Objective:To explore the value of adenosine loaded 99Tc m-MIBI single photon emission computed tomography (SPECT) in evaluating the therapeutic effect of nicorandil on coronary microvascular angina (CMVA). Methods:Sixty eight patients diagnosed with CMVA in the Second Affiliated Hospital of Xuzhou Medical University from January 2021 to March 2022 were selected and randomly divided into a control group and a nicorandil group, with 34 patients in each group, using a random number table method. The control group received isosorbide mononitrate in addition to conventional treatment, while the nicorandil group received nicorandil in addition to conventional treatment. Both groups were treated continuously for 3 months. All patients underwent adenosine loading 99Tc m-MIBI SPECT before and after treatment to measure the degree of myocardial perfusion defect (SDS), myocardial perfusion defect area (SRS), and degree of improvement of myocardial perfusion defect (SIS). Clinical symptoms, electrocardiogram changes, myocardial enzyme indicators [cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH)], hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO), peripheral resistance (TPR), left ventricular work index (LVWI), and myocardial oxygen consumption (MVO 2)] were evaluated. Results:After treatment, the SDS and SRS of the nicorandil group were significantly lower than those of the control group ( P<0.01), and the SIS was significantly higher than that of the control group (all P<0.01); The improvement of abnormal myocardial perfusion imaging was significantly better than that of the control group (χ 2=4.976, P<0.05); the frequency, duration, and severity of angina attacks, Canadian Heart Association (CCS) grading, and incidence of ischemic changes on electrocardiogram were all lower than those of the control group ( P<0.01); The levels of serum cTnI, CK-MB, and LDH were significantly lower than those in the control group (all P<0.01); SBP, DBP, HR, LVWI, and MVO 2 were significantly lower than those in the control group (all P<0.01), while SV and CO were significantly higher than those in the control group (all P<0.01). Conclusions:Adenosine loaded 99Tc m-MIBI SPECT can effectively evaluate the therapeutic effect of nicorandil on CMVA, and nicorandil can improve myocardial perfusion defects and clinical manifestations in CMVA patients.

Objective:To retrieve, evaluate, and sum up the evidence on target temperature management in stroke patients, and summarize the best evidence.Methods:Based on the "6S" pyramid model, clinical practice guidelines, expert consensus, evidence summary, and systematic review on target temperature management in stroke patients were searched from top to bottom in British Medical Journal Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Health Care Center, Guidelines International Network, Agency for Healthcare Research and Quality, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, American Heart Association, American Stroke Association, European Stroke Organization, Medlive, Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, VIP and China Biology Medicine Disc. The search period was from database establishment to October 7, 2022. Two researchers received evidence-based nursing training independently evaluated the quality of the article, extracted, integrated, and summarized the best evidence.Results:A total of 12 articles were included, including three clinical practice guidelines, four systematic reviews, and five expert consensuses. 24 best pieces of evidence were summarized from five aspects, involving target temperature population, target temperature implementation, complication monitoring, nutritional support, and prognosis evaluation.Conclusions:This study adopts an evidence-based approach to systematically summarize the best evidence for target temperature management in stroke patients, which can provide the best decision-making basis for clinical medical and nursing staff to manage temperature in stroke patients, further standardize temperature monitoring and management, and offer scientific basis for future research and practice.

Objective:Through the statistics and comparison of SCI papers jointly published by the hospital investigators and university scholars, this paper aims to provide a reference for the next step of interdisciplinary research cooperation in ″medicine, science, engineering and liberal art″.Methods:The collaborative SCI papers were searched from the Science Citation Index expanded (SCIE) database, basic information of the cooperative papers were collected. Taking into consideration of the time spots that 3 years before (2015-2017) and after (2018-2020) when the hospital became affiliated to the university. The number of the paper, paper quality, author's basic information, hospital disciplines and the distribution of department/unit in the university were analyzed.Results:The number of the collaborative papers has increased from 23 to 131. There are statistical significance in both the personnel situations and the qualifications to supervise postgraduate students of the authors. The number of the related hospital departments has increased from 7 to 22, and the number of the universities′ unit increased from 3 to 10.Conclusions:After becoming the university affiliated hospital, the interdisciplinary collaborations in medicine, science, engineering and liberal art have already made some achievements, the breadth and depth of cooperation have been continuously expanded, which is related to the various policies implemented by the hospital and the advantages of interdisciplinary collaboration in resource sharing.

The incidence of acute kidney injury (AKI) in Neonatal Intensive Care Unit (NICU) is about 30%.The morbidity and mortality of AKI are higher in very premature infants, very low birth weight infants and infants with long mechanical ventilation.Serum creatinine (Scr) and urine output are diagnostic indicators for AKI, which usually change within 12-48 hours after the onset of irreversible injury, and cannot be used for early diagnosis and clinical intervention.Therefore, it is necessary to search for indicators of early renal insufficiency, aiming to intervene and prevent early-stage AKI or reduce the occurrence of AKI.Near-infrared spectroscopy (NIRS) is a non-invasive, continuous, real-time monitoring method, which serves as a supplement to conventional biochemical markers.It provides evidence of early-stage renal ischemia and hypoxia, which contributes to prevent or reduce AKI.This study reviews the clinical application of neonatal renal oxygen saturation monitoring, thus providing clinical reference for renal function protection in critically ill neonates to reduce the occurrence of AKI and improve their prognosis.

Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.

Objective:To analyze the clinical value and predictive difference of serum Golgi protein 73 (GP73) and serum autophagy-related protein p62 levels in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF).Methods:Clinical data of admitted cases to our hospital from October 2018 to April 2020 were retrospectively analyzed. Simultaneously, there were 32 cases with HBV-related ACLF in group A, 65 cases with hepatitis B virus-related cirrhosis in group B and C (Child-Pugh Class A, 34 cases as B group, and Child-Pugh B/C class, 31 cases as group C), and another 30 healthy subjects served as the control group (group D). The serum GP73 and p62 levels of the four selected groups were measured. ACLF group patients were followed up for 3 months to analyze the prognosis of the patients. The serum GP73 and p62 levels of patients who died and survived during hospitalization were compared. The data were analyzed by one-way analysis of variance, independent sample t-test, and Pearson’s correlation analysis. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of GP73 and p62 levels in surviving patients.Results:GP73 levels in the four groups A, B, C and D were (284.30 ± 70.55) ng/ml, (125.33 ± 20.57) ng/ml, (159.82 ± 31.20) ng/ml, and (45.46 ± 10.22) ng/ml, respectively. The p62 levels were (1.30 ± 0.35) ng/ml, (2.88 ± 0.58) ng/ml, (2.02 ± 0.545) ng/ml, and (4.68 ± 1.03) ng/ml, respectively. GP73 detection value was significantly higher in group A than the other three groups ( P < 0.05). Group D had significantly lower value than the other three groups ( P < 0.05), and group C had significantly higher value than group B ( P < 0.05). The detection value of p62 in group A was significantly lower than the other three groups ( P < 0.05). Group D had significantly higher value than the other three groups ( P < 0.05), and group B had slightly higher value than group C, and the differences were statistically significant ( P < 0.05). There was a negative correlation between GP73 and p62 ( r = -0.695, P < 0.001). Survived patients GP73 level in the ACLF group was significantly lower than dead patients [(212.17 ± 22.47) ng/ml and (340.08 ± 32.91) ng/ml, t = 12.493, P < 0.05], and p62 level was significantly higher than dead patients [(1.46 ± 0.28) ng/ml and (1.18 ± 0.35) ng/ml, t = 2.445, P < 0.05]. According to the ROC curve analysis results, the area under the curve (AUC) of GP73 was 0.865, the AUC of p62 was 0.750, and the combined AUC of the both was 0.968. Conclusion:Both GP73 and p62 have a certain predictive value for the short-term prognosis of HBV-related ACLF patients, but the combination of the two indicators has a higher predictive value.

Objective:To observe the inhibitory effect of gambogic acid on the proliferation of liver cancer cells HepG2 and explore its mechanism.Methods:The vitro cultured liver cancer cells HepG2 were divided into the control group, low dose gambogic acid group, medium dose gambogic acid group and high dose gambogic acid group according to random number table method, 5 multiple holes in each group. The control group was cultured in normal medium and 0.5% DMSO was added as the solvent control. The 0.1, 1 and 10 μmol/L of gambogic acid were added to low, medium and high dose group of gambogic acid for intervention. MTT method was used to detect the inhibition rate of cell proliferation, flow cytometry was used to detect the apoptosis rate, Hoechst nuclear staining was used to observe the nucleus apoptosis, and Western blot was used to detect the expression of Bcl-2 and Bax protein.Results:Compared with the control group, the HepG2 cells proliferation rate (68.00% ± 3.55%, 51.93% ± 4.36%, 47.16% ± 4.73% vs. 99.87% ± 4.53%) in low, medium and high dose gambogic acid group significantly decreased ( P<0.01); apoptosis rate (23.00% ± 1.22%, 40.09% ± 4.65%, 70.32% ± 4.99% vs. 4.33% ± 0.57%) significantly elevated ( P<0.01); Bcl-2 experssion (0.73 ± 0.10, 0.25 ± 0.10, 0.19 ± 0.08 vs. 0.97 ± 0.11) significantly decreased ( P<0.01); and Bax expression (0.39 ± 0.14, 0.88 ± 0.15, 0.85 ± 0.13 vs. 0.22 ± 0.08) significantly elevated ( P<0.01); Bax/Bcl-2 (0.34 ± 0.10, 1.87 ± 0.29, 1.63 ± 0.23 vs. 0.13 ± 0.06) significantly increased ( P<0.01). Hoechst staining showed that the apoptosis rate of HepG2 cells increased in a dose-dependent manner with the increasing concentration of gambogic acid. Conclusions:Gambogic acid could inhhibit HepG2 cells proliferation by regulating the expression of Bax and Bcl-2.

Objective: To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation. Methods: A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution. Results: Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO₂, percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017). Conclusions Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can′t be completely relieved with adenotonsillectomy.

Objective To investigate the risk factors of anastomotic leakage after radical gastrectomy for gastric cancer and establish a risk prediction scoring model for postoperative anastomotic leakage.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 757 patients who underwent radical gastrectomy for gastric cancer in the First People's Hospital of Yibin from February 2000 to December 2017 were collected.There were 1 207 males and 550 females,aged (59± 11) years,with a range from 48 to 70 years.Observation indicators:(1) follow-up situations;(2) risk factors analysis of anastomotic leakage after radical gastrectomy for gastric cancer;(3) establishment of risk prediction scoring model and verification;(4) risk prediction scores and probability of anastomotic leakage in patients with different scores.Follow-up using outpatient examination and telephone interview to detect anastomotic leakage after radical gastrectomy and reoperation or death caused by anastomotic leakage up to June 2018.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolute number.The univariate analysis and multivariate analysis were performed using the chi-square test and Logistic regression model respectively.The discrimination and fitting degree of the model were detected by the Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve.Results (1) Follow-up situations:800 of 1 757 patients were followed up at 1 week,1 month,3 months and 6 months after discharge.During the follow-up,75 had anastomotic leakage,60 of which recovered after conservative treatment,9 recovered after reoperation,6 died of complications including septic shock and cardiac and respiratory failure.(2) Risk factors analysis of anastomotic leakage after radical gastrectomy for gastric cancer:results of univariate analysis showed that patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin and volume of intraoperative blood loss were related factors affecting anastomotic leakage after radical gastrectomy for gastric cancer (x2=5.604,4.975,18.563,35.688,P＜0.05).Results of multivariate analysis showed that patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞ 400 mL were independent risk factors affecting anastomotic leakage after radical gastrectomy for gastric cancer (odds ratio=2.337,1.946,3.478,4.357,95％ confidence interval:1.136-4.804,1.022-3.705,1.871-6.464,2.678-7.090,P＜0.05).(3) Establishment of risk prediction scoring model and verification.Risk prediction equation was established according to the multivariate Logistic regression results:P =1/1 +exp (4.092-0.666 * X1-0.849 * X2-1.246 * X3-1.472 * X4).The fitting degree of the model was detected by the Hosmer-Lemeshow test (P=0.287).The discrimination of the model was detected by the ROC curve,with the area under curve as 0.734 (95％ confidence interval:0.689-0.834,P=0.002).(4) Risk prediction scores and probability of anastomotic leakage in patients with different scores:the risk prediction scores of anastomotic leakage after radical gastrectomy for gastric cancer were 1,1,2,2 in patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞400 mL,respectively.The incidence of anastomotic leakage of patients with risk prediction scores of 0,1,2,3,4,5,6 was 1.6％,3.2％,5.9％,10.1％,19.3％,31.8％ and 47.6％,respectively.The incidence of anastomotic leakage was 13.7％ of patients with score ≥3 and 3.5％ of patients with score ＜ 3.Conclusions Patients with diabetes,preoperative pulmonary insufficiency,preoperative level of albumin ＜ 30 g/L and volume of intraoperative blood loss ＞ 400 mL are independent risk factors affecting anastomotic leakage after radical gastrectomy for gastric cancer.Establishment of a risk prediction scoring model for anastomotic leakage after radical gastrectomy for gastric cancer can effectively identify high-risk patients with anastomotic leakage after radical gastrectomy.

Objective To detect mutations of p53 gene 2-4 exons from peripheral blood and to explore their relevance in HPV16-positive cervical cancer susceptibility and clinical significance. Methods Collected firstly cases from the Third Affiliated Hospital of Kunming Medical University from October 2012 to April 2014, included 167 cases HPV16-postive cervical cancer and 160 cases HPV-negative healthy women. Genomic DNA from the host peripheral venous blood was taken, mutations of p53 gene 2-4 exons were analyzed with software DNAstar after PCR and bidirectional sequencing. Meanwhile,mutations of p53 gene 2-4 exons among different clinicopathological characteristics in HPV16-postive cervical cancer were distinguished. Results (1)Three mutations and an 16-bp insertion/deletion sequences were found in p53 gene exons 2-4, included C/G mutation of single nucleotide polymorphism(SNP)11827 in intron2, A/C mutation of SNP11992 in intron3, C/G mutation in codon 72 (rs1042522) of exon4 and 16-bp(acctggagggctgggg) repeat insertion or deletion in intron3 (rs17878362), while deletion recorded as A1, insertion recorded as A2. No significant differences were found in each point allele and genotype frequency(P＞0.05). (2) Stratified analysis for cervical cancer group resulted with some differences. Compared group of non-squamous carcinoma with squamous carcinoma group, there were obviously decreased in allete A2 [11.8%(4/34) vs 3.5%(10/284); χ2=4.90,P=0.027], genotype A1A2 [4/17 vs 7.0%(10/142); χ2=5.14,P=0.023], and haplotype C-A2 [11.8%(4/34)vs 3.5%(10/284);χ2=4.91,P=0.027]. Compared with poorly differentiated group,allele C of SNP11827 and rs1042522 were obviously decreased in medium high differentiation group [50.8%(61/120)vs 38.8%(62/160);χ2=4.07,P=0.044], while haplotype G-A1 were apparently higher [49.2%(59/120)vs 61.2%(98/160);χ2=4.07,P=0.044], genotype GG of SNP11827 and rs1042522 were obviously decreased in superficial myometrial invasion depth group than that in deep myometrial invasion depth group [46.3%(25/54) vs 21.1%(8/38); χ2=7.06,P=0.029]. No significant differences were found between stage Ⅰ and Ⅱ, pelvic lymph node metastasis or not (all P＞0.05). Conclusions No obvious correlation is found between polymorphisms in exons 2-4 of p53 gene and susceptibility of HPV16-postive cervical cancer. But the patient with allete C and A2, genotype GG and A1A2, haplotype C-A2 and G-A1 may be increase risk of poorly differentiation, deep muscular invasion and bad pathological type. Analysis of p53 gene polymorphism may be provide a basis for the prognosis evaluation and individualized treatment of cervical cancer.