OBJECTIVE To investigate the intervention effect and potential mechanism of breviscapine on hepatic fibrosis （HF） in rats based on the transforming growth factor-β（1 TGF-β1）/Smad2/extracellular signal-regulated protein kinase 1（ERK1） and Kelch-like epichlorohydrin-associated protein 1（Keap1）/nuclear factor-erythroid 2-related factor 2（Nrf2）/heme oxygenase-1（HO-1） pathways. METHODS Totally 60 rats were randomly divided into normal control group， model group， breviscapine low-dose， medium-dose and high-dose groups （5.4， 10.8， 21.6 mg/kg）， and colchicine group （positive control， 0.45 mg/kg）， with 10 rats in each group， half male and half female. Except for the normal control group， HF model of the other groups was induced by carbon tetrachloride. Subsequently， each drug group was given corresponding medicine by gavage once a day for 28 days. The liver appearance of rats in each group was observed and their liver coefficients were calculated. The levels of alanineaminotransferase （ALT） and aspartate aminotransferase （AST）in serum， those of ALT， AST， superoxide dismutase （SOD），malondialdehyde （MDA） and glutathione peroxidase （GSH- Px） in liver tissue were detected. The liver tissue inflammatory and fibrotic changes were observed. The protein and mRNA expressions of TGF-β1， Smad2， ERK1， Nrf2， Keap1 and HO-in liver tissue were detected. RESULTS Compared with the normal control group， the model group showed large areas of white nodular lesions in the liver， obvious inflammatory cell infiltration and collagen fiber deposition. The body weight， the levels of SOD and GSH-Px in liver tissue， the protein and mRNA expressions of Nrf2 and HO-1 were significantly lowered in the model group （P＜0.05）； the liver coefficient， the percentage of Masson staining positive area， ALT and AST levels of serum and liver tissue， MDA level of liver tissue， the protein and mRNA expressions of TGF-β1， Smad2， ERK1 and Keap1 were significantly increased （P＜0.05）. Compared with the model group， the liver lesions of rats in each drug group were improved， and the above quantitative indexes were generally reversed （P＜0.05）. CONCLUSIONS Breviscapine has a good intervention effect on HF rats， which may be related to inhibiting TGF-β1/Smad2/ERK1 pathway for anti-fibrosis and regulating Keap1/Nrf2/HO-1 pathway to inhibit oxidative stress.

Authenticity verification is a very important aspect of medical device registration quality management system verification of medical device. How to verify the authenticity of samples is a problem worth discussing. This study analyzes the methods of authenticity verification from the aspects of product retention sample, registration inspection report, traceability of records, hardware facilities and equipment. In order to provide reference for relevant supervisors and inspectors in the verification of registration quality management system.

Objective:To investigate the clinical manifestations and related risk factors of patients with Pseudomonas aeruginosa (PAE) bloodstream infection, and to provide references for clinical diagnosis and treatment of PAE bloodstream infection after combining with bacterial resistance condition. Methods:The clinical data and biological data of all patients with PAE bloodstream infection who received treatment in the Third Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 were analyzed retrospectively. The independent influential factors of PAE bloodstream infection were analyzed using binary logistic regression. Results:Eighty-three patients had PAE bloodstream infection. Among them, 71 patients were included in the final analysis. Among the 71 patients, 36 patients (50.70%) had carbapenem-resistant Pseudomonas aeruginosa ( CRPA). Univariate analysis showed that the history of hospitalization within 90 days ( χ2 = 3.90, P = 0.048), indwelling catheterization ( χ2 = 5.08, P = 0.024), septic shock ( χ2 = 4.00, P = 0.046), mechanical ventilation ( χ2= 12.35, P < 0.001), deep venous catheter ( χ2 = 4.08, P = 0.043), acute physiology and chronic health evaluation score II ≥ 10 points ( χ2 = 4.06, P = 0.044), and multi-drug resistance ( χ2 = 11.75, P = 0.001) were the suspicious influential factors of CRPA bloodstream infection. Multivariate logistic regression analysis showed that mechanical ventilation was an independent risk factor for CRPA bloodstream infection ( OR = 7.43, 95% CI 1.182-46.674, P = 0.032). Multi-drug resistance was an independent risk factor for CRPA bloodstream infection ( OR = 5.842, 95% CI 1.520-22.450, P = 0.010). Conclusion:Mechanical ventilation and multi-drug resistance are the independent influential factors of CRPA bloodstream infection. Invasive operations such as mechanical ventilation should be avoided in the clinic.

Objective:To evaluate the relationship between preoperative widespread pain and chronic post-surgical pain (CPSP) following total knee arthroplasty (TKA) in the patients with knee osteoarthritis.Methods:Two hundred American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients with knee osteoarthritis, aged 40-70 yr, undergoing elective the first unilateral primary TKA under general anesthesia, were enrolled.The widespread pain index, visual analogue scale score, Hospital Anxiety and Depression Scale and Central Sensitization Inventory scores were recorded at 1 day before surgery.The patients were divided into CPSP-positive group and CPSP-negative group according to visual analogue scale score at 6 months after surgery.Risk factors for CPSP were analyzed by logistic regression.Results:The results of logistic regression analysis showed that increased preoperative widespread pain index score, Central Sensitization Inventory score and Hospital Anxiety and Depression Scale score and female were risk factors for CPSP after TKA.Conclusions:Preoperative widespread pain is a risk factor for CPSP following TKA in the patients with knee osteoarthritis.

Objective:To evaluate the value of mechanical ventilation combined with ultrasound in evaluating the volume reactivity of patients with septic shock.Methods:A prospective study was performed, and 59 patients with septic shock who were admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to February 2018 were included according to the established inclusion and exclusion criteria. First, end-expiratory block test (EEO) and end-inhalation block test (EIO) were performed, followed by volume expansion test (VE) (intravenous infusion of 250 mL saline for 10 min), with cardiac index (CI) change value after VE (ΔCI)≥15% for volume-responsive group (37 cases), ΔCI<15% for volume-free group (22 cases), Vigileo-FloTrac system was used to continuously monitor EEO, EIO, and VE before and after changes in hemodynamic parameters, such as central venous pressure (CVP), mean arterial pressure (MAP), stroke volume variation (SVV), CI, and improved inferior vena cava diameter (IVCD) and respiratory variability index (RVI). The values of predicted capacity reactivity such as changes in CVP, MAP, SVV, CI, and RVI before and after EIO were evaluated, and the relationship between EEO, EIO, and capacity reactivity was analyzed by ROC curve.Results:There was no significant difference between MAP and CI in the response group and non-response group after EEO, EIO and VE intervention ( P>0.05). EEO-ΔSVV, EEO-ΔRVI, EEO-ΔCVP, EIO-ΔSVV and EIO-ΔRVI were compared between the reaction group and the non-reaction group, and the difference was statistically significant ( P<0.05); In the correlation analysis, EEO-ΔRVI and EIO-ΔRVI were correlated with VE-ΔRVI ( r=0.695, P<0.01; r=-0.489, P<0.01); EEO-ΔCVP and VE-ΔCVP were correlated ( r=0.566, P<0.01); EEO-ΔSVV, EIO-ΔSVV are related to VE-ΔSVV ( r=0.842, P<0.01; r= -0.727, P<0.01), and the ROC curve showed ( AUCEEO-ΔSVV=0.890, 95% CI: 0.792-0.988), showed AUCEEO-ΔSVV> AUCEEO-ΔRVI> AUCEIO-ΔSVV> AUCEIO-ΔRVI> AUCEEO-ΔCVP. Conclusions:EEO and EIO combined with ultrasound have certain clinical value in the evaluation of volume responsiveness in patients with septic shock, and the evaluation value of SVV and RVI is superior to CVP, MAP, and CI.

Objective To investigate the CT spectral imaging features of benign and malignant ovarian tumors and to assess the value of spectral CT in differentiating between benign and malignant ovarian tumors.Methods This study was granted by the institutional review board with a waiver for informed consent.34 patients with ovarian tumor(11 benign tumors and 23 malignant tumors)underwent preoperative CT scanning that included arterial phase (AP)and venous phase (VP)with GSI mode.Measurements were performed on the GSI viewer.The iodine concentration (IC,100 ug/cm3)was saved,and the normalized iodine concentration (NIC)and the spectral curve(spectral Hounsfield unit curve)were recorded.The slope of the curve was calculated as the formula:(CT attenuation (40 keV)-CT attenuation(100 keV))/60.The CT value was measured at 70 keV in Mono image.CT values,the slope of the spectral curve,the iodine concentration and NIC were compared between the two groups by using independent sample t-test with software SPSS 2 1.0.Receiver operating characteristic (ROC)was used to determine the threshold of slope of the spectral curve,the iodine concentration and NIC for differentiating benign and malignant ovarian tumors in VP.Results The slope of the spectral curve,the iodine concentration and NIC of malignant ovarian tumors in VP were 1.72±0.77,14.50±6.44 (100 μg/cm3),and 0.33±0.12.The slope of the spectral curve,the iodine concentration and NIC of benign ovarian tumors in VP were 1.05±0.48,8.86±4.04 (100 μg/cm3),and 0.22±0.13.Significant differences were found between the slope of spectral curve,the iodine concentration and NIC of the malignant ovarian tumors and those of the benign ovarian tumors in VP (P=0.01).CT values in double phases revealed no difference between these two groups (P>0.05).Conclusion There is a significant difference between the solid component of benign ovarian tumors and that of malignant ovarian tumors in spectral CT.GSI scan mode can provide more information for the differential diagnosis of benign and malignant ovarian tumors.

Objective To study the effect of masked hypertension (MH) and white coat hypertension (WCH) on vascular elasticity and endothelial function in elderly patients.Methods Four hundred and eighty-seven elderly patients who underwent physical examination in our our hospital were divided into normotension group (n=128),WCH group (n=115),MH group (n=112) and hypertension group (n=132) according to their diagnostic office blood pressure and 24 h ambulatory blood pressure.The brachial artery FMD,serum NO and endothelin-1 (ET-1) levels,and cfPWV were measured.Results The FMD and serum NO level were significantly lower while the serum ET-1 level and cfPWV were significantly higher in WCH group,MH group and hypertension group than in normotension group (P＜0.05).The FMD and serum NO level were significantly higher while the serum ET-1 and cfPWV were significantly lower in WCH group and MH group than in hypertension group (P＜ 0.05).Multivariate linear stepwise regression analysis showed that WCH,MH and hypertension were the independent influencing factors for FMD,serum NO and ET-1 level and cfPWV with normotension used as reference after adjustment of confounding factors (P＜0.01).Conclusion MH and WCH are the risk factors for the decreased vascular elasticity and endothelial dysfunction in elderly patients.

Objective To study the effect of empty-nest (EN) on the variability of HBPV in elderly hypertensive patients.Methods 457 elderly essential hypertensive patients admitted to our hospi tal were divided into non EN group (A group,n =183),EN couple group (B group,n =150),and EN single group (C group,n=124).They underwent 7-day HBPV,their BPV was detected,their loneliness and depressive symptoms were assessed according to the UCLA-LS and GDS.Results The variability of self-measured DPB and SBP,UCLA-LS and GDS score were significantly higher in B and C groups than in A group (P＜0.05).The variability of SBP,UCLA-LS and GDS score were significantly higher in C group than in B group (46.06±7.98 vs 38.95±8.11;7.67±2.58 vs 6.48±2.60,P＜0.05).Partial correlation analysis showed that the variability of SBP and DBP was positively related with the UCLA-LS and GDS score (P＜0.05).The variability of SBP was significantly higher in B and C groups than in A group after adjustment of confounding factors (P=0.000).Conclusion EN,an independent influencing factor for the variability of blood pressure in elderly hypertensive patients,is related with their loneliness and depression.

Objective To study the association between morning surge (MS) of systolic blood pressure (SBP) and white matter lesions in elderly essential hypertensive (EH) patients.Methods Three hundred and thirty-seven elderly EH patients from Zhangqiu of Shandong Province were divided into MS group (n=150) and non-MS group (n=187).Their 24 h ambulatory SBP was monitored.Their white matter hyperintensity (WMH) was assessed according to their brain MRI.Results The total WMH,periventricular WMH,and deep WMH were significantly higher in MS group than in non-MS group (P＜0.01).The MS of SBP was positively related with the total WMH,periventricular WMH,and deep WMH (r=0.561,r=0.563,r=0.283,P＜0.01),and was an independent risk factor for total WMH,periventricular WMH,and deep WMH after adjustment for confunders (r=0.479,r=0.486,r=0.208,P＜0.01).Conclusion MS of SBP is an independently risk factor for WMH in elderly EH patients.

Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia(HGIN)and early gastric cancer(EGC)after endoscopic submucosal dissection (ESD). Methods The clinical and follow-up data on 444 patients(451 lesion)with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized, and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up, and the recurrence rate was 3.2%(13 patients, 13 lesions), with mean recurrence time of 17.6±9.6 months(6-38 months). Univariate and multivariate analysis revealed that the size of the lesion>4.0 cm was the only risk factor of recurrence(P=0.012,OR=10.855,95%CI:1.673~70.442). Conclusion The rate of recurrence is increasing with the EGC extending, therefore, postoperative monitoring should be strengthened to patients with larger lesion.