Objective To analyze the relationship between fragmented QRS(fQRS)and microalbuminuria(MAU)and serum uric acid(SUA)in patients with type 2 diabetes mellitus(T2DM).Methods From October 2022 to June 2023,245 T2DM patients diagnosed by The Department of Endocrinology,Jinhua Hospital Affiliated to Zhejiang University School of Medicine were selected and divided into fQRS group(fQRS,n=111)and T2DM group(n=134)according to ECG results.The general data,biochemical indexes,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),interventricular septum(IVS),left ventricular posterior wall(LVPW),left ventricular ejection fraction(LVEF),left atrial diameter(LAd),peak value ratio of mitral orifice blood flow velocity in early and late diastole(E/A)and mitral orifice blood flow velocity in early diastole were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between fQRS wave and other indexes in T2DM patients,and Logistic regression analysis was used to analyze the influencing factors of fQRS.Results The prevalence rates of UACR,SUA,HbA1c and MAU in fQRS group were higher than in T2DM group(P＜0.05 or P＜0.01).LVEDd,LAd,E,E/e'and E/A>1.5 in QRS group were higher than in T2DM group(P＜0.05 or P＜0.01).Pearson correlation analysis showed that fQRS wave was positively correlated with smoking history,BMI,HbA1c,UACR,MAU,SUA,LVEDd,LAd,E/A and E/e'(P＜0.05).Logistic regression analysis showed that MAU was the influencing factor of fQRS wave in T2DM patients.Conclusions The fQRS in ECG in patients with T2DM is associated with MAU and SUA and may be an important evidence of myocardial fibrosis associated with subclinical cardiac diastolic dysfunction.

Objective:To explore clinical features, diagnosis, localization, and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies.Methods:A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021. There were 14 females and 9 males with the age ranged from 35 to 82 (55.0±12.7)years. In all the cases, esophageal CT was taken to confirm the esophageal foreign body. Multiplanar reconstruction (MPR) was performed to locate the foreign body from the horizontal, coronal and sagittal dimensions as well as the corrected reconstructed MPR. According to the location of the foreign body, appropriate surgical method was selected.The symptoms, complications, types of foreign body, positioning, surgical methods, and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software.Results:The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia (20/23), foreign body sensation (6/23), hoarsenss (1/23), difficulty in turning neck(1/23), difficulty in opening mouth (1/23), fever (7/23), poor appetite (1/23), and abdominal pain (1/23). The foreign bodies included 19 fish bones, 2 wires, 1 embroidery needle and 1 chicken bone. There were 9 cases (39.1%) of foreign bodies located in extraluminal cervical esophagus, 2 cases (8.7%) of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases (52.2%) of foreign bodies located in pharynx. Twenty-one cases of foreign bodies were removed by cervical lateral incision, in which 11 were removed by cervical lateral incision directly, 10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR, 1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope, 1 foreign body was removed by tracheoscopy. Compared with patients with intraluminal foreign bodies ( n=308) treated in the same period, intake of fishbone [19 (19/23) vs. 133 (82.6% (43.2%, 133/308), OR=7.31] and first visit was more than 24 hours [20(87.0%, 20/23) vs. 77(25.0%, 77/308), OR=17.2] were the significant risk factors of migratory esophageal foreign bodies. Conclusions:MPR and the corrected MPR can accurately locate the migrating pharyngeal and cervical esophageal foreign bodies, by providing more intuitive imaging evidence for doctors, which provide imaging basis for formulation of surgical programs. Foreign bodies in pharyngeal and cervical esophagus need to be treated as soon as possible, otherwise they are easy to migrate, leading lead to serious complications.

Studies have shown that plasma apolipoprotein B (ApoB) has a good predictive value for ischemic stroke and plays an important role in the prevention and treatment of ischemic stroke. More and more guidelines and consensus opinions began to recommend ApoB as a routine intervention target. This article reviews the biological characteristics, clinical detection advantages, and role and treatment prospect of ApoB in the prevention and treatment of ischemic stroke.

Objective:To investigate the clinical efficacy and possible mechanism of bifidobacterium tetralogy combined with escitalopram oxalate in the treatment of patients with depression and to provide evidence for further clinical research.Methods:A total of 100 patients with depression who received treatment in Taizhou Second People's Hospital from September 2019 to March 2021 were included in this study. They were randomly assigned to receive either escitalopram oxalate and placebo (control group, n = 50) or escitalopram oxalate and bifidobacterium tetralogy (observation group, n = 50). All patients received 9 weeks of treatment. Psychological status pre- and post-treatment was evaluated using the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Serum cortisol, inflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels were detected using the enzyme-linked immunosorbent assay. Results:Physiological status scores in each group were significantly lower after treatment compared with before treatment. Scores of the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores post-treatment in the observation group were (10.78 ± 2.03) points and (6.37 ± 2.58) points, which were significantly lower than those in the control group [(16.78 ± 2.85) points, (13.23 ± 2.95) points, t = 11.40, 13.38, both P < 0.001]. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α in each group were significantly decreased after treatment compared with before treatment. Serum levels of cortisol, inflammatory factors IL-1β and TNF-α post-treatment in the observation group were (137.34 ± 63.29) μg/L, (14.38 ± 6.08)ng/L, (13.95 ± 6.46) ng/L, which were significantly lower than those in the control group [(181.22 ± 59.27) μg/L, (25.94 ± 6.92) ng/L, (20.44 ± 6.24) ng/L, t = 15.29, 6.16, 9.24, all P < 0.001). Conclusion:Bifidobacterium tetralogy combined with escitalopram oxalate is highly effective on depression. The combined therapy can remarkably reduce depression and anxiety symptoms and greatly decrease serum cortisol, IL-1β, and TNF-α levels.

Objective To investigate the value of the automated breast volume scanning (ABVS) combined with virtual touch tissue imaging quantification (VTIQ) in the differential diagnosis of benign and malignant breast lesion.Methods Five hundred and seven patients with a total of 675 breast nodules were detected using ABVS and VTIQ technique.Of them,coronal plane imaging,SWVmax,SWVmin,and SWVmean (in m/s) for each nodule was acquired three days before operation or core needle biopsy.According to pathological results,the receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of the ABVS alone (retraction phenomenon on coronal plane),VTIQ alone and their combination in the diagnosis of breast lesions.Results Among all nodules,504 lesions were benign,and 171 were malignant.The rate of retraction phenomenon on coronal plane in malignant lesions was significantly higher than that in benign lesions (x2=279.89,P ＜ 0.001).The value of SWVmax,SWVmin,SWVmean (6.79± 1.71 m/s,5.03 ± 1.24 m/s,5.74± 1.36 m/s) in malignant nodules were higher than that of benign nodules [(3.41 ±1.51) m/s,(2.46± 0.87) m/s,(2.65 ± 1.23) m/s],the differences were statistically significant (t=32.43,33.85,26.77,all P ＜ 0.001).The AUC of malignant nodules for SWV (maximum,minimum,and average) were 0.922,0.934 and 0.937,respectively.With cut-off value of 4.045 m/s,SWVmean showed the best diagnostic performance.The sensitivity,specificity and accuracy of the retraction phenomenon on coronal plane,SWVmean and their combination in diagnosing malignant breast lesion were (39.65％,94.39％,95.78％),(97.50％,94.39％,95.53％) and (82.84％,93.51％,94.25％),respectively.And the SWVmean showed significant higher sensitivity than that of retraction phenomenon.The diagnostic capacity significantly improved when the two approaches were combined.Conclusion Both the retraction phenomenon on coronal plane and VTIQ had high diagnostic value,combining the two methods can improve the differential diagnosis ability for breast lesions.

Objective To evaluate the preventive effects of predictive phased intervention on lower extremity deep vein thrombosis in ICU patients.Methods A total of 82 cases of critically ill patients admitted to our hospital from June 2013 to June 2016 were divided into observation group and control group according to the random number table method, with 41 cases respectively. Patients in the observation group received predictive phased intervention, while patients in the control group received routine nursing intervention. After 4 weeks of intervention, the lower extremity deep venous thrombosis rate, lower limb perimeter and blood flow velocity of lower extremity venous were compared between two groups.Results The incidence of lower extremity deep venous thrombosis was 2.44% in the observation group and 19.51% in the control group. The difference between two groups was statistically significant (x2=6.604,P<0.05). After the intervention, the lower limb perimeter of patients in the observation group was (30.01±2.34) cm, which was significantly lower than that of the control group; the venous blood flow velocity of the lower extremity of patients in the observation group was (25.43±3.01) cm/s, which was significantly higher than that of the control group (t=2.285, 2.357;P<0.05).Conclusions Predictive phased intervention has obvious advantages in the prevention of lower extremity deep venous thrombosis in ICU patients and it is worth clinical promotion.

OBJECTIVETo study the relationship between fibrotic focus (FF) and carbonic anhydrase (CA) IX in invasive ductal carcinomas (IDC) of the breast.

METHODSIn 167 cases of IDC, the FF was assessed morphologically, and expression of ER, PR and CA IX was evaluated using MaxVision immunohistochemistry.

RESULTSThe expression of CA IX in IDC with and without FF was 56.3% (45/80) and 28.7% (25/87) respectively, with significant difference (P=0.001). In IDC with FF, the CA IX expression of tumor cells in tumors with CA IX-positive fibroblasts (35/40, 87.5%) was significantly (P<0.001) higher than that in tumors with CA IX-negative fibroblasts (10/40, 25.0%). In IDC with FF, the CA IX expression of fibroblasts of FF in grade 3 IDC (23/33, 69.7%) was significantly (P=0.006) higher than that in grade 1+2 tumors (17/47, 36.2%). The ER and PR expression of tumor cells in tumors containing CA IX-negative fibroblasts was 72.5% (29/40) and 65.0% (26/40) respectively, whereas the ER and PR expression of tumor cells in tumors containing CA IX-positive fibroblasts was 50.0% (20/40) and 42.5% (17/40) respectively; the difference was statistically significant (for both ER and PR, P=0.04). The age of patients with tumors containing CA IX-negative fibroblasts was significantly (P=0.002) older than those containing CA IX-positive fibroblasts. The FF diameter/tumor diameter in tumors containing CA IX-positive fibroblasts was significantly larger than those containing CA IX-negative fibroblasts. (3) For the groups of tumor size≤2 cm and tumor size between 2 cm to 5 cm, the diameter of the fibrotic focus was significantly (P<0.01) smaller than the fibrotic focus size of tumors>5 cm in size.

CONCLUSIONSCA IX expression is correlated with FF, and that in fibroblasts of FF correlated with patients' age, tumor grade, hormone receptors and FF diameter/tumor diameter. CA IX expression in FF might be a marker for poor prognosis in patients with breast cancer.

Age Factors ; Antigens, Neoplasm ; Breast Neoplasms ; metabolism ; pathology ; Carbonic Anhydrase IX ; Carbonic Anhydrases ; Carcinoma, Ductal, Breast ; enzymology ; pathology ; Female ; Fibroblasts ; metabolism ; Humans ; Immunohistochemistry ; Neoplasm Grading ; Neoplasm Proteins ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism

Amyloidosis ; Cardiomyopathy, Hypertrophic ; Humans

Objective To explore the value of energy spectrum CT in the diagnosis of breast cancer.Methods Thirty-two hospitalized patients whose American Colledge of Radiology (ACR) breast imaging reporting and data system (BI-RADS) scores were 4-5 by mammography received non-enhanced spectral CT scans.The spectrum images,spectrum curve,lesion's size,morphology were observed,and also the pectoralis major muscle and axillary lymph node metastasis were evaluated and compared with mammography.Results Thirty-two patients were confirmed by pathology,including 16 cases of invasive duct carcinomas,1 case of medullary carcinoma,15 cases of lobular carcinomas,and 11 cases of the pectoralis major muscle invaded,9 cases of the axillary lymph nodes metastasis.ACR BI-RADS scores 4 were 23 cases,5 were 9 cases.Axillary lymph node metastasis and primary tumor spectrum curves were basically the same.Energy spectrum CT showed the lesion's shape,size,the relationship with the pectoralis major muscle and axillary lymph node metastasis.In 40-70 keV spectrum curve breast cancer displayed a downward trend.There were no significant differences between energy spectrum CT and mammography for the lesion's shape,edge,internal calcification and thickening of adjacent skin (P ＞ 0.05).While energy spectrum CT exhibited obvious advantages in demonstrating the pectoralis major muscle invaded and axillary lymph node metastasis (P ＜ 0.05).Conclusion Energy spectrum CT imaging displays greater clinical value for diagnosing breast cancer,and it can provide multi-parameter image for supporting clinical practice.

Objective To discuss the value of joint detection in patients with progressive cerebral infarction (PCI) on high sensi‐tivity c‐reactive protein(hs‐CRP) ,and homocysteine(Hcy) ,D‐Dimer ,Fibrinogen(Fib) ,ferritin(SF) .Methods According to the de‐velopment and evolution of the 156 patients with acute cerebral infarction were divided into progressive cerebral infarction group and non‐progressive cerebral infarction group ,to determine the level of serum hs‐CRP ,Hcy ,one or two D‐Dimer ,Fib ,SF .Results hs‐CRP ,Hcy ,D‐D ,Fib ,SF in the PCI group were higher than those in the control group ,the difference was statistically significant (P<0 .05) .Conclusion Between the development of the PCI with hs‐CRP ,Hcy ,D‐D ,Fib and SF ,there is a close relationship ,to detect the level has a certain significance to the prediction of progressive ischemic stroke .