Objective:To explore the risk factors of renal function progression in patients with acute renal injury (AKI) after moderate hypothermic circulatory arrest surgery in acute aortic dissection (AD).Methods:Retrospective analysis was made base on the data of 290 patients with acute AD who underwent surgical treatment from January 2014 to August 2022 in the Affiliated Hospital of Jining Medical University. According to the Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria in 2015, patients with AKI after surgery were selected as the study objects. Patients with progressive deterioration of renal function or required continuous renal replacement therapy after AD operation were defined as the progression group of AKI, the other patients with gradual improvement of renal function after AD operation were defined as the improvement group of AKI. The clinical data of the two groups were compared, and the risk factors for the progression of AKI after AD were analyzed by multivariate logistic regression.Results:A total of 290 AD surgeries were completed, of which 143 cases developed AKI after surgery, including 81 cases in AKI progression group and 62 cases in AKI improvement group. In the progression group of AKI, before surgery the proportion of patients with coronary heart disease: 24.7% (20/81) vs.11.3% (7/62), serum creatinine (Scr) >133 μmol/L: 24.7% (20/81) vs. 3.2% (2/62), pericardial tamponade: 22.2% (18/81) vs. 8.1% (5/62), lower limb ischemia: 25.9% (21/81) vs. 3.2% (2/62) were significantly increased. Postoperative acute physiology and chronic health evaluation Ⅱ (APACHE) score: 14.00 (9.00, 19.75) scores vs. 10.00 (7.00, 12.00) scores, ICU hospitalization days: 8 (5, 13) d vs. 5 (3, 7) d, postoperative mortality: 24.7%(20/81) vs. 1.6%(1/62), the proportion of KDIGO phase 3 ratio: 46.9%(38/81) vs. 3.2%(2/62), postoperative infection: 61.7%(50/81) vs. 38.7% (24/62), low cardiac output syndrome: 29.6% (24/81) vs. 6.5% (4/62), cerebral infarction complications: 38.2%(31/81) vs. 16.1%(10/62), and mortality after surgery were also higher. Compared with improvement group of AKI, all differences were statistically significant ( P<0.05). Multivariate Logistic regression analysis showed that preoperative lower limb ischemia ( OR = 9.430, 95% CI 1.975 to 45.032, P = 0.005), postoperative low cardiac output syndrome ( OR = 5.288, 95% CI 1.543 to 18.126, P = 0.008), and postoperative infection ( OR = 2.273, 95% CI 1.022 to 5.057, P = 0.044) were independent risk factors for the progression of AKI after AD surgery. Conclusions:The independent risk factors of renal function progression in patients with AKI after hypothermic circulatory arrest surgery in acute AD include preoperative lower limb ischemia, postoperative low cardiac output syndrome, and postoperative infection.

Objective:To investigate the perioperative complications and risk factors of postoperative death in patients with acute Stanford type A aortic dissection (ATAAD).Methods:The perioperative data of 228 patients with ATAAD who underwent continuous surgery in the Affiliated Hospital of Jining Medical University from January 2013 to July 2021 were retrospectively analyzed. The complications were analyzed. According to the survival within 30 days after surgery, they were divided into death group (24 cases) and survival group (204 cases). The risk factors of postoperative death were analyzed by univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawed to evaluate the predictive efficacy of various risk factors on postoperative death of ATAAD patients.Results:The first three complications before operation were hypoxemia (10.1%, 23/228), pericardial tamponade (7.9%, 18/228), renal insufficiency (5.3%, 12/228), the first three complications after surgery were hypoxemia (75.8%, 173/228), renal insufficiency (26.8%, 61/228) and liver insufficiency (26.3%, 60/228). A total of 24 patients died, the fatality rate was 10.5%(24/228). Logistic regression analysis showed that age≥55 years old ( OR=7.733, 95% CI: 1.986-30.111, P=0.003), preoperative pericardial tamponade ( OR=5.641, 95% CI: 1.546-20.577, P=0.009), cardiopulmonary bypass time (CBP)≥200 min ( OR=1.008, 95% CI: 1.002-1.014, P=0.007) and postoperative renal insufficiency ( OR=5.875, 95% CI: 1.927-17.907, P=0.002) were independent risk factors for early death after ATAAD. The area under the ROC curves of joint prediction was 0.905 (95% CI: 0.820-0.950, P<0.01). The sensitivity and specificity of joint prediction were 88.4%, 76.5%, respectively. Conclusions:ATAAD has many perioperative complications and high mortality. Age≥55 years old, preoperative pericardial tamponade, CPB time≥200 min, and postoperative renal insufficiency were independent risk factors for postoperative death in ATAAD patients.

The clinical data of 14 patients with niacin deficiency diagnosed and treated in Department of Dermatology, Affiliated Hospital of Jining Medical College from 2012 to 2021 were retrospectively analyzed. There were 11 males and 3 females aged 26-65 years. The etiological factors were alcoholism in 8 cases, gastrointestinal disease in 3 cases, medication history in 1 case, and unknown etiology in 2 cases.Patients had typical skin lesions, 1 case also had both digestive system and nervous system symptoms, and 3 cases had combined digestive system symptoms and 2 cases had neurological symptoms. All patients were systematically treated with oral nicotinamide and vitamin B complex, and also with topical drugs; and they all improved after 14-52 days of treatment. During regular follow-up, 2 cases of alcoholics and 1 case with diarrhea had recurrence. It is suggested that the typical clinical triad of niacin deficiency is uncommon, and the diagnosis is based on the medical history, clinical manifestations and relevant laboratory test, and the treatment with nicotinamide and vitamin B complex is usually effective; alcoholism is the main cause in male patients and is prone to recurrence.

Gastric cancer (GC) is known as a top malignant type of tumors worldwide. Despite the recent decrease in mortality rates, the prognosis remains poor. Therefore, it is necessary to find novel biomarkers with early diagnostic value for GC. In this study, we present a large-scale proteomic analysis of 30 GC tissues and 30 matched healthy tissues using label-free global proteome profiling. Our results identified 537 differentially expressed proteins, including 280 upregulated and 257 downregulated pro-teins. The ingenuity pathway analysis (IPA) results indicated that the sirtuin signaling pathway was the most activated pathway in GC tissues whereas oxidative phosphorylation was the most inhibited. More-over, the most activated molecular function was cellular movement, including tissue invasion by tumor cell lines. Based on IPA results, 15 hub proteins were screened. Using the receiver operating character-istic curve, most of hub proteins showed a high diagnostic power in distinguishing between tumors and healthy controls. A four-protein (ATP5B-ATP5O-NDUFB4-NDUFB8) diagnostic signature was built using a random forest model. The area under the curve (AUC) values of this model were 0.996 and 0.886 for the training and testing sets, respectively, suggesting that the four-protein signature has a high diag-nostic power. This signature was further tested with independent datasets using plasma enzyme-linked immune sorbent assays, resulting in an AUC value of 0.778 for distinguishing GC tissues from healthy controls, and using immunohistochemical tissue microarray analysis, resulting in an AUC value of 0.805. In conclusion, this study identifies potential biomarkers and improves our understanding of the pathogenesis, providing novel therapeutic targets for GC.

Objective: To investigate neglect among preschool children in two-child families in southwest Shandong Province, and to provide reference is for improving nursing parenting quality of two-child families. Methods: A questionnaire survey was conducted among 2 646 parents of two-child families and 2 074 parents of one-child families from 16 kindergartens in southwest Shandong Province. Results: The total neglect rate of two-child family preschool children in southwest Shandong Province was 27.37%, and the degree score of neglect was(40.15±5.51). The physical neglect rate(10.39%), emotional neglect rate(40.15±5.51), total neglect (38.15±4.88) and emotional neglect (46.12±6.91) of boys were higher than those of girls, and the difference was statistically significant(χ2/t=4.57, 6.65, 4.58, 4.72, P<0.05); No significant frequencies were found in total neglect rate, total neglect, neglect rate and neglect at all levels among all age groups(P>0.05); Among preschool children with siblings aged 7-<13, ≥13, total neglect rate(30.44%, 32.77%), emotional neglect rate(10.20%,12.00%), total neglect degree (44.71±5.98, 45.33±5.20) and emotional neglect degree (45.95±7.12, 48.86±4.97) of preschool children in two-child families have higher than those in onechild families, and the differences were of statistical significance(χ2/t=31.10, 4.55, 27.92, 24.13, 19.83, P<0.05); the total neglect rate(27.37%), emotional neglect rate(23.47%), emotional neglect (43.68±6.83) of twochild families and the total neglect (40.15±5.51) were higher than those of one-child families, and the differences were of statistical significance(χ2/t=4.98, 4.96, 3.76, 8.53, P<0.05). The age of siblings(OR=0.58), the education level of mothers(OR=0.64), and the main executor of family education (OR=1.54) were main factors to influence the child neglect of preschool children in two-child families(P<0.05). Conclusion Neglect of preschool children in two-child families is higher than that in one-child families in southwest Shandong, especially among those preschool boys and preschool children whose siblings were of school age.

Objective To discuss the application of self-developed novel 16-slice mobile CT head scan.Methods A total of 391 patients were performed 16-slice mobile CT scan:145 were scanned in the emergency department,156 in the neurosurgical ICU,55 in the operated room,and 35 in the ambulance vehicle.Sixty-eight patients were with brain injury,122 were with cerebral hemorrhage,120 were with cerebral infarction,59 were with brain tumors,and 22 were with hemifacial spasm.Thirty-five patients were randomly selected from 391 patients and 8-slice mobile CT head scan was performed on them,which included 12 with brain injury,6 with cerebral hemorrhage,12 with cerebral infarction,3 with brain tumors and 2 with hemifacial spasm.The resolution,imaging quality,radiation doses,power consumption and performance stability of novel 16-slice mobile CT and 8-slice mobile CT head scan were compared.Results The resolution line pairs of brain tissues were 91 p/cm by 16-slice mobile CT and 71 p/cm by 8-slice mobile CT,respectively.The imaging quality of the two kinds of mobile CT head scans was high level to the clinic diagnostic criteria.The radiation dose of 16-slice mobile CT were 40.43 mGy,which decreased by 51.01％ as compared with that of 8-slice mobile CT (82.52 mGy).The personal power consumption of 16-silce mobile CT (0.29 kW· h) decreased by 38.30％ as compared with those of 8-layer mobile CT (0.47 kW· h).The 16-slice mobile CT kept regularly,while 8-slicer mobile CT stopped to work twice during clinical trial.Conclusion The 16-slice mobile CT scan has high resolution,fine imaging quality,low radiation dose,small power consumption and stable working performance.

Objective To investigate the curative effect and safety of transcatheter arterial chemoembo -lization (TACE) containing raltitrexed scheme for primary hepatocellular carcinoma (PHCC).Methods From May 2013 to June 2014,a total of 90 patients with inoperable PHCC were treated with TACE containing raltitrexed scheme.The short-term effect,long-term effect and adverse reactions were analyzed.Results Of the 90 patients,complete response was obtained in 23,partial response in 36,stable disease in 24 and progressive disease in 7,the effective rate was 65.6％.The one-year survival rate was 72.2％,the median survival time was 15.9 months,and the progression free survival was 9.1 months.Single factor analysis showed that the statistically significant differences in survival rate existed among the patients with different BCLC staging,combination therapy,lipiodol deposit pattern and vascular tumor thrombus (P＜0.05).Multivariate analysis of Cox model indicated that BCLC staging (x2=9.83,P=0.002) and combined therapy (x2=6.40,P=0.011) were independent prognostic factors.The main adverse reactions were fever,pain,vomiting and bone marrow suppression.Grade Ⅲ-Ⅳ adverse reactions were rare and no treatment-related death occurred.Conclusion For the treatment of inoperable PHCC,TACE containing raltitrexed scheme is effective and safe,and this therapy can be well tolerated by patients.

Background:Esophageal cancer is a common gastrointestinal cancer with poor prognosis,and effective chemotherapy is lacking currently. Studies have shown that cardiac glycosides can inhibit tumor cells growth,but its mechanism has not been fully clarified. Aims:To investigate the effect and mechanism of ouabain in regulating proliferation of human esophageal carcinoma cells. Methods:OE19 human esophageal carcinoma cells were treated with ouabain,and cells in control group were treated with DMSO. Cell proliferation was assessed by cell counting method. mRNA expressions of Sox2,Sox4,Sox7,Sox9 and Sox10 were determined by real-time PCR. Protein expression of Sox4 was determined by Western blotting. Gene expressions of phospho-histone3( ph3),a cell proliferation marker and Sox4 were detected by immunofluorescence staining. Results:Ouabain( ≥ 40 nmol/ L)could significantly inhibit OE19 cells proliferation. mRNA and protein expressions of Sox4 were significantly decreased in OE19 cells in ouabain(40 nmol/ L)group than those in control group(P < 0. 05). No significant differences in mRNA expressions of Sox2,Sox7,Sox9 and Sox10 were found between the two groups(P > 0. 05). Gene expressions of ph3 and Sox4 in nucleus of OE19 cells were decreased in ouabain (40 nmol/ L)group than those in control group. Conclusions:Ouabain is effective in inhibiting human esophageal carcinoma cells proliferation,the underlying mechanism might be related with down-regulation of Sox4 expression and the subsequent cell cycle modulation.

Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation (RFA) to reopen occluded self-expandable metal stents in patients with malignant biliary obstruction.Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied.During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire.This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage.The patients were closely observed and followed up.Results RFA was successfully carried out in all the patients and patencies were achieved when compared with pre-RFA.The median post-RFA luminal diameter of the strictures showed significant improvement: 6 (4 ～ 10) mm versus 2 (0 ～ 5) mm, and the mean post-RFA total bilirubin level decreased sharply : (39.4 ± 8.7) μ mol/L versus (130.1 ± 38.2) μmol/L.Following this intervention, 3 patients developed fever, which were controlled with conservative therapy.There was no mortality, haemorrhage, bile duct perforation or bile leak.Of the 11 patients, 3 were dead and 6 were alive at a median follow-up of 187 (75 ～ 304) days.The median stent patency was 135 (75 ～ 203) days and the median survival was 278 (75 ～ 304) days.Four patients had their stents patent at the time of the last follow-up or death.Seven patients had their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure.Condusions Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction.This efficacy needs to be confirmed by future randomized studies.

Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest (DHCA) operation.Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic an-eurysm underwent aortic operations under DHCA .According to the occurrence of neurological complications after surgery , patients were divided into neurological complication group (26 patients) and normal group (44 patients).Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis .Results Central neurological compli-cations occurred in 26 patients (37.14%) , including 18 patients with temporary neurological dysfunction and 7 patients with perma-nent neurological dysfunction , 1 patient with paraplegia , 1 patient died of cerebral infarction .Univariate analysis showed that hyperten-sion disease( P =0.001), emergency surgery within 72 hours( P =0.009),cardiopulmonary bypass time ( P =0.015),antegrade se-lective cerebral perfusion ( ASCP) ( P =0.005 ) , hemodilution degree ( P =0.001 ) , erythrocyte ( P =0.033 ) and plasma ( P =0.034 ) transfusion volume in the perioperative period , oxygen index <200 mmHg in 4 hours postoperatively ( P =0.043 ) , arterial blood pressure instability ( P =0.037 ) and hypernatremia in 24 hours postoperatively ( P =0.001 ) , and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score are the risk factors for central neurological complication .Hypertension disease( P =0.017 ) , emergency surgery within 72 hours ( P =0.048 ) , ASCP ( P =0.015 ) , hypernatremia in 24 hours postoperatively ( P =0.008 ) were independent determinats for central neurological complication .Conclusions A series of procedure including evaluating patients condition correctly before operation , controlling hypertension effectively in the perioperative period , applying the ASCP and the suitable hemodilution degree in operation , maintaining electrolyte balance , and correcting hypernatremia timely in the postoperative pe-riod maybe reduce the incidence of neurological complications after DHCA operation .