Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective:To investigate whether prophylactic use of metal clips is necessary after cold snare polypectomy (CSP) of colorectal polyps of 6-10 mm.Methods:A total of 200 patients with 6-10 mm polyps that met the criteria of cold snare resection in Chengdu Third People's Hospital from 15 February 2022 to 30 May 2022 were randomly divided into two groups: a group that received preventive metal clip treatment and an observation group. Age, gender, body mass index (BMI), Boston score, endoscopy entry time, wound size, operation time, intraoperative bleeding time, postoperative delayed bleeding rate and cost between the two groups were compared and analyzed.Results:Ninety-eight patients in the metal clip group had 122 polyps removed, and 97 patients in the observation group had 119 polyps removed. There was no significant difference in the age, gender, BMI, Boston score, endoscopy entry time or wound size between the two groups. There were significant differences in the operation time (171.03±90.78 s VS 69.81±43.26 s, t=2.266， P=0.010), intraoperative bleeding time (19.98±17.37 s VS 29.16±17.56 s, t=-2.875， P=0.006) and surgery cost (571.63±110.92 yuan VS 366.32±13.2 yuan, t=18.102， P<0.001) between the metal clip group and the observation group. There was no significant difference in the delayed bleeding incidence［0.0%（0/98）VS 1.0%（1/97）， P=0.497］between the two groups. Conclusion:For patients with continuous bleeding time <60 seconds after CSP of 6-10 mm colonic polyps, the prophylactic use of metal clips may reduce the bleeding time, but may increase the operation time and cost. Metal clips have little effect on preventing postoperative complications.

Objective To explore the expression of tiny RNA-25 (microRNA-25, miR-25) in the plasma、tissues of triple-negative breast cancer(TNBC) patients and cell lines, to investigate the potential molecular mechanisms of miR-25 on migration and invasion of TNBC. Methods Real-time fluorescent quantitative PCR was used to detect the expression of miR-25 in the plasma of TNBC patients. Linked omics web platform was used to analyse miR-25 level in samples of TNBC and non-TNBC. Real-time fluorescent quantitative PCR was also used to detect the miR-25 level in TNBC cell lines. The wound healing and transwell assay was applied to assess the effects on migration and invasion of TNBC cell lines which transfected with miR-25 inhibitor or the negative control. The luciferase reporter assay was used to validate the relationship between miR-25 and the sphingosine-1-phosphate phosphatase 1 (SGPP1) in HEK293T cell. The wound healing and transwell assay was used to detect the migration and invasion ability of TNBC cell lines when cotransfected with pCMV6-SGPP1 and miR-25. Furthermore, Western blot was performed to detect the SGPP1 level in TNBC cell lines. Results The expression of miR-25 was significantly elevated in the plasma of 86 TNBC patients compared with the healthy controls (P value was 0.031). LinkedOmics web platform analysis showed that miR-25 expression was significantly higher in TNBC samples than in non-TNBC samples with Luminal A or Luminal B (P value was<0.001 and 0.006). The level of miR-25 was also elevated in TNBC cell lines HS578T, HCC1806, MDA-MB-231 and BT549(P value was 0.006, 0.01, 0.029 and 0.046). The MDA-MB-231 and HS578T cells which transfected with miR-25 inhibitor exhibited a significant slower wound healing rate than control (P value was 0.035 and 0.001). At the same time, when transfected with miR-25 inhibitor, MDA-MB-231 and HS578T both exhibited a decreased invasion ability compared with the control group(P value was 0.002 and 0.001). LinkedOmics web platform analysis showed that sphingosine-1-phosphate phosphatase 1 (SGPP1) gene level was negatively correlated with miR-25 in the tissues of TNBC patients (P value was 0.037). The luciferase reporter assay validated that SGPP1 was a directed target of miR-25. The western blot assay indicated that the SGPP1 level was increased in MDA-MB-231 and HS578T after transfection with miR-25 inhibitor. Over-expression of SGPP1 could abrogate the positive effects of miR-25 on migration and invasion when pCMV6-SGPP1 was cotransfected with miR-25 (P value was all 0.002). Conclusions MiR-25 was elevated in both plasma and tissues of TNBC patients and also increased in TNBC cell lines. Transfection of MDA-MB-231 and HS578T cells with miR-25 inhibitor resulted in reduced migration and invasion. Moreover, SGPP1 was identified as a novel target of miR-25. The ability of miR-25 to promote TNBC cell migration and invasion is attributable to its effect on SGPP1 suppression.

The aim of the present study is to evaluate the vasodilation effects of Tongmai Yangxin Pills (TMYX) on rat mesenteric artery as well as its mechanism of action. The relaxation effects of TMYX extracts with different concentrations were determined on isolated rat mesenteric artery in normal condition as well as pretreating by phenylephrine and KCl. Vascular relaxation effects of TMTX were also determined in mesenteric artery preincubated with L-ANME and indomethacin or in endothelium denuded mesenteric artery. Moreover, effects of TMYX by 50 mg·L⁻¹ on NO secretion and the phosphorylation of eNOS in a cellular model of human umbilical vein endothelial cell (HUVEC) pretreated with or without L-NAME were also observed. The experimental results showed that TMYX has no obvious effect on vasodilation of arteries in normal or KCl pretreated condition, while it can dose-dependently relax the rat mesenteric artery with intact endothelium stimulated with phenylephrine at a maximal diastolic rate of (64.71±10.03)%. After preincubating with L-NAME for 15 min or removal of mesenteric artery endothelium, the maximal diastolic rate was decreased to (35.77±8.93)% and (25.85±10.84)% respectively. However, preincubating with indomethacin had no inhibitory effect on TMYX induced vascular relaxation. Meanwhile, TMYX at 50 mg·L⁻¹ could increase the expression of P-eNOS and the secretion of NO in HUVEC. L-NAME significantly inhibited NO release and phosphorylation of eNOS induced by TMYX. The results suggested TMYX exerted endothelium-dependent relaxation effects against PE-induced contractions of isolated rat mesenteric artery through NO-cGMP signaling pathway.
Animals ; Endothelium, Vascular ; Humans ; Mesenteric Arteries ; Rats ; Vasodilation

Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm (RASA) with those of surgical treatment.Methods A total of 31 successive patients with RASA,who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study.Among them,11 patients received transcatheter closure therapy,their mean age was (36.64±10.87) years old;20 patients received surgical closure,their mean age was (28.90± 10.06) years old.The technical success rate,complications,residual shunt,operation time,hospitalization days,amount of blood transfusion,medical expenses,etc.were compared between the two groups.Results No statistically significant differences in age,sex and preoperative cardiac functional grading established by the Heart Disease Association of New York (NYHA) existed between the two groups (P＞0.05).The technical success rates in transcatheter closure group and surgical closure group were 100％ (11/11) and 95％ (19/20)respectively (P＞0.05).The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and (427.25±331.36) ml respectively (P＜0.01).The time spent for operation in transcatheter closure group and surgical closure group was (60.00±00.00) min and (205.50±129.35) min respectively (P＜0.05).Days staying in intensive care unit (ICU) in transcatheter closure group and surgical closure group were 0 day and (1.50±0.61) days respectively (P＜0.01).The residual shunt rates in transcatheter closure group and surgical closure group were 9.09％ (1/11) and 10.00％ (2/20) respectively.None perioperative death occurred in both groups.No statistically significant differences in hospitalization days and in medical expenses existed between the two groups (P＞0.05).Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA,although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management,operative time and length of hospital stay.For patients with a RASA which position is suitable for percutaneous interventional management,transcatheter closure therapy should be employed as a preferred therapy.

To implement the excellent doctor education training plan and construct the training model of practical ability in clinical education,the researchers analyzed the problems existing in the training of clinical practice ability and put forward a new train of thought,and constructed a training method system of personal experience,reading classics,teacher guidance,simulation training,clinical practice and reflection strengthening.In addition,we also established a safeguard mechanism with the characteristics of the organizational corporation of teaching,the expert-oriented teaching team,team-oriented mentoring,pro-ject-oriented ability training,the diversification of evaluation system,the modernization of teaching platform and the realistic training environment,to train the qualified clinical medical talents.

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group.Group D:topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF:intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic (FOB)-assisted awake nasotracheal intubation was performed.Mean arterial pressure (MAP),heart rate (HR),Pulse oxygen saturation (SpO2),Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris (T1),peep the epiglottis(T2),intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P ＜ 0.05 or P ＜ 0.01) than those of group MF while Ramsay sedation scores were obviously higher (P ＜ 0.05) than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D (n =21) were significantly higher than group MF (n =12) ; initial success rate of intubation in group D was obviously higher than that in group MF (70％,n =21 vs.47％,n =14).And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37％,n =11 vs.67％,n =20).Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.

Objective To report the clinical features and treatment outcomes of 27 patients with fungal endophthalmitis (27 eyes)over a five year period.Methods The authors retrospectively reviewed the etiology,direct smear examination,fungal cul-ture and treatments of 27 patients with culture-proven fungal endophthalmitis at the affiliated Hospital of Medical College Qing-dao University from 2007 to 2012.Results Exogenous infection was defined in 21 patients (77.8%),including 20 associated with penetrating wound,and 1 following cataract surgery.Endogenous infection was found in 6 patients (22.2%),including 3 associated with recent use of high-dose steroids,1 after abortion,1 following pelvic fracture,and 1 with long-term use of im-munosuppressive agents.Fungal hyphae were found in 17 smears of 27 samples (63.0%)by direct microscopic examination. The fungal strains cultured from 27 samples belonged to 8 genus and 12 species.The most common isolates were Aspergillus , Fusarium and Candida species.A.flavus (22.2%)and A.fumigatus (18.5%)were the predominant Aspergillus species. F .moniliforme (14.8%)and F .oxysporum (11 .1 %)were the most predominant Fusarium species.Two eyes were eviscer-ated immediately due to the serious condition.Among the other 25 eyes,22 (88.0%)got improvement after at least one of such treatments as intravitreal injection of antifungal agent,vitrectomy or penetrating keratoplasty (PK).Conclusions Exoge-nous fungal endophthalmitis is the most common type of fungal endophthalmitis in this hospital.Penetrating wound is the main cause of such infections.Microscopic examination of hyphae and fungal culture were effective for the diagnosis of fungal endophthalmitis.Aspergillus is the predominant pathogens, followed by Fusarium.Intravitreal injection of antifungal a-gent combined with vitrectomy is an effective treatment of fungal endophthalmitis.

Objective To observe the clinical effects of sufentanil combined with sevoflurane for anesthesia induction in the elderly.Methods A total of 84 patients undergoing elective laparoscopic were randomly divided into 4 groups by dose of Sufentanil (21 cases,each):0.25,0.50,0.75 and 1.00 μg/kg sufentanil.Mean arterial pressure (MAP)and heart rate (HR)were measured at baseline (To),immediately before intubation(T1),immediately,1,3 and 5 min after intubation(T2-5).Intubation scores were also recorded.Results The intubation scores including visual analogue score (VAS) and Ramsay score at 10 min,30 min and 60 min after tube drawing were as the following sequence:1.0 μg/kg ＞ 0.75 μg/kg ＞0.5 μg/kg ＞ 0.25 μg/kg sufentanil (F =5.78.P＜ 0.05).Compared with T0,MAP and HR decreased in each group at T1,while increased at T2 in group A (P＜0.05).As compared with T0,MAP was decreased and HR was slower at T1 in the 4 groups (F=34.99,P＜0.05),but MAP level was increased in 0.25 μg/kg sufentanil group at T2 (F=12.48,P＜0.05).Compared with group of 0.25 μg/kg sufentanil,MAP was reduced in 0.75 μg/kg and 1.00 μg/kg groups at T4 andT5 (F =6.98,6.25,P＜0.05).MAP was also lower in 0.75μg/kg and 1.00μg/kg groups than in 0.50 μg/kg sufentanil group at T2-T5(F=7.08,20.56,P＜0.05).Conclusions Sufentanil of 0.25 0.50 μg/kg combined with sevoflurane can provide excellent intubating conditions and stable hemodynamics during anesthesia induction in patients undergoing gynecologic surgery.

Objective To investigate the incidence and the relation between pulmonary hypertension (PH) and cardiac output in hemodialysis (HD) patients with PH. Methods The incidence of PH was estimated with Doppler echocardiography in 78 patients receiving HD. Left ventricular ejection fraction, cardiac volume, cardiac output and cardiac index were compared between patients with or without PH. Results PH was found in 20 patients (25.64%), among them15 had mild PH, 4 had moderate PH and 1 had severe PH. There was no statistical difference of ejection fraction, cardiac volume, cardiac output and cardiac index between the two groups. PH was not related to cardiac output. Conclusion HD can lead to PH, but cardiac output can not result in PH. Further investigations about the effect of elevated cardiac output induced by internal arteriovenous fistula and other factors on PH are needed.