ObjectiveTo investigate the possible mechanism of Shenfuhuang Formula （参附黄配方） in prevention and treatment of epsis-associated encephalopathy from the perspective of brain genomics. MethodsC57BL/6 mice were randomly divided into sham surgery group， sepsis group， and Shenfuhuang group， with 20 mice in each group. The sepsis group and Shenfuhuang group were induced to develop sepsis by cecal ligation and puncture （CLP） procedure. At 4 hours after modelling， Shenfuhuang group were gavaged with 2.5 g/（kg·d） of Shenfuhuang Formula， 0.5 ml each time， at 12 hours intervals， for a total of 4 times after modelling. Sepsis group and sham surgery group were given 0.5 ml of purified water orally. At 48 hours after modeling， the transcriptome sequencing was used to explore the differential gene expression in the effects of Shenfuhuang Formula on the brain regions of septic mice， and real-time PCR and ELISA were later used to further validate the differential gene and proteins expression. ResultsA total of 4605 genes were differentially expressed in Shenfuhuang group compared with sepsis group， of which 2353 genes were up-regulated and 2252 genes were down-regulated. According to the results of previous publications， six key genes were screened， including serine/threonine-protein kinase （Nek1）， myelin-associated glycoprotein （Mag）， endothelial cell-specific tyrosine kinase receptor （Tek）， a disintegrin and metalloproteinase with thrombospondin motifs 20 （Adamts20）， lymphocyte antigen 86 （Ly86）， and E3 ubiquitin-protein ligase （Traip）. Further genetic and protein validation revealed that， compared to the sham surgery group， the mRNA levels and corresponding protein levels of Nek1， Mag， Tek， Adamts20， Ly86， and Traip in the brain tissue of septic mice significantly reduced （P＜0.05）. In comparison to the sepsis group， Shenfuhuang group showed significantly increased mRNA levels and corresponding protein levels of Nek1， Mag， Tek， Adamts20， Ly86， and Traip （P＜0.05）. ConclusionThe potential therapeutic targets of Shenfuhuang Formula for treating sepsis-associated encephalopathy may be related to the Nek1， Mag， Tek， Adamts20， Ly86， and Traip genes and their encoded proteins.

Stress urinary incontinence (SUI) and underactive bladder (UAB) are common types of lower urinary tract dysfunction in women.As the treatment mechanisms of the two conditions are contradictory, the treatment of SUI patients complicated with UAB remains a difficult clinical problem.In order to improve the treatment rate of such patients and promote research, this paper reviews the latest domestic and overseas diagnostic criteria of UAB, summarizes the treatment experience of conventional midurethral sling (tension-free vaginal tape or outside-in transobturator tape) and adjustable sling procedures (transobturator adjustable tape or Remeex system) combined with medication or intermittent catheterization, and the application prospects of cutting-edge technologies such as stem cell injection, cytokine therapy and gene therapy, so as to provide reference for clinicians and researchers.

In this paper, the current situation and existing problems of spinal surgery practice are analyzed and summarized. Combined with the review of the structure and function of spinal region, we have expounded the application and advantages of Essential Anatomy software in the clinical practice teaching of spinal surgery. This software has a friendly interface, simple operation, real content, intuitive and visual model, and it can provide videos and slice function, which makes the original complex and abstract spinal anatomy practice content become novel and vivid, and greatly deepens doctors' understanding of the structure, function, movement and the disease pathogenesis of spinal region. At the same time, it also greatly mobilizes the learning interest and initiative of the clinical practice doctors, and improves the effect of clinical practice.

Objective To evaluate the effect of Weisu granule combined with conventional therapy in treatment of chronic atrophic gastritis (CAG). Methods A total of 99 CAG patients who met the inclusion criteria were randomly divided into control group (49 cases) and observation group (50 cases) according to random number table method. The control group was treated with quadruple therapy, while the observation group was treated with Weisu granule on the basis of the control group. Both groups were treated for 90 days. Interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) were detected by ELISA. The scores of TCM symptoms between the two groups before and after treatment were compared. Adverse reactions during treatment were observed and recorded. The eradication rate of H.pylori was measured by 14C urea breath test, and the clinical efficacy was evaluated. Results The total effective rate was 92.0% (46/50) in the observation group and 73.5% (36/49) in the control group. There were significant differences between the two groups (χ2=5.975, P=0.015). After treatment, the level of serum IL-6, hs-CRP and TNF-α in the observation group was significantly lower than those in the control group (t=7.112, 7.753, 9.310, respectively, all P<0.01). After treatment, the scores of symptoms such as abdominal distension and pain, emotional disturbance, hypochondrium pain and belching in both groups decreased (P<0.01), and those in the observation group was significantly lower than those in the control group (t=12.892, 12.451, 10.596, respectively, P<0.01). The eradication rate of H.pylori was 90.0% (45/50) in the observation group and 24.5% (12/49) in the control group. There was a significant difference between the two groups (χ2=43.381, P<0.01). Conclusions The Weisu granule combined with quadruple therapy has a definite theraputic effect. It can improve the clinical symptoms of patients, improve the clearance rate of H.pylori, and alleviate inflammation.

BACKGROUND: 3D printing technology provides possibility for the preparation of an ideal bone tissue engineering scaffold with high individualization, precise regulation of the porosity, pore size and inter-aperture connectivity. OBJECTIVE: To study the physical properties and biocompatibility of allogeneic bone microparticle/poly (lactic-co-glycolic acid) composite absorbable scaffolds fabricated via fused deposition modeling 3D printing. METHODS: 3D printed bone microparticle/poly (lactic-co-glycolic acid) composite absorbable scaffolds were fabricated via fused deposition modeling. The porosity, water absorption, water contact angle and in vitro degradation rate of the scaffold were measured. (1) Cytotoxicity test: Rabbit adipose-derived mesenchymal stem cells were cultured in normal medium (negative control group) and composite scaffold extract (experimental group) for 1, 3, 5, 7 days, and cell counting kit-8 was then used to detect cell proliferation. (2) Hemolysis test: Rabbit anti-clotting was added to physiological saline, distilled water and composite scaffold extract, and the hemolysis rate was detected after 50 minutes. (3) Acute toxicity test: The physiological saline and composite scaffold extracts were intraperitoneally injected into the rabbits respectively to observe the general condition of rabbits and the pathological changes of important organs. RESULTS AND CONCLUSION: (1) The porosity, water absorption and water contact angle of the composite scaffold were (60.86±2.88) ％, (53.98±2.04) ％ and (76.27±0.34) °, respectively. (2) After in vitro immersion in PBS for 4 weeks, the absorbable composite scaffold degraded relatively slowly, and the scaffold morphology remained stable, while the degradation rate accelerated after 4 weeks. The scaffold was almost completely absorbed at about 11 weeks, and it is a relatively ideal absorbable scaffold material. (3) There was no difference in cell proliferation between the experimental group and the negative control group at different time points (P> 0.05) . The cytotoxicity of the absorbable composite scaffold was grade 1. (4) The hemolysis rate of the absorbable composite scaffold was 3.8％, which met the hemolytic requirement of biomedical materials (the hemolysis rate of less than 5％) . (5) Within 72 hours after injection of absorbable scaffold extract, the rabbits showed no acute toxic reaction, as well as no pathological changes in the liver, heart and kidney were observed after 7 days of injection. (6) To conclude, the 3D printed allogeneic bone microparticle/poly (lactic-co-glycolic acid) fabricated via fused deposition modeling 3D printing has preferable physical properties and biocompatibility.

Objective To evaluate the value of virtual touch tissue imaging quantification (VTIQ),which was combined with ultrasound Breast Imaging Reporting and Data System (BI-RADS),for differentiating benign from malignant breast lesions.Methods Totally 190 patients with 214 breast lesions were enrolled in this study.All lesions were classified according to the BI-RADS for sonography.The maximum,minimum and mean shear wave velocity (SWV) values on VTIQ in the lesions were obtained.The SWV between benign and malignant lesions were analyzed.Receiver operating characteristic(ROC) curves were plotted to determine the cut off value of VTIQ for differential diagnosis of breast lesions. Results Pathology confirmed 166 benign lesions and 48 malignant lesions.The SWVmax,SWVmin,SWVmean of malignant lesions were significantly higher than those of benign lesions (all P<0.001).The SWVmean 3.67 m/s as the best value in the diagnosis of benign and malignant lesions.The sensitivity,specificity,positive predictive value and negative predictive value of the combination of the SWVmean and BI-RADS classification standard in the diagnosis of benign and malignant breast lesions were 77.6%,97.5%,92.7%,91.3%,respectively.Conclusions The combination of VTIQ and ultrasonic BI-RADS can improve the ability of differential diagnosis of benign and malignant breast lesions.

Objective To investigate virtual touch tissue imaging quantification shear wave elastography in the differential diagnosis between benign and malignant breast lesions and the value of heterogeneity. Methods A total of 149 patients with 155 breast lesions by ultrasonography were selected from October 2016 to March 2017 in Drum Tower Hospital Affiliated to Nanjing University Medical School. All patients were confirmed by surgical pathology. The breast lesions were first examined by conventional ultrasound and the conventional ultrasonography features were recorded. The lesions were classified by breast imaging reporting and data system (BI-RADS). Then the shear wave velocity (SWV) values were measured under the virtual touch tissue imaging quantification (VTIQ) speed mode. The SWV maximum, average were obtained and coefficient of variation was calculated. According to pathological results, the receiver operating characteristic (ROC) curves of SWV maximum, average and coefficient of variation in differentiating benign or malignant breast lesions were drawn. Results The surgical pathology confirmed that there were 48 malignant lesions and 107 benign lesions in 155 breast lesions. The SWV maximum, average and coefficient of variation in malignant lesions were all higher than those of benign lesions [(6.85±2.26) cm/s vs (3.95±1.54) cm/s, (4.74±1.36) cm/s vs (3.10±0.94) cm, (0.30±0.15) vs (0.17±0.10)], and the difference was all statistically significant (t=8.085, 7.583, 5.366, all P < 0.001). According to ROC curve, the areas under the curves of SWV maximum, average and coefficient of variation in differentiating benign or malignant breast lesions were 0.842, 0.826 and 0.759 and the cutoff values were 5.51 cm/s, 4.28 cm/s and 0.25 respectively. The diagnostic sensitivity, specificity and accuracy of SWV maximum, average and coefficient of variation were 72.92%, 85.98% and 81.93%, 64.58%, 87.85% and 80.65%, 64.58%, 84.11% and 78.06%, respectively. And the combined diagnostic sensitivity of coefficient of variation with SWV maximum and SWV average were 81.25%. Conclusion VTIQ technology plays an important role in the differential diagnosis between benign and malignant breast lesions and the value of heterogeneity.

A suitable ultra-high performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS) method was developed for the determination of 11 mycotoxins with isotope internal standard in malt. The mycotoxins in malt were extracted and purified by one-step ultrasonic extraction procedure using acetonitrile/water/acetic acid (80 : 19 : 1), and then detected and confirmed by UPLC-MS/MS, and quantified by isotope labeled AFB1 ([13C17]-AFB1) and ZEN ([13C18]-ZEN) internal standards. Rapid separation of the 11 mycotoxins was successfully achieved on a Phenomenex Kinetex C18 column (100 mm x 2.1 mm, 2.6 μm) with gradient elution using the mobile phase of methanol containing 0.1% formic acid and 2 mmol x L(-1) ammonium acetate in water. Simultaneous acquisition was performed in multiple reaction monitoring (MRM) mode with electrospray ionization (ESI) source operated in both positive and negative ionization modes. The established method provided a good linearity for the 11 mycotoxins within their respective linear ranges with correlation coefficients all higher than 0.999 1. The average recoveries ranged from 75.0% to 117.0% with relative standard deviations (RSDs) below 5.1%. The limits of detection (LODs) and quantitation (LOQs) ranged from 0.05 to 30 μg x kg(-1) and 0.15 to 87.5 μg x kg(-1), respectively, which were below the maximum residue levels (MRLs) set by the European Union. Twenty malt samples were analyzed and nine samples were detected with mycotoxins, which were confirmed according to the same fragment ions found in positive samples and the standards at the same retention time. This study has demonstrated that the one-step extraction procedure of mycotoxins from complex matrices coupled to UPLC-MS/MS method is simple, quick, accurate and sensitive for quantitative and qualitative analysis of multiple mycotoxins in malt.

Objective To evaluate the value of intravascular interventional embolization in the emergency treatment of patients with hemodynamically unstable pelvic fracture.Methods The retrospective analysis was made on the medical records of 45 cases treated from October 2012 to December 2014.There were 27 male and 18 females(39.2-± 10.3) years (range,28-54 years).Time from injury to admission was within 3 h.Injury severity score (ISS) was (25.3 ± 8.1) points.The pelvic fracture included 32 cases of Type B and 13 Type C according to Tile classification system.After admission,anti-shock treatment and pelvic immobilization with the belt or external fixator were performed,and emergent intravascular interventional embolization was used to stanch bleeding after the bleeding of other organs was excluded.Vascular intervention,post-treatment vitazl signs and prognosis were evaluated.Results Time from admission to interventional therapy was 1.2-2.7 h [(1.9 ± 0.8) h].Time of interventional treatment was 1.6-3.2 h [(2.3-± 0.6) h].Of the 45 cases,contrast extravasation was seen in 38 cases,abnormal vascular morphology in 5 cases,no obvious bleeding in 1 case,and contrast extravasation in the angiographic venous phase in 1 case.Among the 38 cases of contrast extravasation,the offending vessels involved were internal pudenda artery (26 cases),obturator artery (16 cases),superior gluteal artery (4 cases),inferior gluteal artery (4 cases),inferior epigastric artery (1 case) and external iliac artery (1 case),but 8 cases were noted to have two offending vessels and 1 case had delayed bleeding.Of the 45 cases,the hemostatic effect was good in the early stage.After the interventional embolization therapy,the heart rate was (105.2 ± 14.8) beats/min,arterial pressure was (79.0 ± 10.6) mmHg,central venous pressure was (5.1 ± 0.8) cmH2O,and shock index was 1.1 ±-0.5,showing improved vital signs postoperatively (P ＜ 0.05).Four cases died mainly due to the multiple organ failure.One case had abdominal distention aggravated 3 days after operation,which were confirmed to be bleeding in the branch of external iliac artery,and the symptom was alleviated after embolization therapy.Forty-one cases survived with ICU length of stay of (14.5 ± 5.4) d,hospitalization time of (35.2 ± 12.8) d and medical expense of (96,755.3-± 20,568.1) CNY.Conclusion In the emergency treatment of patients with hemodynamically unstable pelvic fracture,the intravascular interventional embolization has become an important measure of comprehensive treatment that allows fast and mini-invasive procedure hemostasis,and deserves clinical promoting.

Objective To investigate the present status of early diagnosis and misdiagnosis of nasopharyngeal carcinoma (NPC). Methods A total of 50 patients diagnosed as NPC were recruited at the department of nasopharyngeal carcinoma in our hospital. The time from that patients felt discomfort to be diagnosed of NPC was determined bydifferent symptoms and signs. Furthermore , the status of misdiagnosis were also investigated. The spearmans rank correlation was used to analyze the correlation between the cancer stage and the time of confirmeddiagnosis , and the relationship between the rate of misdiagnosed and the rank of the hospital they visited. The χ2 test was then used to analyze the cancer stage with the time when they were diagnosed. Results Results indicated that the time when patients were diagnosed significantly correlated with pTNM stage (P < 0.05). Patients diagnosed in one month were most at stage Ⅱ, diagnosed in six months were stage III, and diagnosed after twelve months were stage Ⅳ(P < 0.05). Furthermore, we found that the rate of misdiagnosis of NPC was 12%. Moreover,the misdiagnosed rate was associated with the rank of the hospital patients visited. Discussion In conclusion , the present status of the early diagnosis of NPC is not optimistic. Most of the patients with NPC were misdiagnosed in basic medical institutions , especially in town or village health center. Thus, it is important to popularize the health knowledge about the secondary prevention of NPC and train the doctor in basic medical institutions.