Objective To investigate the prognostic value of plasma thrombomodulin(TM)in patients with septic shock.Methods A retrospective analysis was conducted on the clinical data of 180 patients with septic shock admitted to the intensive care unit of the 908th Hospital from May 2018 to November 2022.The patients were divided into survival group(106 cases)and death group(74 ca-ses)based on the 30-day follow-up outcomes.Propensity score matching(PSM)was used to match 57 surviving patients with 57 de-ceased patients in a 1∶1 ratio,based on confounding factors such as age,gender,underlying diseases,primary infection site,laborato-ry results and disease severity scores.TM and other coagulation molecular markers were compared between the two groups,and logistic regression,receiver operating characteristic(ROC)curve,survival and correlation analyses were performed.Results After PSM,the TM levels in the death group(18.3[13.2,22.3]TU/mL)were significantly higher than those in the survival group(13.7[9.0,18.3]TU/mL)(P＜0.05).Multivariate logistic regression analysis showed that TM was an independent risk factor for 30-day mortality in the patients with septic shock(OR=1.137,95％CI:1.023-1.262,P＜0.005).ROC curve analysis revealed that the areas under the curve(AUCs)for predicting 30-day mortality were 0.665,0.627 and 0.600 for TM,Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA)scores,respectively.Kaplan-Meier survival analysis stratified by the optimal TM cut-off value(17.9 TU/mL)showed that the 30-day survival rate of the TM＜17.9 TU/mL group was 1.56 times that of the TM≥17.9 TU/mL group(Log-Rank test,P＜0.000 1).Spearman correlation analysis demonstrated that TM levels were positively correlated with APACHE Ⅱ(r=0.10,P＜0.005)and SOFA scores(r=0.35,P＜0.005).Conclusion Plasma TM has showed a good predictive value for assessing the prognosis of patients with septic shock and may serve as a potential biomarker for determining the prognosis of septic shock.

Objective To analyze the anesthetic effect and hemodynamic impact of oxybutynin(OBI)combined with dexmedetomidine(DEX)on patients undergoing endoscopic dacryocystorhinostomy(En-DCR).Methods Patients who underwent En-DCR from February 2024 to May 2024 at Mianyang Wanjiang Eye Hospital were recruited.They were randomly divided into the DEX group(DEX administration only)and the combined group(DEX combined with OLI administration)according to the random number table method.The primary observational index in this study was the 24-h postoperative pain numerical rating scale(NRS)scores.The secondary observation indexes were heart rate(HR),mean arterial pressure(MAP),respiratory recovery time(SRT),extubation time(ET)and awakening time(AT),peak systolic value(PSV),end-diastolic blood flow velocity(EDV),resistance index(RI)and blood flow(BF).The occurrence of adverse events in patients during hospitalization was observed and recorded.Results A total of 80 patients were included in the study,with 40 in each of the DEX group and the combined group.In terms of analgesia,the NRS scores in the combined group were lower than those in the DEX group at T1(within 0.5 h after catheter removal),T2(4 h postoperatively),T3(8 h postoperatively),and T4(24 h postoperatively)(P＜0.05),and the remedial analgesia rate in the combined group was significantly lower than that in the DEX group(P＜0.05).Regarding anesthetic effects,HR and MAP at time points T6(during induction of anesthesia),T7(intraoperatively)and T8(during resuscitation)were lower in the combined group than in the DEX group(P＜0.05);and SRT,ET and AT were shorter in the combined group compared with the DEX group(P＜0.05).In terms of hemodynamics,at 24 h postoperatively,PSV,EDV and BF were significantly higher in both groups compared with those before anesthesia,whereas RI was significantly lower than before anesthesia(P＜0.05);PSV,EDV and BF were higher in the combined group than those in the DEX group,and RI was lower than that in the DEX group(P＜0.05).Regarding adverse reactions,the incidence of adverse reactions in the combined group was significantly lower than that in the DEX group(P＜0.05).Conclusion OLI combined with DEX prophylactic analgesia for patients with En-DCR is effective,not only to reduce postoperative pain,stabilize hemodynamics,shorten the time of extubation and awakening,and reduce the incidence of adverse reactions.

Objective:To establish an automated labeling method of 18F-AlF-1, 4, 7-triazocyclohexane-1, 4, 7-triacetic acid- D-Phe1-Tyr3-Thr8-octreotide (NOTATATE) and perform neuroendocrine tumor (NET) imaging. Methods:Based on the GE-FASTLab2 synthesis module, 18F-AlF-NOTATATE was automatically prepared by one-step chelation labeling with aluminum fluoride, and its labeling conditions were optimized. The product quality was analyzed. One patient (male, 47 years old) with lower rectal segment NET and one patient (female, 52 years old) with pancreatic NET underwent 18F-AlF-NOTATATE PET/CT imaging. Results:18F-AlF-NOTATATE was successfully prepared with a total synthesis time of 35 min. The optimized radiochemical yield was (23.8±3.1)% (without decay correction, n=3), the radioactivity was (4.63±0.68) GBq, and the radiochemical purity was >95%. The stability was good, and the product quality met the requirements. 18F-AlF-NOTATATE showed clear imaging in the patient with rectal segment NET, with SUV max of 13.3 and tumor/liver ratio of 3.3. Metastatic lesions in the liver, lymph nodes, and ribs showed high SUV max and tumor/liver ratios. The imaging of the pancreatic NET patient showed an abnormal increase in local radioactive uptake at the uncinate process of the pancreatic head, with SUV max of 5.6 and SUV max of 6.3 and the tumor/liver ratio of 2.3 after 2-hours imaging. Conclusions:Using the GE-FASTLab2 synthesis module, 18F-AlF-NOTATATE can be prepared with high activity. The preparation is simple, the method is stable, and the product has high radiochemical purity. 18F-AlF-NOTATATE exhibits good imaging performance in NET patients, providing valuable information for diagnosis, treatment, and prognosis evaluation.

Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG)in heparin monitoring during continuous renal replacement therapy.Methods A total of 97 cases who were undergoing continuous renal replacement therapy(CRRT)in the intensive care unit of the 94th People's Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this stud-y.The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy.In total,278 hemofilters were used in all the blood purification therapies.Complication of bleeding,CRRT time,total heparin dose and SOFA(sequential organ failure assessment)score of the patients were compared between the TEG and APTT groups.The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis.Rusults Compared with APTT group,the total heparin dose in TEG group were significantly higher(P＜0.05).The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group(P＜0.05).Compared to APTT group,the 28-day SOFA in TEG group was significantly lower(P＜0.05).Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group(P＜0.05).The 72-hour filter life of TEG group was significantly longer than that of APTT group(P＜0.05).Conclusion The use of hmTEG for monitoring heparin in blood purification should be superior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.

Wake up ischemic stroke (WUIS),also known as awakening stroke,refers to patients with no new stroke symptoms during sleep,but after waking up,the patients or witness who found the acute cerebral infarction with stroke performance.The key to the treatment of acute ischernic stroke is to effectively restore reperfusion within the time window.The original intravenous recombinant tissue-type plasminogen activator (rt-PA) thrombolytic therapy,is widely recognized as an effective treatment method of choice for 4.5h onset of acute ischemic stroke reperfusion.Because the exact onset time of WUIS is unclear and limited by current scientific and technical levels,intravenous thrombolysis may lead to an increased risk of intracranial hemorrhage.Therefore,the American Heart Association and the American Stroke Association (AHA/ASA) were included in the "Intravenous Thrombolysis".Intravenous thrombolysis is not recommended in the Standard Scientific Statement.Patients who may be suitable for thrombolytic therapy are not able to obtain thrombolytic therapy,resulting in poor clinical prognosis.In recent years,with the further development of relevant clinical research and the rapid development of imaging technology,the latest research found that multi-mode imaging examination is safe and effective for intravenous thrombolytic therapy in patients with poststroke stroke.Multi-mode imaging studies help screening patients with acute reperfusion therapy,so that part of WUIS patients will benefit from the acute reperfusion therapy.This article reviews and summarizes the literature findings of WUIS in recent years.The pathophysiological changes,clinical features and imaging changes of patients with WUIS and non-WUIS are almost unanimously.Early CT and MRI examinations can help to extend acute stroke treatment to patients with WUIS.At present,for this type of patients,there are great research progress in the formulation and implementation of clinical treatment strategies.This article will briefly summarize the research progress and treatment status of WUIS.

Whether to select one-tailed test or two-tailed test,how to establish null hypothesis and alternative hypothesis,how to improve the test efficacy were elaborated,and the common problems encountered when hypothesis was applied in scientific papers were pointed out with examples.

Objective To analyze the anatomic variation of the portal vein based on magnetic resonance angiography using THRIVE sequence in one-stop examination of the liver.Methods Reconstructed three-dimensional images of 648 cases of hepatic portal vein acquired by THRIVE sequence were analyzed.Anatomic variation of the hepatic portal vein was investigated and the diameters of main portal vein (MPV), splenic vein (SV), superior mesenteric vein (SMV) and inferior mesenteric vein (IMV) were measured.Results (1)Four types of different variations of intrahepatic portal vein were observed, with normal type accounting for 79.2% (514/648), type Ⅰ 8.3% (54/648), type Ⅱ 9.0% (58/648) and type Ⅲ 3.4% (22/648), respectively.(2)Four types of different variations of extrahepatic portal vein were also observed, with type Ⅰ accounting for 37.4% (167/447), type Ⅱ 20.4% (91/447), type Ⅲ 36.2% (162/447) and other 6.0% (27/447), respectively.(3)Diameter of MPV, SV, SMV and IMV were (14.03±2.44) mm, (9.51±2.40) mm, (11.14±1.99) mm and (6.01±0.78) mm, respectively.Conclusion It is feasible to analyze anatomic variation in the hepatic portal vein using reconstructed three-dimensional images acquired by THRIVE sequence in one-stop examination of the liver.

Objective To investigate the application value of combination of thinprep cytologic test (TCT),human papilloma virus (HPV),c-MYC and human chromosome telomerase gene (hTERC) genes to screen cervical cancer.Methods A total of 230 cases of the study objects was detected with TCT and HP,respectively.Amplification of c-MYC and hTERC genes was tested with fluorescence in situ hybridization (FISH) method.The histopathological results were the gold standard,and the sensitivity,specificity and accuracy of cervical intraepithelial neoplasia (CIN) Ⅱ / Ⅲ and squamous cell carcinoma (SCC) were compared with the four combined detection.Results Of 230 screened patients,there were 124 cases of TCT positive,155 cases of HPV positive,c-MYC gene amplified in 118 cases,and hTERC gene amplified in 128 cases.When TCT,HPV,c-MYC,and hTERC were used alone,the highest sensitivity was HPV (84.5％),the highest specificity was c-MYC (97.6％),and the highest accuracy was hTERC (85.2％).When the three indexes were used in coordination with each other,the sensitivity and accuracy of TCT + HPV + hTERC were the highest (98.6％ and 90.9％),and the specificity of TCT + c-MYC + hTERC was the highest (79.3％).When the four indexes were used together,the sensitivity was 98.6％,the specificity was 72.0％,and the accuracy was 89.1％.Conclusions Combined examination can improve the sensitivity and accuracy of screening cervical lesions,and the three combination of TCT + HPV + hTERC had the best effect,and c-MYC gene detection had the highest specificity.

Objective To explore the reproductive outcomes of different management strategies of ectopic pregnancy .Methods A retrospective cohort study was performed for 648 consecutive patients with a diagnosis of ectopic pregnaney between June 2011 and september 2013.The follow-ups were conducted telephone interviews of pregnancy outcomes after various treatments .Results The subsequent intrauterine pregnancy rates after surgical , medical and expectant managements were 89(65.0%), 35(79.6%) and 6 (54.5%) the intrauterine pregnancy was higher for medical treatment than that for surgical treatment (P<0.05).The subsequent infertility rate after surgical , medical and expectant management were 4.5%, 36.4%, 19.0%.The subsequent infertility rate after medical treatment was lower than that for surgical and expectant managament ( P<0.05) .The re-ectopic pregnancy rates of laproscopic versus abdominal operation were [11 (11.7%), 13(30.2%)] with significant difference (P<0.05).And abdominal operation was higher than laproscopic operation .Conclusion For younger ectopic pregnancy patients , medical treatment shold be as possible as we can .If operation is necessary , laproscopic operation is preferred .

Objective To explore the different apoptotic gene expressions and apoptotic signaling transduction of human rhabdomyosarcoma (RD) cells infected by enterovirus 71 (EV71) in different stage.Methods The survival of EV71-infected RD cells was observed by trypan blue staining.The apoptotic morphology and rates of RD cells were surveyed and detected by Annexin V-FITC/PI staining and flow cytometry,respectively.PCR array was employed to analyze 88 apoptotic gene expressions from EV71-infected RD cells at 8 h and 20 h postinfection (p.i),respectively.Results After RD cells were infected with EV71 (MOI =5) at 8 h p.i,the viability was significantly decreased.Flow cytometry data demonstrated that the apoptotic rates of EV71-infected RD cells had increased to 18.0％ and 19.1％ at 20 h p.i in early and later stage respectively.RT-PCR array studies revealed significant variations in the expression of apoptotic genes.Among 88 genes,only the expression of IFN-β1 was upregulated 5.22 folds,whereas 47 genes including ACIN1,Akt,Apaf1,caspase and CIDEB were found to be downregulated that were lower than 2 folds at 8 h p.i.However,28 genes including FasL,CD40L,TNF,caspase-10 and caspase-3 were induced more than 2 folds after EV71 infection at 20 h.Conclusion The downregulation of apoptosis-related genes is associated with viral apoptosis-suppressing effect in RD cells in the early stage of EV71 infection.The death receptor signaling pathways including Fas/FasL and TNF/TNFR are activated to induce cell apoptosis in the late stage of EV71 infection.Moreover,host cell can also inhibit apoptosis by regulating signal pathway of CD40/CD40L,NF-κB/RelA and PI3K/Akt activation.