Objective: To assess the dynamic changes of microcirculation at acupoints in patients with primary dysmenorrhea and cold congelation and blood stasis syndrome using laser speckle blood flow imaging. Methods: Patients with primary dysmenorrhea and cold coagulation and blood stasis syndrome (primary dysmenorrhea group, n=53) and healthy female college students(control group, n=57) who met the inclusion and exclusion criteria from October 2020 to July 2022 were enrolled at Hebei University of Chinese Medicine. On the premenstrual and first day of menstruation, a laser speckle blood flow imaging system was used to measure the microcirculation blood flow perfusion on the surface of acupoints related to the conception, thoroughfare, and governor vessels, and stomach, spleen, and bladder meridians in the abdomen and lumbosacral regions. The dynamic changes in microcirculation were calculated based on the difference in average blood flow perfusion at each acupoint before and after menstruation. Receiver operating curve (ROC) analysis was used to analyze the diagnostic efficacy of dynamic changes in microcirculation on the surface of each acupoint. The microcirculation sensitization rate of acupoints was calculated. Results: Compared with the control group, the dynamic changes in microcirculation at the following acupoints in the primary dysmenorrhea group were increased (P<0.05): conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]); left thoroughfare vessel (left Huangshu[KI16], left Zhongzhu[KI15], left Siman[KI14], left Qixue[KI13], left Dahe[KI12], left Henggu[KI11]); left stomach meridian (left Tianshu[ST25], left Wailing[ST26], left Qichong[ST30]); left spleen meridian (left Daheng[SP15], left Fujie[SP14]); right thoroughfare vessel (right Huangshu[KI16], right Zhongzhu[KI15], right Siman[KI14], right Qixue[KI13], right Dahe[KI12], right Henggu[KI11]); right stomach meridian (right Wailing[ST26], right Daju[ST27], right Shuidao[ST28], right Guilai[ST29], right Qichong[ST30]); and right spleen meridian (right Fujie[SP14]). The area under the ROC curve of conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]), thoroughfare vessel (right Siman[KI14], left Huangshu[KI16], right Qixue[KI13], right Zhongzhu[KI15], right Dahe[KI12], left Zhongzhu[KI15], left Siman[KI14], right Huangshu[KI16], left Qixue[KI13], right Henggu[KI11], left Henggu[KI11], left Dahe[KI12]); stomach meridian (left Tianshu[ST25], right Guilai[ST29], left Wailing[ST26], right Shuidao[ST28], right Daju[ST27], right Wailing[ST26], right Qichong[ST30], left Qichong[ST30]), and spleen meridian (left Daheng[SP15], left Fujie[SP14], right Fujie[SP14]) was 0.610-0.682 (P<0.05). Compared with the control group, the sensitization rate of some acupoints in the primary dysmenorrhea group increased (P<0.05). Conclusion With the onset of menstruation, the blood flow perfusion of some acupoints in the abdomen (thoroughfare, and conception vessels, and stomach and spleen meridians) of patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome increased, and the status of acupoints changed from a resting state to an active state. These acupoints are sensitive in patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome and have a certain diagnostic efficacy, providing a basis for further analyzing the efficacy and mechanism of acupuncture and moxibustion to treat primary dysmenorrhea with cold blood coagulation and blood stasis syndrome.

Objective We aimed to observe the differences in the effects of different acupuncture technique on the endometrium of mice with simple endometrial hyperplasia model and to explore the potential mechanisms. Methods According to the random number tables,32 female C57BL/6J mice were divided into a blank control group,a model group,a quick needle group and a retaining needle group,with 8 mice in each group. A mouse model of simple endometrial hyperplasia was established using bilateral ovariectomy combined with estrogen loading. In the quick needle group,mice were punctured at the bilateral for "Yinbai"(SP1) points and withdrawn immediately,with the treatmeat performed once every other day for a total of 12 times. In the retaining needle group,mice were punctured at the bilateral "Yinbai"(SP1) points and the needles were retained for 15 min each time,with the treatment also performed once every other day for a total of 12 times. After the intervention,samples were collected. HE staining was used to observe morphological changes in the mouse uterine tissue;ELISA was used to detect serum estradiol level;flow cytometry was used to detect the ratio of M1 and M2 macrophages(M1/M2) and immunohistochemical method was used to measure the expression of CD86 and CD206 in uterine tissue;and Western blotting was used to detect the expression of interleukin-13 (IL-13) and interferon-γ(IFN-γ) in uterine tissue. Results The endometrium of mice in the model group showed simple hyperplasia. Compared with the blank control group,the endometrium of the model group was thickened (P<0.01);the level of estradiol in the serum was increased (P<0.01);M1/M2 in uterine tissues was decreased (P<0.01),the expression of CD86 was decreased (P<0.01),and the positive expression of CD206 was increased (P<0.01);and the level of IFN-γ protein expression in uterine tissues was decreased (P<0.01),and the expression of IL-13 protein was increased (P<0.01). Compared with the model group,the endometrial thicknesses of the quick needle group and the retaining needle group were reduced (P<0.05),the levels of estradiol in serum were reduced (P<0.05),M1/M2 in uterine tissues increased (P<0.01),and the reduction of CD206 positive expression,and IL-13 protein expression reduced (P<0.01);the level of CD86 positive expression,IFN-γ protein expression increased (P<0.01). Compared with the quick needle group,IL-13 protein expression increased in the retaining needle group (P<0.01).Conclusion Both quick needle and retaining needle may be through the regulation of the expression of IFN-γ and IL-13,thus prompting the polarization of macrophages from M2 to M1 type,inhibiting the pro-cell proliferative ability and tissue repair ability of M2 type macrophages,thus reducing the degree of endometrial hyperplasia,and the quick needle group was superior to the retaining needle group in regulating the expression of IL-13.

Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43％(43/87),higher than that of conventional MRI(30/87,34.48％,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19％(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85％,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CN Ⅸ-Ⅺ PNS in jugular foramen(P＜0.05)and CN Ⅸ-Ⅻ PNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P＜0.05),of PNS of CN Ⅲ-Ⅴ in cavernous sinus were higher than that of T2WI-FS(P＜0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P＜0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.

Objective To explore the correlation of serum microRNA-499a-5p (miR-499a-5p), fibroblast growth factor 9 (FGF9) and inflammatory factors with the severity and prognosis of acute lung injury (ALI) caused by sepsis. Methods A total of 151 septic patients were selected for the study. They were divided into sepsis with acute lung injury (ALI) group (68 cases) and general sepsis group (83 cases) based on the occurrence of ALI. According to the oxygenation index, septic patients with ALI were further categorized into mild (23 cases), moderate (26 cases), and severe (19 cases) groups. The survival status of septic patients with ALI was assessed within 28 days, and they were divided into good prognosis group (43 cases) and poor prognosis group (25 cases). Additionally, 151 healthy individuals undergoing physical examinations during the same period were selected as the control group. The differences and correlations among miR-499a-5p, FGF9 and inflammatory factors in each group were analyzed. The predictive efficacy of serum miR-499a-5p and FGF9 in patients with sepsis complicated with ALI was analyzed by receiver operating characteristic (ROC) curve. Results The levels of miR-499a-5p and FGF9 in the mild, moderate, and severe groups showed significant decrease in a sequential manner, while the inflammatory factors interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels showed significant increase in a sequential manner (P < 0.05). The miR-499a-5p and FGF9 levels in the poor prognosis group were significantly lower than those in the good prognosis group, while the IL-1, IL-6, TNF-α, and CRP levels were significantly higher in the poor prognosis group (P < 0.05). In patients with sepsis and ALI, miR-499a-5p and FGF9 were negatively correlated with IL-1, IL-6, TNF-α, and CRP levels (P < 0.05); miR-499a-5p could positively regulate FGF9 expression (P < 0.05). The diagnostic efficacy of predicting the prognosis of septic patients with ALI using a combination of miR-93 and miR-135a was significantly higher than that of individual prediction (P < 0.05). Conclusion The levels of miR-499a-5p, FGF9 and inflammatory factors are associated with the severity and prognosis of ALI in patients with sepsis. The miR-499a-5p and FGF9 may serve as potential biomarkers for the evaluation of prognosis in septic patients with ALI.

Objective:To explore the status of empathy fatigue among Intensive Care Unit (ICU) nurses and analyze its influencing factors.Methods:In May 2021, convenience sampling was used to select 300 ICU nurses from 11 Class Ⅱ hospitals and 5 Class Ⅲ hospitals in Nanyang as the research object. Nurses were surveyed using the General Information Questionnaire, Chinese version of Compassion Fatigue-Short Scale, the second version of the Nurse Work-related Quality of Life Scale, and the Perceived Social Support Scale (PSSS) . Pearson correlation was used to explore the relationship between empathy fatigue and other variables. A total of 300 questionnaires were distributed, and 292 valid questionnaires were recovered, with a valid recovery rate of 97.33% (292/300) .Results:Among 292 ICU nurses, the Chinese version of the Compassion Fatigue-Short Scale was scored as (48.37±10.21) . Univariate analysis showed that there were statistically significant differences in the scores of the Chinese version of the Compassion Fatigue-Short Scale for ICU nurses with different educational backgrounds, marital status, average annual leave days, employment nature, and monthly night shift days ( P<0.05) . Pearson correlation analysis showed that the second version of Nurse Work-related Quality of Life Scale total score was negatively correlated with the total score of the Chinese version of the Compassion Fatigue-Short Scale ( P<0.05) . The total score of PSSS and the scores of each dimension were negatively correlated with the total score of the Chinese version of the Compassion Fatigue-Short Scale ( P<0.05) . Conclusions:ICU nurses have high levels of empathy fatigue. Empathy fatigue was related to work-related quality of life and perceived social support among ICU nurses, and was affected by the nurses' educational background, marital status, average annual leave days, employment nature, and monthly night shift days. Nursing managers should carry out individualized preventive measures according to the influencing factors of empathy fatigue, improve the work-related quality of life of ICU nurses, and help them establish an effective social support system, thereby reducing the level of empathy fatigue of ICU nurses.

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

Objective: To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China. Methods: The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis. Results: Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ²=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ²=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ²=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg^-1·d^-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150). Conclusion The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.

Objective To investigate the effect of FAM83A on the stem cell-like phenotype, chemosensitivity and radiosensitivity of PANC-1 cells, aiming to provide new ideas for clinical combination therapy of pancreatic cancer. Methods The PANC-1 cells with stable silencing FAM83A were constructed by using lentivirus and validated by qPCR and Western blot. Flow cytometry was used to detect the number of CD133 positive cells and cellular apoptosis; the sphere formation assay was used to test the ability of sphere formation of PANC-1 cells;the effect of gecitabine on the cell viability was detected by MTT assay;the effect of radiation on the proliferation of PANC-1 cells was detected by colony formation assay; the effect of FAM83A on Wnt/β-catenin pathway was examined by Western blot. Results The expressions of FAM83A protein ( 0.83 ± 0.08 ) and mRNA ( 0.29 ± 0.03 ) in PANC-1 cells with stable silencing FAM83A were significantly lower than those in the scrambled control group, respectively (1.95 ± 0.19, 0.98 ± 0.09;t=9.410, 12.600, P<0.05). After silencing FAM83A, the expression of stem cell marker CD133 (8.97 ± 0.62) and the sphere formation ability (8 ± 1) also decreased significantly compared with the scrambled group, respectively (21.60 ± 2.60, 25 ± 3; t=8.184, 9.311, P<0.05), and the stem cell-like phenotype of PANC-1 cells was also significantly inhibited. When PANC-1 cells were silenced by FAM83A and further treated with 50 μmol/L gecitabine at 72 h, the activity of FAM83A-silenced PANC-1 cells (32.33 ± 3.05)％ was significantly lower than that of the gecitabine alone treated group (63.06 ± 5.98)％ (t=6.378, P<0.05), and the apoptosis rate of FAM83A-silenced PANC-1 cells (76.52 ± 8.34) ％ was significantly higher than that of gemcitabine alone group (40.88 ± 4.91)％(t=7.929, P<0.05). After silencing FAM83A combined with IR irradiation, the activity of PANC-1 cells (43.25 ±4.21)％ was significantly lower than that of IR alone (78.13 ± 7.98)％ (t=6.694, P<0.05), and the apoptosis rate (44.56 ± 5.32)％ was significantly increased compared with IR alone (15.15 ±1.95)％ (t = 8.990, P < 0.05). After silencing FAM83A, the expression of Active-β-catenin was significantly decreased while the expression of p-β-catenin was significantly increased, the expression of β-catenin in the nucleus was significantly reduced, although total β-catenin had no significant change, and the activity of Wnt/β-catenin signaling pathway was significantly inhibited. Conclusions Silencing FAM83A could significantly reduce the stem cell-like traits and enhance the chemosensitivity and radiosensitivity of pancreatic cancer cells to gemcitabine and radiation via Wnt/β-catenin signaling pathway, which may provide a new target for targeted and combination therapy of pancreatic cancer.