Objective:To investigate the changes of thyroid hormones and the flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyrotoxicosis before and after treatment with methimazole.Methods:A case-control study was conducted to select 45 cases of Graves' disease and 45 cases of Hashimoto's thyroiditis from October 2021 to December 2022 in the Department of Endocrinology, North China University of Science and Technology Affiliated Hospital. The changes of thyroid hormone and blood flow velocity of superior thyroid artery in patients with Graves' disease and Hashimoto's thyroiditis before and after treatment with methimazole were analyzed. Measurement data satisfying normal distribution were expressed by xˉ±s, and the mean between two groups was compared by t test. Measurement data not satisfying normal distribution were expressed by M( Q1, Q3), and the median between two groups was compared by Wilcoxon rank sum test. χ 2 test was used to compare the constituent ratio of enumeration data among groups. Results:There was no significant difference in thyroid stimulating hormone (TSH) between the two groups before treatment, and there was no significant difference in TSH between the two groups after 1 month and 3 months of treatment (all P>0.05). The levels of free triiodothyronine (FT3) were (24.09±9.29) pmol/L and (17.41±9.36) pmol/L in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. FT4 were (60.23±20.82) and (43.47±21.71) pmol/L, respectively, and the peak stolie vloiy (PSV) were (69.53±5.70) and (52.65±4.64) cm/s, respectively in Graves' disease group and Hashimoto's thyroiditis group respectively before treatment. There were significant differences between the two groups ( t values wrere 3.39 and 3.74, Z=13.83, all P<0.001). The difference of FT3 between one month after treatment and before treatment was (-6.36±5.32) and (-12.64±9.08) pmol/L ( t=4.02, P<0.001) and the difference in FT3 between 3 months of treatment and before treatment was (-10.14±9.50) and (-17.80±11.17) pmol/L, respectively ( t=3.51, P<0.001) between the Graves disease group and the Hashimoto's thyroiditis group. The difference in FT4 between the Graves disease group and the Hashimoto's thyroiditis group after 1 month of treatment and before treatment was (-28.47±10.09) and (-20.57±14.48) pmol/L ( t=7.01, P<0.001), and the difference of FT4 was (-47.06±20.57) and (-30.17±20.54) pmol/L ( t=3.91, P<0.001) between the Graves disease group and the Hashimoto toxin group. The difference between one month after treatment and before treatment was (-13.10(-34.10,-2.60)) and (-10.50(-27.5,-0.20)) cm/s ( Z=2.63, P=0.009), respectively. The difference between 3 months and before treatment was (-31.40(-53.20,-12.70)) and (-19.90(-46.00,-4.70)cm/s ( Z=4.40, P<0.001)) between the Graves disease group and the Hashimoto's thyroiditis group, and the difference was statistically significant. Conclusion:Thyroid hormone levels were decreased after treatment with methimazole in patients with diffuse toxic goiter and Hashimoto toxemia, but the difference was not statistically significant. The PSV level of superior thyroid artery in patients with diffuse toxic goiter was significantly lower than that in patients with Hashimoto's thyrotoxicosis.

Objective To investigate the effect of esketamine on postoperative anxiety and cognitive function in gynecological malignant tumor patients with preoperative anxiety and cognitive decline.Methods Eighty-nine patients were selected for resection of gynecological malignant tumors,aged 18-64 years,BMI 18-28 kg/m2,ASA physical status Ⅱ or Ⅲ,the hospital anxiety and depression scale(HADS)anxiety subscale score≥8 points and montreal cognitive rating scale(MoCA)＜26 points 1 day before surgery.The patients were divided into two groups using the random number table method:the esket-amine group(group S,n = 45)and the normal saline group(group C,n = 44).In group S,esketamine 0.2 mg/kg was injected intravenously during anesthesia induction,0.25 mg·kg-1·h-1 was injected by pump during anesthesia maintenance,and esketamine 100 mg was used in the postoperative analgesic pump.Group C was given the same volume of normal saline during anesthesia induction,maintenance and PCIA analgesia,and other medications were the same as those in group S.HADS and MoCA were used to evaluate patients'anxiety and cognitive function 1 day before surgery and the 1 day and 3 days after surgery.The con-centration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),S100 calcium-binding protein(S100β),and brain-derived neurotrophic factor(BDNF)were detected 1 day before surgery and 3 days af-ter surgery.The intraoperative dosage of remifentanil,ephedrine use rate,Ramsay sedation score 10 minutes after admission to PACU,extubation time,the number of total and effective compressions of PCIA within 48 hours after surgery,postoperative remedial analgesia,and the occurrence of adverse reactions,such as hy-pertension,hypotension,nausea and vomiting,chill,dizziness,and fever within 48 hours after surgerywere recorded.Results Compared with group C,the incidence of anxiety were significantly reduced and MoCA cognitive score were increased 1 day and 3 days after surgery,the concentrations of TNF-α,IL-6,and S100β were significantly reduced,the concentration of BDNF was significantly increased,the dosage of remifentanil was significantly reduced,the sedation score of Ramsay was significantly increased,the number of total compressions and effective compressions of PCIA within 48 hours after surgery was significantly re-duced,and postoperative fever was significantly reduced in group S(P＜0.05).There were no statistically significant differences in ephedrine use rate,extubation time,postoperative remedial analgesia rate,the in-cidence of other adverse reactions,such as hypertension,hypotension,nausea and vomiting,chills and diz-ziness within 48 hours after surgery between the two groups.Conclusion Esketamine can decrease the con-centrations of inflammatory factors and reduce nerve damage,help relieve anxiety and cognitive function of patients with gynecological malignant tumors.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To study the inner ear appearance on three-dimensional real inversion recovery(3D re-al IR)imaging in patients with sudden sensorineural hearing loss,and to investigate the relationship between blood-labyrinth barrier permeability and pathogenesis and prognosis of sudden hearing loss.Methods A total of 41 pa-tients with sudden sensorineural hearing loss received 3D real IR at 3.0 T MRI,and the signal intensity of inner ear were recorded.We respectively measured cochlear signal intensity in affected and healthy ears,and medullary signal intensity,and calculated the cochlear/medulla ratio(CM ratio)separately.On the basis of CM ratio,we evaluated hearing levels at initial and after treatment,and the relationship between CM ratio and hearing prognosis.Results Among the 41 patients,33 cases(occupying 80.48％)individually had a higher CM ratio in the affected ear than in the healthy one.The CM ratio of the affected side was not higher than that of the healthy side in 8 cases,and the ef-fective rate was 100％,eighteen cases had below 1.5 times the CM ratio in affected ears as in healthy ears,with 77.78％effective rate of treatment;seven cases had 1.5 to 1.75 times,with 100％effective rate;two cases had 1.75 to 2 times,with 50％effective rate;and the rest 14 cases had over 2 times,with 14.28％effective rate(P＜0.05).Conclusion The variation of blood-labyrinth barrier permeability in patients with sudden hearing loss can be read on the 3D Real IR,and it indicates that 80.48％patients have higher-intensity signals in lateral cochlea.The CM ratio can be adopted to evaluate the extent of inner ear damage of patients more accurately.As the CM ratio ri-ses,patients'prognosis become worse,and patients with over 1.75 times the CM ratio in the affected ear as in the healthy one,mostly suffer poor prognosis.

Objective To investigate the relationship between the therapeutic effect of anti-vascular endothelial growth factor(VEGF)and cytokines in aqueous humor in patients with diabetic retinopathy(DR).Methods From July 2023 to December 2023,50 DR patients(56 eyes)who were treated with anti-VEGF drugs in the Department of Ophthal-mology,the Third Affiliated Hospital of Xinxiang Medical University were included in this study.The patients were divided into the diabetic macular edema(DME)group(30 patients,36 eyes)and the proliferative DR(PDR)group(20 patients,20 eyes).Patients in the DME group received an intravitreal injection of aflibercept once a month for three consecutive times,with aqueous humor extracted before each injection.Patients in the PDR group received an intravitreal injection of aflibercept one week before vitrectomy,with aqueous humor extracted before injection and during vitrectomy,respective-ly.The concentrations of vascular endothelial growth factor A(VEGF-A),placental growth factor(PLGF),interleukin(IL)-1β,IL-23,IL-17A,and tumor necrosis factor-α(TNF-α)in the aqueous humor were detected using the Luminex as-say.Before injection therapy,all patients underwent best corrected visual acuity(BCVA)and central macular thickness(CMT)examinations,and their correlations with cytokine concentrations in DR patients before injection therapy were ana-lyzed.Results Compared to before injection therapy,the concentrations of VEGF-A,PLGF,and IL-23 in the aqueous humor of patients in the DME group decreased significantly after treatment(all P＜0.05);additionally,the CMT de-creased,and the BCVA increased(both P＜0.05).After injection therapy,the concentrations of VEGF,PLGF,IL-1β,IL-23,IL-17A,and TNF-α in the aqueous humor of patients in the PDR group significantly decreased compared to before injec-tion therapy(all P＜0.05).Before injection therapy,the levels of VEGF-A,PLGF,and IL-23 in the aqueous humor of pa-tients in the DME group were higher than those in the PDR group,and the differences were statistically significant(all P＜0.05).The correlation analysis results showed that before injection therapy,VEGF was negatively correlated with BCVA(r=-0.767,P=0.004)and was positively correlated with CMT(r=0.662,P=0.019)and IL-23(r=0.765,P=0.004)in the DME group.There was no correlation between the cytokines in the aqueous humor of patients in the PDR group be-fore injection therapy(all P＞0.05).Conclusion Changes in the concentration of VEGF-A,PLGF,and IL-23 are closely related to the occurrence and development of DR.Anti-VEGF treatment can improve BCVA and decrease CMT in DME pa-tients.The expression level of IL-23 in aqueous humor can serve as a predictive factor for the anti-VEGF efficacy in DR pa-tients,providing new targets for early diagnosis and treatment of DR.

Objective:To explore the effect of multiple communication skills in patients with anxiety disorders.Methods:Using convenient sampling method, 96 patients with anxiety disorders in the Third People's Hospital of Fuyang from September 2018 to September 2021 were selected as the research object. The patients were divided into the control group and the observation group by random number table method, 48 cases in each group. The control group was given routine psychological intervention, and the observation group received multiple communication skills. The scores of Hamilton Anxiety Scale (HAMA) , Self-rating Scale of Systemic Family Dynamics (SSFD) and Quality of Life Index (QL-Index) were compared between the two groups before and after the intervention.Results:Before intervention, there were no significant differences in HAMA, SSFD and QL-Index scores between the two groups ( P>0.05) . After intervention, the HAMA dimension scores in the observation group were lower than those in the control group, and the QL-Index scores and SSFD scores in each dimension were higher than those in the control group, with statistical differences ( P<0.05) . Conclusions:Multiple communication skills can help improve the anxiety of patients with anxiety disorders, and improve the family motivation and quality of life of patients.

Objective:In this paper, based on the 4D dose distribution of the treatment plan, the effects of respiratory movement on the dose distribution of three-dimensional conformal radiation therapy (3DCRT) and sliding window intensity-modulated radiation therapy (SW-IMRT) techniques were analyzed, and the dose errors caused by respiratory movement based on the 4D dose distribution were evaluated.Methods:In this study, the dynamic thoracic phantom (CIRS-008A) was used to simulate the patient with a 3 cm spherical insert as the tumor. Four motion patterns were simulated with cos 4( x) and sin ( x) wave forms of 10 mm and 5 mm amplitudes. The 4DCT scans with the phantom were performed in different breathing modes, and the maximum intensity projection (MIP), average intensity projection (AIP) and 10 separate 4DCT phase images were transferred to the Eclipse treatment planning system. The targets were contoured on MIP, with corresponding 3DCRT and SW-IMRT plans designed and dose calculated on AIP. By copying the plan designed on the AIP to each phase image of the 4DCT set, the MATLAB software package was employed to register and superimpose all the phase-specific doses onto one of the reference phase to create a 4D-accumulated dose distribution. Both films (EBT2) and optically stimulated luminescence (OSLD) detectors were inserted in and around the target area of the phantom to measure the delivered doses. The calculated 4D-accumulated doses were compared to the measured doses and their differences were evaluated using Gamma analysis. Results:Under different respiration modes, the average Gamma index (3%/3 mm) passing rates between the 4D-accumulated doses and EBT2-measured doses for 3DCRT and SW-IMRT plans were (98.8±0.78)% and (96.4±1.89)%, respectively. The absolute measurements of OSLDs both inside and outside of the target area well matched the 4D-accumulated doses.Conclusions:4DCT can be effectively applied to evaluate the treatment plan dose distribution through 4D dose accumulation, which can potentially avoid cold spots and target under-coverage. Under different respiration modes, both 3DCRT and SW-IMRT plans provide dose measurements consistent with those predicted by the 4D-accumulated dose of treatment plan.

Objective:To analyze the research status and research hot spots of pressure injury (PI) in the nursing field and provide ideas and reference basis for development of pressure injury research in China.Methods:Based on Web of Science database, literatures related to pressure injury published in the nursing field from establishment of databases to December 31, 2019 were searched. CiteSpace software was used to visualize the literature data of its country, research institutions, high-frequency keywords, etc.Results:A total of 927 English literatures were included. Research on PI in the nursing field began in 1999, and the overall trend was increasing since 2004. In 2016, the number of articles published was the largest, reaching 102. The hot spots of pressure injury in the nursing field were mainly the prevention, prevalence, risk factors, nursing, risk assessment and evaluation of PI. The research frontier of pressure injury in the nursing field mainly focused on the risk assessment of pressure injury, nurses' knowledge and attitudes towards pressure injury and so on.Conclusions:CiteSpace software can visually display the hot spots and trends of pressure injury in nursing field. The research frontier of pressure injury in nursing field in this study can provide references and directions for scientific research and clinical practice in pressure injury in nursing field in China.

Objective: To validate the high-expression of G2 and S phase-expressed protein 1 (GTSE1) gene expression in primary liver cancer tissues and cell lines, and further to study the effect of GTSE1 gene silencing on the apoptosis of liver cancer cells. Methods: The expression matrix data of 4 individual clinical studies on primary liver cancer from Gene Expression Omnibus (GEO) database were analyzed using R software, and the differentially expressed genes between liver cancer and adjacent tissues were screened. The high expression of GTSE 1, one of the up-regulated genes, was validated in 3 cases of liver cancer tissues and 3 stains of liver cancer cell lines by Western blotting. Hep-G2 and Bel-7402 cells were transfected with the specific siRNA targeting GTSE 1 gene, then the effects of GSTE1 gene expression down-regulation on the proliferation, apoptosis and 5-fluorouracil (5-FU) sensitivity of liver cancer cells were measured by CCK-8 and FCM, respectively. Furthermore, the content and sub-cellular localization of p53 as well as the expression alteration of Bcl-2 family members were detected by Western blotting. Results: 51 up-regulated and 146 down-regulated genes were found in all 4 studies. Among them, the up-regulation of GTSE1 gene expression was further verified in 3 clinical liver cancer tissue samples and 3 liver cancer cell lines Hep-G2, Bel-7402 and SMMC-7721 (all P < 0.001). The silencing efficiency of GTSE1 gene in Hep-G2 and Bel-7402 cells transfected with the specific siRNA was more than 70%. After the down-regulation of GTSE1 expression, the proliferation of Hep-G2 and Bel-7402 cells was significantly inhibited in a time-dependent manner (all P < 0.05), the cell cycle was arrested in G1 phase, the apoptotic rate was significantly increased, and the cell sensitivity to 5-FU was significantly enhanced (all P < 0.01). In GTSE1 expression down-regulated Hep-G2 and Bel-7402 cells, the levels of total p53 and phosphorylated p53 were up-regulated (all P < 0.05), and the nuclear portion of p53 was increased (both P < 0.01); while the expression levels of Bcl-2 family pro-apoptotic members Bak and Bax were significantly raised, and the anti-apoptotic member Bcl-2 expression were reduced (all P < 0.05), respectively. Conclusion: The down-regulation of GTSE1 expression promotes the apoptosis of liver cancer cells by activating p53 pathway, and enhances the response to anti-tumor drugs.

Objective To investigate the value of DWI in the evaluation of the therapeutic effect of cyber knife in the treatment of hepatocellular carcinoma.Methods Ninety patients who were clinically diagnosed with hepatocellular carcinoma (95 lesions) in the 5th Medical Center of General Hospital of PLA from February 2011 to December 2013 were retrospectively analyzed. All 90 patients underwent pre‐treatment dynamic contrast‐enhanced MRI scans of liver. Fourty six of them underwent liver MRI scan 3 months after treatment with cyber knife, and 49 patients underwent liver MRI scans 6 months after treatment. According to the evaluation criteria of solid tumor effect, complete necrosis tumor lesions and postoperative residual active lesions were determined. The ADC values of residual active tissue lesion, necrosis lesion in tumor and normal liver were measured. Paired sample t test was used to compare the difference of ADC values of tumor necrosis lesions and normal liver tissues between 3 and 6 months after treatment and before treatment, and ROC was used to evaluate the efficacy of ADC values in predicting complete tissue necrosis after treatment. Results In the 95 lesions, 91 lesions were completely necrotic, and active tissues were found in 4 lesions after treatment. There were statistically significant differences in the ADC values of the lesions at 3 and 6 months after treatment and before treatment (P<0.05),and the ADC values of the tissues after treatment were higher than those before treatment. There was no statistically significant difference in ADC values between 3 and 6 months after treatment and before treatment in normal liver tissue (P>0.05). The area under the ROC of using ADC value to predict the complete necrosis after treatment with cyber knife was 0.767, and the ADC value was 1.23×10‐3 mm2/s as the diagnostic cutoff value. The sensitivity and specificity of the diagnosis were 76.5% and 70.6%, respectively. Conclusion ADC values can distinguish the necrotic component from the active component of hepatocellular carcinoma after treatment, and can be used to evaluate the therapeutic effect of cyber knife in hepatocellular carcinoma.