levels of serum CRP, IL-6, and TNF-α in both groups were lower than before treatment, and the levels of serum CRP, IL-6, and TNF-α in the observation group were lower than those in the control group after treatment (all P<0.05). Before treatment, there was no statistically significant difference in VAS scores and GQOLI-74 total scores between the two groups (all P>0.05); After treatment, the VAS scores of both groups were lower than before treatment, and the total GQOLI-74 score was higher than before treatment. In addition, the VAS score of the observation group was lower than that of the control group after treatment, and the total GQOLI-74 score was higher than that of the control group, with statistical significance (all P<0.05). Before treatment, there was no statistically significant difference in CMS scores, abduction, flexion, and extension angles between the two groups (all P>0.05); After treatment, the CMS scores of both groups were higher than before treatment, and the angles of abduction, flexion, and extension were greater than before treatment. The CMS scores of the observation group were higher than those of the control group after treatment, and the angles of abduction, flexion, and extension were greater than those of the control group, with statistical significance (all P<0.05). Conclusions:Zhuyu Xiaozhong Decoction combined with warm acupuncture and moxibustion can achieve a better clinical effect in the treatment of rotator cuff injury of qi stagnation and blood stasis type, which can control the inflammatory reaction of the body, alleviate pain symptoms, improve shoulder joint function and mobility, and optimize the quality of life.

OBJECTIVE To extract and isolate the four chemical components of Yao medicine Ventilago leiocarpa， and to conduct identification and content determination for them. METHODS The chemical components of V. leiocarpa were separated and purified by solvent extraction， extraction， silica gel column chromatography and preparative liquid chromatography； then the chemical structures of four isolated compounds were identified based on their spectral data. The contents of four components were determined by high performance liquid chromatography（HPLC）-quantitative analysis of multi-components by single-marker （QAMS） method， with the following chromatographic conditions： chromatographic column was Echway GowonTM C18 （250 mm× 4.6 mm， 5 μm）. The mobile phase was acetonitrile-0.1% phosphoric acid for gradient elution； the detection wavelength was 269 nm， and the column temperature was 25 ℃ . Using emodin as internal reference， the relative correction factors （fi/s） between emodin and the other 3 components were established and used to calculate the content. At the same time， the content of each component was calculated with the external standard method （ESM）， and the differences between these two methods were compared. RESULTS Four compounds were isolated from V. leiocarpa， and they were identified as emodin， frangulin A， pleuropyrone A， emodin-8-O-β-D-glucoside. The result of HPLC-QAMS showed that the fi/s of pleuropyrone A， emodin-8-O-β-D- glucoside and frangulin A were 1.147 2， 0.874 7 and 0.644 4， respectively. The content of these four components was measured as a good linearity （r≥0.999 6）； relative standard deviation （RSD） of precision， stability and reproducibility tests were all lower than 2.00%， and average recoveries were E-mail：dearhuangjianyou@126.com 99.41%-100.46%（RSD≤2.05%）. There was no significant difference between QAMS method and ESM （RSD＜3.00%）. CONCLUSIONS Emodin， frangulin A， pleuropyrone A and emodin- 8-O-β-D-glucoside are isolated from V. leiocarpa； among them， the last three components are all isolated from for the first time. The established HPLC-QAMS method is accurate and reliable for the determination of 4 components in V. leiocarpa， and can used for quality control of V. leiocarpa.

Objective:To investigate the efficacy and value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy.Methods:A total of 150 older adult patients with liver cancer, who underwent laparoscopic hepatectomy at The 2 nd Affiliated Hospital of Wenzhou Medical University between July 2019 and April 2020, were randomly assigned to two groups: a control group ( n = 75) and an observation group ( n = 75) using the random number table method. The control group received postoperative analgesia with parecoxib sodium, while the observation group received preemptive analgesia with parecoxib sodium. A comparative analysis was conducted between the control and observation groups in terms of the Numerical Rating Scale (NRS) scores at 8, 12, and 24 hours postoperatively, postoperative recovery, length of hospital stay, and overall cost. Results:There were no statistically significant differences in operation time, dosage of Sufentanil 24 hours postoperatively, or the total and effective usage counts of patient-controlled intravenous analgesia with Sufentanil between the control and observation groups (both P > 0.05). However, the NRS scores of the observation group were significantly lower than those of the control group at 8, 12, and 24 hours postoperatively. Specifically, the NRS scores of the observation group were (4.38 ± 1.24) points, (3.41 ± 0.19) points, and (2.90 ± 0.17) points, respectively, while those of the control group were (5.24 ± 1.01) points, (4.65 ± 1.24) points, and (3.32 ± 1.00) points, respectively ( t = 4.66, 8.56, 3.59, all P < 0.001). Patients in the observation group exhibited significantly more frequent off-bed activities [(2.62 ± 1.24) times], a notably longer cumulative duration of off-bed activities [(1.36 ± 0.20) hours], and a significantly shorter duration of first anal exhaust [(13.50 ± 1.27) hours] compared with those in the control group [(1.06 ± 0.12) times, (0.36 ± 0.09) hours, (20.10 ± 2.16) hours, t = -10.84, -39.49, 22.81, all P < 0.001]. Furthermore, the observation group demonstrated a shorter postoperative hospital stay [(8.90 ± 1.34) days], lower hospitalization costs [(55.8 ± 2.1) thousand yuan], and higher patient satisfaction scores [(88.98 ± 5.64) points] compared with the control group [(11.15 ± 1.29) days, (59.4 ± 6.2) thousand yuan, (72.16 ± 3.26) points, t = 10.48, 4.76, -22.36, all P < 0.001]. Conclusion:The implementation of preemptive analgesia intervention among older adult patients undergoing laparoscopic hepatectomy effectively enhances analgesic outcomes, accelerates postoperative recovery, reduces hospitalization duration, and markedly decreases hospitalization costs.

Objective The tissue motion mitral annular displacement(TMAD)technique was used to evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and its correlation with myocardial damage was analyzed.Methods Sixty-nine cases of hyperthyroidism diagnosed in Affiliated Hospital of Youjiang Medical University for Nationalities from July 2021 to November 2022 were selected as the study objects.According to whether the patients were combined with hyperthyroidism heart disease,they were divided into simple hyperthyroidism group(n=43)and thyrotoxic heart group(n=26).35 healthy people who underwent physical examination in our hospital during the same period were selected as normal control group.Three-dimensional echocardiography was used to obtain the left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)and TMAD parameters.The differences of above parameters among all groups were compared,and the correlations of TMAD parameters with creatine kinase isoenzymes(CK-MB)and high-sensitivity cardiac troponin T(hs-cTnT)were analyzed.Results The LVEDV,LVESV,LVEF,TMAD parameters,CK-MB and hs-cTnT of three groups were statistically significant(P<0.001),and LVEDV,LVESV,CK-MB and hs-cTnT of normal control groupsimple hyperthyroidism group>thyrotoxic heart group.All parameters of TMAD were positively correlated with LVEF(P<0.001),and some parameters of TMAD were negatively correlated with CK-MB(P<0.05).Conclusion TMAD technology can early evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and is related to CK-MB and hs-cTnT.

Objective To explore the nutritional status and immune function of hospitalized patients with decompensated cirrhosis.Methods A total of 132 patients with decompensated cirrhosis who were hospi-talized in this hospital from January 2020 to June 2022 were selected.According to Nutritional Risk Screening 2002 (NRS2002) score,the patients were divided into the high-nutritional-risk group,the low-nutritional-risk group,and the non-nutritional-risk group.Comparative analysis was conducted on nutritional status indica-tors,cellular immune indicators,Child-Pugh classification of liver function,and complications among the three groups.Results BMI,TSF,AMC,Hb,ALB,PA,RBP and TG in the high-nutritional-risk group and low-nu-tritional-risk group were lower than those in the non-nutritional-risk group.BMI,TSF,and AMC in the low-nutritional-risk group were lower than those in the non-nutritional-risk group.ALB and TG in the high-nutri-tional-risk group were lower than those in the low-nutritional-risk group,with statistically significant differ-ences (P<0.05).The immune indexes IgG and IgA in the high-nutritional-risk group and the low-nutritional-risk group were higher than those in the non-nutritional-risk group,with statistically significant differences (P<0.05).The percentage of CD4+T cells and the ratio of CD4+T cells to CD8+T cells (CD4+T/CD8+T) in the high-nutritional-risk group and the low-nutritional-risk group were lower than those in the non-nutrition-al-risk group,with statistically significant differences (P<0.05).The NRS2002 score was negatively correla-ted with BMI,TSF,AMC,Hb,ALB,PA,RBP,TC,TG,CD4+T,CD4+T/CD8+T (P<0.05).It was positive-ly correlated with IgG,IgA,IgM (P<0.001).Multivariate stepwise regression analysis showed that there was a linear regression relationship between Hb,TSF,AMC,ALB,RBP,and NRS2002 score.Conclusion The nu-tritional status and immune function of patients with high nutritional risk decompensated cirrhosis are poor.It is necessary to carry out nutritional intervention in patients with high nutritional risk decompensated cirrhosis in time.

Objective:Peritoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer.This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging(GRASP DCE-MRI)to predict the presence of peritoneal free cancer cells in gastric cancer patients.Methods:All enrolled patients were consecutively divided into analysis and validation groups.Preoperative magnetic resonance imaging(MRI)scans and perfusion were performed in patients with gastric cancer undergoing surgery,and peritoneal lavage specimens were collected for examination.Based on the peritoneal lavage cytology(PLC)results,patients were divided into negative and positive lavage fluid groups.The data collected included clinical and MR information.A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid,and the validity of the model was verified based on data from the verification group.Results:There was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test.MR tumor stage,tumor thickness,and perfusion parameter Tofts-Ketty model volume transfer constant(Ktrans)were independent predictors of positive peritoneal lavage fluid.The nomogram model featured a concordance index(C-index)of 0.785 and 0.742 for the modeling and validation groups,respectively.Conclusions:GRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients.The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.

BACKGROUND: The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration. METHODS: This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities. RESULTS: A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation. CONCLUSIONS Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; East Asian People ; Hypokalemia/etiology* ; Kidney Failure, Chronic/mortality* ; Potassium/blood* ; Prospective Studies ; Renal Dialysis ; Serum Albumin/analysis*

Objective:To evaluate the current situation of prevention and control of iodine deficiency disorders (IDD), and to describe the iodine nutrition level of pregnant women in key population in Zhejiang Province.Methods:In 2021, a cross-sectional survey on iodine nutrition status of the population was conducted in all 90 counties (cities, districts) in Zhejiang Province. Each county (city, district) was divided into five districts: east, west, south, north, and central. One township (street) was selected from each district, and 20 pregnant women were selected from each township (street) to collect edible salt samples and one random urine sample for salt and urinary iodine testing. The above indicators were stratified and analyzed according to urban, rural, coastal, inland, early pregnancy, mid pregnancy, and late pregnancy.Results:A total of 9 679 pregnant women's salt samples were tested, with a salt iodine content of (20.2 ± 9.2) mg/kg, an iodized salt coverage rate of 84.2% (8 153/9 679), and a qualified iodized salt consumption rate of 80.4% (7 785/9 679). Among them, the qualified iodized salt consumption rate of pregnant women in coastal areas was 69.4% (3 175/4 575), significantly lower than that in inland areas [90.3% (4 610/5 104)]; and the proportion of non iodized salt consumption in coastal areas [25.8% (1 181/4 575)] was significantly higher than inland areas [6.8% (345/5 104)]. A total of 9 679 pregnant women's urine samples were tested, with a median urinary iodine of 133.0 μg/L ( < 150 μg/L). In urban areas, the median urinary iodine (129.8 μg/L) was lower than that in rural areas (135.0 μg/L). Likewise, the median urinary iodine was 126.0 μg/L, lower than inland areas (140.3 μg/L). And as pregnancy progressed, the iodine nutrition level of pregnant women gradually decreased (the median urinary iodine: 137.0 μg/L in early pregnancy, 134.1 μg/L in mid pregnancy, and 129.4 μg/L in late pregnancy).Conclusion:In 2021, pregnant women in Zhejiang Province are in a state of iodine deficiency, and there is a greater risk in urban areas compared to rural areas and coastal areas compared to inland areas.

Dracaena marginata is a widely cultivated horticultural plant in the world, which has high ornamental and medicinal value. In this study, the whole genome of leaves from D. marginata was sequenced by Illumina HiSeq 4000 platform. The chloroplast genome were assembled for functional annotation, sequence characteristics and phylogenetic analysis. The results showed that the chloroplast genome of D. marginata composed of four regions with a size of 154 926 bp, which was the smallest chloroplast genome reported for Dracaena species to date. A total of 132 genes were identified, including 86 coding genes, 38 tRNA genes and 8 rRNA genes. Codon bias analysis found that the codon usage bias was weak and there was a bias for using A/U base endings. 46 simple sequence repeat and 54 repeats loci were detected in the chloroplast genome, with the maximum detection rate in the large single copy region and inverted repeat region, respectively. The inverted repeats boundaries of D. marginata and Dracaena were highly conserved, whereas gene location differences occurred. Phylogenetic analysis revealed that D. serrulata and D. cinnabari form a monophyletic clade, which was the closest relationship and conformed to the morphological classification characteristics. The analysis of the chloroplast genome of D. marginata provides important data basis for species identification, genetic diversity and chloroplast genome engineering of Dracaena.
Phylogeny ; Dracaena ; Genome, Chloroplast/genetics* ; Base Sequence ; Genes, Plant