Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Medical service pricing system is the basic system of health economics, which has a profound impact on physicians′ medical behavior and the running mode of hospital. Rui′an City, Wenzhou City, Zhejiang Province, freed up the cost space of drug and consumables based on the reasonable diagnosis and treatment behavior of doctors and selection of drug and consumables in the hospital procurement link. 68% of the free space was used to improve the price of medical services. 248 medical service items with obvious cost inversion were selected, such as nursing, traditional Chinese medicine, diagnosis, etc., and the price adjustment range was determined according to the agreed free space limit. Meanwhile, the credit mechanism of Alipay was applied to synchronously implement " vacating space and adjusting structure" , so as to solve the game problem between medical treatment and medical insurance, broaden the path of the " translation compensation method" of medical service price reform, and produce policy superposition and linkage effect with the reform of medical insurance payment mode.

Objective:To analyze the 6-year operation faults of PHILIPS Brilliance big bore CT, identify the common problems, make corresponding maintenance plans, reduce the incidence of failures, and carry out simulation prediction of the occurrence rate of failures in the next few years.Methods:The failure data of Brilliance big bore CT from June 2012 to June 2018 were collected, and the curve estimation function in SPASS 19.0 software and the pareto diagram were used to analyze the relationship between the number of failures, time and failure types, and the prediction was made.Results:A total of 28 faults occurred during the 6-year opeation of Brilliance big bore CT. During the first half year, five times of faults occurred with the highest fault rate and then tended to stabilize. The linear function model was obtained using the curve estimation: y=-0.033 x+ 2.099( y for the number of fault, unit for times, x for the unit of time for half a year), the model of R2=0.003. In the next three years, approximately twice faults occurred within half year. The pareto chart showed that 16 faults occurred during data collection, including 3 faults in the treatment bed and 3 faults in the power supply system, respectively. The accumulative ratio of the above three faults was 71.4%, which were the main fault sources. Conclusion:The fault statistical analysis of Brilliance big bore CT is helpful for department maintenance personnel to better understand CT, develop effective maintenance programs, reduce the occurrence of faults, and predict the incidence of faults in the future.

OBJECTIVE: To investigate the effects of exendin-4 on hepatic lipid metabolism, fibrosis and oxidative stress in mice with streptozotocin (STZ)-induced diabetes and explore the underlying mechanisms. METHODS: C57BL/6J mice were fed with high-fat diet (HFD) for 4 weeks and received intraperitoneal injections of 120 mg/kg STZ to induce diabetes. After successful modeling, the mice were randomized into diabetic control group and exendin-4 treatment group (DM+E4), and in the latter group, the mice were given a daily dose of 1 nmol/kg of exendin-4 for 8 weeks. The changes in the body weight (BW) and random blood glucose (RBG) in the mice were recorded. The mRNA expressions of the genes related with liver lipid metabolism, fibrosis and oxidative stress were analyzed using RT-PCR, and the structural changes of the liver tissues were observed with HE, Sirius red and oil red O staining; the expressions of TGF-β1, Nrf2 and HO-1 proteins in the liver tissues were detected using Western blotting. RESULTS: The diabetic mice showed significantly higher RBG levels and BW with obvious lipid deposition, fibrosis and oxidative stress in the liver as compared with the normal control mice ( < 0.001). Exendin-4 treatment of the diabetic mice did not significantly lessened liver lipid deposition but obviously reduced the levels of RBG and TG ( < 0.05), lowered the expression levels of liver fibrosis-related genes TGF-β, -SMA and Col-Ⅰ ( < 0.05), increased the expression levels of the antioxidant genes Nrf2, HO-1 and GPX4 ( < 0.01), and enhanced the protein expressions of Nrf2 and HO-1 in the liver tissues ( < 0.01). CONCLUSIONS Exendin-4 improves liver fibrosis and oxidative stress in diabetic mice by activating Nrf2/HO-1 pathway without significantly reducing liver lipid deposition.
Animals ; Diabetes Mellitus, Experimental ; Exenatide ; Liver ; Liver Cirrhosis ; Mice ; Mice, Inbred C57BL ; NF-E2-Related Factor 2 ; Oxidative Stress ; Streptozocin

OBJECTIVETo detect potential mutation of TCOF1 gene in a Chinese family affected with Treacher-Collins syndrome.

METHODSClinical data of the patient was collected. The analysis included history taking, clinical examination and genetic testing. All coding regions of the TCOF1 gene were subjected to PCR amplification and Sanger sequencing.

RESULTSA novel mutation c.2261ins G (p.E95X) of the TCOF1 gene was discovered in the patient. The same mutation was not found in his parents and 100 healthy controls.

CONCLUSIONThe c.2261insG (p.E95X) mutation of the TCOF1 gene probably underlies the disease in the patient. Genetic testing can facilitate diagnosis and genetic counseling for families affected with TCS.

Objective To investigate the value of endoscopic retrograde appendicitis therapy ( ERAT) in the diagnosis and treatment of atypical acute appendicitis. Methods All the 48 patients suspected of atypical acute appendicitis in Jiangsu Province Hospital from January 2015 to December 2016 were randomly divided into ERAT group and conservative treatment group according to the treatment method. The final appendectomy rate of the two groups was analyzed. Results Only 17 of the 24 patients in the ERAT group received endoscopic treatment because of complex conditions or personal wishes, and 16 cases were diagnosed as acute appendicitis. Surgical resection was performed in 5 cases because of recurrence of the disease after ERAT, and the appendectomy rate was 31. 2％ ( 5/16 ) . In the conservative treatment group, all 24 patients were treated with antibiotics. Twenty of them underwent surgical resection with appendectomy rate of 83. 3％ ( 20/24) , and 1 of them had appendiceal perforation. The appendectomy rate of the ERAT group was significantly lower than that of the conservative treatment group (χ2=11. 111, P<0. 05) . Conclusion ERAT has a high diagnostic and therapeutic value for atypical acute appendicitis.

Objective To observe the effects of liraglutide on GRP78,ATF4,CHOP and TRB3 protein and mRNA expression in rats which fed with high fat diet,and to explore the effect of liraglutide on ATF4/CHOP pathway of pancreas in rats fed with high fat diets.Methods Forty-four male Wistar rats were randomly divided into the control group,high fat group,intervention group 1 and intervention group 2,11 cases in each group.The control group was fed with common food,other 3 groups were fed with high fat diet for 8 weeks.Then the intervention group 1 was given with liraglutide (100 μg · kg-1 · d-1) by subcutaneous injection;the intervention group 2 was given liraglutide (200 μg · kg-1 · d-1) by subcutaneous injection.After 2 weeks medication intervention,the rats were killed.Five rats were taken from each group and performed the hyperinsulinemic englycemic clamp experiment under waking state for calculating the glucose infusion rate (GIR).The fasting blood glucose (FBG),fasting insulin (FINS),serum free fatty acid (FFA),total cholesterol (TC),triglyeeride (TG),low density lipoprotein cholesterol (LDL-C) and high density lipoprotein(HDL) were examined,and islet beta cell function index(HOMA-β) were calculated.PCR and Western blot method were used to detect the expression of pancreas GRP78,ATF4,CHOP and TRB3 protein and mRNA.Results Compared with the control group,the levels of FBG,FFA,TC,FINS,TG and LDL-C in the high fat group were significantly increased,the levels of HDL-C,GIR and HOMA-β were significantly decreased(P＜0.05 or P＜0.01);compared with the high fat group,the levels of HDL-C,GIR and HOMA-β in the intervention group 2 were increased(P＜0.05 or P＜0.01),the other indicators were significantly decreased;compared with the intervention group 1,blood FGB,FFA,TC in the intervention group 2 were decreased,while the levels of GIR and HOMA-β were increased(P＜0.05).Compared with the control group,expression of GRP78,ATF4,CHOP and TRB3 protein and mRNA in the high fat group were significantly increased;compared with the high fat group,the expression of GRP78,ATF4,CHOP and TRB3 protein and mRNA in the intervention group 1 and 2 were gradually decreased with the liraglutide concentration increase.Conclusion Liraglutide can improve insulin resistance and protect pancreatic beta cells in a concentration-dependent manner,its mechanisms may involve in the pancreatic endoplasmic reticulum ATF4/CHOP pathway.

Objective To investigate the effects of tripterygium glycosides combined with methotrexate in treatment of rheumatoid arthritis (RA) curative effect and peripheral blood of patients with IL-6, effects of IL-10 and TNF- alpha. Methods 80 patients with RA from February 2014 to August 2016 in our hospital were retrospectively analyzed. According to the different treatment methods by for the observation group, the control group (40 cases). To compare and analyze the curative effect before and after short-term treatment and treatment of patients in the 2 groups were the main clinical symptoms and signs of change and ESR, RF, CRP, IL-6, TNF- alpha, IL-10 index. Results The total effective rate of observation group (92.50％) was significantly higher than the control group (77.50％), the difference was statistically significant (P<0.05), 2 groups of patients before treatment of main clinical symptoms and signs, there was no significant difference, after treatment, clinical symptoms and signs of 2 groups of patients were compared with those before treatment was statistically significant to alleviate the differences (P<0.05), and the observation group of main clinical symptoms and signs were lower than the control group and the remission (down), the difference was statistically significant (P<0.05).Before ESR, the treatment of 2 patients with RF, CRP, TNF- IL-6, alpha, IL-10 index level, no statistical significance, the 2 groups after treatment in patients with ESR, RF, CRP, IL-6, TNF- alpha, IL-10 index level than before treatment with significant difference (P<0.05), and the observation group ESR, RF, CRP, TNF- alpha, IL-6 average index of water compared with the control group decreased significantly, IL-10 index increased significantly than the control group. The difference was statistically significant (P<0.05). Conclusion Tripterygium glycosides combined with methotrexate in treatment of rheumatoid arthritis And it can effectively inhibit the expression of peripheral serum L-6 and TNF- alpha, promote the expression of IL-10 and alleviate the inflammatory reaction

Objective To explore application of bundles of care intervention in rehabilitation of pa-tients with breast cancer after radical mastectomy (BCARM), so as to improve the patients' quality of life, and to provide reference basis for rehabilitation nursing for patients with BCARM.Methods A total of 195 cases with BCARM treated in Department of Breast Surgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2014 to April 2015 were selected and divided randomly into experiment group with 97 cases and control group with 98 cases. Patients in the control group received routine care for breast cancer, while those in the experimental group received bundles of care intervention. Incidence of postoperative subcutaneous effu-sion, skin flap nectosis, upper limb edema, and bleeding of patients in the two groups were compared, together with motion range of joints in the affected limb when extending outward and backward, and quality of life of the patients.Results After the surgery, subcutaneous effusion occurred to 17 patients in the experiment group, and upper limb edema to 19, which were obviously less than that in the control group, with subcutaneous effusion to 20 and upper limb edema to 22 (χ2 =12.311, 14.030;P<0.01). 4 weeks and 12 weeks after the surgery, outward extending degree of the affected limb in the experiment group were (130.01±6.16)° and (135.51±4.65)° , and the backward extending degree (38.92±4.28)° and (39.53±4.02)° , obviously better than that in the control group, with outward extending degree of (128.18±7.35)°, (130.04±6.11)°, and backward extending degree of (36.61±4.13)° and (38.99±4.63)°. At 4 weeks and 12 weeks after the surgery, there was statistical difference between numbers of the time points, groups, and interaction between the groups and time (P<0.05). At 6 months and 12 months after the surgery, the measured scores of quality of life in the experiment group were (16.80±3.29) points and (19.00±2.27) points, with scores of additional attention (21.95±3.39) points and (22.24±3.06) points, with the scores in the control group (14.20±3.39), (15.59±2.91), (20.55±3.34) and (20.96±2.79). At 6 months and 12 months after the surgery, there was statistical difference between numbers of the time points, groups, and interaction between group and time (P<0.05).Conclusions The effect of bundles of care intervention on rehabilitation of patients with BCARM is far better than traditional nursing methods.

Objective To explore the relations ofnicotinamide adenine dinucleotide phosphate (NAD [P]H) oxidase p22phox C242T gene polymorphism with hyperlipidemia and cerebral infarction.Methods A case-control association study containing 207 hyperlipidemia patients (collected from Physical Examination Center from March 2014 to March 2015),185 cerebral infarction patients (collected from Department of Neurology from March 2014 to March 2015) and 183 controls (collected from Physical Examination Center from March 2014 to March 2015) was carried out.The genetypes and allele frequency were compared;the clinical data,lipoprotein oxidation level and NAD (P)H oxidase activity were performed correlation analysis between different patient groups and different genetypes.Results There were no differences in low-density lipoprotein (LDL),oxidized LDL and malondialdehyde levels,NAD (P)H oxidase activity,and frequencies of CT+TT genotype and T allelic gene between patients with hyperlipidemia and controls (P＞0.05).Group of cerebral infarction had significantly higher serum levels of oxidized high-density lipoprotein (HDL) and malondialdehyde,and NAD(P)H oxidase activity than the controls (P＜0.05);the frequencies of CT+TT genotype and T allelic gene in patients with cerebral infarction were significantly higher than those in the controls (P＜0.05).There was no difference between CC genotype patients and CT+TT genotype patients in the serum levels of triglyceride,cholesterol and HDL (P＞0.05),but CC genotype patients had significantly higher serum levels of oxidized HDL,oxidized LDL and malondialdehyde,and NADPH oxidase activity than CT+TT genetype patients (P＜0.05).Logistic regression analysis indicated that smoking,hypertension,serum levels oflipoprotein (a),oxidized HDL and malondialdehyde,NADPH oxidase activity and T allelic gene (OR=0.299,95％CI:0.102-1.879,P=0.028) were independent risk factors for cerebral infarction.Conclusion C242T polymorphism is associated with lipoprotein oxidation and cerebral infarction in Han people from Shanghai Songjiang of China,and T allelic gene and lipoprotein oxidation are independent risk factors for cerebral infarction.