Objective To investigate the clinical efficacy of low-dose plasma exchange (PE) combined with artificial liver in the treatment of acute-on-chronic liver failure (ACLF) and its effect on mortality rate after stratification. Methods A total of 272 ACLF patients who were admitted to Department of Infection and Hepatology, The First Affiliated Hospital of Kunming Medical University, from January 2018 to December 2020 were enrolled and divided into low-dose PE+double plasma molecular absorption system (DPMAS)/hemoperfusion (HP) group ( n =190) and medical treatment group( n =82). Laboratory markers were collected before and after treatment, and clinical outcome was compared between the two groups; stratified analysis (early stage, early-middle stage, late stage or types A, B, C) was performed for the two groups according to Diagnostic and treatment guidelines for liver failure (2018 edition), and all patients were followed up to observe general status and death at 12 weeks (short-term) and 48 weeks (long-term) after discharge. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the paired samples t -test was used for comparison before and after treatment; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Wilcoxon test was used for comparison before and after treatment; the chi-square test was used for comparison of categorical data between groups. Results Both low-dose PE combined with DPMAS/HP and medical treatment alone could reduce the levels of alanine aminotransferase (ALT), aspartate aminotransferase, total bilirubin (TBil), and blood ammonia and increase the level of albumin (Alb), and both groups had significant changes in these indices after treatment (all P < 0.05). Compared with medical treatment alone, low-dose PE combined with DPMAS/HP better reduced ALT, TBil, and blood ammonia and improved Alb, with significant changes in these indices after treatment (all P < 0.05). Low-dose PE combined with DPMAS/HP could significantly reduce bile acid, international normalized ratio, neutrophil-lymphocyte ratio, and MELD score and increase platelet-to-white blood cell ratio (all P < 0.05), while medical treatment alone could not improve the above indices (all P > 0.05). Compared with medical treatment alone, low-dose PE combined with DPMAS/HP could reduce the short-term mortality rate of ACLF patients, especially the short-term mortality rate of ACLF patients with early-stage, early-middle-stage or type A ACLF, and there were significant differences between the two groups (all P < 0.05). In the low-dose PE+DPMAS/HP group, the patients with early-stage ACLF had significantly lower short- and long-term mortality rates than those with late-stage ACLF, and the patients with type A ACLF had significantly lower short- and long-term mortality rates than those with type C ACLF (all P < 0.05). Conclusion Low-dose PE combined with DPMAS/HP has good clinical efficacy and can effectively reduce the short-term mortality rate of ACLF, especially the short-term mortality rate of patients with early-stage, early-middle-stage, or type A ACLF.

Objective: To improve synchrony tracking components of CyberKnife (tracking vest and tracking markers) and to analyze the clinical application value of the improved tracking components in CyberKnife treatment of thoracic and abdominal tumors. Methods: The tracking apron was made of knitted four-side elastic spandex cloth and suture design of Velcro, which was used to stick the tracking markers on the chest and abdomen of patients. The tracking markers added a 2 cm thick light foam block to the bottom of the original markers, and then the hook face of the Velcro was fixed to the bottom of the light foam. The improved trace component (the improved component) and the original component (the vendor component) were applied to the lung tracking treatment model, and the manufacturer components were included in the reference group. Adoption of improved components into the observation group; 20 different types of respiratory waveforms were simulated and applied to the same mold plan. After treatment, the coverage rate, mean standard deviation, maximum standard deviation and the slope of XYZ-axis vs. R correlation graph were recorded. The relevant parameters of Synchrony model and wearable time of two components were compared, and the application significances of the improved tracking component in the breathing tracking process of the CyberKnife were evaluated. Results: The maximum slope [median(interquartile range)] of XYZ-axis vs. R related graph in the reference group was 0.73 (3.89), 0.27 (0.49) and 0.34 (1.02), respectively. The maximum slope of XYZ-axis vs. R related graph in the observation group was 0.70 (2.78), 0.31 (0.30) and 0.36 (0.75), respectively. There was no statistically significant difference in the slope of XYZ-axis vs. R between the reference group and the observation group (all P > 0.05). There was no significant difference in the average standard error and maximum standard error between the reference group and the observation group [(1.7±0.4) mm vs. (1.7±0.5) mm, t=-0.382, P= 0.710; (2.0±0.6) mm vs. (1.7±0.5) mm, t=-0.877, P= 0.401], and the difference of the model coverage rate between the two groups was statistically significant [(48±18)% vs. (60±22)%, t= 2.762, P= 0.042]. The setup time of tracking components in the observation group was less than that in the reference group, and the difference was statistically significant [(44±24) s vs. (81±15) s, t=-4.310, P= 0.001]. Conclusions The improved tracking components are comparable to the manufacturer tracking components in the standard error of the Synchrony model. The improved components shorten the wear time and appropriately improve the coverage of the Synchrony model.

Objective To establish the blood Septin9 methylation detection system for early screening of colorectal cancer based on fluorescence PCR technology .Methods The PCR primer of Septin9 was designed by searching the CpG island site of Septin9 methylation in the NCBI database .The high methylation site of Septin9 gene promoter region was confirmed by PCR amplification and sequencing after extracting DNA from colorectal cancer and para-carcinoma tissues .The fluorescence PCR and TaqMan probe detection technique was designed by aiming at high methylation site for constructing the plasma sample methylation detection sys-tem .Then its accuracy ,specificity ,repeatability and minimum detectable amount were performed the assess-ment and analysis .The SETP9 methylation detection was performed in plasma samples from 57 cases of color-ectal cancer and 30 healthy persons .Results The high methylation site of Septin9 gene in tissue samples was confirmed by sequencing .This site served as the target for designing fluorescence PCR detection system .After assessment ,the accuracy ,specificity and repeatability of this detection system were 100％ ,the lowest detection amount reached 0 .1 ng/μL .Among the plasma samples in 57 cases of colorectal cancer ,the positive rate of Septin9 methylation site detection was 71 .92％ (41/57) and the positive rate of in the patients with pathologi-cal stage Ⅰ and Ⅱ of colorectal cancer reached 64 .2％ .But Septin9 gene had no methylation in plasma of healthy population .Conclusion The plasma fluorescence PCR detection system with Septin9 gene methylation as the target has the characteristics of high sensitivity ,high specificity and high accuracy ,which is the reliable detection technique for the early screening of colorectal cancer and has good clinical application prospect .

Objective: To investigate the clinical and histological features, diagnosis and differential diagnosis of myofibroma/myofibromatosis. Methods: The clinical data and pathology features of nine cases of myofibroma/myofibromatosis were collected from August 2011 to November 2016 in Affiliated Drum Tower Hospital, Nanjing University Medical School and Children′s Hospital of Nanjing Medical University. Immunohistochemistry(IHC), PDGFRB molecular analysis and ETV6-NTRK3 gene fusion were performed and relevant literature reviewed. Results: There were 7 males and 2 females, with age ranging from 3 days to 18 years (mean 5 years). The tumors were located in head and neck (eight cases) and trunk (one case). Clinically, the tumors presented as freely movable nodules. Microscopically, they appeared biphasic with alternating light- and dark-staining areas. The light-staining area consisted mainly of plump myoid spindle cells with eosinophilic cytoplasm arranged in nodules, short fascicles, or whorls.The dark-staining area was composed of round or polygonal cells with slightly hyperchromatic nuclei or small spindle cells arranged around a distinct hemangiopericytoma-like vascular pattern. IHC showed the tumor cells in the light-staining area were strongly positive for vimentin and SMA, while cells in dark-staining area were strongly positive for vimentin, and weakly for SMA. Tumor cells were negative for desmin, S-100 protein, h-Caldesmon, CD34 and STAT6. Analysis of PDGFRB mutations was performed in seven cases. Two cases showed 12 exon point mutation c. 1681 c>T(p.R561C), one case showed 14 exon point mutation c. 1998C>G (p.N666K). ETV6-NTRK3 gene fusion was not detected by fluorescence in situ hybridization in four patients under three years old. All cases were followed for 6 to 68 months, with two recurrences. Conclusions Myofibroma/myofibromatosis is an uncommon benign myofibroblastic tumor of infancy and childhood. The tumor can appear biphasic, and may show PDGFRB point mutation which is of potential diagnostic value.

Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

AIM:We investigated how AT 1-R stimulated by mechanical stresses induces cardiac fibrosis .METHODS:We produced in vivo cardiac pressure overload model in angiotensinogen knockout ( ATG-/-) mice and in vitro mechanically-stretched cell model in cultured neonatal cardiac cells of ATG-/-mice both lack the participation of Ang II .RESULTS: Pressure overload for 4 weeks in ATG-/-mice induced myocardial hypertrophy accompanied by the significant interstitial fibrosis , however , the TGF-β, a key regulatory factor of fibrosis, was not significantly increased in these ATG-/-mice.Meanwhile, the inhibitor for AT1-R significantly inhibited mechani-cal stress-induced cardiac fibrosis in these ATG-/-models whereas inhibition of TGF-βdid not.CONCLUSION:The results showed that mechanical stress-induced fibrotic responses through AT 1-R required the phosphorylation of Smad 2 but not the involvement of TGF-β.

Objective To investigate the effects of urotensin Ⅱ/urotensin Ⅱreceptor ( UⅡ/UT) system on the expression of inflammatory signal molecules p 38 mitogen-activated protein kinase ( p38 MAPK) and nuclear factor-κB ( NF-κB ) in lipopolysaccharide ( LPS )-stimulated Kupffer cells ( KCs ) . Methods Rat KCs were isolated and purified by means of in situ perfusion and density gradient centrifuga-tion.The isolated cells were randomly divided into six treatment groups including group 1:UⅡ(-) urantide (-)LPS(-), group 2:UⅡ(+)urantide(-)LPS(-), group 3: UⅡ(-)urantide(+)LPS(-), group 4:UⅡ(-)urantide(-)LPS(+), group 5:UⅡ(+) urantide(-) LPS(+) and group 6:UⅡ(-)urantide(+) LPS(+) .Western blot assay was performed to detect p 38 MAPK/p-p38 MAPK protein and NF-κB p65 sub-unit.The DNA-binding activity of NF-κB was tested by electrophoretic mobility shift assay (EMSA).Re-sults There was no significant difference with the expression of p 38 MAPK protein in KCs among the six groups (P>0.05).The expression of p65 protein and p-p38 MAPK and the DNA-binding activity of NF-κB were significantly enhanced in LPS-stimulated KCs from groups 4, 5 and 6 in comparison with those in group 1 (P<0.01).No significant differences with the levels of p65 protein and phosphor-p38 MAPK and the DNA-binding activity of NF-κB were observed between UⅡ/urantide-treated cells ( group 2 or group 3) and untreated cells (group 1) (all P>0.05), but that were decreased in group 6 than those in group 4 (all P<0.01).Conclusion UⅡ/UT system participated in the activation of p38 MAPK and NF-κB signaling pathways in LPS-stimulated primary Kupffer cells .

Objective To establish the quality standard for Shengxinfa Capsule. Methods TLC was used to identify Praeparata, Psoraleae Fructus and Gastrodiae Rhizoma in Shengxinfa Capsule, and 2,3,5,4’-the four-stilbene-2-O-β-D-glucoside was identified by HPLC. The column of Agilent TC-C18 (4.6 mm×250 mm, 5 μm) was used. The mobile phase was acetonitrile-water (15∶85). The flow was 1.0 mL/min and column temperature was 30 ℃. UV detecting wavelength was 320 nm. Results Praeparata, Psoraleae Fructus and Gastrodiae Rhizoma could be identified by TLC. The linear range of 2,3,5,4’-the four-stilbene-2-O-β-D-glucoside was in the range of 0.05-0.50 μg. The average recovery was 97.8% (RSD=0.39%). Conclusion The method is feasible and accurate. The quality of Shengxinfa Capsule can be controlled effectively with the established quality standard.

Objective To investigate the breast cancer risk factors in women of the Karamay Oilfield.Methods A case control study included 129 breast cancer patients and 129 normal healthy women.The logistic regression model was used for evaluating the breast cancer risk factors.Results The risk factors of breast cancer included a family history of breast cancer (OR =2.744,95 ％ CI =1.884-4.674),breast hyperplasia (OR =1.423,95 ％ CI =1.160-1.810),mastitis (OR =2.363,95 ％ CI =2.039-3.934),uterine fibroids (OR =1.623,95 ％ CI =1.263-2.024),abortion (OR =1.723,95 ％ CI =1.143-2.600),drinking (OR =1.243,95 ％ CI =1.040-1.483),trauma (OR =2.184,95 ％ CI =1.753-3.025),long-term exposure to ionizing radiation (OR =1.374,95 ％ CI =1.152-1.699); protective factors inculded increased age at menarche (OR =0.773,95 ％ CI =0.674-0.956),cumulative lactation time (OR =0.672,95 ％ CI =0.480-0.941),adhere to exercise (OR =0.572,95 ％ CI =0.391-0.837).Conclusion These 11 factors could be important factors for breast cancer risk in Karamay Oilfield women.

Objective To study sedative hypnotic pharmacodynamics of Shui'an Capsule,and provide experimental basis for the expansion of clinical indications.Method The effects of different concentrations of Shui'an Capsule on spontaneous activity of mice,induced dormancy of the mice with subliminal and suprathreshold dose of sodium pentobarbital and resisted convulsions of mice caused by Dimenlini Hydrochloridum were observed.Result Shui'an Capsule could significantly decrease times of spontaneous motion in mice,prolong sleeping time with pentobarbital sodium of superthreshold dose,and decrease the latent period of sleep.Conclusion Shui'an Capsule produces obvious sedative hypnotic effect.