Objective:To develop a simple, practical and repeatable ultrasound method to locate the muscle at the trigger point of female myofascial pelvic pain(MPP), which can provide imaging reference for clinical precision treatment.Methods:A total of 113 patients with suspected MPP who came to the Women′s Hospital School of Medicine Zhejiang University from September 1, 2021 to April 20, 2023 were prospectively selected. The gynecologist performed internal examination with index finger on some pelvic floor muscles (puborectalis, pubococcygeus, iliococcygeus, coccygeus) and pelvic wall muscles (piriformis and obturator internus) respectively, searched for the muscles where the pain trigger point was located, and scored the pain by referring to visual analogue scale (VAS) and numerical rating scale (NRS), and then referred the patients to the ultrasound department. The ultrasound doctor used transvaginal ultrasound to display the above muscle groups in real time for observation and appropriate pressure. The muscle where the painful trigger point was located was found through tenderness and the pain score was performed. The two scores were compared for consistency and difference analysis.Results:The trigger point was clear and of good reproducibility. For the location and score of pain trigger points located in bilateral puborectalis, pubococcygeus and coccygeus, there was a strong consistency between the tenderness guided by vaginal ultrasound probe and clinical palpation (the consistency rate was ≥70%), and there was no significant difference in the pain scores of the trigger points located in the puborectalis muscle and coccygeal muscle between the two methods ( P>0.05), and there was statistically significant difference in the pain scores of the trigger points located in the other pelvic floor and pelvic wall muscles (all P<0.05). At the same time, ultrasonic examination made up for the deficiency of clinical palpation in the evaluation of piriformis muscle. Conclusions:The present method for finding the trigger point of MPP guided by the ultrasound probe is a new non-invasive, safe, simple and practical imaging method, which can provide a new imaging reference for the clinical diagnosis of MPP and the formulation of treatment strategies.

Objective To investigate the characteristics of phenylalanine hydroxylase (PAH) gene mutations in Han ethnic children with phenylketonuria of Xinjiang region.Methods The mutations in the promoter,exons 1-13 and flanking introns of PAH genes from 71 Han ethnic PKU children and their parents of Xinjiang region were detected by PCR,DNA sequencing and high-throughput targeted sequencing,and the obtained results were compared with those from other four provinces in northwest of China,Japan and Europe.Re suits A total of 37 kinds of mutations,including missense mutation,splice site mutation,nonsense mutation,deletion mutation and frameshift mutation,were detected in 90.1％ (128/142) of PAH alleles from 71 Han ethnic PKU children of Xinjiang region.Most mutations existed in exons 7,6,3,12,2 and 11 and intron 4 of PAH gene.The most common missense mutations were R243Q (21.8％) and R53H (7.7％).The most common splicing sites were EX6-96A ＞ G(6.3％),IVS4-1G ＞ A(4.9％) and V399V (4.2％).Moreover,The most common nonsense mutations were R111X(4.9％) and Y356X(4.9％).The detection rate of R53H mutation (7.7％) in Han ethnic PKU children of Xinjiang region was significantly higher than that in other 4 provinces of northwest of China,and a novel PAH gene nutation P225S(c.673C ＞ T) was found.Conclusion The mutation spectrum of PAH gene in Han ethnic PKU children of Xinjiang region is similar to that in other 4 provinces of northwest of China,but significantly different from that of Japanese and European population,which displays a distinct and conservative characteristic.

Objective To investigate the effects of a variety of different methods of analgesia on postoperative pain and cognitive function in elderly esophageal cancer patients.Methods Sixty elderly pa-tients scheduled for the left into the thoracic esophageal cancer surgery were randomly divided into two groups (n =30).Group A:Before the closure of thoracic cavity to block intercostal nerve with 0.375% rop-ivacaine,followed by intravenous pumps for analgesia,formulation of sufentanil 3 μg/kg+flurbiprofen 100 mg,pump speed 2 ml/h,self-controlled analgesia 0.5 ml/pressing,locking time 15 min.Group B:Before the closure of thoracic cavity given sufentanil 10 μg+flurbiprofen 50 mg as loading dose followed by epidural analgesia pump,recipe with group A.Two groups were observed mini mental state examination (MMSE) score 1 d before surgery and 3,5,7 d after surgery,each time point visual analogue pain score (resting and exercise VAS)score postoperative within 48 h,BCS comfort score and effective pressing times of postopera-tive analgesia pump.Results Compared with group B,the rest and exercise VAS scores of group A at post-operative recovery,4,8,12,24,48 h were significantly lower (P <0.05);the BCS scores of group A at postoperative 4,8,12,24,48 h were significantly higher (P <0.05);the pressing times of group A at postoperative 4,8,12,24,48 h were significantly reduced (P <0.05);the MMSE scores of group A at postoperative 3,5,7 d were significantly higher (P <0.05);the incidence of POCD of group A on postop-erative 3,5,7 d were significantly lower.Conclusion Thoracic surgery perioperative multimodal analgesia (intercostal nerve block and intravenous analgesia)can relieve postoperative pain,reduce the incidence of POCD,improve the postoperative patient comfort and help postoperative patients with rapid recovery.

Objective:To investigate the breakthrough points and methods of pharmaceutical care performed by clinical pharma-cists for chemotherapy-induced Ⅳ degree myelosuppression. Methods: One advanced lung adenocarcinoma patient suffering from IV degree myolosuppression after being treated with pemetrexed combined with nedaplatin was selected as the example, and the chemother-apy regimen, the cause and treatment of IV degree myolosuppression and the pharmaceutical service could be carried out were ana-lyzed. Results: With the help of clinical pharmacists, the patient conquered chemotherapy-induced myelosuppression, and clinical pharmacists enhanced the awareness of pharmaceutical care and played a positive role in the safe and effective drug use. Conclusion:The participation of clinical pharmacists in clinical pharmaceutical care through providing pharmaceutical service is beneficial to safer and more effective drug therapy.

Objective To investigate the relationship among urinary protein molecular weight of IgA nephropathy ,renal tubu‐lointerstitium damage and clinical index ,and discuss the role of low molecular weight urinary protein in the mechanism of IgA pro‐gression .Methods A total of 34 patients with biopsy proven IgAN were studied .We detect the molecular weight of urinary protein by SDS‐PAGE .Data were processed with the classes of tubulointerstitial lesions and laboratory tests such as 24h urinary protein quantitation and serum creatinine(Scr) .Results The urinary protein were divided into four types according the SDS‐PAGE:the ball urinary protein group ,physiologic urinary protein group ,23 × 103 proteinuria group and 10 × 103 proteinuria group .Scores of tubu‐lointerstitial lesions ,twenty four hour urine protein quantitation and Scr level were all significantly higher in 10 × 103 proteinuria group than 23 × 103 proteinuria group (P<0 .05) .Conclusion 10 × 103 proteinuria may have close relationship with the progression of IgAN ,and it may be a useful index for the degree of tubulointerstitial lesions of IgAN .

Objective To understand the role of increasing peripheral blood platelet count in the diagnosis and prognosis of patients with active pulmonary tuberculosis.Methods This analysis included 80 inpatients with active pulmonary tuberculosis evidenced by positive sputum smear,43 patients in recovery and 89 healthy controls during the period from January to June in 2012.Peripheral white blood cell,platelet count,and neutrophil percentage were assayed.Erythrocyte sedimentation rate (ESR)and serum C-reactive protein (CRP)were measured and compared.The data were analyzed by using SPSS 13.0 software.Results ESR and CRP values were significantly higher in the patients with active pulmonary tuberculosis than in the patients in recovery (P=0.006 5 and P=0.007 3,respectively).The peripheral blood platelet count exceeded normal range in 41.94% of the patients with active pulmonary tuberculosis,which was significantly higher than that in the patients in recovery (P=0.001 4)and controls (P=0.000 0).Platelet count was positively correlated with CPR (r=0.515,P<0.000 1)and ESR (r=0.398,P<0.001)value.However,peripheral white cell count and neutrophil count were not different from the corresponding values of controls.Conclusions Increasing peripheral platelet count may play a role in assessment of tuberculosis disease activity and the effect of anti-tuberculosis treatment.

Objective To evaluate the effects of pretreatment with different doses of phosphocreatine on hepatic ischemia-repeffusion (I/R) injury in rats.Methods.Thirty male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 5 groups (n =6 each):sham operation group (group S),hepatic I/R group (group I/R),and pretreatment with different doses of phosphocreatine groups (groups P1-3).Hepatic I/R was induced by 90 min occlusion of the hepatic artery and portal vein entering the middle and left lobes of the liver followed by 4 h reperfusion in anesthetized rats.Phosphocreatine 50,150 and 450 mg/kg were injected via the tail vein at 60 min before ischemia in groups P1-3,respectively.In groups S and I/R,the equal volume of normal saline was given instead.Blood samples were taken from the abdominal aorta at 4 h of reperfusion for determination of plasma alanine aminotransferase (ALT),aspartate aminotransferase (AST),TNF-α and IL-1β concentrations.The rats were then sacrificed and the livers were removed for determination of myeloperoxidase (MPO) activity (by ELISA),intercellular adhesion molecule-1 (ICAM-1) expression (by immunohistochemistry),and cell apoptosis (by TUNEL) and for microscopic examination (by electron microscopy).Results The MPO activity in liver tissues,plasma ALT and AST activities,TNF-α and IL-1β concentrations and the number of apoptotic cells were significantly higher in groups I/R and P1-3 than in group S,while lower in groups P1-3 than in group I/R (P ＜ 0.05).The parameters mentioned above were decreasedin turn in groups P1-3 (P ＜ 0.05).Conclusion Phosphocreatine pretreatment can attenuate the hepatic I/R injury in rats in a dose-dependent manner and inhibition of the inflammatory responses is involved in the mechanism.

Objective In contrast to conventional radiotherapy ,analyze the dosimetry and prognosis of 3D conformal radiothera-py in the treatment of gliomas with different pathological stages .Methods 97 patients with gliomas were selected ,and divided into two groups as conventional radiotherapy group (CR group) and 3D conformal radiotherapy group(3D group) .analyzed the influence of different radiotherapy to the gliomas in the same pathological stage .Compared the dosimetry differences between these two radio-therapies .Results There was no obvious differences in 3 year survival rate between CR group and 3D group at low grade gliomas . But 3D group had better 3 year survival rate than CR group at high grade gliomas .And 3D group had lower rate of relevant sequel after radiotherapy .3D group had higher conformal index (CI) and average dosage of radiation than CR group .Conclusion 3D radio-therapy has better dosimetry and conformal index than conventional radiotherapy ,especially has better prognosis in high grade glio-mas and lower rate of relevant sequel after radiotherapy .

Objective To study the T cells lineage polymorphism of TCR BV CDR3 in the peripheral blood of ankylosing spondylitis (AS) patients,in order to provide experimental basis for the immunological patho-genesis study of AS.Methods Twenty-six subfamilies of CDR3 T cells of TCR BV in the PBMC of AS patients were amplified by RT-PCR method,then TCR BV CDR3 lineages polymorphism were analyzed by immunization scanning spectrum.Results TCR BV CDR3 scanning spectrum of 20 active AS patients showed abnormal distribution peak,including monoclonal,oligoclonal/oligoclonal trend,skewing peak and irregular abnormal peak.Among them,some subfamilies of 18 patients showed oligoclonal/oligoclonal trend expansion,BV16 and BV18 two subfamilies of one case showed monoclonal expansion.Most spectral type of PBMC TCR BV CDR3 in five normal controls showed Gauss distribution.Conclusion TCR BV CDR3 lineage have significant characteristic polymorphism and spectrum drift characteristics in the peripheral blood of AS patients,which further indicate that T cells has plaied an important role in the immunological pathogenesis of AS.Monoclonal/oligoclonal expansion of T cells may be autoreactive T cells in nature and they may be involved in the pathogenesis of AS.

Commonly used tumor markers have poor sensitivity and specificity. A lot of research are being conducted searching for the ideal novel serum markers. There are a large number of tumor-associated autoantibodies in cancer patients's serum. Screening and detecting autoantibodies may be used in the early diagnosis of cancer.