[Analysis on the implementation of payment policies for four non-national immunization program vaccines in China].

This study systematically retrieved information on the payment policy of vaccination fees for pneumococcal vaccines, human papillomavirus vaccines, haemophilus influenzae type b vaccines and rotavirus vaccines using a Python-based crawler. The proportion of the population covered by policies among the total applicable population was estimated based on the medical insurance coverage ratio and population data in 2020. This study showed that the payment policies included two categories, government-funded free vaccination policies and medical insurance payment policies. Among the four non-national immunization program vaccines, the free vaccination policies only involved pneumococcal vaccines and human papillomavirus vaccines. Among them, the 13-valent pneumococcal conjugate vaccine, the 23-valent pneumococcal polysaccharide vaccine, and the human papillomavirus vaccine were provided free of charge in 1, 10 and 15 provinces, respectively. For these policies, the corresponding covered population and the proportion among the total applicable population were children aged 6 months to 2 years old (2.5%), older people (1.2% to 21.5%) and middle school girls (1.1% to 12.2%). Medical insurance payment policies were implemented in 14 provinces, and nearly covered the four types of vaccines in the policy implementation areas, with the proportion of the covered population about 10.9% to 41.5% among the total applicable population.

Exosome-mediated delivery of SCD-1 siRNA promoted the death of anaplastic thyroid carcinoma cells via regulating ROS level.

PURPOSE: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive cancers in the world. Stearoyl-CoA desaturase-1 (SCD-1) is one of major enzymes in the de novo synthesis of fatty acids and is related to cancer aggressiveness and poor patient prognosis. The study aimed to construct exosomes loaded SCD-1 interference, investigate its effects and mechanisms on the cell proliferation and apoptosis of ATC cells. METHODS: The expressions of SCD-1 in normal thyroid cell line and ATC cell lines were determined by qRT-PCR and western blotting, respectively. Exosomes were prepared and purification then loaded with SCD-1 siRNA by electroporation and observed by transmission electron microscopy. Higher SCD-1 mRNA and protein levels were found in ATC cell lines compared than normal thyroid cell line (P < 0.05), and both Hth-7 and FRO cells could uptake PKH67-labeled exosomes. The effects of exosomes loaded SCD-1 siRNA on ATC cells were measured by CCK8 assay and apoptosis detection kit. RESULTS: When compared with control group, the cell viability significantly decreased in both two ATC cell lines taken up exosomes loaded SCD-1 siRNA (P < 0.001), and apoptotic and necrotic cells obviously increased (P < 0.05). In order to explore the mechanism of exosomes loaded SCD-1 on ATC, the ROS level was detected by fluorescence reagent. It was found that exosomes loaded SCD-1 siRNA significantly increased intracellular ROS level of ATC cells (P < 0.05). CONCLUSIONS: Exosomes loaded SCD-1 siRNA inhibited ATC cellular proliferation and promoted cellular apoptosis, and the mechanisms involved maybe the regulation of fatty acids metabolism and ROS level. Our study provides a promising therapeutic strategy for ATC.

DGCR8 promotes the metastasis in triple-negative breast cancer by epigenetically regulating TGF-ß.

OBJECTIVE: Breast cancer (BC) is one of the most ordinary fatal cancers. Recent studies have identified the vital role of genes in the development and progression of Tri-negative breast cancer (TNBC). In this research, DGCR8 was studied to identify how it functioned in the metastasis of TNBC. PATIENTS AND METHODS: DGCR8 expression of tissues was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) in 50 TNBC patients. Wound healing assay and transwell assay were used to observe the changes in the biological behaviors of TNBC cells through knockdown or overexpression of DGCR8. In addition, qRT-PCR and Western blot assay were performed to discover the potential target protein of DGCR8 in TNBC. RESULTS: DGCR8 expression level in TNBC samples was higher than that of adjacent ones. Besides, the migration ability and invasion ability of TNBC cells were inhibited after DGCR8 was silenced, while they were promoted after DGCR8 was overexpressed. In addition, TGF-ß was downregulated after silencing of DGCR8 in TNBC cells, while TGF-ß was upregulated after overexpression of DGCR8 in TNBC cells. Furthermore, TGF-ß was upregulated in TNBC tissues, which was positively associated with DGCR8. CONCLUSIONS: Our study uncovers a new oncogene in TNBC and suggests that DGCR8 can enhance TNBC cell migration and invasion via targeting TGF-ß, which provides a novel therapeutic target for TNBC patients.

[Outcomes of 33 patients with anaplastic large cell lymphoma treated after hematopoietic stem cell transplantation].

Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK(+) and 9 ones (27.3%) ALK(-). Of them, 25 patients (19 ALK(+) and 6 ALK(-)) underwent auto-HSCT and 8 cases (5 ALK(+) and 3ALK(-)) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion: ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.

[Evaluation of clinical outcomes of allogeneic hematopoietic stem cell transplantation for relapsed/refractory peripheral T-cell lymphoma with chemoresistance].

Objective: To evaluate the clinical outcomes in patients with relapsed or refractory peripheral T-cell lymphoma (PTCL) who had undergone allogeneic hematological stem cell transplantation (allo-HSCT). Methods: From June 2007 to June 2017, the clinical data of PTCL patients who underwent HSCT from eight hospitals were assessed retrospectively. Results: There were 23 patients diagnosed as relapsed or refractory PTCL with chemoresistance who underwent allo-HSCT. Among these patients, 18 were identified as progressive disease (PD) status and 5 patients as stable disease (SD) status before allo-HSCT. Seventeen patients received allo-HSCT from matched sibling donor (MSD),2 patients from matched unrelated donor and 4 patients from related haplo-identical donor (HD). After a median follow-up of 29 months, 21 patients survived longer than 28 days after allo-HSCT. Hematopoietic reconstitution was achieved in 20 of the 21 patients. The median time of myeloid and platelet engraftment were+13 (9-22) d and+16(10-38) d, respectively. The 100-d treatment-related mortality rate was 13.1%. Acute GVHD occurred in 11(47.8%) patients at a median time of 22(6-82) d after transplantation. Grade Ⅱ~Ⅳ aGVHD occurred in 6 patients. Chronic GVHD occurred in 10 patients at a median of 7.9 (3.5-27) months. After a median follow-up of 29 months, 13 patients died after HSCT. Four of them died of complications associated with allo-HSCT, and other 9 patients died of the primary lymphoma. The 3-years cumulative overall survival (OS) and progress-free survival (PFS) were 43.03% (95%CI: 29.79-69.16) and 39.13% (95%CI: 23.50-65.14), respectively. No significant difference was found in the 3-year PFS between patients with PD status and SD status before allo-HSCT (P=0.133). Conclusion: Allo-HSCT can be a promising treatment for relapsed or refractory PTCL with chemoresistance.

[Vestibular function test in patients sudden sensorineural hearing loss patients with vertigoand its clinical significance].

Objective:The aim of this study is to analyze the results of vestibular function tests and clinical value of patients with sudden sensorineural hearing loss （SSHL） and vertigo. Method:Twelve cases（24 ears） of unilateral SSHL with vertigo were included in the study group. 11 age and sex matched normal subjects（22 ears） were recruited as the normal control group. Both patients and normal subjects underwent carolic tests, ocular vestibular evoked myogenic potential （oVEMP）, and cervical vestibular evoked myogenic potential （cVEMP） in bilateral ears. The results were compared between the subjects and the normal control group. Result: The rate of positive oVEMP was 25.0% in the affected ear and 50.0% in the contralateral ear in patients with SSHL and vertigo, and 90.9% in normal subjects; while the rate of positive cVEMP was 58.3% in the affected ear and 58.3% in the contralateral ear in patients with SSHL and vertigo, and 90.9% in normal subjects. There were no significant differences between the affected and contralateral ears （P>0.05）. Compared to normal subjects, oVEMP and cVEMP in both the affected and contralateral ears were significantly reduced （P<0.05）. The parameters of oVEMP and cVEMP （N1 latency, P1 latency, amplitudes） were not significantly different among the groups（P<0.05）. Compared to normal subjects, the threshold difference of oVEMP and cVEMP in both the affected and contralateral ears werehigher than the normal subjects（P<0.05）. Among 12 SSHL patients who underwent caloric test, 9 were found with unilateral semicircular canal weakness（CP>25%）, and the abnormal rate was 75% （9/12）. Conclusion:Patients with vertigo with vertigo have impaired conduction function in the ipsilateral and contralateral vestibular pathways, mainly due to decreased vestibular evoked myogenic potential, increased threshold, and abnormal cold and heat tests. The vestibular function test provides an objective basis for assessing the inner ear injury in patients with vertigo.

[Comparative analysis of sleep monitoring between young and middle-aged and elderly OSA patients].

Objective:The aim of this study is to compare the night sleep hypoxia degree and sleep structure of young and middle-aged and elderly patients with OSA, so that PSG has more important application value.Method:A total of 438 patients diagnosed with OSA from February 2017 to January 2019 were selected,including 119 patients in the youth group with an average age of (28.5±5.1）years,and 319 patients in the middle and elderly group with an average age of (45.8±2.7)years.The results recorded by PSG in the two groups were retrospectively analyzed. Result:①The AHI, ODI, OAI, MAI and ASaO2of OSA patients in the junior group were significantly higher than those in the middle-aged and elderly group, while CAI was not statistically significant between the two groups (P=0.419).②The NREM stage Ⅰ (61.1±4.3)% in the junior group was significantly higher than that in the junior group (53.3±3.4)%.NREM stage Ⅱ (33.2±2.3)% and NREM stage Ⅲ+Ⅳ (4.3±1.3)% in the junior group were higher than those in the middle-aged group (29.2±3.9)% and stage Ⅲ+Ⅳ (2.6±0.9)%, while the percentage of REM stage and microarousal index were not statistically significant between the two groups.③Young OSA patients were associated with hypertension and 47.0% middle-aged and elderly patients were associated with hypertension.There was no statistical difference between the two groups in whether hypertension was associated with hypertension or not.Conclusion:The NREM phase is particularly susceptible to age, and age affects slow wave sleep. The sleep structure of middle-aged and older people demonstrates their sleep characteristics: reduced total sleep time,slow wave sleep,low sleep efficiency,and delayed sleep. The young people's nighttime hypoxia is more serious. AHI,ODI,OAI,MAI,ASaO2 and other indicators are significantly higher than the middle-aged and elderly people, but the sleep structure 2 groups are similar, indicating that young people have strong sleep physiological compensation and Adjustment ability.

Do pediatricians routinely perform genitourinary examinations during well-child visits? A review from a large tertiary pediatric hospital.

BACKGROUND: The male genital examination is a common source of discomfort for the patient and medical provider. Performance of male genital examination is imperative; however, as many treatable diagnoses can be made. Undescended testicles (UDTs), hernias, testicular tumors, and urethral abnormalities are all potentially concerning findings which can be discovered on routine examination. OBJECTIVE: The objectives of this study are to determine the rate at which general pediatricians perform routine genitourinary (GU) examinations in the pediatric population and to determine the rate at which UDT are diagnosed or documented in the patient's history. The authors hypothesize the rate of pediatric GU examination during routine well-child visits to be in line with the previously reported rates in the adult literature. STUDY DESIGN: Nine hundred ninety-six consecutive male well-child visits conducted by general pediatricians at the study institution were reviewed. These visits were evaluated for documentation of a detailed GU examination as well as the presence of UDT from these examinations. In addition, past medical and surgical histories were reviewed to determine if a diagnosis of UDT was noted. RESULTS: Pediatricians at the study institution documented GU examinations 99.1% of the time during male well-child visits. Only 1.1% of the cohort had a documentation of UDT at any time point. Of the 11 patients with UDT, 6 boys (54.5%) had spontaneous descent with no referral to urology, whereas 5 (45.5%) required orchidopexy. DISCUSSION: Prior reports suggest 70-75% of routine office visits include a genital examination. None of these reports reviewed the pediatric population, thus making this review novel in this respect. In addition, the results are vastly different from these prior studies as the authors demonstrated over 99% of male well-child examinations included documentation of a thorough genital examination. A limitation of the study is its retrospective nature, which creates a lack of standardization across the data set. In addition, without being physically present in the examination room, one cannot discern whether an examination is simply being documented without actual performance because of the template format of the electronic medical record (EMR). Furthermore, the study was not designed to best evaluate the true rate of UDTs; therefore, the reported rate of 1.1% cannot be accurately associated with a particular age at diagnosis. CONCLUSIONS: Pediatricians do, in fact, document GU examinations on a routine basis. This finding cannot be taken with complete certainty as verification of actual examination performance is impractical. While the data demonstrated a lower than expected rate of UDT, depending upon age at diagnosis, this could indicate that although examinations are being documented, their accuracy may be diminished because of various factors at play in the healthcare system as a whole, including improper exam performance and EMR templates. Follow-up studies are required to verify these potentially changing rates of UDT and to determine if there is discordance between documentation and performance of GU examinations.

[Clinical outcomes of hematopoietic stem cell transplantation for angioimmunoblastic T-cell lymphoma].

Objective: To evaluate clinical outcomes of autologous (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for angioimmunoblastic T-cell lymphoma (AITL) . Methods: From June 2007 to June 2017, clinical data of AITL patients who underwent HSCT in eight hospitals were assessed retrospectively. Results: Of 19 patients, 13 male and 6 female with a median age of 50 (32-60) years old, 12 auto-HSCT and 7 allo-HSCT recipients were enrolled in this study, all donors were HLA-identical siblings. Two of allo-HSCT recipients were relapsed auto-HSCT ones. There were 5 patients (5/12) in complete response (CR) status and 7 (7/12) in partial remission (PR) status before transplantation in auto-HSCT group, and 2 (2/7) in PR status and 3 (3/7) in progression disease (PD) status before transplantation in allo-HSCT group. The median follow-up for the surviving patients was 46.5 months (range, 1-100 months) for the whole series, two patients lost in auto-HSCT group. Three patients developed acute graft-versus-host disease (aGVHD) and 5 chronic graft-versus-host disease (cGVHD) after allo-HSCT. Three patients died of primary disease and 1bleeding in auto-HSCT group. One patient died of primary disease and 2 transplantation-related mortality in allo-HSCT group. The 3-year cumulative overall survival (OS) were 56% (95%CI 32%-100%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.979) . The 3-year cumulative progression-free survival (PFS) were 34% (95%CI 14%-85%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.451) . Conclusion: Both auto-HSCT and allo-HSCT were optimal choices for AITL. In clinical practice, which HSCT was better for AITL patients should be based on comprehensive factors including sensitivity to chemotherapy, risk stratification and disease status at transplantation.

[Two cases of piriform pit carcinoma were repaired with thyroid lobe].

Two cases with piriform fossa cancer underwent larynx lateral wall repair surgery. Case 1: The patient was admitted to the hospital because of pharyngeal discomfort with swallowing pain for 2 months Electronic laryngoscopy revealed neoplasm in the left piriform fossa. Space occupying lesion in left piriform fossa and paranasal space was found in MRI scan. The pathological diagnosis of this patient was squamous cell squamous cell carcinoma (T2N1M0). Case 2: The patient was admitted to the hospital because of blood in the sputum for more than 1 year. The electronic laryngoscope suggested neoplasm in the pharyngeal space and left vocal cord paralysis.Soft tissue thickening of the oropharynx and hypopharyngeal right wall was found in MRI scan. The pathological diagnosis of this patient was squamous cell carcinoma (T1N2M0).

[Various choices of reconstructing the left subclavicular artery to extend the proximal landing zone thoracic endovascular aortic repair].

Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for Stanford type B aortic dissection. Covered the left subclavian artery (LSA) directly may cause corresponding complications in Stanford type B aortic dissection with unfavourable proximal landing zone. TEVAR can be successfully implemented by reconstructing LSA to expand the proximal landing zone. Currently, the methods of reconstructing LSA mainly include hybridization technology (carotid-subclavian artery transposition), chimney technology (including branch stent technology) and fenestration (or slot technology), etc. These techniques are all valid for aortic dissection that needs to reconstructing LSA. The choices and applications of these techniques should follow the individualized principles.

Oncogenes expand during evolution to withstand somatic amplification.

Background: Cancer-related genes are under intense evolutionary pressure. We conjectured that gene size is an important determinant of amplification propensity for oncogenes and thus cancer susceptibility and therefore could be subject to natural selection. Patients and methods: Gene information, including size and genomic locations, of all protein-coding genes were downloaded from Ensembl (release 87). Quantification of gene amplification was based on Genomic Identification of Significant Targets in Cancer scores obtained from available The Cancer Genome Atlas studies. Results: Oncogenes are larger in size as compared with non-cancer genes (mean size: 92.1 kb versus 61.4 kb; P < 0.0001) in the human genome, which is contributed by both increased total exon size (mean size: 4.6 kb versus 3.4 kb; P < 0.0001) and higher intronic content (mean %: 84.8 versus 78.0; P < 0.01). Such non-random size distribution and intronic composition are conserved in mouse and Drosophila (all P < 0.0001). Stratification by gene age indicated that young oncogenes have been subject to a stronger evolutionary pressure for gene expansion than their non-cancer counterparts. Pan-cancer analysis demonstrated that larger oncogenes were amplified to a lesser extent. Tumor-suppressor genes also moved toward small oncogenes in the course of evolution. Conclusions: Oncogenes expand in size whereas tumor-suppressor genes move closer to small oncogenes in the course of evolution to withstand oncogenic somatic amplification. Our findings have shed new light on the previously unappreciated influence of gene size on oncogene amplification and elucidated how cancers have shaped our genome to its present configuration.

[Research progress of Lgr5-positive stem cells in the formation of organoid in 3D culture].

Stem cell is critical to regeneration of tissue or organ of human. How to promote repair or regeneration in the tissues/organ using its pluripotency is always an important issue. Lgr5-possitive cell is one type of the stem cell-like cells capable of pluripotent differentiation in various tissues/organs of both humans and mice. Current study showed that single or small amount Lgr5-possitive stem cells can grow and form a plurality of organs in 3D culture system, and some organs can present similar biological and physiological properties with the progenitor they were derived. These studies provided new insight into future orientation, for example, Lgr5-possitive inner ear cells were confirmed as inner ear pluripotent cells population, the experiences obtained from organoid studies of Lgr5-possitive cells have certainly showed potential in the future study of inner ear stem cells. This review will focus on the recent progress associated with Lgr 5-positive stem cells forming organoids in the 3D culture.

Polyketides with different post-modifications from desert endophytic fungus Paraphoma sp.

Three new polyketides 4,6,8-trihydroxy-5-methyl-3,4-dihydronaphthalen-1(2H)-one (1), 5,7-dihydroxy-3-(1-hydroxyethyl)-3,4-dimethylisobenzofuran-1(3H)-one (2) and 1-(4-hydroxy-6-methoxy-1,7-dimethyl-3-oxo-1,3-dihydroisobenzofuran-1-yl) ethyl acetate (3) together with seven known analogues (4-10) were isolated from desert endophytic fungus Paraphoma sp. The structures of these compounds were elucidated by analysis of NMR data. The absolute configuration of (1-3) was established on the basis of CD experiments. The possible biosynthetic pathway of compounds (1-10) was suggested, which implied that these secondary metabolites might be originated from polyketide biosynthesis with different post-modification reactions. Compounds 2, and 5-8 were evaluated for bioactivities against plant pathogen A. solani, whereas none of them displayed any biological effects. In addition, compounds 1, 2 and 5-10 were also tested for cytotoxic activities against three human cancer cell lines (HepG2 cells, MCF-7 cells and Hela cells) without biological effects.

[Brief discussion of history of vascular surgery in New China].

The history of vascular surgery in new China could be divided into the following three stages: the first stage, since the early 1980s, the technique of endovascular surgery was introduced in China, developed in some major hospitals, and gradually popularized to some basic hospitals conditionally. Vascular surgery had gradually developed into an independent discipline in China by the late 1980s. The second stage, since the late 1980s, vascular diagnosis and treatment technology, vascular equipment, and related research modification had been improving continuously in China, and achieved certain success, especially since the establishment of the department of vascular surgery affiliated to the Chinese Medical Association in 1993, vascular surgery in China representing its period of primary development. The third stage, since the beginning of the 21st century, the innovation of the technique of endovascular surgery and hybridization technology, and the development of materials technology had contributed to the second leaping forward of vascular surgery in China. Since then, vascular surgery enters a new era of minimally invasive surgery and opens a period of rapid development.

[Analysis of the recurrence related factors of sinonasal inverted papilloma].

Objective:To evaluate the influence risk factors of recurrence and the methods for reducing recurrence of sinonasal inverted papilloma (SNIP). Method:Clinical data of 34 patients with SNIP were analyzed retrospectively. All of them were unilateral onset. The diagnosis was confirmed pathologically and the range of lesions was determined by endoscopic and imaging examination; clinical classification according to Krouse classification method; All operations were performed under nasal endoscope, of which 20 cases were operated by simple nasal endoscope, and 14 cases were operated by endoscopic anterior lacrimal recess approach. The patients were followed up for 12-36 months. The curative effects were observed and the prognostic factors of the patients were analyzed. Result:Thirty-four cases of SNIP patients with postoperative recurrence rate was 17.65% (6/34); simple nasal endoscopic surgery in 20 cases, the recurrence rate was 25.00%(5/20); endoscopic anterior lacrimal recess approach in 14 cases, the recurrence rate was 7.14%(1/14), the difference was statistically insignificant (χ²=1.807, P>0.05). Four cases in stage Ⅰ had no recurrence；20 cases in stage Ⅱ, the recurrence rate was 15.0%(3/20); 9 cases in stage Ⅲ, the recurrence rate was 33.3%(3/9); 1 case in stage Ⅳ had no recurrence, the recurrence rate of the patients with different stages were statistically insignificant (χ²=2.692, P>0.05). Conclusion:Simple endoscopic resection of the tumor and endoscopic anterior lacrimal recess surgery are effective methods for the treatment of SNIP. The nasal surgery history and tumor origin are the risk factors for recurrence. The operation completely tumorresection,detailed preoperative examination and postoperative regular endoscopic examination are the keys to preventing recurrence.