Objective:To explore the protective effect of astaxanthin on acute liver injury induced by α-amanitin in mice.Methods:In June 2023, 42 healthy SPF male Kunming mice were selected. The mice were divided into blank control group, model (0.45 mg/kg α-amanitin) group, olive oil (10 ml/kg olive oil) group, low dose (20 mg/kg) astaxanthin group, medium dose (40 mg/kg) astaxanthin group, high dose (80 mg/kg) astaxanthin group and silybin (20 mg/kg) group by random number table method. Each group had 6 animals. Mice in the blank control group were intraperitoneally injected with 10 ml/kg normal saline, and mice in the other group were injected with α-amanitin. After that, the blank control group and model group were infused with 10 ml/kg normal saline, olive oil group and astaxanthin groups were given olive oil and astaxanthin according to dose by gavage, and silybin group was injected with silybin by dose. The drug was administered once every 12 h for a total of 4 doses. After 60 h, the mice were killed, the liver weight was weighed, and the liver index was calculated. The contents of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum of mice were detected, and the contents of superoxide dismutase (SOD), reduced glutathione (GSH), catalase (CAT), malondialdehyde (MDA) in liver tissues were also detected. One-way analysis of variance (ANOVA) was used to compare the difference of indexes among each group, and pairwise comparison was performed by Dunnett- t test. Results:The mice in the blank control group had smooth hair color, good spirit and normal behavior, while the mice in the other groups showed varying degrees of retardation and decreased diet, and no death occurred in each group. Body mass[ (26.67±1.51) g] and liver mass[ (1.23±0.14) g] in model group were significantly lower than those in blank control group [ (33.50±2.43) g and (1.87±0.16) g], and the differences were statistically significant ( P<0.05). The liver index [ (5.39±0.32) %, (5.83±0.30) %, (5.75±0.24) % and (5.78±0.16) %] in low, medium and high dose astaxanthin groups and silybin group were significantly higher than those in model group [ (4.61±0.12) %], and the differences were statistically significant ( P<0.05). Serum ALT and AST contents in model group [ (153.04±13.96) U/L and (59.08±4.03) U/L] were significantly higher than those in blank control group [ (13.77±1.29) U/L and (10.21±0.35) U/L], and the differences were statistically significant ( P<0.05). The contents of CAT, GSH and SOD in liver tissues of model group [ (9.40±2.23) U/mgprot, (3.09±0.26) μmol/gprot and (48.94±3.13) U/mgprot] were significantly lower than those of blank control group [ (26.36±2.92) U/mgprot, (6.76±0.71) μmol/gprot and (89.89±4.17) U/mgprot], the differences were statistically significant ( P<0.05). MDA content[ (6.33±0.24) nmol/mgprot] in liver tissue of model group was significantly higher than that of blank control group [ (0.91±0.21) nmol/mgprot], and the difference was statistically significant ( P<0.05). The CAT contents[ (18.64±1.76) U/mgprot, (18.20±1.76) U/mgprot, and (15.54±1.36) U/mgprot] in liver tissues of low, medium and high dose astaxanthin groups were significantly higher than those of model group, with statistical significances ( P<0.05). Compared with model group, SOD contents[ (72.16±7.44) U/mgprot, (93.18±5.28) U/mgprot, (103.78±7.07) U/mgprot, and (96.60±7.02) U/mgprot] in liver tissues of mice in low, medium and high dose astaxanthin groups and silybin group were significantly increased ( P<0.05), MDA contents [ (4.30±0.84) U/mgprot, (3.66±0.28) U/mgprot, (2.96±0.29) U/mgprot, and (2.88±0.39) U/mgprot] were significantly decreased ( P<0.05). Compared with model group, GSH content [ (7.90±1.25) μmol/gprot] in high dose astaxanthin group was significantly increased ( P<0.05) . Conclusion:Astaxanthin may alleviate acute liver injury induced by α-amanitin by alleviating oxidative stress in mice liver.

Objective:To explore the protective effect of astaxanthin on acute liver injury induced by α-amanitin in mice.Methods:In June 2023, 42 healthy SPF male Kunming mice were selected. The mice were divided into blank control group, model (0.45 mg/kg α-amanitin) group, olive oil (10 ml/kg olive oil) group, low dose (20 mg/kg) astaxanthin group, medium dose (40 mg/kg) astaxanthin group, high dose (80 mg/kg) astaxanthin group and silybin (20 mg/kg) group by random number table method. Each group had 6 animals. Mice in the blank control group were intraperitoneally injected with 10 ml/kg normal saline, and mice in the other group were injected with α-amanitin. After that, the blank control group and model group were infused with 10 ml/kg normal saline, olive oil group and astaxanthin groups were given olive oil and astaxanthin according to dose by gavage, and silybin group was injected with silybin by dose. The drug was administered once every 12 h for a total of 4 doses. After 60 h, the mice were killed, the liver weight was weighed, and the liver index was calculated. The contents of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum of mice were detected, and the contents of superoxide dismutase (SOD), reduced glutathione (GSH), catalase (CAT), malondialdehyde (MDA) in liver tissues were also detected. One-way analysis of variance (ANOVA) was used to compare the difference of indexes among each group, and pairwise comparison was performed by Dunnett- t test. Results:The mice in the blank control group had smooth hair color, good spirit and normal behavior, while the mice in the other groups showed varying degrees of retardation and decreased diet, and no death occurred in each group. Body mass[ (26.67±1.51) g] and liver mass[ (1.23±0.14) g] in model group were significantly lower than those in blank control group [ (33.50±2.43) g and (1.87±0.16) g], and the differences were statistically significant ( P<0.05). The liver index [ (5.39±0.32) %, (5.83±0.30) %, (5.75±0.24) % and (5.78±0.16) %] in low, medium and high dose astaxanthin groups and silybin group were significantly higher than those in model group [ (4.61±0.12) %], and the differences were statistically significant ( P<0.05). Serum ALT and AST contents in model group [ (153.04±13.96) U/L and (59.08±4.03) U/L] were significantly higher than those in blank control group [ (13.77±1.29) U/L and (10.21±0.35) U/L], and the differences were statistically significant ( P<0.05). The contents of CAT, GSH and SOD in liver tissues of model group [ (9.40±2.23) U/mgprot, (3.09±0.26) μmol/gprot and (48.94±3.13) U/mgprot] were significantly lower than those of blank control group [ (26.36±2.92) U/mgprot, (6.76±0.71) μmol/gprot and (89.89±4.17) U/mgprot], the differences were statistically significant ( P<0.05). MDA content[ (6.33±0.24) nmol/mgprot] in liver tissue of model group was significantly higher than that of blank control group [ (0.91±0.21) nmol/mgprot], and the difference was statistically significant ( P<0.05). The CAT contents[ (18.64±1.76) U/mgprot, (18.20±1.76) U/mgprot, and (15.54±1.36) U/mgprot] in liver tissues of low, medium and high dose astaxanthin groups were significantly higher than those of model group, with statistical significances ( P<0.05). Compared with model group, SOD contents[ (72.16±7.44) U/mgprot, (93.18±5.28) U/mgprot, (103.78±7.07) U/mgprot, and (96.60±7.02) U/mgprot] in liver tissues of mice in low, medium and high dose astaxanthin groups and silybin group were significantly increased ( P<0.05), MDA contents [ (4.30±0.84) U/mgprot, (3.66±0.28) U/mgprot, (2.96±0.29) U/mgprot, and (2.88±0.39) U/mgprot] were significantly decreased ( P<0.05). Compared with model group, GSH content [ (7.90±1.25) μmol/gprot] in high dose astaxanthin group was significantly increased ( P<0.05) . Conclusion:Astaxanthin may alleviate acute liver injury induced by α-amanitin by alleviating oxidative stress in mice liver.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

OBJECTIVE To establish an evaluation syste m of clinical effec tiveness of Drug Selection Guideline for Medical Institutions，and to provide reference for drug selection in medical institution. METHODS Retrieved from relevant Chinese government websites ，PubMed，Embase，CBM and CNKI ，etc.，from the inception to Sept. 14th 2021，related contents of clinical effectiveness related to three secondary indicators ，such as “recommended level and strength of guideline ”“clinical pathway ”and “evidence and level of efficacy ”were extracted respectively ；evaluation system was construction for the clinical effectiveness. RESULTS A total of 5，4 and 17 policy documents or literatures were included according to “recommended level and strength of guideline”“clinical pathway ”and“evidence and level of efficacy ”，respectively.“The recommended level and strength of drug guideline”could reflect the clinical effectiveness of drugs ，and the evaluation content referred to the recommended level and strength of the selected drugs in the guidelines for corresponding indications. “Clinical pathway ”was the embodiment of drug effectiveness, and the evaluation content referred to the clinical path of whether the selected drugs were included in the corresponding indications. The evaluation contents of “evidence and level of efficacy ”were different between chemical medicine/ biological agent and Chinese patent medicine ；evidence and quality level of efficacy research for chemical medicine/biological agent referred to GRADE system ，while those for Chinese patent medicine referred to classic works or clinical experience inheritance. Therefore，the evaluation contents of this index system were the evidence and quality level of the efficacy research related to selected drugs. CONCLUSIONS The evaluation system of clinical effectiveness of drugs constructed from the perspective of drug selection in medical institutions can lay the foundation of evaluation system for the construction of Drug Selection Guideline for Medical Institutions ，and also provide reference for drug selection in medical institutions.

Objective To establish a novel method using a nano microfluidic chip to detect circulating tumor cells (CTCs) in peripheral blood in gallbladder carcinoma,and to study the relationship between CTCs with clinicopathology and prognosis in these patients.Methods The peripheral blood samples of 51 patients with gallbladder carcinoma were collected from June 2014 to January 2017.The CTCs from peripheral blood samples were detected by a novel nano microfluidic chip.This study aimed to study the correlation between CTCs with the clinical and pathological features.The significance of CTCs on prognosis in patients with gallbladder carcinoma was also analyzed.Results The positive rate of CTCs in the peripheral blood of gallbladder carcinoma patients was 43.1％ (22/51).There were significant correlations between CTCs with liver metastasis (P ＜ 0.05) and Nevin staging (P ＜ 0.05).The 1-and 2-year overall survival (OS) in patients with CTCs were 70.7％ and 35.3％,and the 1-and 2-year OS in patients without CTCs were 92.0％ and 56.1％.There was a significant difference in the 2-year OS (P ＜ 0.05) but no significant difference in the 1-year OS between the 2 groups of patients (P ＞ 0.05).Conclusions Peripheral blood CTCs in patients with gallbladder carcinoma were efficaciously detected by a novel nano microfluidic chip.Peripheral blood CTCs was closely related to the Nevin staging and liver metastasis.CTCs could serve as a potential prognostic indicator in patients with gallbladder carcinoma.

Objective To detect circulating tumor cells (CTCs) in the peripheral blood of patients with pancreatic cancer using a new nano microfluidic chip and to explore the relationship between CTCs and clinicopathological feature,postoperative recurrence and prognosis of pancreatic cancer.Methods The peripheral blood samples of 53 patients with pancreatic cancer who underwent curative resection in the second affiliated hospital of Jiaxing college of medicine were collected from January 2015 to January 2017.The CTCs from peripheral blood were detected by novel nano microfluidic chip.The cut-off value for CTCs-positive and negative groups was 1 CTC.The relationship between CTCs positive and postoperative recurrence and prognosis of pancreatic cancer were evaluated.Results The number of CTCs for 23 pancreatic cancer of 53 patients ranged from 5 to 196 per ml,and the mean number was 78.5 ± 44.7 per ml;the rate of CTCs-positive patients was 43.4％ (23/53).There were significant correlation between CTCs with vascular invasion (P =0.001),but but CTCs was not correlated with the gender,age,the presence of clinical symptoms,tumor size,pathological type,lymph metastasis and TNM stage.31 patients had tumor recurrence,and the rate of tumor recurrence was 58.5％.Among them,there were 13 cases with tumor local recurrence,10 cases with tumor distant metastasis (including liver,lung,kidney,etc.) and 8 cases with both tumor local recurrence and distant metastasis.The median recurrence free survival time of all patients was 14.0 months (13.0-17.0) and the median overall survival time was 19.0 months (15.5-24.0).The cumulative one-year and two-year recurrence free survival rate were 66.9％,12.2％ for patients with CTCs-positive and 88.3％,42.2％ for CTCs-negative patients,and the differences were statistically significant (both P ＜ 0.05).The cumulative one-year and two-year overall survival rate were 85.4％,33.6％ for patients with CTCs-positive and 96.3％,62.2％ for CTCs-negative.There was no difference in statistics in cumulative one-year overall survival rate and with a statistically significant difference in cumulative two-year overall survival rate (P =0.028).Conclusions Peripheral blood CTCs of pancreatic cancer can be effectively detected by a novel nano microfluidic chip.There were significant correlation between CTCs with vascular invasion and survival time after surgery.CTCs may be a potential prognostic indicator of the postoperative recurrence and prognosis of pancreatic cancer.

Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.

Objective: To detect the expression of B cell transposition gene 3(BTG3) in pancreatic ductal adenocarcinoma(PDAC), and explore its relationship with postoperative recurrence and metastasis of tumor. Methods: Six self-paired frozen PDAC specimens and 3 normal pancreatic tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected and the expression of BTG3 was detected by qPCR. Ten normal pancreatic tissues and 52 cases of PDAC tumor and paracarcinomatous tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected from June 2009 to December 2016. The expression of BTG3 and relationship among BTG3 and clinicopathological characteristics of PDAC and patients′ prognosis were detected and analyzed using immunohistochemistry.χ² test, Kaplan-Meier method and Cox regression model were used to analyzed the data. Results: The results of qPCR showed that expression level of BTG3 in PDAC (0.63±0.17) was lower significantly than that in paracarcinomatous (0.96±0.04) and normal tissues (1.00)(t=4.673, 5.502; both P<0.05). Immunohistochemistrv showed that BTG3 mainly expressed in the cytoplasm.The high expression rate of BTG3 in PDAC tumor tissues was 25.0%(13/52), which was remarkably lower than that in paracarcinomatous tissues(65.4%) and normal liver tissues(7/10)(χ²=17.120 and 5.849, both P<0.05). The low expression of BTG3 in PDAC was correlated with primary tumor, and TNM stage(χ²=7.704, P=0.006; U=154.000, P=0.018, respectively). Survival analysis showed that disease free survival rate of patients with low expression of BTG3 was significantly less than that with high expression(χ²=192.493, P<0.01). The Cox multivariate analysis demonstrated that low expression of BTG3 was independent risk factors for disease free survival in patients with PDAC after a curative resection(RR=3.366, 95%CI: 1.040-10.889, P=0.043). Conclusion BTG3 may be involved in the occurence and development of tumor, and its low expression may be associated with poor prognosis in patients with PDAC.

Objective To explore the diagnostic value of k ras mutation detection of specimen obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)for pancreatic cancer.Methods Seventy-eight patients with pancreatic carcinoma and 49 patients with pancreatic benign diseases were collected from January 2013 to December 2015.All the patients underwent EUS-FNA and cell or tissue samples were collected.DNA was extracted from the samples,and the codon 12 and 13 mutation of K-ras gene was detected by specific nano capture probe.Liquid cytology was also conducted.The sensitivity and specificity of the two methods were compared.Results The K-ras mutation rate was 92.3％ (72/78) in 78 patients with pancreatic carcinoma,which was obviously higher than the mutation rate of 20.4％ (10/49) in 49 patients with pancreatic benign tumors,and the difference was statistically significant (x2 =68.002,P =0.000).The sensitivity of the cytology examination of EUS-FNA specimens in the diagnosis of pancreatic carcinoma was 75.6％,the specificity was 87.8％,Youden index was 0.634,the positive and negative predictive value was 6.196 and 0.227.The detection of K-ras mutations had a sensitivity of 92.3％ and a specificity of 79.6％ in the diagnosis of pancreatic carcinoma,the Youden index was 0.719,the positive and negative predictive value was 4.524 and 0.096.K-ras mutation detection had a higher sensitivity compared with cytology,and the difference was statistically significant (x2 =8.47,P =0.004).The sensitivity was 94.9％ and specificity of 95.9％ using the combination of K-ras mutations and cytology for diagnosing pancreatic cancer,and the specificity was obviously increased compared with only k ras mutation detection and the difference was statistically significant (x2 =6.13,P =0.013).Conclusions K-ras mutation detection of EUS-FNA specimen using nano capture probe system can significantly improve the sensitivity of diagnosing pancreatic cancer,and the sensitivity and specificity could be further improved when combined with cytology.

Objective To detect K-ras mutations in plasma by a nano capture probe system , and to explore the diagnostic and prognostic value of this method for patients with pancreatic cancer .Methods The clinical data of 62 patients with pancreatic cancer , 38 patients with benign pancreatic diseases and 31 healthy controls admitted in the Second Affiliated Hospital of Jiaxing Medical College from June 2013 to June 2015 were collected.The diagnosis of all the patients were confirmed by pathology .The DNA were extracted from all plasma samples and were detected for the codon 12 and 13 mutation of K-ras gene by nano capture probe and conventional PCR plus direct sequencing .The correlation of K-ras gene mutation with certain clinical data and the diagnostic and prognostic value in pancreatic cancer were analyzed .Results The K-ras mutation were detected by nano capture probe in 27 pancreatic cancer patients , and the mutation rate was 43.5%(27/62), including 25 cases with codon 12 mutation and 2 cases with codon 13 mutation .The K-ras mutation rate in patients with benign pancreatic diseases was 7.9%(3/38), which were all in codon 12.K-ras mutation was detected in only 17 pancreatic cancer patients by conventional PCR plus direct sequencing , and the mutation rate was 27.4%(17/62), The K-ras mutation rate of benign pancreatic diseases was 5.3%(2/38).The mutation rate detected by nano capture probe was higher than that by conventional PCR , and the difference was statistically significant (P=0.006).K-ras mutation in the plasma of patients with pancreatic cancer was related to TMN stage and liver metastasis , but there was no correlation of the factors such as sex , age, clinical symptoms, tumor size, serum CA19-9 and CEA levels with K-ras mutation.The sensitivity of K-ras gene mutation for diagnosing pancreatic cancer was 43.5%, the specificity was 92.1%, the positive predictive value was 90%, the negative predictive value was 50%, Youden index was 0.356.The 1-year survival rate of patients with K-ras mutation was 44.4%, which was lower than that (71.4%) of patients with wild-type K-ras, and the difference was statistically significant (P<0.05).Conclusions The nano capture probe system could certainly detect K-ras mutation in a small quantity of plasma DNA , and its diagnosis sensitivity for pancreatic cancer is low , but the specificity is relatively high .K-ras mutation in plasma is closely related to the TMN stage and prognosis of pancreatic cancer .