Treatment progress of triple positive breast cancer / 中国临床药理学与治疗学

Triple positive breast cancer overexpress ER (estrogen receptor), PR and HER2 (human epidermal growth factor receptor 2, HER2), accounting for about 50%-60% of the HER2 positive breast cancer patients. Based on the data from clinical trials, the crosstalk between the ER signaling pathway and the HER2 signaling pathway in triple-positive breast cancer may weaken the efficacy of anti-HER2 therapy and endocrine therapy, and this feature has attracted widespread attention. Emerging evidence shows that while blocking HER2 signaling pathway, together with enhancing blocking of ER signaling pathway, such as anti-HER2 dual-targeting + endocrine therapy ± CDK4 / 6 inhibitors, could effectively overcome drug resistance, and improve the efficacy. Predictive biomarkers including Ki67, intrinsic subtypes, and multi-gene assay, which have the potential benefit for personalized treatment.

Construction and in vitro evaluation of an LNP system for mRNA delivery / 药学实践杂志

Objective To construct lipid nanoparticles DLin-LNP for mRNA delivery. Methods DLin-LNP was prepared by thin film hydration method, and DLin-LNP/mRNA was further constructed by using EGFP-mRNA as model drug. The particle size, zeta potential, and appearance morphology were measured. Furthermore, the intracellular distribution and transfection of DLin-LNP/mRNA in RM-1 cells was investigated by laser scanning confocal microscope. Results DLin-LNP was successfully prepared. The average particle size was about (151.1±2.1) nm, the no-load potential was (23.7±0.5) mV. The cytotoxicity of DLin-LNP was far lower than that of the commercially available liposomal Lipo8000. The results of transfection experiment indicated that DLin-LNP has high transfection efficiency for mRNA delivery with low cytotoxicity and good stability. Conclusion DLin-LNP could become a potential mRNA vector for gene therapy.

Analysis of the characteristics of SPTB gene variants among 16 children with Hereditary spherocytosis / 中华医学遗传学杂志

OBJECTIVE@#To analyze the clinical characteristics and spectrum of SPTB gene variants among 16 Chinese children with Hereditary spherocytosis (HS) and explore their genotype-phenotype correlation.@*METHODS@#Sixteen children who were diagnosed with HS at the Affiliated Hospital of Capital Institute of Pediatrics from November 2018 to July 2022 were selected as the research subjects. Genetic testing was carried out by whole exome sequencing. Candidate variants were verified by Sanger sequencing and subjected to bioinformatic analysis and prediction of 3D structure of the protein. Correlation between the SPTB genotypes and clinical phenotypes was analyzed using Chi-squared test.@*RESULTS@#The male-to-female ratio of the HS patients was 6 : 10, with the median age being 7-year-and-10-month. Clinical features of the patients have included anemia, reticulocytosis and gradual onset of splenomegaly. Mild, moderate and severe anemia have respectively occurred in 56.25% (9/16), 31.25% (5/16) and 12.50% (2/16) of the patients. SPTB gene variants were detected in all patients, among which 10 were unreported previously and 7 were de novo in origin. Loss of function (LOF) variants accounted for 93.75% (15/16). Only one missense variant was detected. Eleven, 4 and 1 of the variants had occurred in the repeat domain, CH1 domain, and dimerization domain, respectively. There was no significant correlation between the type or domain of the SPTB gene variants with the clinical features such as severity of anemia (x² = 3.345, P > 0.05). All of the variants were predicted to be pathogenic or likely pathogenic based on the guidelines from the American College of Medical Genetics and Genomics.@*CONCLUSION@#Mild to moderate anemia are predominant clinical features of the HS children harboring a SPTB gene variant, for which LOF variants are the main mutational type. The clinical feature of HS is unaffected by the type of the variants.

Multimodal imaging to distinguish choroidal neovascularization from macular inflammation lesions in multifocal choroiditis / 中华眼底病杂志

Objective:To observe the multimodal image features of inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC).Methods:A retrospective clinical analysis. A total of 90 eyes of 46 patients with MFC diagnosed in the Department of Ophthalmology of Yunnan University Affiliated Hospital from May 2017 to April 2021 were included in the study. Among them, there were 21 males and 25 females; the average age was 38.30±8.97 years old. Twenty-nine cases of MFC were diagnosed in the past, and they visited the doctor again due to new symptoms; 17 cases without a clear past medical history were the first visits. All eyes underwent color fundus photography, fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and OCT angiography (OCTA). With reference to the literature and the results of multimodal fundus imaging examinations, MFC lesions were divided into active CNV lesions, inactive CNV lesions, active inflammatory lesions, and inactive inflammatory lesions, with 31 (34.4%, 31/90), 12 (13.3%, 12/90), 26 (28.9%, 26/90), 90 (100.0%, 90/90) eyes. Nineteen eyes were treated with anti-vascular endothelial growth factor drugs. To summarize and analyze the manifestations of inflammatory lesions and CNV lesions in different imaging examinations. The Wilcoxon rank test was used to compare the detection rate of CNV lesions between FFA and OCTA.Results:In eyes with active inflammatory lesions and active CNV lesions, yellow-white lesions, retinal hemorrhage and exudation were seen on fundus color photography; FFA examination showed fluorescein leakage in the lesions; OCT examination showed retinal pigment epithelium (RPE) layer in the lesions was uplifted, the boundary was unclear, combined with subretinal and intraretinal fluid; OCTA examination showed that there was no blood flow signal in each layer of vascular tissue in active inflammatory lesions, and blood flow signals were seen in active CNV lesions. In the eyes of inactive inflammatory lesions and inactive CNV lesions, the fundus color photography showed that the lesions had clear boundaries without bleeding or exudation; FFA examination, the lesions were fluorescently stained, and there was no fluorescein leakage; OCT examination, inactive CNV lesions manifested as raised lesions with clear boundaries, and inactive inflammation manifested as scars formed by mild RPE hyperplasia or depressions in outer structures formed by atrophy; OCTA examination, inactive inflammatory lesions showed patchy loss of blood flow signal or penetrating blood flow signal below, blood flow signal can be seen in inactive CNV lesions.Conclusion:MFC active inflammatory lesions and active CNV lesions are often accompanied by retinal hemorrhage and exudation; FFA shows fluorescein leakage; OCT shows that the boundary of raised lesions is unclear; OCTA can identify the nature of CNV or inflammatory lesions.

Multimodal imaging characteristics of combined hamartoma of retina and retinal pigment epithelium / 中华实验眼科杂志

Objective:To observe the multimodal imaging characteristics of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE).Methods:A cross-sectional study was conducted.Sixteen eyes of 16 patients with CHRRPE were enrolled in Second People's Hospital of Yunnan Province from March 2013 to July 2019.Fundus color photography, fundus autofluorescence (FAF), fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and multicolor imaging were performed in all patients.The multimodal imaging characteristics were analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Second People's Hospital of Yunnan Province (No.20130106). Written informed consent was obtained from patients or their guardians prior to any medical examination.Results:Tumors were located in the posterior optic disc, and translucent glial lesions with unclear borders and slight elevations were observed.The surface of the lesions was attached by different degrees of fibroproliferative membrane, and the adjacent vessels were twisted and dilated.The tumors presented flat bulging green reflexes on the retina at the posterior pole by multicolor imaging, and OCT image showed thickened optic disc and retina near the optic disc, structural disorder, high reflectance of the surface, and low reflectance of the deep retina below the periretinal membrane.OCTA showed irregular blood flow signals, and the signal of retinal blood vessels was twisted and dilated.FAF showed that the autofluorescence intensity of tumors was weakened to different degrees.Early lesions presented different degrees of blocked fluorescence in FFA.Deformed and tortuous blood vessels were found in the eyes, and telangiectasia showing needle-like punctate strong fluorescence leakage was observed in severe eyes by FFA.ICGA showed no abnormal choroidal vessels.Conclusions:The main imaging features of CHRRPE include abnormal retinal blood vessels in the tumor area and fibrous proliferative membranes on the surface in color image; OCT shows that the retina and the retinal pigment epithelium are involved, and the retina in the tumor is thickened with disordered structure; high reflection OCTA shows irregular internal blood flow signals inside the tumor; FFA examination shows fluorescence obscuration and obviously tortuous retinal blood vessels.Multimodal imaging examinations are helpful for the diagnosis of CHRRPE.

Clinical observation on the evolution of fundus lesions in different subtypes of serpiginous choroiditis / 中华眼底病杂志

Objective:To observe the clinical evolution process and imaging characteristics of choroidal lesions in different subtypes of serpiginous choroiditis (SC), and to explore the clinical significance of subtype classification.Methods:A retrospective, uncontrolled and observational study. A total of 45 eyes of 25 SC patients diagnosed in Yunnan Eye Hospital from May 2009 to September 2021 were included in the study. According to the initial location of the lesion and fundus images, including fundus color photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and other examination results. SC was divided into peripapillary serpiginous choroiditis, macular serpiginous choroiditis and ampiginous choroiditis. According to the shape of the lesions at the first diagnosis, it can be divided into new lesions with only infiltrating edema, old lesions with only atrophy and recurrent lesions with coexistence of edema and atrophy. the imaging features, development and complications of different subtypes of ocular lesion were observed.Results:Among the 45 eyes of 25 cases, 15 cases were male and 10 cases were female, 20 cases of binocular and 5 cases of monocular, age was 42.3±5.7 years old. There were 21 eyes with active lesions, of which 5 eyes were new lesions and 16 eyes with recurrent lesions; 24 eyes were old lesions. Concurrent optic disc edema occurred in 3 eyes; mild vitreitis occurred in 5 eyes; retinal occurred vasculitis in 3 eyes; choroidal neovascularization occurred in 3 eyes. Among the 16 cases (64%, 16/25) of the peripapillary serpiginous choroiditis, 2 cases (2 eyes) were monocular, and 14 cases (28 eyes) were binocular. Active lesions were found in 16 eyes, of which patients with binocular lesions only one had active lesions. The choroidal lesions that were close to the optic disc or around the optic disc, expanded outwards centrifugally with the prolongation of the disease course, and can progress to the macula. The edge of the lesion was tortuous, with a geographic-like, amoeboid-like and finger-like, polypoid or propeller-like shape. Active lesions in FFA showed weak fluorescence in the early stage and strong fluorescence in the late stage; the old lesions showed weak fluorescence in the early stage and mottled fluorescence in the late stage, and mostly strong fluorescence on the edge. OCT showed thickening of active lesions and thinning of old lesions. Among the 4 cases (16.0%, 4/25) of macular type, 2 cases (2 monocular eyes) had active lesions; 2 cases (4 eyes) had lesion in both eyes, among them, 1 case (2 eyes) had old lesion, and the other case had alternate active lesions. The initial lesions were all located in the off-center of the macula, and most of them were disk-shaped and progressing centrifugally to the periphery. The FFA and OCT imaging findings of the lesions were similar to those of the peridisc type. Among the 5 cases (20.0%, 5/25) of ampiginous choroiditis, 1 case (1 eye) was monocular and 4 cases (8 eyes) were binocular. These lesions were multiple old lesions of varying sizes, gray-white with pigmentation, with clear borders in the posterior pole. Among them 4 eyes have new active lesions appeared near the old lesions. The old lesions showed weak fluorescence with clear borders, and the fluorescein leakage at the late edge formed a strong fluorescence ring; the active lesions showed weak fluorescent spots with blurred edges, and the fluorescence was slightly enhanced in the late stage. In old lesions, atrophy of the photoreceptor layer, RPE and choroid can be seen, and RPE hyperplasia in some areas.Conclusions:SC subtype is a classification of the location of the first lesion, but the characteristics of the repeated attack of this disease can lead to the annihilation of each subtype due to the continuous expansion of the lesion. The phenomenon that the fundus active lesions only occur in one eye that can explain the clinical manifestations of asymmetric morphology of binocular lesions. The characteristics of binocular subtype warn that the predilection site of the healthy eye should be paid attention to.

Analysis of interleukin 1 receptor-associated kinase 1, disease activity and CD4 + T cell subsets in peripheral blood of rheumatoid arthritis patients / 中华风湿病学杂志

Objective:To explore the expression level of interleukin-1 receptor-associated kinase-1 (IRAK1) in the peripheral blood of rheumatoid arthritis (RA) patients and analyze its relevance between disease activity and CD4 + T cell subsets. Methods:① The concentration of IRAK1 in the peripheral blood of 77 RA patients and 24 healthy controls were detected by enzyme linked immunosorbent assay (ELISA). ② The demo-graphic and clinical data of the RA group including disease activity score with 28 joints (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), CD4 + T cell subsets in peripheral blood. ③Independent sample t test or Mann-Whitney U test were used to compare the differences between the two groups. Spearman rank correlation test and multiple linear regression were used to analyze the correlation between IRAK1 expression level and clinical data. Results:① The IRAK1 level of the peripheral blood of RA patients was significantly higher than in the normal controls ( P<0.001). ② Compared to normal controls, the peripheral blood of the RA group, the absolute numbers and proportion of regulatory T (Treg) cells were decreased ( P<0.001), the absolute numbers and proportion of helper T (Th) 17 and the ratio of Th17/Treg were increased. Moreover, the ratio of Th17/Treg was also increased. ③ With the increase of disease activity in RA patients, the expression of IRAK1 also increased. The expression of IRAK1 in the peripheral blood of RA group was positively correlated with ESR, number of joints involved and DAS28, and had statistically significant difference between the two groups ( r=0.23, P<0.05; r=0.24, P<0.05; r=0.27, P<0.05). Meanwhile, it was sign-ificantly negatively correlated with the percentage of Treg ( r=-0.27, P<0.05), and was significantly positively correlated with the ratio of Th17/Treg ( r=0.23, P<0.05) . However, there was no significant correlation with the ratio of Th1/Th2( P>0.05). Furthermore, multiple stepwise regression analysis showed that the expression of IRAK1 in the peripheral blood of RA group was positively correlated with ESR and the number of joints involved ( β=0.34, P=0.019; β=0.27, P=0.004), and it was inversely correlated with percentage of Treg ( β=-0.23, P=0.047, R2=0.219). Conclusion:IRAK1 expression in the peripheral blood of RA patients is up-regulated and correlated with disease activity. The decrease of Treg and the imbalance of Th17/Treg caused by high expression of IRAK1 may be one of the main factors for the occurrence and development of RA. Interfering the expression of IRAK1 may be a potential new target for RA treatment.

Factors affecting scoliosis among children and adolescents / 预防医学

Objective@#To investigate the prevalence of scoliosis and identify the influencing factors among children and adolescents in Jiaxing City, Zhejiang Province, so as to provide insights into the management of scoliosis among children and adolescents. @*Methods@#The fourth, fifth and sixth grade primary school students and the first, second and third grade junior high school students were selected using the stratified cluster sampling method in Jiaxing City in 2019. Students' demographic features, diet habits, physical activity and learning environments and habits were collected using questionnaire surveys. Scoliosis was screened using whole-spine X-ray scans in an upright position, and the factors affecting scoliosis were identified using multivariable logistic regression analysis.@*Results@#Valid surveys were completed among 2 568 students, including 1 352 boys ( 52.65% ) and 1 216 girls ( 47.35% ), and there were 1 335 primary school students ( 51.99% ) and 1 233 junior high school students ( 48.01% ). A total of 93 students were detected with scoliosis, with a prevalence rate of 3.62%. Multivariable logistic regression analysis identified age ( OR=0.826, 95%CI: 0.710-0.960 ), gender ( OR=2.079, 95%CI: 1.343-3.221 ) and vigorous physical activity in the past 7 days ( OR=2.514, 95%CI: 1.248-5.063 ) as factors affecting scoliosis among primary and junior high school students.@*Conclusions@#The prevalence of scoliosis is high among primary and junior high school students in Jiaxing City. Age, gender and physical activity may affect the risk of scoliosis. Scoliosis screening is recommended to be included in routine healthy

Protective effect and mechanism of cx3cr1 antibody intravitreal injection in microcirculation of retinal ischemia-reperfusion injury in mice / 中华实验眼科杂志

Objective:To investigate the protective effect of C-X3-C motif chemokine receptor 1 (cx3cr1) antibody, a microglia activation inhibitor, on microcirculation during retinal ischemia reperfusion (RIR) and its possible mechanism.Methods:One hundred and fifty healthy adult C57BL/6 mice were randomized into blank control group, model group and cx3cr1 injection group by random number table method, with 50 mice in each group.The RIR model was established by anterior chamber infusion to elevate intraocular pressure in this study.Mice in the blank control group were intravitreally injected with 2 μl of sterile water.In the cx3cr1 injection group, the RIR model was established at 4 hours after the intravitreal injection (2 μl) of 0.2 μg/μl cx3cr1 antibody.Immunofluorescence staining of frozen eyeball sections was performed to assess the microglia activation by observing the Iba-1 positive expression in different retinal layers three days following the model establishment.Retinal preparation vascular staining was carried out to observe the changes in the density of deep and shallow retinal blood vessels and the number of activated microglia to evaluate the changes in retinal microcirculation.FITC-dextran contrast method was used to determine the retinal vascular leakage area.Real-time fluorescent quantitative polymerase chain reaction (qPCR) method was employed to detect the mRNA expression changes of hypoxia-related factors and inflammatory factors in the mice retina.The study protocol was approved by an Ethics Committee of Kunming Medical University (No.20180106). The use and care of the animals complied with the Regulations of the Administration of Affair Concerning Experimental Animals.Results:The immunofluorescence staining result of eyeball frozen section showed that in the blank control group, Iba-1 positive microglial cells were sparsely distributed in the retinal ganglion cell layer and inner plexiform layer, presenting branched state.In the model group, Iba-1 positive microglial cells were increased and moved outward to the outer retinal plexiform layer and outer nuclear layer obviously, showing globular or amoeba-like.The number of globular or amoeba-like Iba-1 positive cells was significantly reduced in the cx3cr1 injection group in comparison with the model group ( P<0.05). The number of activated microglial cells in different retinal layers of the model group was significantly larger than that of the cx3cr1 injection group and the blank control group (both at P<0.05). Compared with the model group, the number of activated microglial cells around the retinal blood vessels was reduced significantly in the cx3cr1 injection group.The double fluorescence result of retinal vascular staining and activated microglial cells showed that the density of deep blood vessels in the blank control group and cx3cr1 injection group was significantly higher than that of the model group, and the number of microglial cells around superficial and deep retinal vessels was significantly larger in the model group than that of the cx3cr1 injection group (all at P<0.05). The relative vascular leakage rate of the blank control group, model group and cx3cr1 injection group were (100.0±4.7)%, (162.1±10.6)% and (130.5±9.5)%, respectively, and the overall difference was statistically significant ( F=128.66, P<0.01). The relative vascular leakage rate in the cx3cr1 injection group was significantly lower than that in the model group ( P<0.05). The qPCR result showed that the relative expression levels of vascular endothelial growth factor-A (VEGF-A), hypoxia inducible factor-1a (HIF-1α), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) mRNA were significantly reduced in the retina of the cx3cr1 injection group in comparison with the model group (all at P<0.05). Conclusions:Intravitreal injection of cx3cr1 can protect the vascular integrity of the retinal microcirculation system in RIR mice.

Determinating the content of iridoid glycosides and flavonoids constitutents simultaneously in Xiaoer-Ganyan granules by UHPLC-PDA / 国际中医中药杂志

Objective:To establish an UHPLC-PDA method for determinating the content of 7 iridoid glycosides and 4 flavonoids constitutents simultaneously in Xiaoer-Ganyan granules. Methods:To take Agilent Ecilipse C18 (2.1 mm × 100 mm, 1.6 μm), and the colunm temperature was at 30 ℃. The mobile phase consists of acetonitrile (A) and 0.05% phosphoric acid (B) in gradient elution at a flow rate of 0.3 ml/min. The detection wavelength was set at 240 and 278 nm.Results:The linear ranges of swertiamain, gentiopicrin, sweroside, shanzhiside methy ester, gardenoside, genipin-1-β-D-gentiobioside, geniposide, baicalin, wogonoside, baicalein and wogonin were 19.16-306.56 μg ( r=0.999 4), 3.34-53.28 μg ( r=0.999 1), 5.30-84.64 μg ( r=0.999 5), 0.80-12.80 μg ( r=0.999 4), 0.46-7.20 μg ( r=0.999 2), 2.78-44.48 μg ( r=0.999 6), 6.02-96.16 μg ( r=0.999 9), 33.22-531.36 μg ( r=0.999 9), 3.92-62.72 μg ( r=0.999 2), 2.38-37.92 μg ( r=0.999 7), 1.32-20.96 μg ( r=0.999 9), respectively. The average recoveries ( n=9) varied from 94.62%-107.53% with RSDs no more than 3.0%. Conclusion:Method validation suggested that the developed method was suitable for simultaneous determination of 11 major constitutents in Xiaoer-Ganyan granules, thus providing reference for the improvement of quality standard of the drug.

A case analysis of a patient with salmonella infection and allergy to antibiotics / 药学实践杂志

Objective Through clinical pharmacists participating in the treatment of hip prosthesis infection, to explore the factors of Salmonella infection and skin itching, and to increase the importance of Salmonella infection and the pharmaceutical monitoring of adverse reactions of antibiotics. Methods The causes and treatment of Salmonella infection were analyzed by reviewing the literature, monitoring indicators and patient's clinical symptoms, and analyzing the cause of the patient's skin itching, to provide the patient with a reasonable anti-infective treatment plan. Results After several antibacterial drug adjustments during hospitalization, the patient's inflammatory indicators decreased, and the clinical symptoms improved. Conclusion Although the prosthetic joint infection caused by Salmonella is very rare, attention should be paid to the detection of Salmonella. At the same time, clinical pharmacists should increase the monitoring of antibiotics in their daily work.

Clinical analysis of two pediatric precursor B-cell acute lymphoblastic leukemia with C-MYC rearrangement / 中华实用儿科临床杂志

Objective:To explore the characteristics, diagnosis, and treatment of precursor B-cell acute lymphocytic leukemia with C- MYC rearrangement (preBLL) in children. Methods:The clinical data in 2 cases of childhood preBLL in Department of Hematology, Children′s Hospital Affiliated to Capital Institute of Pediatrics in June and August 2019 were summarized and analyzed.Results:Both cases were acute lymphoblastic leukemia with precursor B-cell immunophenotype.Hepatosplenomegaly and peripheral white blood cells were significantly increased, and the morphology of bone marrow was L3. C- MYC rearrangement was discovered by cytogenetic tests.Both children have received the treatment of the mature B-cell tumor protocol (FAB/LMB96), and early remission was developed in 1 case with TP53 gene mutation but relapsed thereafter and died finally.Another case had reached sustained complete remission after treatment. Conclusions:Children with preBLL is rare, and routine C- MYC rearrangement should be performed in children with Precursor B-cell lymphoblastic leukemia whose morphology of bone marrow was L3.Its treatment needs to be further studied, and multi-center clinical trials need to be actively conducted to analyze and summarize large numbers of cases to identify effective protocol and improve the prognosis.

Preparation of cryoprecipitate coagulation factor from liquid-state plasma by supercooling method / 中国输血杂志

【Objective】 To establish a novel preparation method of cryoprecipitate coagulation factor from overcooled liquid-state plasma. 【Methods】 The fresh liquid plasma was kept at -11℃ to -13℃ for a period of time. It can remain in the liquid state with some coagulation factors generated due to supercooling. Then cryoprecipitate can be obtained from the liquid plasma by siphon method. 【Results】 The average fibrinogen content yielded in cryoprecipitate, prepared from 50 samples of 16-hour-stored fresh liquid plasma, was (186.02±22.72) mg, with the average recovery rate of (37.51±7.42) %, and the average content of coagulation FⅧ was (104.66±22.88) IU, with the average recovery rate of (46.62±5.58) %. 【Conclusion】 The cryoprecipitate coagulation factors could be obtained not only from fresh frozen-thawed plasma, but also from overcooled liquid plasma which is simple and stable, also meets the requirements of relative standards.

High-dose Dual Therapy for Treatment of Helicobacter pylori Infection: A Meta-analysis of Randomized Controlled Trials / 胃肠病学

Background: High-dose dual therapy (HDDT) is a novel regimen for the eradication of Helicobacter pylori (Hp) infection, however, its efficacy and safety remain unclear. Aims: To evaluate the efficacy, safety and compliance of HDDT for Hp eradication. Methods: Randomized controlled trials (RCTs) on HDDT for eradication of Hp infection were retrieved from PubMed, Embase, The Cochrane Library, Web of Science from the date of database establishment to October 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.2 software was used for performing meta-analysis. Results: Nine RCTs including 2 627 patients were included. Meta-analysis results showed that no significant differences in ITT eradication (85.4% vs. 79.8%, RR=1.03, 95% CI: 0.96-1.10, P=0.40), PP eradication (88.7% vs. 83.4%, RR=1.01, 95% CI: 0.95-1.08, P=0.68), and compliance (96.5% vs. 95.9%, RR=1.01, 95% CI: 0.99-1.02, P=0.37) were found between HDDT and the guideline-recommended regimens, however, the incidence of adverse events was significantly decreased in HDDT (15.3% vs. 27.0%, RR=0.57, 95% CI: 0.42-0.76, P=0.000 2). Conclusions: There are no significant differences in eradication rates and compliance between HDDT and the guideline-recommended regimens, however, HDDT is much safer.

Reversal effects and mechanisms of Flavonoids from Tetrastigma hemsleyanum on drug resistance in gefitinib-resistant lung cancer cells / 中国临床药理学与治疗学

AIM: To investigate the sensitization of flavonoids from Tetrastigma hemsleyanum (FTH) on gefitinib (GEF)-resistant lung adenocarcinoma cells. METHODS: The viabilities of A549 and A549/GR cells treated with FTH and GEF were detected by MTT method. The apoptotic rates and cell cycles of A549/GR cells treated with FTH and GEF were detected by Flow cytometry. The anti-tumor effects of flavonoids from FTH and GEF were assayed in A549/GR tumor-bearing mice. The expressions of proteins (PTEN, PI3K, p-PI3K, AKT, p-AKT) were detected by Western blot analysis. RESULTS: Compared with GEF group, FTH significantly enhanced the inhibition of GEF on the proliferation of A549/GR cells (P< 0.05). Combination with FTH and GEF significantly increased the apoptosis of A549/GR cells which were arrested at the G

Multimodal imaging of acute syphilitic posterior placoid chorioretinitis / 中华眼底病杂志

Objective:To observe the multimodal imaging features of the eyes with acute syphilitic post-polar squamous chorioretinitis (ASPPC) at different stages of disease.Methods:A retrospective case study. From July 2016 to March 2019, 8 patients (11 eyes) of ASPPC patients diagnosed in the ophthalmological examination of Yunnan Second People's Hospital were included in the study. Among them, there were 7 males (10 eyes) and 1 female (1 eye); the average age was 48.7±8.9 years; the average course of disease was 13.24±11.30 months. All patients underwent fundus color photography, infrared photography (IR), FAF, FFA, OCT, OCT angiography (OCTA). According to the stage and characteristics of the disease, the affected eyes were divided into acute phase and absorption phase, with 7 and 4 eyes respectively. We observed the color fundus images of ASPPC, IR, FAF, FFA, OCT, OCTA image characteristics of different disease stages.Results:In the acute phase, the posterior pole subretinal yellow-white squamous lesions, neuroepithelial detachment, and yellow-white exudates were observed in fundus color photography; uneven infrared reflections can be seen in the lesion area by IR; the posterior pole was round or scaly with strong autofluorescence in FAF, the range was larger than the fundus color photography; FFA arteriovenous stage lesions showed fuzzy weak fluorescence, the fluorescence gradually increased with time, the late stage showed a round-shaped strong fluorescence, surrounded by a weak fluorescence ring, and the area with thick exudation was covered by fluorescence; the neuroepithelium of the diseased area was detached, the uniform strong reflection signal can be seen in it by OCT. In the absorption phase, fundus color photography showed the yellow-white scaly lesions under the posterior retina absorption, and the pigment was slightly depleted; IR showed the mottled infrared reflection in the lesion area was significantly reduced compared with the acute phase; FAF showed the posterior spot-like strong autofluorescence, including "leopard spot-like changes" 3 eyes; FFA showed mottled fluorescent staining in the lesion, and no fluorescein leakage or accumulation; OCT showed needle-like protrusions in the RPE layer, and the outer membrane and ellipsoid zone were unclear; OCTA showed weakened choroidal capillary blood flow signal, the signal was missing in some areas.Conclusions:In the acute phase of ASPPC, the posterior pole subretinal shows yellow-white squamous lesions, neuroepithelial detachment, yellow-white exudate, FFA shows late fluorescein leakage in the lesion area; in the absorption period, the fundus shows yellow-white lesions have been absorbed, and FFA shows fluorescence dyed without any leakage. OCT indicates that the RPE, outer membrane and ellipsoid zone are damaged to varying degrees. OCTA indicates that the choroid of the diseased area had weakened blood flow signal.

Optical coherence tomography angiography features of angioid streaks / 中华眼底病杂志

Objective:To analyze the OCT angiography (OCTA) features of eyes affected with angioid streaks.Methods:Retrospective analysis of 26 patients (52 eyes) diagnosed as angioid streaks by multimodal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from May 2017 to February 2019 were included in this study. There were 18 males and 8 females, with the mean age of 50.8±6.9 years. All the patients were binocular. There were 34 eyes in 20 patients with CNV. Among them, 13 eyes had a course of disease within 1 month, 16 eyes had a course of disease over 1 month, and 5 eyes were treated with anti-VEGF drugs. All patients were examined by ultra-wide-angle fundus photography, infrared fundus imaging (IR), spectral-domain OCT, FAF and FFA. At the same time, the Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s, and the width was 45 nm. A 3 mm × 3 mm scan was obtained. Each cube consisted of two 304 B scans of repeated volumes, and motion correction was performed using two orthogonally captured image volume registration. The results of fundus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.dus color photography, IR, FAF, FFA, OCT and OCTA were compared and analyzed to summarize the image features of AS and its secondary CNV in OCTA.Results:Among 52 eyes, 40 eyes showed choroidal capillary shadows in OCTA, and no obvious abnormal OCTA images in 12 eyes. Ten eyes OCTA showed a vascular network beseide the optic disc, FFA showed fluorescent staining instead of fluorescein leakage. Among the 52 eyes, 34 eyes had secondary macular CNV, and 34 eyes had different forms of CNV. Different forms had a certain correlation with the length of medical history and treatment history. Among them, 13 eyes with short course of disease (less than 1 month) and untreated patients had smaller flower-ring morphology, 16 eyes with longer course (more than 1 month) but no treatment had larger fan-shaped segments, and 5 eyes with anti-VEGF therapy were trimmed after the dendritic shape.Conclusions:AS streaks appeared no blood flow signal area in OCTA, and repairing vascular network beside the optic disc can be observed in some AS patients. The CNV performance with different disease course and treatment experience is different.

Optical coherence tomography angiography features of adult-onset foveomacular vitelliform dystrophy / 中华眼底病杂志

Objective:To observe the OCT angiography (OCTA) features of adult-onset foveomacular vitelliform dystrophy (AFVD).Methods:Retrospective clinical observational study. Twelve patients (22 eyes) diagnosed as AFVD by multi-modal imaging in Ophthalmology Department of Yunnan Second People’s Hospital from March 2018 to May 2019 were included in this study. There were 8 males (16 eyes) and 4 females (6 eyes). The patients aged from 33 to 62 years, with the mean age of 48.7±8.9 years. Ten patients were binocular, 2 patients were monocular. The visual acuity was 0.08-0.6. In 22 eyes, the vitelloid-like substance was relatively complete in 8 eyes, the vitelloid-like substance had different degrees of rupture in 14 eyes, secondary choroidal neovascularization (CNV) was observed in 10 eyes. The Heidelberg OCTA instrument was used for OCTA examination. The central wavelength was 840 nm, the acquisition speed was 85,000 times/s. A 3 mm × 3 mm scan was obtained. In the scanning process, eye-tracking technology was adopted to select images with better image quality and position for marking and saving. The image characteristics of vitelloid-like substance, fundus vascular changes and secondary CNV in OCTA were analyzed.Results:In 8 eyes with a relatively complete vitelloid-like substance, B-scan images showed dense vitelloid-like substance under the retinal neurocortical layer, which was located between the RPE layer and the ellipsoid zone and had a uniform density. Blood flow signals at the vitelloid-like substance can be seen in the en-face image, which was the artifact of the vitelloid-like substance reflecting the blood vessels above. In the 14 eyes with different degrees of vitellin-like material rupture, the signal of vitellin-like substance between the ellipsoid zone and the RPE layer in the B-scan image was not uniform, and some weak reflected signal lacunae could be seen. In the image of en-face, the relatively intact areas of vitelloid-like substance still showed the artifact of the blood vessels above the reflection, while there was no blood flow signal at the rupture of vitelloid-like substance. In 22 eyes, the morphology of retinal small blood vessels in the superficial and deep capillary arch ring region of retina was abnormal in 10 eyes. Some small blood vessels could be seen to have branch and shape changes, and the anastomosis failed to show a complete arch ring structure.No significant structural changes in retinal capillaries were observed in 12 eyes. Among the 10 eyes with secondary CNV, 8 eyes showed the non-active CNV which was as thick as "wild branches", and 2 eyes showed the active CNV which was composed of dense and small vascular branches.Conclusion:AFVD in OCTA can be manifested as abnormal retinal vascular morphology caused by the vitelliform material pushing, vascular artifacts reflected by the vitelliform material itself, and the presence of CNV under the vitelliform material.

Multimodal imaging characteristics of choroidal metastasis / 中华眼底病杂志

Objective To observe the multimodal imaging characteristics ofchoroidal metastasis.Methods A retrospective clinical observation study.From January 2016 to November 2018,28 patients with choroidal metastasis diagnosed in Department of Ophthalmology in the Second People's Hospital of Yunnan Province were included in the study.There were 12 males and 16 females,with the mean age of 50.8±6.9 years.There were 18 unilateral patients and 10 bilateral patients.The lesion of choroidal metastasis was regressed after systemic antitumor therapy in 3 patients (4 eyes).All patients underwent ultra-wide-angle fundus photography,infrared fundus imaging,fundus autofluorescence,FFA,frequency-domain OCT,and B-ultrasound examinations.Results In the ultra-wide-angle fundus photography,metastatic tumors were located in the posterior or middle part of the retina,of which 26 were isolated lesions and 12 were multifocal.A yellow-white bulge lesion with (11 eyes) or without pigmentation (27 eyes).There were 12 eyes with exudative retinal detachment.Infrared photography of the fundus showed that the tumor area showed varying degrees of mottled brightness change,and the infrared photograph of the exudative retinal detachment area was relatively low.Fundus autofluorescence showed that 14 eyes had plaque-like strong autofluorescence in the tumor,13 eyes had a mottled autofluorescence formed by strong and weak fluorescence in the tumor;3 eyes of old lesions showed "leopard-like" autofluorescence.Among the 38 eyes in the fluorescein angiography,32 eyes of the early lesions showed low fluorescence,and the venous phase showed a needle-like high fluorescence point,and the post-leakage fluorescence gradually increased.Two eyes with old lesions showed a "leopard-like" change.In 38 eyes,OCT showed wavy ridges of the choroid and pigment epithelium,and a large number of fine-grained or cluster-like high-reflector accumulations were observed between the retinal neuroepithelial layer and the pigment epithelial layer.B-ultrasound showed substantial lesions in the posterior pole and uniform internal echo.There were 23 eyes with flat shape,12 eyes with flat hemisphere,and 3 eyes with irregular shape.Conclusions Color photography of the fundus showed the size,location,pigmentation and peripheral retinopathy of the metastatic lesions.Infrared photography showed different reflex signals in the tumor,exudation,and atrophy.The autofluorescence of the fundus showed the damage of pigment epithelium in the lesion.In the fluorescein angiography,the fresh tumor showed fluorescence leakage,while the atrophic tumor showed transmitted fluorescenc.OCT reflected the height of the lesion and the change of pigment epithelium.

Structural changes of retinal microcirculation in mouse model of ischemia-reperfusion injury / 中华实验眼科杂志

Objective To study the structural changes of retinal microcirculation in mouse model of ischemia reperfusion injury(RIR).Methods Ninty healthy male C57BL/6 mice were devided into normal group and RIR group by using random number table method,45 mice for each group.The left eyes in both groups were used in this study.The mouse model of RIR was established by perfusion of saline solution in the anterior chamber.The damage of microcirculation was analyzed from different levels of vascular structure and function by retinal blood vessel staining,FITC angiography,histopathological examination,and ultrostructure of retinal vessels was observed with transmission electron microscope.The experimental animals and experimental conditions complied with the Regulations on the Management of Laboratory Animals of Kunming Medical University.Results There was no significant difference in retinal arterioles diameter in the RIR group compared to the normal control group (P=0.350).The small veins were obviously dilated in comparison with normal control group (P =0.03) and were in hyper-congestive state.The artery/vein value was 0.76±0.03 in the RIR group,and that in the normal control group was 0.97±0.01,with significant difference between them (P=0.000).The main changes were capillary occlusion,non-perfusion zone formation and other structural changes,accompaning by blood-retinal barrier damage;the destruction of capillary endothelial cells and pericytes and basement membrane thickening were seen under the transmission electron microscope.Conclusions RIR mainly results in capillary damage,including capillary barrier damage,capillary occlusion and non-perfusion area formation.