Background In the context of global climate change, heatwaves pose an increasing threat to human health. Emergency ambulance calls are an important outcome indicator of acute health response in populations during heatwave weather. However, studies on the association between emergency ambulance calls and heatwaves in China have primarily focused on the southern regions, and less attention is paid to the northern regions, which hinders a comprehensive assessment of acute health impact posed by extreme heat. Objective To quantify the association between heatwaves and emergency ambulance calls in Dezhou City, Shandong Province. Methods The data on daily records of emergency ambulance calls, meteorological factors, and air pollution from May to September of 2020 to 2022 in Dezhou City, Shandong Province were collected. Heatwaves were defined by combining thresholds at the 90th, 92.5th, 95th, and 97.5th percentiles (P₉₀, P_92.5, P₉₅, and P_97.5) of the year-round daily mean temperature and durations of ≥2, 3, or 4 consecutive days, respectively. A generalized additive model with a distributed lag nonlinear model was used to estimate the relative risk of emergency ambulance calls during heatwave days compared with non-heatwave days. Results During the study period, a total of 143393 emergency ambulance calls were analyzed, with 59.75% of individuals aged <65 years, 53.38% male, and 44.94% due to respiratory causes. Compared to non-heatwave periods, all 12 types of defined heatwaves were significantly associated with an increased risk of emergency ambulance calls. The heatwave effect intensified progressively with higher temperature thresholds and longer durations. The cumulative relative risk rose from 1.12 (95%CI: 1.07, 1.17) for the P₉₀_2d type to 1.26 (95%CI: 1.14, 1.40) for the P_97.5_4d type. No significant gender difference was observed in the association between heatwaves and emergency ambulance calls. Regarding age, older adults were more vulnerable, with a relative risk of 1.60 (95%CI: 1.42, 1.81) for the most severe heatwave type P_97.5_4d compared with non-heatwave periods. Among the different causes of calls, the association between respiratory diseases and heatwaves was the most pronounced, with the relative risk increasing from 1.22 (95%CI: 1.15, 1.29) for the mildest heatwave type P₉₀_2d to 1.72 (95%CI: 1.54, 1.93) for the most severe heatwave type P_97.5_4d. Conclusion In Dezhou City, Shandong Province, heatwaves are significantly associated with an increased risk of emergency ambulance calls. The effects of heatwaves on emergency ambulance calls vary by age and disease type, with the elderly and patients with respiratory diseases being more susceptible. These groups should take protective measures.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To establish virus culture method and full genome sequencing method for severe acute respiratory syndrome coronavirus (2019-nCoV), and to illuminate the variation of 2019-nCoV.Methods:The pharyngeal swab specimens were inoculated into Vero-E6 cells for isolation, and the cytopathic effect were observed day by day, and the result of virus isolation were confirmed by Real-Time RT-PCR. Some isolated viruses were diluted 10 times to detect the virus titer. Full-genome of 2019-nCoV was sequenced with the whole genome capture technology and next generation sequencing technology. Phylogenetic analysis and molecular characterization for obtained 2019-nCoV sequences were undertaken.Results:Twenty-two 2019-nCoV strains were isolated with Vero-E6 cell line in the Biosafety Level-3 Laboratory (BSL-3). Eighteen full-genome sequences obtained (almost 29 000 nucleotide) were analyzed with 99.94%~100% identity and 28 nucleotides and 20 amino acids variations. Phylogenetic analysis showed that the 2019-nCoV sequences belonged to different clades, including clade S and clade L with Europe lineage L. I and Europe lineage L. II.1. Furthermore, 5 of 18 2019-nCoV harbor the D614G mutation.Conclusions:2019-nCoV were successfully isolated with Vero-E6 cells, and partially illuminated the phylogenetic characteristics, which provided a basis for subsequent drug screening and biological characteristics research. Continuous monitoring and analysis of the sequences of new cases would be vital to understand the genetic evolution and rates of substitution of the 2019-nCoV.

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in neoadjuvant chemotherapy(NAC) for triple negative breast cancer(TNBC)in the elderly.Methods A total of 16 elderly patients with TNBC admitted to hospital from October 2017 to June 2018 were selected,and they underwent ultrasound examination before treatment.Changes in lesion size and time intensity curve (TIC)parameters were compared against postoperative microscopic diagnoses,which were used as the gold standard,to evaluate the effect of NAC in elderly TNBC patients.Results Compared with pre-treatment imaging data,the sum of the diameters of target lesions was reduced by 38.0％ after NAC treatment[(7.29±1.62)cm vs.(4.52± 1.21)cm,t =2.313,P＜0.05],and TIC parameters showed that the peak intensity(PI)and the time to peak(TTP)and the slope of the ascending part of the curve,or Grad,were statistically different between pre and post-NAC treatment measurements[(-65.14± 3.75)dB vs.(57.67± 1.93)dB,(11.57±7.34)s vs.(5.35±0.83)s,(1.21±0.27) vs.(2.29± 0.45),t =3.512,2.271 and 2.727,P =0.003,0.049 and 0.026,respectively].When compared with microscopic examination results,CEUS TIC analysis for evaluating the efficacy of NAC showed an accuracy of 87.5％ (14/16),a sensitivity of 92.9％ (13/14),a specificity of 50.0％ (1/2),a positive predictive value of 81.3％ (13/16) and an inter-method kappa value of 0.429(x2=0.500,P=0.230).Using CEUS to evaluate the efficacy of NAC achieved an accuracy rate of 81.3％(13/16).Conclusions CEUS can effectively evaluate the efficacy of NAC in elderly patients with TNBC,and guide the clinician to develop an accurate,individualized treatment program benefiting the patients.

Objective To investigate radiation-related human plasma metabolic features by using metabonomics method and to analyze relative metabolic pathway .Methods The plasma samples of 40 patients pre-and post-total body irradiation (TBI) from January 2012 to May 2014 were collected, and the effect of TBI on human plasma metabolites was studied by gas chromatography mass spectrometry ( GC-MS) , and the differential plasma metabolic features related to irradiation damage were screened . Results The levels of glucose, myristic acid, oxalic acid, 3-hydroxy butyric acid, urea, aspartic acid, valine, leucine, lysine and threonine in plasma were significantly (P<0.05) increased after TBI, while the levels of cholesterol, pyruvic acid, propionic acid, lactic acid, alanine, glycine, inositol, sorbitan, ethylene glycol and hypoxanthine were decreased drastically (P<0.05).Conclusions TBI could cause significant changes in the levels of human plasma metabolites including amino acid metabolism , glucose metabolism, lipid metabolism and so on.

Objective To evaluate the value of endorectal ultrasonography (ERUS) combined with real-time elastography in the diagnosis of benign and malignant rectal neoplasms in elderly patients.Methods Fifty-six consecutive patients with rectal neoplasms underwent ERUS and realtime tissue elastography at Beijing Hospital from February 2016 to December 2016.The imaging results were compared with results from postoperative or colonoscopic findings.Results Histopathological examinations identified 50 cases of adenocarcinomas,5 cases of adenomas and 1 case of neurilemmoma.The accuracy,sensitivity and specificity of ERUS in the diagnosis of benign and malignant rectal neoplasms were 89.3％ (50/56),92.0％ (46/50),and 66.7％ (4/6),respectively.The accuracy,sensitivity and specificity of real-time elastography in the diagnosis of benign and malignant rectal neoplasms were 80.4％ (45/56),82.0％ (41/50),and 66.7％ (4/6),respectively.However,there was no significant difference in sensitivity and specificity (x2 =3.20 and 0.50,P=0.074 and 0.480) between the two approaches.With the combination of ERUS and real-time elastography in the diagnosis of benign and malignant rectal neoplasms,the sensitivity and specificity were 75.4％ and 98.6％ for the series method and 88.9％ and 44.5％ for the parallel method.Conclusions Although elastography may not improve the accuracy of the diagnosis of benign and malignant rectal neoplasms,the strain information it provides can be used as a basis for subsequent diagnosis and treatment decisions.

Objective To evaluate the value of endorectal ultrasound(ERUS)combined with real-time elastography in the staging of advanced rectal cancer in elderly patients.Methods A total of 50 patients with advanced rectal cancer underwent endorectal ultrasound and real-time tissue elastography imaging at our hospital from Jun.2014 to Oct.2015.Their staging results were compared with postoperative pathology.Results The accuracy,sensitivity and specificity of ERUS in the staging of advanced rectal cancer(T3)were 90％ (45/50),93.5％ (43/46)and 50％ (2/4),respectively.The accuracy,sensitivity and specificity of real-time elastography in the staging of advanced rectal cancer(T3)were 84％(42/50),89.1％(41/46)and 25％(1/4),respectively.With the combination of the two techniques,the accuracy,sensitivity and specificity in the staging of advanced recta[cancer(T3)were 96％ (48/50),97.8％ (45/46)and 75％ (3/4),respectively.There was no significant difference in accuracy and sensitivity(x2 ＝4.000 and 3.100,P＝0.373 and 0.542)between the three approaches.Kappa values between each of the three approaches and surgical pathology were 0.531,0.252 and 0.728,respectively.Conclusions Real-time tissue elastography in the diagnosis and staging of advanced rectal cancer can be enhanced when used in combination with endorectal ultrasound.

Apoptosis refers to the programmed death process of cells modulated by genes. It plays an important role in promoting the evolution of organisms, regulating the development of multiple systems, and maintaining the stability of internal environment. The major apoptosis pathways include mitochondrial pathways, death receptor pathways, and endoplasmic reticulum pathways. With the rapid development of the scientific research on acupuncture, it’s revealed that cell apoptosis should be closely related to the action of acupuncture. So far, the major apoptosis factors involved in relevant researches are P53, Bcl-2 family, Cyt-C, Caspase, Fas/Fasl, TNFR1/TNF-?, and FADD-Caspase8, and PERK, etc. Via influencing these apoptosis factors or genes, acupuncture can produce various effects in improving tissue ischemia, protecting neural cells, reducing inflammation, and correcting endocrine disorders. This article summarized and reviewed the apoptosis pathways and key factors related to the action of acupuncture, to provide some beneficial references for future studies.

The development of TCM acupuncture represents a internationalized and modern trend. A recent study with the title of "Acupuncture for chronic knee pain: a randomized clinical trial" published in Journal of the American Medical Association on October 1st, 2014, which raised doubts on acupuncture efficacy as well as traditional manipulation and acupoint theory, makes some negative impact and challenges on the development of acupuncture. From the view of future development of acupuncture, the potential influence of this research on acupuncture development is proposed, and by combining acupuncture theory, some discussions and doubts on the research design and outcome explanations are made. Additionally, enlightenments of this research on further clinical research are summarized.
Acupuncture Therapy ; Chronic Pain ; therapy ; Female ; Humans ; Low-Level Light Therapy ; Male