Objective : To study the effect of crisaborole on imiquimod (IMQ) Ⅳinduced psoriasis in mice. Methods: Forty eight Balb/c mice were randomly divided into crisaborole group (7. 5 , 15 , 30 mg/cm2），halometasone group ( 15 mg/cm2 ) , model group and normal group. IMQ was applied to the back of mice to establish the psoriasis model. Psoriasis area and severity index ( PASI) score was calculated , pathological changes , skin epidermal thickness and inflammatory cell infiltration in the dermis were observed by HE staining. The expressions of keratin (K) 1 , K10 , K6 , K16 and K17 in skin lesions were detected by Western blot and immunohistochemistry. The levels of cyclic adenosine monophosphate ( cAMP) , protein kinase A ( PKA) and phospho⁃cAMP response element binding protein (p⁃CREB) were detected. Results : Compared with the model group , the PASI score of the crisaborole group decreased , the expression levels of proliferative keratin ( K6 , K16 and K17 ) decreased( F = 12. 62、19. 41、28. 39 ,P < 0. 01) , and the expression levels of differentiation keratin (K1 and K10) increased(F = 27. 95、9. 64 , P < 0. 01) . Conclusion Crisaborole plays a therapeutic role in IMQ⁃induced psoriasis in mice by regulating the abnormal proliferation and differentiation of keratinocytes.

Objective:To analyze clinical characteristics and high-frequency ultrasound features of localized scleroderma, and to construct and validate a non-invasive prediction model for staging of skin lesions based on the high-frequency ultrasound features.Methods:Patients with localized scleroderma were retrospectively collected from the Department of Dermatology and Venereology, Second Xiangya Hospital of Central South University from February 1, 2021 to February 28, 2023, and clinical data as well as high-frequency ultrasound and pathologic features of 85 lesions from these patients were analyzed. Lesions were divided into modeling cohort and validation cohort according to the chronological order of patient enrollment. The univariate analysis and multivariable logistic regression models were used to analyze the independent influential factors in the staging of localized scleroderma lesions in the modeling cohort, construct the regression equation, and to build a nomogram prediction model. The Bootstrap validation method was used for internal validation, and the predictive performance of the nomogram model in the modeling cohort and validation cohort was further evaluated by the calibration curve and receiver operating characteristic (ROC) curve.Results:In the modeling cohort, 60 patients with localized scleroderma, including 16 males and 44 females, were enrolled, with the age [ M ( Q1, Q3) ] being 22.0 (10.0, 39.2) years, and there were 28 lesions in the oedematous phase and 32 lesions in the fibrotic and atrophic phase; in the validation cohort, 25 patients with localized scleroderma, including 8 males and 17 females, were enrolled, with the age being 18.0 (7.0, 30.0) years, and there were 9 lesions in the oedematous phase and 16 lesions in the fibrotic and atrophic phase. Univariate analysis in the modeling cohort showed no significant differences in the age and gender of patients or the location of lesions between the oedematous phase group and the fibrotic and atrophic phase group (all P > 0.05) ; compared with the oedematous phase group, the fibrotic and atrophic phase group showed an increased proportion of patients with disease duration ≥ 2 years (20/32 cases vs. 10/28 cases, χ2 = 4.29, P = 0.038), decreased thicknesses of the subcutaneous fat layer in skin lesions (1.4 [0.0, 26.0] mm vs. 1.8 [0.1, 14.3] mm, Z = -2.14, P = 0.032), increased decrements in the subcutaneous fat layer thickness in the lesional sites compared with non-lesional control sites (1.8 [0.5, 11.0] vs. 0.3 [-1.9, 8.0] mm, Z = -4.72, P < 0.001), increased ratios of the lesional elasticity values to control elasticity values (2.9 [1.8, 6.9] vs. 1.8 [1.1, 5.9], Z = -4.34, P < 0.001), and increased ultrasound-based lesional activity scores (5.0 [3.0, 8.0] points vs. 3.0 [0.0, 5.0] points, Z = -4.76, P < 0.001). Multivariable logistic stepwise regression analysis showed that the disease duration ≥ 2 years ( P = 0.032), increased ratios of the lesional elasticity values to control elasticity values ( P = 0.019), increased ultrasound-based lesional activity scores ( P = 0.013), and increased decrements in the subcutaneous fat layer thickness in the lesions compared with the controls ( P = 0.013) helped to confirm localized scleroderma lesions in the fibrotic and atrophic phase. Based on the results of regression analysis, a total of 4 factors were included in the nomogram prediction model, including the disease duration, the decrement in the subcutaneous fat layer thickness in lesions compared with controls, the ratio of the lesional elasticity values to control elasticity values, and the ultrasound-based lesional activity score; additionally, the constructed logistic regression model formula for predicting the probability (p) of skin lesions in fibrotic and atrophic phase was "ln (p/[1 - p]) = -9.595 + 2.204 × the disease duration + 0.784 × the decrement in the subcutaneous fat layer thickness in the lesions compared with the controls (mm) + 0.887 × the ratio of the lesional elasticity values to control elasticity values + 1.374 × the ultrasound-based lesional activity score". The calibration curve showed a good predictive performance of the model through the Bootstrap validation method, and the ROC curve demonstrated good discrimination and accuracy (modeling cohort: area under the curve = 0.936, 95% CI: 0.879 - 0.994; validation cohort: area under the curve = 0.889, 95% CI: 0.748 - 1.000) . Conclusions:High-frequency ultrasound could provide essential details for staging the localized scleroderma lesions. Based on the disease duration, subcutaneous fat layer thickness, skin elasticity values, and ultrasound-based lesional activity scores, the constructed prediction model could predict the stages of localized scleroderma lesions with excellent discrimination, accuracy, and predictive performance.

Objective To systematically review the efficacy of different artificial liver support systems in the treatment of acute-on-chronic liver failure (ACLF) using a network Meta-analysis. Methods PubMed, Embase, the Cochrane library, Clinical Trial, CNKI, SinoMed, and Wanfang Data were searched for randomized controlled trials (RCTs) on different artificial liver support systems in the treatment of ACLF. Literature screening, data extraction, and method ological quality assessment were performed according to inclusion and exclusion criteria, and Stata15.1 software and R4.1.0 software were used to perform a network Meta-analysis. Results A total of 14 RCTs were included, with 1141 patients in total. The network meta-analysis showed different intervention methods had no significant difference in reducing mortality rate based on cross comparison (all P > 0.05). The probability ranking diagram showed that plasma exchange (PE) showed the best effect in reducing 30-day mortality rate, followed by extracorporeal liver assist device (ELAD), fractionated plasma separation and adsorption with Prometheus system, molecular adsorbent recirculating system (MARS), Biologic-DT liver dialysis device, and PE+MARS. PE showed the best effect in reducing 90-day mortality rate, followed by Prometheus, ELAD, and MARS. Biologic-DT showed the best effect in improving hepatic encephalopathy, followed by MARS, PE+MARS, and ELAD. Patients undergoing ELAD had the lowest risk of bleeding, and compared with standard medical treatment, Biologic-DT might increase the risk of bleeding [risk ratio=1.9×10 8 , 95% confidence interval: (4.6-6.2)×10 27 ]. Conclusion PE might be the best option for reducing 30- and 90-day mortality rates in ACLF patients. Biologic-DT has a better effect in improving hepatic encephalopathy, but it may increase the risk of bleeding.

Objective: To analyze the urinary iodine status of urban and rural residents in some areas of Gansu Province and its related influencing factors, and to provide certain references for scientific iodine intake of urban and rural residents in Gansu Province. Methods: Subjects in Gansu Province with normal thyroid function were recruited in the investigation of thyroid diseases and iodine nutritional status, conducted a questionnaire survey and measured height, weight, waist circumference, collected 1 urine sample, and tested their urinary iodine levels. The urinary iodine levels of different groups were compared based on different gender, region, age, body weight, the waist, and salt intaking. The affecting factors of urinary iodine levels were analyzed by multiple linear regression models. Results: Totally 1 964 subjects were recruited, including 1 099 males, and 865 females. The age was (41.23 ± 14.75) years old. The median urinary iodine of the selected group was 225.60 (158.80, 311.58) μg/L. The urinary iodine level of rural residents was significantly higher than that of urban residents [μg/L: 249.80 (180.58, 336.88) vs 206.25 (148.03, 280.33), Z=-8.015, P < 0.05], and there was no significant difference between the urinary iodine levels of male and female [μg/L: 222.40 (161.60, 298.90) vs 230.60 (158.00, 326.40), P > 0.05]. The composition ratio of < 100 μg/L group in rural areas was lower than that in urban areas (5.14% vs 8.27%, χ²= 7.45, P < 0.05), and the composition ratio of ≥300 μg/L group was higher than that in urban areas (34.93% vs 21.51%, χ²= 43.87, P < 0.05). The composition ratio of ≥300 μg/L group in male was lower than that in female (24.57% vs 31.21%, χ²= 10.73, P < 0.05). The multiple linear regression analysis showed that lived in rural areas, age, moderate and severe salt intaking, student, and weight were independently correlated with urinary iodine levels (β= 0.074, -0.001, 0.059, 0.034, 0.096, -0.003, P < 0.05). And the urinary iodine levels were decreased with age and weight increased (P < 0.05). Conclusions At present, the iodine nutrition level of urban and rural residents in some areas of Gansu Province is generally over the adequate level. The urinary iodine level of rural residents is higher than that of urban residents. In the future, we should pay attention to the impact of different living areas, salt intaking and body weight on urinary iodine levels to prevent thyroid diseases.

Objective To investigate the protective effect of dexamethasone on hearing loss induced by canalwall-down mastoidectomy.Methods A total of 76 patients (76 ears) were randomized to dexamethasone group and non dexamethasone group with 38 patients in each group.For dexamethasone group,gelfoam soaked with dexamethasone (5 mg/ml) was topically applied to the round window niche at the end of the surgery,and dexamethasone was administrated intravenously at the dosage of 5 mg/50 kg immediately after the surgery.While for non-dexamethasone group,dexamctbasone was not used.The pure-tone audiograms were performed before mastoidectomy and 90 days after the surgery.Absolute bearing change was defined as the difference in hearing thresholds in decibels before and after the surgery.Results The changes of bone conduction thresholds in dexamethasone group were 8.3± 3.9 dB at 6 kHz,11.3±5.2 dB at 8 kHz,and 10.1±7.2 dB for HPTA (4-6-8 kHz high tone average).As in non-dexamethasone group,the changes of bone conduction thresholds were 13.7±4.6 dB at 6 kHz,25.1±5.4 dB at 8 kHz,19.3±9.7 dB for HPTA.There were significant differences in the changes of bone conduction thresholds between dexamethasone and non dexamethasone groups at frequencies of 6 kHz (P=0.039),8 kHz (P=0.007) and HPTA (P=0.009).Conclusion The results demonstrated that application of dexamethasone significantly reduced sensorineural high frequencies (6 kHz and 8 kHz) hearing loss after canal-wall down mastoidectomy,thus the use of dexamethasone is recommended.

Objective To study the protective effects of salvia miltiorrhiza on acute acoustic trauma (AAT) showed by temporary threshold shifts (TTS) induced by impulse noise.Methods A total of 62 male soldiers from a boot camp were randomly divided into the experimental group and the control group,each with 31 persons.The experimental group was treated with salvia miltiorrhiza,and the control group with placebo.Salvia miltiorrhiza was taken orally at the dosage of 780 mg each time,three times a day for 3 consecutive days before the live fire training and 1 day after the live fire training.The pure tone thresholds of right ears of these two groups were measured and compared 72 hours before live fire training and 6 hours after the live fire training.Results The puretone averages at 0.5,1 and 2 kHz of the right ears of the experimental group and the control group before live fire training were 16.32±6.12 dB and 16.21±5.42 dB,respectively,and the averages at 4,6 and 8 kHz were 14.22±5.16 dB and 14.89±5.38 dB,respectively.There were no significant differences between the 2 groups(P＞0.05).The PTAs of the right ears of the experimental group and the control group 6 hours after live fire training were 21.88±5.71 dB and 21.66±6.62 dB,respectively(P＞0.05),while the HPTAs were 25.89 ± 7.97 dB and 39.75 ± 7.84 dB,respectively(P＜0.01).There were significant differences in TTS between the two groups at 4,6 and 8 kHz(P＜ 0.01).Conclusion Salvia miltiorrhiza can reduce TTS at high frequencies induced by AAT.It has a potential preventive effect on AAT.

Objective To assess the efficacy and safety of urinary kallidinogenase combined with sodium ozagrel for cerebral infarction (CI), and provide references for clinical rational drug use. Methods Retrieved from Cochrane library, PubMed, CBM, FMJS, VIP, Wangfang database and CNKI ( published until January 2015), randomized controlled trails (RCT)about urinary kallidinogenase combined with sodium ozagrel for treatment of CI were included,then methodological quality were evaluated and statistical analysis of those studies were carried out by Rev Man 5.3.4 software. Results 19 RCTs were included,involving 1 747 patients. Results of Meta-analysis showed that urinary kallidinogenase combined with sodium ozagrel could significantly improve total effective rate[RR= 1.18, 95%CI(1.13, 1.23), Z= 7.97, P<0.000 01], cure rate[RR = 1.42, 95%CI(1.23, 1.64), Z= 4.86, P<0.000 1], neurological deficit scores[MD= -4.40, 95%CI(-5.36, -3.43), Z= 8.90,P<0. 000 01] and activity of daily living scores[MD = 19.14, 95%CI(17.39, 20.90), Z = 21.36, P<0.000 01]. Conclusion Urinary kallidinogenase combined with sodium ozagrel was effective in the treatment of CI, and no significant adverse reactions were observed. The combination therapy was worthy of clinical application.

Objective To investigate the effect of Hospital-Community-Family integrated management in the rehabilitation of patients with chronic gastric ulcer. Methods From June 2012 to June 2014, a total of 250 patients with chronic gastric ulcer were divided into the observation group ( n=125 ) and the control group (n=125) according to the random number table. After discharged from the hospital, the control group was given the conventional follow-up, the observation group was given Hospital-Community-Family integrated management. The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS) and general quality of life inventory ( GQOLI-74 ) when discharging and 12 weeks after discharged were compared between two groups. Results At 12 weeks after discharged, the scores of SAS and SDS of the observation group were (45.3 ±10.2) and (44.1 ±9.9), which were significantly lower than those of the control group (t=3.857, 3.991;P < 0. 01). The score of GQOLI-74 of the observation group was (265. 0 ± 23. 6), which was significantlylowerthan(252.9±23.1)ofthecontrolgroup(t=4.097,P<0.01).Conclusions Inpatients with chronic gastric ulcer, Hospital-Community-Family integrated management can relieve anxiety and depression. It is conducive to the rehabilitation of patients and worthy of clinical promotion.

BACKGROUNDPreoperative incisional local anaesthesia with ropivacaine is a common method of providing post-laparoscopy pain relief. The pulmonary recruitment manoeuvre also provides pain relief, but the combined effect of these two methods on pain following laparoscopic procedures has not been reported. We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.

METHODSThis prospective, randomized, controlled study involved 60 patients divided into two groups (n = 30, each). Group 1 received 20 ml of 0.5% ropivacaine injected peri-incisionally preoperatively, with intra-abdominal carbon dioxide removed by passive deflation. Group 2 received 20 ml of 0.5% ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery. The last inflation was held for 5 seconds. The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0, 2, 4, 8, 12, 24 and 48 hours postoperatively by an independent blinded anaesthesiologist. Tramadol was given postoperatively for analgesia.

RESULTSCompared with group 1, incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour, 4 hours, and 24 hours postoperatively (4.1 ± 2.2 vs. 2.1 ± 1.9, P = 0.002; 2.7 ± 2.7 vs. 1.2 ± 1.3, P = 0.035; and 3.5 ± 2.1 vs. 2.1 ± 1.8, P = 0.03, respectively). Static incisional pain was significantly relieved at 0 hour, 2 hours, and 24 hours postoperatively (3.1 ± 1.7 vs. 1.6 ± 1.3, P = 0.001; 1.4 ± 1.3 vs. 0.5 ± 0.8, P = 0.012; and 2.3 ± 1.9 vs. 1.0 ± 1.5, P = 0.038, respectively). Group 2 had more patients without shoulder pain (P < 0.05) and fewer requiring tramadol (P < 0.05).

CONCLUSIONRopivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.

Adolescent ; Adult ; Amides ; therapeutic use ; Anesthetics, Local ; pharmacology ; Female ; Humans ; Hysteroscopy ; methods ; Laparoscopy ; methods ; Middle Aged ; Pain, Postoperative ; drug therapy ; Positive-Pressure Respiration ; Shoulder Pain ; drug therapy ; Young Adult

Objective To make a concrete analysis of micro-perfusion pump and compatible syringes used in neonatal intensive care unit (NICU) for low birth weight infants,and to find solutions to the defects in application.Methods 20 ml sterile syringes were set different infusion rates (1ml/h,5ml/h,6ml/h,10ml/h),different infusion time (5min,30min,lh).Then,the card slot on the micro-perfusion pump where the end of 20ml sterile syringe was placed was regulated.The regulated syringes were also set different infusion rates (5ml/h,6ml/h,l0ml/h) and time as before.The error accuracy was calculated.Results The results showed that at the end stage of 20ml sterile syringes pumping,there was always 0.5～1.5 ml residual liquid which could not be pumped out,but perfusion pump displayed injection was completed.Before regulation,the error accuracy between different infusion rates of 20ml sterile syringes was 6.00％,3.80％,2.33％,1.30％ respectively.However,after improvement,the regulated syringes could completely pump all liquid out,and the error accuracy between different infusion rates and different infusion time was also superior to pre-improvement.Conclusions Improved micro-infusion pump and sterile solution prefilled syringe have no drug residual,and display high accuracy and small error accuracy.