ObjectiveTo observe the analgesic efficacy and safety of Qihuang acupuncture theory combined with opioid analgesics in patients with moderate to severe cancer pain due to lung cancer. MethodsPatients with moderate to severe cancer pain from lung cancer were randomly divided into Qihuang acupuncture group and control group， with 33 cases in each group. The control group was treated with long-acting opioid analgesics at maintenance doses and supplementary analgesic medications as needed. In case of breakthrough pain， short-acting opioids were used for rescue. The Qihuang acupuncture group received Qihuang acupuncture treatment in addition to the treatment used in the control group， administered once every other day， with 3 sessions constituting one treatment course. The treatment duration for both groups was 5 days. The primary outcome was the change in pain intensity， measured using the numerical rating scale （NRS） before and after treatment， and the NRS change rate was calculated. Secondary endpoints included the daily NRS change rate， the Eastern Cooperative Oncology Group （ECOG） Performance Status （PS） score， the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire （EORTC QLQ-C30） score， and the 24-hour equivalent hydrocodone sustained-release tablet dose. Laboratory tests， including routine blood， urine， stool， liver function， and kidney function， were performed before and after treatment. Adverse events were recorded throughout the trial. ResultsAll patients completed the trial， and both groups showed a decrease in average NRS scores and PS scores after treatment， with the Qihuang acupuncture group showing lower average NRS scores and PS scores than the control group （P＜0.05 or P＜0.01）. After treatment， the NRS change rate in the Qihuang acupuncture group was （0.42±0.17）， significantly higher than that in the control group （0.14±0.27， P＜0.01）. The daily NRS change rate during treatment was also higher in the Qihuang acupuncture group compared to the control group （P＜0.01）. The Qihuang acupuncture group showed an increase in overall health status and functional scores in the EORTC QLQ-C30， and a decrease in symptom scores for fatigue， nausea and vomiting， pain， dyspnea， insomnia， appetite loss， constipation， and financial difficulties. In contrast， overall health status and constipation scores in the control group increased， while scores of fatigue， nausea and vomiting， pain， and appetite loss decreased （P＜0.05 or P＜0.01）. After treatment， the 24-hour equivalent hydrocodone sustained-release tablet dose did not show significant difference in the Qihuang acupuncture group （P＞0.05）， while the control group showed a significant increase in the 24-hour dose （P＜0.01）. No significant abnormalities were observed in laboratory tests before and after treatment in either group. During the study， the incidence of nausea and vomiting as well as constipation in the Qihuang acupuncture group was both 3.03% （1/33）， while the incidence in the control group was 27.27% （9/33） and 36.36% （12/33）， respectively， with the Qihuang acupuncture group showing significantly lower incidence （P＜0.01）. No serious adverse reactions were observed in either group. ConclusionQihuang acupuncture therapy combined with opioid analgesics is more effective than using opioids alone in relieving pain in patients with moderate to severe cancer pain due to lung cancer. It can improve the patients' physical condition and quality of life， reduce the dose of opioid analgesics， and has good safety.

Purpose To investigate the value of a radiomics model based on dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of granulomatous mastitis and breast cancer.Materials and Methods The MRI data of 82 patients with granulomatous mastitis or breast cancer confirmed by pathology in Xiyuan Hospital of China Academy of Chinese Medical Sciences from February 2019 to January 2022 were retrospectively collected.Based on the first phase of DCE-MRI,the regions of interest(ROI)were delineated layer by layer by semi-automatic segmentation method and manual segmentation method,respectively.99 ROI were randomly assigned to 69 in training groups and 30 in test groups.The consistency difference between the two methods was compared.The original data extracted by the semi-automatic segmentation method were screened by correlation analysis and multi-factor Logistic regression.Six kinds of classifiers(Logistic regression,support vector machine,naive Bayes,decision tree,random forest,K nearest neighbor)were used to construct prediction models,and the differences in diagnostic efficiency,accuracy,sensitivity and specificity of each model were evaluated.Results A total of 99 lesions(n=37 cases with granulomatous mastitis and n=62 cases with breast cancer)were segmented from 82 patients.The radiomics data extracted by the two ROI segmentation methods had poor consistency between groups[Intraclass correlation coefficient=0.68(0.51,0.78)].Among the six prediction models constructed from the data extracted by the semi-automatic segmentation method,the diagnostic performance of the Logistic regression model and the support vector machine model was significantly better than those of other models,and the Logistic regression model had the best diagnostic performance and stability(training group:area under the curve 0.928,accuracy rate 0.855,sensitivity 0.837,specificity 0.885;test group:area under the curve 0.933,accuracy 0.833,sensitivity 0.895,specificity 0.727,respectively).Conclusion Radiomics based on DCE-MRI can provide high value for the differential diagnosis of granulomatous mastitis and breast cancer.The semi-automatic segmentation method is more recommended for the segmentation method of ROI.The prediction model constructed by Logistic regression and support vector machine shows better diagnostic efficiency and stability.

【Objective】 To analyze the value of plasmin-α2-plasmin inhibitor complex (PIC) and thrombin-antithrombin complex (TAT) for risk stratification of massive transfusion (MT) in patients with postpartum hemorrhage (PPH). 【Methods】 Clinical data and blood samples of patients with PPH in our hospital from January 2019 to December 2022 were retrospectively analyzed. MT (MT group, n=60) was defined as transfusion of red blood cells≥10 U within 24 h after delivery, and <10 U was defined as non-MT group (n=190). Plasma PIC and TAT levels were detected by chemiluminescence immunoassay at the onset of PPH. 【Results】 Compared with non-MT group, PPH patients in MT group had higher TAT [2.20 (1.20, 3.00) ng/mL vs 4.00 (2.20, 6.30) ng/mL, Z=-5.464, P<0.001] and PIC [0.99 (0.82, 1.13) μg/mL vs 1.11 (1.05, 1.55) μg/mL, Z=-7.228, P<0.001] level. The analysis of receiver operator characteristic curve showed that the area under the curve required for MT after TAT and PIC combined to predict PPH was 0.820 (95% CI: 0.756-0.886), and the positive likelihood ratio was 4.76 and the negative likelihood ratio was 0.35, which was significantly better than the two predictions alone. Multivariate logistics regression analysis showed that TAT level>3.25 ng/mL and PIC level>1.04 μg/mL were independent risk factors for MT after PPH. 【Conclusion】 Elevated TAT and PIC levels are independent predictors of MT in patients with PPH, and their combined predictive efficacy is better.

Objective:To screen the interaction proteins of WW domain containing protein 1 (WWP1), and explore the effects of WWP1 and etoposide induced 24 (EI24) on cell proliferation in hepatocellular carcinoma (HCC).Methods:Yeast two-hybrid screening system was used to identify the interaction proteins of WWP1. The interaction was further validated by co-immunoprecipitation. WWP1 and EI24 stably over-expressing or deleted HepG2 cells were established by using the lentivirus transduction method. Colony forming assay and cell counting kit-8 (CCK8) assay were performed to identify the effects of WWP1 and EI24 on cell proliferation. In addition, the role of WWP1 in the tumorigenicity of liver cancer in vivo was examined by subcutaneous injection of different level of WWP1 expressed HepG2 into nude mice. Results:WWP1 can interact with EI24 and ubiquitin-degrade EI24 protein. The WWP1 and EI24 over-expressing or deleted HepG2 cell lines were successfully generated. Overexpression of WWP1 decreased while knockdown of WWP1 increased the protein level of EI24. The results of CCK-8 assay showed that the relative proliferation activities of WWP1 overexpressed (WWP1-OE) group and WWP1 knockdown (shWWP1) group on 36 hours were (347.00±8.15)% and (187.08±4.86)%, respectively, significantly different from (270.33±15.01)% of control group (both P<0.05). The relative proliferation activities of EI24 overexpressed (EI24-OE) group and EI24 knockdown (shEI24) group on 36 hours were (183.75±8.11)% and (317.33±9.60)%, respectively, significantly different from (270.33±15.01) % of control group (both P<0.05). The results of colony formation assay showed that the colony numbers of control group, WWP1-OE group and shWWP1 group were (52±7)/visual field (VF), (76±4)/VF, (19±3)/VF, respectively. Overexpression of WWP1 significantly increased while knockdown of WWP1 significantly decreased the colon formation ability of HepG2 cells (both P<0.05). The colon number of control group, EI24-OE group and shEI24 group were (38±4)/VF, (10±3)/VF, (69±7)/VF, respectively. Overexpression of EI24 significantly decreased while knockdown of EI24 significantly increased the colony formation ability of HepG2 cells (both P<0.05). The results of xenograft mice model showed that the tumor volumes of control, WWP1-OE, and shWWP1 group were (1 400.00±43.71)mm 3, (2 636.67±290.45) mm 3 and (642.17±36.00)mm 3, respectively, with significant differences ( P<0.05). The tumor weight for these three groups were (1.23±0.08)g, (2.05±0.17)g, and (0.88±0.09)g, respectively, with significant differences ( P<0.05). The tumor volumes of control, EI24-OE, and shEI24 group were (1 245.17±93.10)mm 3, (662.17±60.88)mm 3 and (1 986.67±226.75)mm 3 respectively, with significant differences ( P<0.05). The tumor weight for these three groups were (1.15±0.04)g, (0.85±0.02)g and (1.73±0.05)g respectively, with significant difference ( P<0.05). Conclusion:WWP1 promote the cell proliferation of liver cancer through ubiquitin-degradation of EI24.

Objective:To screen the interaction proteins of WW domain containing protein 1 (WWP1), and explore the effects of WWP1 and etoposide induced 24 (EI24) on cell proliferation in hepatocellular carcinoma (HCC).Methods:Yeast two-hybrid screening system was used to identify the interaction proteins of WWP1. The interaction was further validated by co-immunoprecipitation. WWP1 and EI24 stably over-expressing or deleted HepG2 cells were established by using the lentivirus transduction method. Colony forming assay and cell counting kit-8 (CCK8) assay were performed to identify the effects of WWP1 and EI24 on cell proliferation. In addition, the role of WWP1 in the tumorigenicity of liver cancer in vivo was examined by subcutaneous injection of different level of WWP1 expressed HepG2 into nude mice. Results:WWP1 can interact with EI24 and ubiquitin-degrade EI24 protein. The WWP1 and EI24 over-expressing or deleted HepG2 cell lines were successfully generated. Overexpression of WWP1 decreased while knockdown of WWP1 increased the protein level of EI24. The results of CCK-8 assay showed that the relative proliferation activities of WWP1 overexpressed (WWP1-OE) group and WWP1 knockdown (shWWP1) group on 36 hours were (347.00±8.15)% and (187.08±4.86)%, respectively, significantly different from (270.33±15.01)% of control group (both P<0.05). The relative proliferation activities of EI24 overexpressed (EI24-OE) group and EI24 knockdown (shEI24) group on 36 hours were (183.75±8.11)% and (317.33±9.60)%, respectively, significantly different from (270.33±15.01) % of control group (both P<0.05). The results of colony formation assay showed that the colony numbers of control group, WWP1-OE group and shWWP1 group were (52±7)/visual field (VF), (76±4)/VF, (19±3)/VF, respectively. Overexpression of WWP1 significantly increased while knockdown of WWP1 significantly decreased the colon formation ability of HepG2 cells (both P<0.05). The colon number of control group, EI24-OE group and shEI24 group were (38±4)/VF, (10±3)/VF, (69±7)/VF, respectively. Overexpression of EI24 significantly decreased while knockdown of EI24 significantly increased the colony formation ability of HepG2 cells (both P<0.05). The results of xenograft mice model showed that the tumor volumes of control, WWP1-OE, and shWWP1 group were (1 400.00±43.71)mm 3, (2 636.67±290.45) mm 3 and (642.17±36.00)mm 3, respectively, with significant differences ( P<0.05). The tumor weight for these three groups were (1.23±0.08)g, (2.05±0.17)g, and (0.88±0.09)g, respectively, with significant differences ( P<0.05). The tumor volumes of control, EI24-OE, and shEI24 group were (1 245.17±93.10)mm 3, (662.17±60.88)mm 3 and (1 986.67±226.75)mm 3 respectively, with significant differences ( P<0.05). The tumor weight for these three groups were (1.15±0.04)g, (0.85±0.02)g and (1.73±0.05)g respectively, with significant difference ( P<0.05). Conclusion:WWP1 promote the cell proliferation of liver cancer through ubiquitin-degradation of EI24.

ObjectiveTo explore the characteristics of nasal bone fracture caused by blunt instrument, including the fracture types, the fracture repair, and the difference of manifestations between X-ray and CT. To provide reference for the identification.MethodsThe information of basic situation, fracture site, injury manner, diagnosis method, expert opinion of 95 adult nasal fracture cases caused by blunt object, which occurred in Gutian county of Fujian province from January 1999 to December 2013, were ana-lyzed by descriptive statistics. The identification conclusions of different injuries were compared accord-ing to new and old standards as well.ResultsThere were total 95 adults including 87 male and 8 fe-male. The fracture site and quantity have significant correlation with the nasal bone anatomical relations and the direction and size of the force. Compound fracture was most common. The fracture that could not be determined by X-ray could be clearly diagnosed by CT examination. According to new and old standards, different fracture types have different identification conclusions.ConclusionThere are gender differences in nasal bone fracture cases. Larger external force is easy to cause compound fracture. CT examination is significantly better than X-ray examination.

Objective T o investigate the m ain point of long backbone fracture caused by blunt force in forensic clinical identification and to provide a reference for the inspection and appraisal practices of such injury. Methods N inety-nine cases of adult long backbone fractures were collected from January 2006 to D ecem ber 2013 in G utian C ounty of Fujian Province. A ccording to the term s of fracture loca-tion, m ode of injury, type, the data were sum m arized. Results In the 99 cases, there were 36 cases caused by hitting, kicking, and falling and 63 cases caused by vehicle collision. T he m ajority of the for-m er was ulna, and those of the latter were tibia and fibula. T he types of fracture were transverse one, short oblique one, long oblique one, and spiral one. Conclusion D ifferent types of long backbone frac-ture, not only causing stress load of fractures as well as structural differences related to each segm ent.

Objectives To detect the expression of human leukocyte antigen-G (HLA-G) in tissues from pregnant women with preeclampsia and discuss the relationship between HLA-G and preeclampsia.Methods Pregnant women with preeclampsia in Maternal and Child Health Hospital of Shaanxi Province from March 2009 to December 2009 were included.Eight were included into mild preeclampsia groups and 22 were included into severe preeclampsia group.And 30 age-matched normal pregnancies were referred as the control group.All women in the three groups received cesarean section.The soluble HLA-G (sHLA-G)levels in peripheral blood,umbilical blood and amniotic fluid were examined by ELISA ; the expressions of HLA-G protein in placenta,fetal membrane and umbilical cord were examined by western blot.Results ( 1 ) The sHLA-G levels in peripheral blood,umbilical blood and amniotic fluid in each group.The sHLA-G levels in peripheral blood in mild and severe preeclampsia group were (50 + 14) and (30+6) μg/L respectively,and the sHLA-G levels in umbilical blood were (34 ± 10) and (26 ±8)μg/L respectively.All were significantly lower than those in the control group ( P ＜ 0.01 ),which were (100 ± 16) and (70±9) μg/L respectively.There was also statistical difference between mild and severe preeclampsia group (P ＜0.01 ).Although the sHLA-G level in umbilical blood of severe preeclampsia group was lower than that in mild preeclampsia group,there was no statistical difference ( P＞0.05 ).The sHLA-G levels in amniotic fluid in mild and severe preeclampsia groups were (26±7 ) and (25 ± 5 ) μg/L respectively,which were lower than that in the control group (27±6) μg/L,but the differences were not significant ( P＞0.05 ).There was no statistical difference between mild and severe preeclampsia groups ( P＞0.05 ).(2) The expression levels of HLA-G protein in placenta,fetal membrane and umbilical cord in each group.The expression levels of HLA-G in placenta and fetal membrane in the control group were 1.59 ± 0.36 and 0.42 ± 0.09 respectively.The expression of HLA-G in placenta was significantly higher than that in fetal membrane ( P＜0.05 ).The expression level of HLA-G in umbilical cord in the control group was 0.24±0.17,statistically different from those in placenta and fetal membrane,respectively (P＜0.01 ).The expression levels of HLA-G in placenta in mild and severe preeclampsia groups were 0.78 + 0.21 and 0.29 ± 0.17 respectively,significantly different from the control group ( P ＜ 0.01 ).There was no expression of HLA-G in fetal membrane and umbilical cord in mild and severe preeclampsia groups.Conclusions The expressions of HLA-G in the peripheral blood,umbilical blood and placenta in women with preeclampsia are significantly lower than those in normal pregnant women.The abnormal expression of HLA-G might be associated with the pathogenesis of preeclampsia.

Objective To evaluate the accuracy of Intraoperative Iso-C3D navigation guiding cervical pedicle screw fixation. Methods Twenty-two cases adopted cervical pedicle screw fixation of cervical spine, including 9 cervical spine fractures, 4 cervical tumors, 6 cervical destabilizing, 3 cervical syndrome. The cervical pedicle screw position were assessed with post-operative CT by grade. Results One hundred and twelve screws were fixed in 22 cases successfully. Grade: 107 in A grade (95.5%); 3 in B grade: 1 in C grade; 1 in D grade. There were not any complication. Conclusion Intraoperative Iso-C3D navigation can improve precision of cervical petiole screw fixation distinctively.

Objective To evaluate the accuracy of 3D-CT navigation in guiding pedicle screw fixation in the thoracic spine.Methods Thoracic pedicle screw placement guided by 3D-CT navigation was performed on 24 cases,including 14 patients with thoracic spine fractures,6 thoracic tumors,and 4 scoliosis.CT data was input into the navigation system,and point-matching test was chosen.The optimal position,diameter,and length of the screw were set up using navigation stick after true-up.Then,the screw was placed dynamically in a stereo way according to navigation plan.After the operation,the position of the pedicle screw was assessed with CT using the Rampersaud grading system.Results Under the guidance of 3D-CT navigation,a total of 144 screws were successfully fixed into the 24 patients.According to the Rampersaud grading system,136 of the screws were at grade A(94.4%),6 at grade B,1 grade C,and 1 grade D.No postoperative injury of the nerve or spinal cord was observed.Of the patients,22 were followed up for a mean of 8 months(range,6-14 months).During the follow-up,no loose or breakage of the screw was detected by X-ray and CT.No delayed spinal cord injury was found.Conclusions The thoracic pedicle screw placement can be accurately guided by 3D-CT navigation.