Objective: To observe the clinical efficacy of Shexian bupleurum on insomnia based on evaluation scales and polysomnogram (PSG). Methods: A total of 260 patients suffering from insomnia admitted to the outpatient department of Handan Central Hospital were included in a randomized, double blind, placebo-controlled trial. The patients were randomly divided into two groups: a control group (receiving placebo, n = 150), and an intervention group (receiving Shexian bupleurum treatment, n = 110). The clinical trial lasted for 4 weeks. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, 17 items of Hamilton Depression Scale (HAMD-17), and Hamilton Anxiety Scale (HAMA) were used to evaluate the patients at baseline as well as two weeks and four weeks after treatment; the Treatment Emergent Symptom Scale (TESS) was used to evaluate adverse reactions; polysomnography (PSG) was used to monitor and analyze their sleep characteristics at baseline and four weeks after treatment. Results: The PSQI, ISI, PHQ-9, HAMD-17, and HAMA scores of the intervention group significantly decreased compared to the control group, while the total sleep time, rapid eye movement sleep latency, stage 2 sleep, deep sleep, rapid eye movement sleep, and sleep efficiency of the intervention group significantly increased compared to the control group. The PHQ-9 score of the control group only decreased two weeks after treatment (p < 0.05) compared to the intervention group. In addition, there were no obvious adverse events in both the intervention group and the control group. Conclusion: Shexian bupleurum not only improves sleep quality, but also relieves depression and anxiety in patients who suffer from insomnia.

目的 观察320排容积CT全脑灌注成像(CTP)在缺血性脑血管病变(ICVD)中的应用价值.方法 选取2017年1月—2018年12月72例拟诊ICVD病人,入院24 h内均行常规CT检查、320排容积CTP检查,获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数及动态CT血管成像图(4D-CTA),分析常规CT平扫、全脑CTP、4D-CTA结果.结果 72例病人CT平扫中43例未见明显异常,29例发现37个脑缺血病灶,全脑CTP灌注异常51例,共发现76个病灶;异常灌注区灌注参数CBF值低于健侧镜像区(P<0.05),MTT值、TTP值均高于健侧镜像区(P<0.05);4D-CTA图像提示59例存在不同程度血管狭窄或闭塞,其中轻度11例,中度18例,重度21例,闭塞9例;脑血管重度狭窄或闭塞灌注异常占比93.33％,高于脑血管无狭窄或轻中度狭窄的16.67％(P<0.05);颅内动脉、颈动脉狭窄程度与MTT、TTP呈正相关(P<0.05),与CBV、CBF无相关性(P>0.05).结论 320排容积CTP能同时获得常规CT扫描、全脑CTP、4D-CTA图像,全面显示脑缺血病灶、脑血流灌注参数及脑血管狭窄程度,为ICVD诊疗提供影像学依据.

Objective: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Materials and Methods: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Results: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Conclusion: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

目的 探讨2型糖尿病(T2DM)患者血清网膜素1(Omentin-1)水平与骨代谢及氧化应激的关系.方法 选取120例T2DM患者,根据病情控制情况将其分为A组(病情控制良好)68例和B组(病情控制不良)52例.另选择同期健康体检者60例作为对照组.采集受试者清晨空腹静脉血,采用ELISA法检测Omentin-1以及骨代谢指标骨特异性碱性磷酸酶(BAP)、骨钙素(BGP)、抗酒石酸酸性磷酸酶(TrACP-5b),硫代巴比妥酸比色法测定血清丙二醛(MDA),羟胺法测定超氧化物歧化酶(SOD)水平.比较三组血清Omentin-1水平、骨代谢指标及氧化应激指标的差异,采用Pearson相关系数法分析T2DM患者血清Omentin-1水平与骨代谢指标及氧化应激指标的相关性.结果 A、B两组血清Omentin-1水平均低于对照组,且B组低于A组(P均<0.05).与对照组比较,A、B两组血清BAP、TrACP-5b水平升高,BGP水平降低(P均<0.05);与A组比较,B组血清BAP、TrACP-5b水平升高,BGP水平降低(P均<0.05).与对照组比较,A、B两组血清MDA水平升高,SOD水平降低(P均<0.05);与A组比较,B组血清MDA水平升高,SOD水平降低(P均<0.05).T2DM患者血清Omentin-1水平与BAP、TrACP-5b、MDA呈负相关(r分别为-0.508、-0.660、-0.625,P<0.05或<0.01),与BGP、SOD呈正相关(r分别为0.701、0.589,P<0.05或<0.01).结论 T2DM患者血清Omentin-1水平降低,血糖控制不佳者下降更显著;Omentin-1水平与骨代谢异常及氧化应激反应有关,可能在糖尿病进展及骨代谢异常中发挥作用.

目的 探讨早期使用十全大补汤联合肠内营养乳剂(TP)治疗胃癌术后(气血两虚证)发生喂养不耐受(FI)的影响因素及对营养指标、中医证候积分的影响.方法 回顾性分析术后早期行十全大补汤联合TP治疗的80例胃癌术后(气血两虚)患者的病历资料,根据是否出现FI分为耐受组(34例)和不耐受组(46例).FI的相关影响因素进行单因素及多因素分析,并观察FI对患者营养指标、中医证候积分的影响.结果 单因素分析显示,患者术后第1天下床活动时间、开始肠内营养(EN)的时间、使用营养泵、早期灌肠与FI的发生密切相关（P ＜ 0. 05）;多因素Logistic 回归分析显示,患者第1 天下床活动时间≥2 h[ OR ＝ 0. 022,P ＝ 0. 001,95％ CI（0. 002,0. 223）]、使 用营养泵[ OR ＝ 0. 021,P ＝ 0. 000,95％ CI（0. 003,0. 162）]是FI 发生的独立危险因素;术后10 d,耐受组患者白蛋白（ALB）、血红蛋白 （Hb）升高水平优于不耐受组（P ＜ 0. 05）,中医证候积分显著低于不耐受组（P ＜ 0. 05）.结论胃癌术后（气血两虚证）患者早期给予十 全大补汤联合TP 治疗开始后,患者第1 天下床活动时间不短于2 h、使用营养泵能有效减少FI 的发生,并改善了患者的营养状态,减 轻了中医临床症状.

目的 探讨体素内不相干运动扩散加权磁共振成像(IVIM-DWI)在心脏成像的应用效果.方法 选取12例健康志愿者行多扩散敏感因子(b值)DWI序列扫描.采用双指数模型,b值序列是:0、20、60、80、120、200、600 s/mm2,在心脏短轴位2、3、5、8、9、11节段分别测量室间隔前部、后部及侧壁的扩散系数(D值)、灌注系数(D*值)和灌注分数(f值),统计分析比较各节段不同供血区心肌的D值、D*值、f值的差异.结果 健康志愿者12例,第5、11节段心肌D值较2、3、8、9心肌节段低,两两比较差异具有统计学意义(P均<0.05),第5、11节段心肌D值差异无统计学意义(P>0.05);第5、11节段心肌D*值和f 值较2、3、8、9心肌节段高,两两比较差异具有统计学意义(P均<0.05),第5、11节段心肌D*值和f值差异无统计学意义(P均>0.05).结论 IVIM-DWI技术能定量反映心肌的扩散状态及血流灌注状态.

Objective To analyze levels of serum E-cadherin and annexin A7 in gastric cancer and the correlation with clinical patho-logical character.Methods 96 patients with gastric cancer were chose from tumor department of our hospital and 60 healthy cases were regarded as control group.Levels of serum E-cadherin and annexin A7 of two groups were measured.Correlation between levels of serum E-cadherin and annexin A7 with clinical pathological character of gastric cancer was investigated.Levels of serum E-cadherin and an-nexin A7 were compared between survival group and death group.Results Compared to control group,level of serum E-cadherin in gastric cancer was remarkably descended and annexin A 7 was evidently elevated(P<0.01).Levels of serum E-cadherin and annexin A7 were no significant correlation with age,sex,and size and location of tumor(P>0.05).And there were significant correlation with differentiation,TNM clinical stage and lymph node metastasis(P<0.01).30 death and 66 survival were recorded by following by one year,level of serum E-cadherin of death group was obviously lower than those of survival group with statistical significance(P<0.01), while annexin A7 was higher obviously.Conclusions The level of serum E-cadherin in gastric cancer is obviously decreased and an-nexin A7 is remarkably increased,significantly related with differentiation,TNM clinical stage and lymph node metastasis of gastric cancer,which play an important role in evaluating prognosis of gastric cancer.

Objective To investigate expressions of silence signal regulating factor-1 (SIRT-1) and epithelial cadherin (E-cadherin) in gastric cancer and their clinical significances.Methods The immunohistochemistry SP technique was used to detect the expressions of SIRT-1 and E-cadherin in the gastric cancer tissues and their corresponding paracancerous gastric tissues.The relationship between the SIRT-1 expression and E-cadherin expression was analyzed using Spearman.Results The positive rate of the SIRT-1 protein expression in the gastric cancer tissues was significantly higher than that of the corresponding paracancerous gastric tissues (x2=5.791,P=0.016).The SIRT-1 protein positive expression was related to the Lauren histological type of gastric cancer (x2=4.941,P=0.026),in other words,in the intestinal type was significantly higher than that of the diffuse type,but which was not related to the age,gender,tumor size,tumor site,differentiation degree,TNM stage,or lymph node metastasis (Po＞0.05).While the positive rate of the E-cadherin protein expression in the gastric cancer tissues was significantly lower than that of the corresponding paracancerous gastric tissues (x2=10.868,P=0.001),which in the intestinal type of gastric cancer was significantly lower than that in the diffuse type of gastric cancer (x2=5.203,P=0.023),also not related to the age,gender,tumor size,tumor site,differentiation degree,TNM stage,or lymph node metastasis (P＞0.05).There was a negative correlation between the SIRT-1 protein and the E-cadherin protein (rs=-0.381,P=0.013).Conclusions Gastric cancer with higher SIRT-1 expression might be way to achieve tumor development through E-cadherin as a facilitator.Upregulation of SIRT-1 and declining of E-cadherin might play a possible role in intestinal type gastric cancer.

This study aims to explore the possibility to apply intravoxel incoherent motion-magnetic resonance imaging (IVIM-MRI) in cardiac imaging. Multi-b-value diffusion-weighted imaging (DWI) sequence scanning was performed on 12 healthy volunteers. A double exponential model was adopted, and the b-value sequence was 0, 20, 60, 80, 120, 200, and 600second/mm(2). The D-value, D*-value, and fvalue of the anterior posterior and lateral walls of the ventricular septum were respectively measured on the short axis section of the heart, the parameters of the myocardium in different blood supply areas in each segment were recorded, and the measured data of these different segments were compared using analysis of variance. Among these 12 healthy volunteers, the D-value, D*-value, and f-value of these 72 segments were not exactly equal, the D-values of the myocardium in the 5th and 11th segment were lower than those in the 2nd, 3rd, 8th, and 9th segments, and the pairwise differences were statistically significant (P<. 001). Furthermore, the difference in D-value between the 5th and 11th segments was not statistically significant (P= 1.000). The D*-value and f-value of the myocardium in the 5th and 11th segment were higher than those in the 2nd, 3rd, 8th, and 9th segments, and the pairwise differences were statistically significant (P<. 001). Furthermore, the differences in D*-value and f-value between the 5th and 11th segments was not statistically significant (P=. 214,.787). The intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) technique can quantitatively reflect the diffusion and blood perfusion status of the myocardium.

Objective:To research the expressions and relationship of silence signal regulating factor-1(SIRT-1)and epithelial cadherin(E -cadherin)in gastric cancer. Methods:HE staining was used to observe the his-topathologic structure in the cancer group and normal gastric mucosa group.Immunohistochemistry SP technique was used to detect the expressions of SIRT -1 and E - cadherin in cancer group and normal gastric mucosa group. Spearman correlation test was used to detect the expression correlation of SIRT-1 and E-cadherin.Results:HE staining gastric cancer tissue:Cell differentiation was poor,pleomorphism and different size.Cells showed fake many layers,cell nucleus was large and karyokinesis,kytoplasm was few.The immunohistochemistry showed the positive ex-pression of SIRT-1 were 40.5% and 64.3% in the normal gastric mucosa group and cancer group.The positive ex-pression rate of E-cadherin were 73.8% and 40.5% respectively in the normal gastric mucosa group and cancer group(P<0.05).Spearman correlation test showed that there was a correlation between SIRT-1 and E-cadherin (P<0.05).SIRT-1 protein expression was related to the tumor size and pathological types(P<0.05).But not re-lated to the age,gender,TNM stage and lymph node metastasis(P>0.05).Conclusion:Gastric cancer with the high-er SIRT-1 expression may be the ways to achieve tumor invasion and metastasis through E-cadherin as a facilita-tor.

Objective To observe the influence of early enteral nutrition on gastrointestinal function and nutritious status of gastric carcinoma after operation.Methods 92 patients with gastric carcinoma were selected and randomly divided into the control group and the observation group,with 45 cases in each group.The control group was treated with parenteral nutrition group 24 h after operation.The observation group was treated with enteral nutrition group.Recovery time of evacuation,defecation,and bowel sound in the 2 groups were recorded.Occurrence rate of abdominal distension was compared in both groups.Levels of prealbumin (PA),albumin (ALB),and growth hormone (GH) were detected in both groups by Elisa.Results After operation,time of evacuation,defecation,and bowel sound for the first time in the observation group were shorter than the control group (P ＜ 0.01).Occurrence rate of abdominal distension in the observation group was obviously lower than the control group 24 and 48 hours after operation(P ＜ 0.01).The excellent and good rate of the observation group was 53.33％,which was higher than the control group,28.89％ with statistical differences (P ＜ 0.05).10 days after operation,serum levels of GH,PA,and ALB in the observation group were evidently higher than the control group with statistical differences (P ＜ 0.01).Condusion Early enteral nutrition can promote the recovery of gastrointestinal function and improve nutritious status of gastric carcinoma after operation.

Objective To investigate the effect of enteral nutrition support in the treatment of severe acute pancreati -tis with nutritional index , immune index and inflammatory response index .Methods We collected 72 patients with severe a-cute pancreatitis from January 2013 to December 2015 .They were randomly divided into research group and control group , each group had 36 cases.All patients were treated with conventional treatment , research group were received immune enteral nutrition therapy by jejunum nutrition tube , control group were received parenteral nutrition support .Compare two groups after treatment, patients’ nutrition indicators (Alb, PAB), humoral immunity (IgA, IgG, IgM), cellular immunity (TLC, CD3 +, CD4 +) and inflammatory indicators (CRP, TNF-α, IL-6) changes.Results Two groups of patients given different nutrition after treatment , the indicators were obviously improved .At 7 days and 14 days, the ALB and PAB levels of the re-search group were significantly higher than that of the control group ( t 7 =1.717, t 7 =2.957;t 14 =2.411, t 14 =2.182, P <0.05);Treatment for 14 days, the IgA, IgG, IgM, TLC, CD3 +, CD4 +of the research group were improved significantly better than the control group ( t =2.031, t =2.106, t =2.198, t =2.050, t =2.182, t =1.850, P <0.05).At the same time, the CRP, TNF-α, IL-6 of the research group declined significantly than the control group ( t =2.437, t =1.705, t =2.697, P <0.05).Conclusion The jejunum nutrition tube given immune enteral nutrition in treatment of severe acute pan -creatitis can effectively improve the nutritional status and immune function of patients , reduce the inflammatory reaction in pa-tients with acute reaction period , so as to improve the prognosis and improve the clinical efficacy .

Objective To analyze the correlation of positive expression of phosphorylated mammalian target of raphmycin (p-mTOR) with clinicopathological factors and prognosis in gastric cancer patients. Methods The expres-sion of p-mTOR of stomach tissue specimens from 89 gastric cancer patients in Handan Municipal Central Hospital from Jan. 2013 to Dec. 2013 were detected by immunohistochemistry method, and its correlation with lymphatic metastasis, depth of invasion, degree of differentiation and pathological stage were analyzed. The relationship of p-mTOR with prog-nosis of patients was assessed according to the expression level of p-mTOR. Results The positive rate of p-mTOR was 77.53%(69/89). The positive rate of p-mTOR in patients with lymphatic metastasis was 90.20%, higher than that of pa-tients without lymphatic metastasis (60.53%), and difference was statistically significant (P<0.05). The Spearman rank cor-relation showed that positive expression of p-mTOR had positive correlation with depth of invasion, degree of differentia-tion and pathological stage (all P<0.01), with correlation coefficient of 0.65, 0.69, and 0.64 respectively. The median pro-gression free survival in group of low p-mTOR expressing was 23.5 months, longer than that of group of high p-mTOR ex-pressing which was 12.8 months, and the difference was statistically significant (P<0.01). Conclusion There is high ex-pression of p-mTOR in gastric cancer patients, and the detection of p-mTOR is in favor of assessment of prognosis.

目的：分析急性脑卒中患者临床病情严重程度评分与血清炎性因子水平变化的研究。方法：选择诊断急性脑血管病患者120例，依据入院患者格拉斯哥昏迷评分分为轻度（GCS≥12）、中度（GCS ，8～11）、重度（GCS ，3～7）组，入院24h检测不同程度卒中患者血清降钙素原（PCT ，ug／L）、C反应蛋白（CRP ，mg／L）、白介素－6（IL －6，U／L）水平变化，分析IL －6、CRP、PCT 指标与格拉斯哥昏迷评分（GCS）间相关性，比较3组患者早发卒中相关性肺炎发生率。结果：轻度、中度、重度组患者血清CRP水平3组间比较水平差异有统计学意义（ P＜0．05）。入院24h血清 PCT 、CRP、IL －6水平与GCS评分二者间相关性分别为（r＝0．309；0．561；0．792，P＜0．05）。3组间早发卒中相关性肺炎发生率[（4／40，10％）比（5／40，12．50％）比（16／40，40．00％），χ2＝3．005]，差异有统计学意义（ P＜0．05）。结论：急性脑血管病患者病情严重程度评分与机体炎性反应水平关系密切，病情越重，机体炎性反应水平越高，早发卒中相关性肺炎发生率也上升。血清降钙素原水平监测对于早发卒中相关性肺炎诊断价值大。

Objective To explore the influence of the whole course psychological intervention on negative emotion, side effect of chemotherapy and the quality of life in patients with rectal cancer. Methods A total of 112 pa-tients with rectal cancer in our department from February 2008 to November 2014 were selected as the research sub-jects, which were randomly divided into intervention group and non-intervention group based on the digital table meth-od, with 56 patients in each group. Patients in the intervention group received whole course of psychological interven-tion, and patients in the non-intervention group did not receive psychological intervention with other treatments the same. Self-rating anxiety scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the scores of anxi-ety and depression between the two groups before the psychological intervention and before discharge. The scores of quality of life were compared between two groups before the psychological intervention after 1 year of psychological intervention by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). Results The scores of anxiety in the intervention group and the non-intervention group were (42.63 ± 3.66) and (57.56 ± 4.13), and the scores of depression were (39.85 ± 6.37) and (56.67 ± 8.35), respectively. The scores of anxiety and depression in the intervention group were significantly lower than those in the non-intervention group (P<0.05). The scores of physical function, role function and other scores of quality of life in the intervention group were significantly higher than those in non-intervention group, and the differences were statistically significant (P<0.05). The incidence of severe fatigue and weakness in the intervention group and the non-intervention group were 13%and 25%, respectively. The incidence of severe nausea and vomiting were 14%and 27%, respectively. The adverse reaction of chemotherapy in the intervention group was lower than that in the non-intervention group, and the difference was sta-tistically significant (P<0.05). Conclusion The whole course psychological intervention on the basis of routine treat-ment can reduce the patient's negative emotions, significantly improve the quality of life of patients, and reduce the side effects of chemotherapy, which is worth to clinical promotion.

目的:分析急性脑血管病患者临床病情严重程度评分与机体免疫功能变化的关系.方法 :选择2013年10月~2015 年10月诊断急性脑卒中患者150例,依据患者格拉斯哥昏迷评分 (GCS)分为轻度 (GCS≥12)、中度 (GCS,8~11)、重度 (GCS,3~7)3组.入院24h流式细胞仪检测外周血中T细胞亚群:CD3 +T细胞、CD4 +T细胞、CD4 +/CD8 +T细胞比例及CD4 +CD25 +调节性T淋巴细胞比例变化,评价不同程度卒中分组患者细胞免疫功能变化,分析细胞免疫功能指标与格拉斯哥昏迷评分间相关性,比较3组患者早发卒中相关性肺炎发生率.结果:轻度、中度、重度组患者CD3 +T细胞 [(22. 91 ±3. 15)%vs (21. 54 ±3. 78)%vs (20. 17 ±3. 03)%,t=0. 936]、CD4 +T细胞 [(30. 95 ±4. 28)%vs (32. 06 ±4. 89)%vs 33. 78 ±4. 91)%,t=0. 785],3组比较水平差异无统计学意义 (P>0. 05).CD4 +/CD8 +T细胞比例 [(1. 35 ±0. 06)vs (1. 12 ±0. 05)vs (0. 89 ±0. 07),F=3. 431]水平逐渐下降,CD4 +CD25 +调节性T淋巴细胞比例 [(45. 71 ±8. 05)%vs (59. 29 ±8. 17)%vs (69. 03 ±9. 95)%,t=3. 018]水平逐渐上升,3组间比较差异有统计学意义 (P<0. 05).入院24h血CD4 +CD25 +调节性T淋巴细胞比例与GCS评分二者间相关性分别为 (r=0. 584,P<0. 05).3组间早发卒中相关性肺炎发生率 [(5/50,10%)vs (6/50,12%)vs (21/50,42. 00%),χ2 =3. 091],差异有统计学意义 (P<0. 05).结论:急性脑血管病患者病情严重程度评分与免疫功能存在一定联系,随着病情程度加重,机体免疫功能处于抑制状态,早发卒中相关性肺炎发生率也明显升高.