Objective:To investigate the correlation of illness uncertainty with anxiety and depression in perioperative patients with early gastric cancer.Methods:A cross-sectional survey was conducted among 107 patients with early gastric cancer who were admitted in Department of Gastroenterology of a Class A tertiary hospital in Beijing from April 2020 to August 2021. The demographic data questionnaire was used for survey, and the psychological status of patients was evaluated with Mishel′s Uncertainties in Illness Scales (MUIS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Spearman correlation analysis was used to explore the correlation of disease uncertainty with anxiety and depression in patients with early gastric cancer.Results:The illness uncertainty in patients with early gastric cancer was at a moderate level (93.2±14.0). The total scores on the SAS and SDS were (46.5±9.7) and (47.7±10.2), respectively. And the incidence rate of anxiety and depression was 34.6% (37/107) and 31.8% (34/107) respectively. The illness uncertainty of patients with early gastric cancer was positively correlated with anxiety and depression ( r=0.40,0.31,all P<0.05). Conclusion:Some patients with early gastric cancer have illness uncertainty, anxiety and depression, and the illness uncertainty is related to anxiety and depression.

Objective:To compare the diagnostic efficacy and ability of Thyroid Imaging Reporting Data System version (TI-RADS) of American College of Radiology (ACR) and artificial intelligence(AI) TI-RADS in diagnosis of thyroid nodules.Methods:A retrospective analysis was done on 266 patients(276 nodules) proved by ultrasound-guided fine-needle aspiration cytology (US-FNAC) in General Hospital of Eastern Theater Command from January to December 2019. The ROC curve of the two TI-RADS versions was drawn and the area under the curve (AUC) was calculated and compared.Results:AUCs of ACR TI-RADS and AI TI-RADS were 0.747 and 0.853. The sensitivity, specificity, positive predictive value and negative predictive value (96.62%, 62.50%, 74.87%, 94.12%) of AI TI-RADS were higher than ACR TI-RADS (95.27%, 44.53%, 66.51%, 89.06%). AI TI-RADS was able to avoid more unnecessary FNAC (71.74%) than ACR TI-RADS (67.03%).Conclusions:Both ACR TI-RADS and AI TI-RADS have good performances for differential diagnosis of thyroid nodules. AI TI-RADS is a more simple scoring system with better overall diagnostic performance and ability to exclude unnecessary FNAC with high negative predictive value than ACR TI-RADS.

A patient was pregnant four months after the percutaneous coronary intervention, and the ultrasound indicated a complete placenta previa and a placenta percreta. Concerned about radiation and drugs exposure on the fetus, the patient chose to terminate the pregnancy. After multidisciplinary consultation, tirofiban was used for antithrombotic therapy in substitution for dual antiplatelet drugs, and an abdominal aortic balloon was inserted preoperatively. The placenta that penetrated the serous membrane and uterine wall at laparotomy was resected, and the uterus was reconstructed. Prophylactic antibiotics, anticoagulation, and transitional antiplatelet therapy with tirofiban were given after the operation. The patient was discharged on day six postoperatively.

Objective To compare the effects of intensive blood pressure (BP) lowering and guideline-recommended standard BP lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke. Methods This is a randomised controlled trial consisting of 118 consecutive patients who came from Department of Neurology, Nanjing First Hospital from July 2012 to April 2016, accepting intravenous recombinant tissue plasminogen activator thrombolysis with the systolic blood pressure (SBP) being 150-185 mmHg(1 mmHg=0.133 kPa). The patients with ischemic stroke were diagnosed by multi-mode MRI and confirmed to have ischemic penumbra. The SBP of patients randomly assigned to intensive BP lowering group and guideline BP lowering group was maintained in 140-150 mmHg or below 180 mmHg respectively for 72 h and all patients needed to reexamine multi-mode MRI at 24 h. The primary endpoints were the neurologic function at early stage, modified Rankin Scale (mRS) score and the mortality at 90 d;the secondary endpoints were the volume of infarction and hypoperfusion area, the rate of reperfusion, hemorrhagic transformation (HT) and syptomatic intracerebral hemorrhage (sICH). Results Forty-nine cases in intensive BP lowering group and 56 cases in guideline BP lowering group acquired the available images. The volume of infarction was increased both in these two groups, and there was no statistically significant difference in the increased values ((13.21±9.51) cm3 vs (12.95±9.68) cm3). There were no statistically significant differences in the volume of hypoperfusion, reperfusion rate, neurologic function at early stage, the mRS scores and mortality at 90 d, the incidence of sICH except the rate of HT (9.4%, 5/53 vs 23.1%, 15/65, χ2=3.860, P=0.049) between the two groups.Conclusion Early intensive BP-lowering treatment has no adverse effects on the transformation of ischemic penumbra and prognosis after intravenous thrombolysis in patients with acute ischemic stroke and may decrease the the rate of HT in some degree.

Objective To explore the qualitative evaluation of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant thyroid nodules (TNs).Methods Totally 110 outpatients with 132 TNs underwent CEUS were enrolled in this study in Jinling Hospitall Medical School of Nanjing University (Nanjing General Hospital of Nanjing Military).Nanjing General Hospital of Nanjing Military All the nodules underwent ultrasound guided fine needle aspiration biopsy (FNAB).113 TNs were histologically diagnosed,the characteristics of enhancement for each noudle were scored.The characteristicsof enhancement between benign and malignant TNs were compared by chi-square test.The receiver operating characteristic (ROC) curve analysis were conducted to determine the diagnostic values of thyroid CEUS.Results Contrast-enhanced patterns were significantly different between benign and malignant TNs in the degree,homogeneity of enhancement,enhanced ring and boundary,shape and size of the enhanced lesions (x2=23.85,P ＜ 0.001;x2=7.43,P=0.04;x2=34.54,P ＜ 0.001;x2=25.7,P ＜ 0.001;x2=53.10,P ＜ 0.001;x2=22.78,P ＜ 0.001;x2=30.90,P ＜ 0.001).Contrast-enhanced patterns were not significantly different between benign and malignant TNs in the process and completeness of enhancement.Malignant lesions had concentric (79.5％),inhomogeneous (89.0％) and low (71.1％) enhanced with irregular (79.5％) and unclear (64.4％) boundary and bigger size (63.0％).The typical CEUS feature of benign nodules was peripheral ring hyperenhancement (34.7％).According to ROC curve,the cut off value was 3.5 points.The area under the ROC curve (AUC) for CEUS was 0.862 (95％CI:0.797-0.927).The sensitivity,specificity and accuracy for CEUS were 80.8％,79.6％,80.3％ respectively.Conclusion The pattem of CEUS may assist in differential diagnosis of benign and malignant TNs.

Objective To evaluate the value of circular anastomotic stapler for sigmoid colostomy in laparoscopy abdominoperi-neal resection .Methods 62 patients of low colorectal cancer treated in our hospital from October 2010 to February 2013 was retro-spectively analyzed .All the patients were treated by laparoscopy abdominoperineal resection ,34 patients received sigmoid colostomy with circular anastomotic stapler(group A) ,and the other 28 patients received sigmoid colostomy with conventional suturing tech-niques(group B) .The medical records including operation time ,the time of return of bowl function ,postoperative hospital stay and postoperative complication rate were analysed statistically .Results All patients received the operations successfully .No conversion to open procedure and no operative death occured in two groups .The result of statistical analysis showed that in group A ,the opera-tion time ,the time of return of bowl function ,postoperative hospital stay time were shorter than group B ,and the rate of edema of sigmoid in group A were lower than group B(P<0 .05) .Conclusion The application of circular anastomotic stapler for sigmoid co-lostomy in LAPR is a safe ,effective and minimally invasive technique ,which can shorten operation time ,postoperative hospital stay and reduce the related complications of colostomy .

BACKGROUNDInfancy is a critical period of growth and physiological development, in which breast milk is the best source of nutrients. Compared to western countries, research on breast milk of Chinese population are limited. Thus, it is necessary to measure breast milk energy and macronutrient concentrations of healthy urban Chinese mothers at different lactation stages, to expand the database of milk composition of Chinese population, and to examine whether dietary or other maternal factors can affect the levels of macronutrients in breast milk.

METHODSBreast milk of full expression of one side breast from 436 urban Chinese lactating mothers at 5-11 days, 12-30 days, 31-60 days, 61-120 days, and 121-240 days postpartum was obtained at 9:00 a.m. to 11:00 a.m. Total energy, lactose, protein, and fat contents were measured. 24-hour dietary recall was surveyed, and maternal nutrient intakes were analyzed.

RESULTSMilk composition changed over the course of lactation and large individual variations were documented. The concentrations were 61.3 kcal/dl for total energy, 7.1 g/dl for lactose, 0.9 g/dl for protein, and 3.4 g/dl for fat in mature milk. Stage of lactation was a strong factor affecting milk composition. Minimal evidence was found for associations between maternal current dietary intake and milk macronutrient concentration, consistently with prior research. Maternal body mass index (BMI) was positively associated with milk fat content, to a greater extent than did dietary intake. All other maternal characteristics were not significant for milk composition.

CONCLUSIONThese findings suggest that milk composition is generally weakly associated with maternal factors except for stage of lactation, and is likely to be more susceptible to long-term maternal nutritional status than short-term dietary fluctuation.

Adolescent ; Adult ; Body Mass Index ; Female ; Humans ; Lactation ; physiology ; Middle Aged ; Milk, Human ; chemistry ; Mothers ; Young Adult

Objective To establish a method to measure Angiotensin Converting Enzyme activity in serum by MECC. Method Mixture of serum and substrate Hip-His-Leu had been incubated for 120 min at 37℃, substrate Hip-His-Leu was digested into two parts, Hip and His-Leu. The reaction was ended by 0. 1 mmol/L HC1 , the production was analyzed by MECC directly to detecte content of Hip in production, and calculated ACE activity. Running buffer was 20 mmol/L pH 9. 0 boric acid-borate buffer (including SDS 50 mmol/L) , capillary column was 75?m i. d.?37 cm, injection was 3s by press, voltage was 16 kV, running time was 7. 5 min, detected by UV detector at 200 nm, tempreture was 20℃. Result The within-run and between-run CV was 2. 7% and 5. 2%. The detection limits of ACE activity was 0. 2 IU/L ( singal/noise = 3). The ACE activity and absorption was linearly related from 2. 4 to 72 IU/L. The mean value of ACE was 5. 2-21. 9 IU/L (x?1. 96 s) in 50 normals. Conclusion It was a one of rapid, precise methods for determination of ACE activity in serum.

OBJECTIVETo investigate the relationship of plasma homocysteine (Hcy) level to stroke and genetic factor to elevated plasma Hcy level.

METHODSThe plasma Hcy level was measured by capillary electrophoresis-ultraviolet detection and the gene polymorphism of N5,N10-methylenetetrahydrofolate reductase (MTHFR) was studied with PCR-RFLP assay in 43 patients with cortical cerebral infarction and 42 healthy control.

RESULTSThe plasma Hcy level of the patients (19.3 +/- 6.0 micromol/L) was markedly higher than that of the controls (13.7 +/- 5.4 micromol/L) (t = 4.16, P < 0.001). There are 3 genotypes, C/C, C/T and T/T, about base-variation of MTHFR gene at locus 677. The plasma Hcy level of the subjects with T/T genotype was higher than that of subjects with other genotypes. However, the frequencies of each genotype and allele were not significantly different between the patients and the controls.

CONCLUSIONSThe elevated plasma Hcy level is a risk factor for atherothrombotic cerebral infarction, and is related to the C-->T mutation at locus 677 of MTHFR gene.

Aged ; Cerebral Infarction ; blood ; genetics ; Female ; Gene Frequency ; Genotype ; Homocysteine ; blood ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; genetics ; Middle Aged ; Point Mutation ; Polymorphism, Genetic

Objective To investigate the association of the gene polymorphism of plasminogen activator inhibitor 1 (PAI 1) with the cerebral infarction and recurrent cerebral infarction (RCI). Methods The plasma PAI 1 activity, by means of chromgenic substrate assay, and the sequence polymorphisms of 4G/5G in promotor region and (CA)n dinucleotide repeats in the 4th intron of PAI 1 gene, by amplified fragment length polymorphism assay, were measured in 50 patients with first ever cerebral infarction (FCI), 45 patients with RCI and 60 healthy controls.Results The plasma PAI 1 activities in both FCI patients (1.13?1 1 AU/ml) and RCI (1.13?0.150 AU/ml) were remarkably higher than that in the controls (0.7?0.25 AU/ml) (both P