Exploration of prognostic factors and nomogram construction for advanced non-small cell lung cancer treated with immunotherapy based on hematologic indexes / 国际肿瘤学杂志

Objective:To explore influencing factors affecting the prognosis of patients with advanced non-small cell lung cancer (NSCLC) receiving immunotherapy based on hematologic indexes, thus to construct and evaluate a nomogram prediction model.Methods:The clinical data of 80 patients with advanced NSCLC treated with programmed death-1 inhibitor monotherapy or combination regimen from January 2018 to June 2020 at the Affiliated Hospital of North China University of Science and Technology and Tangshan People's Hospital were retrospectively analyzed. Hematologic indexes at the baseline, the optimal remission and the progressive disease (PD) were collected separately, and independent influencing factors for patient prognosis were analyzed using Cox proportional hazards regression model. A nomogram prediction model was constructed based on the results of the multifactorial analysis, and the predictive performance of the model was evaluated by receiver operating characteristic (ROC) curve, concordance index (C-index) and calibration curves.Results:As of the follow-up cut-off date, of the 80 patients, 63 had PD, with a median overall survival (OS) of 16.9 months. Univariate analysis showed that, age ( HR=2.09, 95% CI: 1.17-3.74, P=0.013) , number of treatment lines ( HR=2.23, 95% CI: 1.21-4.12, P=0.010) , lymphocyte to monocyte ratio (LMR) at the baseline ( HR=0.75, 95% CI: 0.57-0.97, P=0.028) , D-dimer ( HR=1.00, 95% CI: 1.00-1.00, P=0.002) and lactate dehydrogenase (LDH) ( HR=1.01, 95% CI: 1.00-1.01, P=0.006) at the optimal remission, haemoglobin ( HR=0.97, 95% CI: 0.96-0.99, P<0.001) , D-dimer ( HR=1.00, 95% CI: 1.00-1.00, P=0.002) , C-reactive protein ( HR=1.01, 95% CI: 1.00-1.01, P=0.011) , albumin (ALB) ( HR=0.91, 95% CI: 0.87-0.96, P=0.001) , neutrophil to lymphocyte ratio (NLR) ( HR=1.16, 95% CI: 1.05-1.27, P=0.002) and LMR ( HR=0.62, 95% CI: 0.42-0.90, P=0.012) at the PD were all influencing factors for the prognosis of advanced NSCLC patients receiving immunotherapy. Least absolute shrinkage and selection operator regression were used to screen the variables for P<0.10 in the univariate analysis, and nine possible influencing factors were obtained, which were age, fibrinogen and LDH at the optimal remission, haemoglobin, D-dimer, C-reactive protein, LDH, ALB and LMR at the PD. Multivariate analysis of the above variables showed that, age ( HR=0.91, 95% CI: 0.86-0.97, P=0.004) , LDH ( HR=1.01, 95% CI: 1.00-1.01, P=0.013) and ALB ( HR=0.82, 95% CI: 0.67-0.99, P=0.041) at the PD were independent influencing factors for the prognosis of patients with advanced NSCLC who received immunotherapy. The area under curve of the nomogram predicting model based on the above indexes, 1- and 2-year OS rates of patients were 0.77 (95% CI: 0.65-0.89) and 0.75 (95% CI: 0.66-0.88) , respectively, and C-index was 0.71 (95% CI: 0.64-0.78) , the calibration curves showed good consistency between predicted and actual probability of occurrence. Patients in the low-risk group ( n=40) had a median OS of 29.9 months (95% CI: 22.5 months-NA) , which was significantly better than that of the high-risk group ( n=40) [13.4 months (95% CI: 11.4-23.5 months) , χ2=11.30, P<0.001]. Conclusion:Age, LDH and ALB at the PD are independent influencing factors affecting the prognosis of patients with advanced NSCLC receiving immunotherapy, and the nomogram model constructed based on the above indexes has good differentiation and calibration for predicting 1- and 2-year OS rates in advanced NSCLC patients receiving immunotherapy.

Analysis of depression-like behavioral performances of mouse models of vitiligo / 中华皮肤科杂志

Objective:To observe and analyze depression-like behavioral performances of mouse models of vitiligo.Methods:Fifteen female C57BL/6 mice aged about 9 weeks were modeled for vitiligo. Whether the mouse models of vitiligo were successfully constructed or not was determined by macroscopy and full-thickness epidermal immunofluorescence staining of mouse tail tissues on day 23 after the start of the experiment; on day 8 (pre-modeling stage) and day 21 (early modeling stage), the elevated plus maze test and the open field test were used to evaluate the behavioral performances of the mice, including the number of entry into the open arms, percentages of time spent in the open arms, percentages of time spent in the central area and total distance traveled, aiming to assess whether depression-like behaviors were exhibited in the mouse models of vitiligo. To further clarify the degree of the impact of vitiligo modeling on the depression-like state in mice, 20 female C57BL/6 mice were equally divided into 2 groups: vitiligo modeling group and vitiligo modeling + chronic restraint stress group; the mice in the vitiligo modeling + chronic restraint stress group were subjected to chronic restraint stress on day 9, that is, these mice were placed in centrifuge tubes and restrained for about 6 hours every day for 28 consecutive days; on days 7, 22, 29 and 38 after the start of vitiligo modeling, the above-mentioned behavioral indicators were determined by the elevated plus maze test and open field test in the 2 groups. Repeated measurement data in a single group were compared before and after treatment by using paired t-test, and repeated measurement data at multiple time points were compared by using two-way repeated measures analysis of variance. Results:By macroscopy, the mice gradually developed well-defined white patches on the tail skin during vitiligo modeling, which were similar to the clinical manifestations of vitiligo patients; on day 23, full-thickness epidermal immunofluorescence staining of the mouse tail tissues was conducted and showed obvious infiltration of CD8 + T cells and a decrease in the number of Melan-A-positive epidermal melanocytes under a laser confocal microscope, which were consistent with typical pathological characteristics of vitiligo; based on the macroscopic results and immunofluorescence findings, a total of 12 mouse models of vitiligo were successfully constructed on day 23. The elevated plus maze test showed that the number of entry into the open arms and the percentages of time spent in the open arms were significantly lower in the 12 mouse models of vitiligo on day 21 (2.33 ± 1.78 times, 5.01% ± 5.27%, respectively) than in those on day 8 (10.75 ± 2.30 times, 29.20% ± 12.48%, t = 9.63, 6.36, respectively, both P < 0.001) ; the open field test showed that the percentages of time spent in the central area and total distance traveled were also significantly lower in the mouse models on day 21 (2.31% ± 1.53%, 2 518.31 ± 528.38 cm, respectively) than in those on day 8 (4.47% ± 2.65%, 3 533.45 ± 465.47 cm, t = 2.40, 5.47, P = 0.036, < 0.001, respectively). In the chronic restraint stress test, a total of 14 mouse models of vitiligo were successfully constructed on day 23, including 5 in the vitiligo modeling group and 9 in the vitiligo modeling + chronic restraint stress group. There were no significant differences in the number of entry into the open arms, percentages of time spent in the open arms, percentages of time spent in the central area, and total distance traveled between the vitiligo modeling group and the vitiligo modeling + chronic restraint stress group on days 7, 22, 29, and 38 ( F = 0.21, 0.20, 0.46, 2.35, P = 0.889, 0.893, 0.719, 0.134, respectively) ; moreover, all the above indicators significantly changed over time (all P < 0.001), except for the total distance traveled ( P = 0.422) . Conclusion:The mouse models of vitiligo developed depression-like behavior at the early modeling stage, and the degree of depression could not be further deepened by chronic restraint stress on the basis of vitiligo modeling.

Association between Yang Deficiency Syndrome and the End-point Events of Diabetic Kidney Disease： A Retrospective Cohort Study / 中医杂志

ObjectiveTo investigate the impact of yang deficiency syndrome on the progression to end-point events of diabetic kidney disease （DKD）. MethodsA retrospective study among patients with stage Ⅳ DKD admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from September 1st， 2016 to September 30th， 2021 was conducted. Data on the patients' general information， clinical indicators including duration of diabetes， duration of proteinuria， history of smoking and drinking， hemoglobin （HGB）， fasting blood glucose （FBG）， albumin （ALB）， serum creatinine （Scr）， urea nitrogen （BUN）， uric acid （UA）， cholesterol （TC） ， triglycerides （TG）， low-density lipoprotein （LDL）， 24-hour urine protein quantification （24h-UTP） and estimated glomerular filtration rate （eGFR）， and TCM syndromes including symptoms， tongue and pulse， and syndrome scores were collected. The patients were divided into exposure group （yang-deficiency group） and non-exposure group （non-yang-deficiency group）. The general information， clinical indicators and incidence rates of end-point events were compared， and the impact of yang deficiency syndrome on the end-point events of stage Ⅳ DKD was analyzed. Survival analysis was performed using Kaplan-Meier method， and multivariate Cox proportional risk models were used to identify independent predictors of end-point events. ResultsA total of 160 patients with stage Ⅳ DKD were included in the study， including 43 cases of yang deficiency syndrome and 117 cases of non-yang deficiency syndrome. Compared to those in the non-yang deficiency group， the waist circumference， BUN and the incidence of end-point events in the yang deficiency group were significantly higher （P＜0.05 or P＜0.01）. Spearman correlation analysis showed that yang deficiency syndrome was positively correlated with incidence of end-point events of stage Ⅳ DKD （r = 0.167， P = 0.035）. Furthermore， 24h-UTP and BUN levels were also positively correlated with end-point events in stage Ⅳ DKD patients （P＜0.01）， while ALB and HGB levels were negatively correlated （P＜0.01）. Kaplan-Meier survival curves showed that yang deficiency syndrome was associated with an increased risk of end-point events （Log Rank P = 0.011）. Moreover， 24h-UTP levels ≥3500 mg， BUN level ≥8 mmol/L， ALB level ＜30 g and HGB level ＜11 g were all associated with the increase of the risk of end-point events （P＜0.05 or P＜0.01）. Multivariate Cox regression analysis showed that yang deficiency syndrome was an independent risk factor for patients with stage Ⅳ DKD to progress into end-point events （HR = 2.36， 1.32 to 4.21； P = 0.004）， as well as 24h-UTP ≥ 3500 mg， BUN ≥ 8 mmol/L， HGB＜11 g and ALB＜30 g （P＜0.05 or P＜0.01）. ConclusionsFor stage Ⅳ DKD， patients with yang deficiency syndrome are more likely to have end-point events， which is an independent risk factor for the progression into end-point events.

Current Situation of Health Technology Assessment in Traditional Chinese Medicine Hospitals / 中国实验方剂学杂志

ObjectiveThis study aims to understand the recognition of practitioners in traditional Chinese medicine （TCM） hospitals on hospital-based health technology assessment （HB-HTA）， assessment needs， challenges， and suggestions， so as to provide references for the future work. MethodThe convenient sampling method was adopted to survey the relevant practitioners in TCM hospitals. The questionnaire included 39 questions in 4 dimensions and was distributed through the online platform Weijuanxing. ResultA total of 244 questionnaires were recovered， and the obtained data were analyzed in SPSS. The results showed that 137 practitioners were very familiar with HB-HTA and there was no significant difference in the recognition of practitioners in different occupations （F=0.251； P=0.778）. The practitioners in Hong Kong， Macao， and Taiwan had lower recognition than those in other regions. In terms of the assessment needs， 127 practitioners believed that it was very necessary to carry out HB-HTA in TCM hospitals in the future. Chinese patent medicines/Chinese herbal medicine decoction pieces （5.91） and TCM appropriate technology （5.57） had higher assessment priority scores. The assessment needs were high for the effectiveness （235 practitioners） and safety （224 practitioners） of health technology. The lack of specialized organization and standardized evaluation process system and the shortage of talents were considered to be the major challenges for the future development in this field. ConclusionThe stakeholders carrying out the health technology assessment in TCM hospitals had certain awareness of HB-HTA. Most practitioners believed that it was necessary to carry out HB-HTA in TCM hospitals in the future， while the work might face challenges such as the lack of organizations and system and the shortage of talents， which requires policy support.

Comparison on TACE+microwave ablation+programmed death-1 and TACE+microwave ablation for treating primary hepatic carcinoma / 中国介入影像与治疗学

Objective To compare the value of TACE+microwave ablation(MWA)+programmed death-1(PD-1)and TACE+MWA for treating primary hepatic carcinoma(PHC).Methods Data of 80 PHC patients who underwent TACE+MWA+PD-1(observe group)or TACE+MWA treatment(control group)were retrospectively analyzed(each n=40).The baseline data,therapeutic efficacy of PHC and complications were compared between groups.Results No significant difference of baseline data was found between groups(all P＞0.05).The objective response rate(ORR)of observe group and control group was 90.00％and 72.50％,respectively,while the disease control rate(DCR)was 97.50％and 95.00％,respectively,with no significant difference between groups(both P＞0.05).The median overall survival(OS)of observe group and control group was 30.80 months and 15.70 months,respectively,while the median progression free survival(PFS)was 23.35 months and 6.80 months,respectively.OS and PFS of observe group were both longer than those of control group(both P＜0.05).No significant difference of the incidence of complications was detected between groups(all P＞0.05),and all were improved after symptomatic treatment.Conclusion TACE+MWA+PD-1 was superior to TACE+MWA for treating PHC.

Survey of Disease Cognition in Patients with Endometriosis and Effect Evaluation of TCM Chronic Disease Management / 中国中医药信息杂志

Objective To understand cognition level and treatment intention of patients with endometriosis(EMs);To evaluate the effects of TCM chronic disease management on EMs patients.Methods The disease cognition level and treatment intention of 1 895 EMs patients from October 2020 to December 2021 in 19 provinces,autonomous regions and municipalities were analyzed through cross-sectional investigation.The cognitive effect of chronic disease management of TCM on 801 patients with EMs from 6 Grade A hospitals in Beijing was evaluated by self-control study.Results The cognition level of EMs patients for the disease was improved with the increase of educational background.Patients generally believed that EMs was a chronic disease,requiring regular review and long-term management.The proportion of patients with high school education or below,junior college education,bachelor degree or above who knew the possibility of malignant changes in EMs was less,only 32.3%,41.6%and 47.7%,respectively.The awareness rate of patients with high school education or below for recurrence after EMs conservative surgery was 46.9%,lower than that of those with junior college education(66.8%)and bachelor degree or above(72.7%).Among the patients with dietary contraindications,the proportion of patients with high school education or below,junior college education,bachelor degree or above who knew the contraindication of the forest frog oil was less,only 20.7%,30.3%and 32.9%,respectively.In the aspect of life adjustment,the awareness of patients was generally high.EMs patients mainly recognized the disease through face-to-face communication with gynecologists.Only 34.4%of patients with high school education or below learned about EMs through WeChat public accounts,APPs and other new media,which was lower than those with junior college education(48.6%)and bachelor degree or above(55.4%).EMs patients generally tend to be treated in comprehensive hospitals,with high acceptance of TCM treatment,mainly TCM decoction,and low acceptance of TCM appropriate technology.After 1 year of TCM chronic disease management,the disease awareness of EMs patients was significantly improved compared with before management,with statistical significance(P<0.05).Conclusion EMs patients with different educational backgrounds have different cognition of the disease,and each has different emphasis.Education and popularization should be carried out according to their knowledge blind spots.Chronic disease management of TCM can improve the disease cognition level of EMs patients.

Safety and efficacy of oral Lacosamide as an add-on therapy in Chinese children with partial-onset seizures / 中华实用儿科临床杂志

Objective:To evaluate the long-term safety, tolerability and efficacy of Lacosamide add-on therapy in Chinese children with partial-onset seizures.Methods:SP848 was a global multicenter single-arm study involving 60 Chinese children with partial-onset seizures with the age of 4-17 years who were managed by Lacosamide add-on therapy at seven hospitals across China from April 2018 to May 2019.After treatment with at least two kinds of anti-seizure medications simultaneously or sequentially, partial seizures were still poorly controlled and Lacosamide oral solution (syrup) or tablets were added.The minimum initial oral dose was 2 mg/(kg·d), and the maximum allowable dose was 12 mg/(kg·d)or 600 mg/d during the study period.The dose was adjusted according to the tolerance and seizure control level of partial-onset seizures children.Seizure frequency and the median percentage change in partial-onset seizures per 28 days from baseline to the final visit were recorded, including 50% responder rate and 75% responder rate.Results:A total of 60 Chinese children with the mean age of 9.18 (4.00-15.40) years were included in this interim analysis, involving 39 males and 21 females.The mean course of epilepsy was 5.04 (0.50-15.20) years.A total of 43 patients (71.7%) still have been treated.One patient (1.7%) has completed the 6-12 months of follow-up, and 14 patients (23.3%) have completed the follow-up for less than 6 months.The median change in the frequency of partial seizures every 28 days from baseline to the last visit was -2.91, with its median percentage as -25.46%, and the proportions of ≥50%, while ≥75% responder rate were 40.0% and 28.3%, respectively.A total of 52 patients (86.7%) had 265 treatment emergent adverse events (TEAE), 11 patients (18.3%) had 19 serious TEAE, 37 patients (61.7%) had 127 drug-related TEAE, and 11 patients (18.3%) had 16 TEAE leading to the discontinuation of the trial.The most common TEAE were upper respiratory tract infections (20 cases, 33.3%), followed by drowsiness (16 cases, 26.7%), dizziness (15 cases, 25.0%) and vomiting (13 cases, 21.7%). There were no abnormal changes in the electrocardiographic findings during the treatment.Conclusions:For Chinese patients with partial seizures who are older than the age of 4 years and poorly controlled by other drugs, Lacosamide is effective and well tolerated as an add-on therapy drug.The safety characteristics are consistent with those reported in children and adults.No new safety concerns are identified.

Comparison on efficacy and safety of TACE combined with 125I seeds implantation or lenvatinib for treating hepatocellular carcinoma complicated with portal vein tumor thrombosis / 中国介入影像与治疗学

Objective To comparatively observe the efficacy and safety of TACE combined with 125I seeds implantation or lenvatinib for treating hepatocellular carcinoma(HCC)complicated with portal vein tumor thrombosis(PVTT).Methods Totally 52 HCC patients complicated with type Ⅱ or type Ⅲ PVTT were enrolled and divided into TACE combined with 125I seeds group(group A,n=27)and TACE combined with lenvatinib group(group B,n=25).Objective response rate(ORR),overall survival(OS)and incidence rate of adverse reaction were compared between groups.Results ORR,the median OS,median OS of type Ⅱ PVTT and median OS of type Ⅲ PVTT was 70.37%(19/27),13.6 months,14.1 months and 13.2 months in group A,and 32.00%(8/25),11.3 months,12.3 months and 10.4 months in group B,respectively.The above indexes in group A were all better than those in group B(all P＜0.05).In group A,the incidence rate of adverse reaction was 48.15%(13/27),and no serious complication occurred.In group B,the incidence rate of adverse reaction was 88.00%(22/25),and severe drug toxicity was noticed in 5 cases(5/25,20.00%).Conclusion The efficacy and safety of TACE combined with 125I seeds were both better than those of TACE combined with lenvatinib for treating HCC complicated with PVTT.

Clinical, Endoscopic and Pathological Characteristics of Crawling - type Early Gastric Adenocarcinoma / 胃肠病学

Background: Crawling-type gastric adenocarcinoma is a rare subtype of gastric cancer, however, the understanding on this special entity of gastric cancer is still lacking. Aims: To investigate the clinical, endoscopic and pathological characteristics of crawling-type early gastric adenocarcinoma. Methods: Patients diagnosed as crawling-type early gastric adenocarcinoma in Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were recruited consecutively in a retrospective study. The clinical data were reviewed, the pathological specimens were collected for immunohistochemical staining, and a telephone follow-up was conducted for prognosis analysis. Results: Fourteen patients with crawling-type early gastric adenocarcinoma and fulfilling the inclusion criteria were enrolled in the study, of them, 9 were male, 5 were female, and the mean age was 65.9 years old. No family history of gastric cancer was reported. The clinical manifestations were not specific. All patients were positive for Helicobacter pylori (Hp) infection. Tumors were more likely to occur in the middle and lower thirds of the stomach, with marked atrophic background mucosa. Macroscopically, 11 lesions were superficial-depressed (0-IIc) and 3 were superficial-flat type (0-IIb+ IIc). The color of the lesions was red. Lesions with indistinct border were observed endoscopically in 10 cases. Complete resection was achieved in all 14 patients after endoscopic submucosal dissection n=10 or surgical treatment n=4. Three submucosal and 11 intramucosal infiltration were observed pathologically. Immunohistochemical results of gastric (MUC5AC and MUC6) and intestinal (MUC2, CD10 and CDX-2) markers showed that most of the patients were mixed immunophenotype; the Ki-67 index ranged mostly between 30% and 70%. In a mean follow-up time of 38 months, all 14 patients were survived. Two patients with heterochronous early gastric cancer were found by follow-up endoscopy. Conclusions: When a superficial-depressed or superficial-flat type tumor with reddish color change and atrophic background mucosa is observed endoscopically in an Hp-positive patient, the possibility of crawling-type early gastric adenocarcinoma should be considered. Adequate preoperative evaluation should be carried out to judge the extent and depth of tumor invasion, which may guide the decision of treatment strategy. Postoperative endoscopic surveillance is recommended.

Clinical, endoscopic and pathological characteristics of synchronous multiple early gastric cancer / 中华消化内镜杂志

Objective:To investigate the clinical, endoscopic and pathological characteristics of synchronous multiple early gastric cancer (SMEGC), and to reduce the rate of missed diagnosis.Methods:Clinical data of 227 early gastric cancer patients treated by endoscopic submucosal dissection (ESD) and/or surgery in Songjiang Hospital, Shanghai Jiaotong University School of Medicine from January 2017 to December 2019 were retrospectively analyzed. The differences of clinical, endoscopic and pathological characteristics between solitary early gastric cancer (SEGC) group (200 cases) and SMEGC group (27 cases) were compared. The relevance of endoscopic and pathological features of major and minor lesions of SMEGC was also analyzed.Results:Among the 227 early gastric cancer patients, 27 (11.9%) were SMEGC (58 lesions), of which 25 cases were detected preoperatively, and 2 cases were reexamined within 6 months after surgery with another lesion found at a different site from the previous lesion. In the SMEGC group, the percentages of male and atrophy and intestinal metaplasia in surrounding mucosa were significantly higher than those of the SEGC group [85.2% (23/27) VS 61.5% (123/200), χ2=5.815, P=0.016; 96.3% (26/27) VS 81.0% (162/200), χ2=3.912, P=0.048]. The mean age of the SMEGC group was significantly higher than that of the SEGC group (68.7±6.7 years VS 63.8±9.8 years, t=-2.561, P=0.011). The correlation analysis showed a significant correlation between the major and minor lesions of SMEGC in the size of lesion ( r=0.640, P<0.001), vertical location ( r=0.518, P=0.006), macroscopic type ( r=0.904, P<0.001) and depth of invasion ( r=0.470, P=0.013). Conclusion:SMEGC is prevalent in elderly males with atrophic gastritis and intestinal metaplasia. It is necessary to be alert to the possibility of multiple cancer lesions, if an early cancer lesion is found under endoscopy, especially those that may have the same or similar shape and invasion depth in the same vertical distribution range.

Treatment and genetic analysis of a child with Kabuki syndrome type 2 and secondary pulmonary infection due to a de novo variant of KDM6A gene / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis of a child with recurrent infection, multiple malformation and dysmorphism.@*METHODS@#The child and his parents were subjected to trio whole exome sequencing.@*RESULTS@#The child had a complaint of fever and cough, with long and thin eye fissures and long eyelashes. Genetic testing revealed that the child has carried a non-triplet deletion of the KDM6A gene, which was unreported previously. The variant resulted in frameshift and premature termination of the translation. His parents were both of the wild type for the locus. After antibiotic and immunoglobulin treatment, the severe secondary pneumonia caused by immunodeficiency has improved.@*CONCLUSION@#With combined laboratory test, imaging examination and genetic testing, the child was ultimately diagnosed with Kabuki syndrome type 2. The characteristics of immunodeficiency of Kabuki syndrome may render conventional antibiotic treatment ineffective, which deserves clinical attention.

Effect of modified Hartel approach for foramen ovale cannulation / 临床麻醉学杂志

Objective Based oncomputer-aided design (CAD) technology, we compared the optimized method of locating inserting point (2 cm lateral to and 1 cm below angulus oris) with traditional ones and assessed its clinical value by simulating foramen ovale (FO) cannulation. Methods Skull CT data of 100 primary trigeminal neuralgia patients were used in this study and three-dimensional reconstruction with FO cannulation simulation were conducted. With self-control test method, each patient was divided into three groups: group of optimized insertion point (method O) : point 2 cm lateral to and 1 cm below angulus oris as the insertion point; group of traditional entry point A (method A) : 2.5 cm lateral the angulus oris as the insertion point; group of traditional entry point B (method B) : intersecting the external extension of angulus oris and the vertical line of the lateral eye angle as the entry point. Puncture simulation was performed along connecting line of insertion point and the central point of the FO. We recorded results of simulation and measured the available area and short diameter of FO in the direction of puncture. Results The cases that the puncture route was obstructed of methods O, A and B were 15, 28 and 31, respectively. The occlusion rate of method O was significantly lower than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). The available area of methods O, A and of B were (9.45 ± 6.57) mm2, (6.91 ± 5.96) mm2, (6.59 ± 5.86) mm2, respectively. The available area of method O was significantly larger than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). The short diameters of methods O, A and B were (2.25 ± 1.04) mm, (1.81 ± 0.97) mm, (1.71 ± 0.92) mm, respectivtly. Short diameters of method O was significantly longer than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). Conclusion compared with the traditional positioning method, the optimized method can provide better condition for puncture through Hartel approach.

Relationship between CYP2C19 gene polymorphism and clopidogrel resistance after PCI in patients with coronary heart disease／ / 心血管康复医学杂志

Objective :To explore influence of CYP2C19 gene polymorphism on clopidogrel resistance after percutane‐ous coronary intervention (PCI) in patients with coronary heart disease (CHD).Methods :A total of 100 CHD pa‐tients ,who were treated and received PCI in our hospital ,were selected .There were 24 cases with clopidogrel re‐sistance (CR ,CR group) and 76 cases without CR (NCR ,NCR group).According to CYP2C19 genotype ,patients were divided into rapid metabolism CYP2C19*1／*1 (n＝49) ,medium metabolism CYP2C19*1／*2 (n＝28) and*1／*3 (n＝11) ,and slow metabolism CYP2C19*2／*2 (n＝9) and *2／*3 (n＝3).Relationship among differ‐ent genotypes ,CR ,maximum platelet aggregation rate (MPA) and incidence of major adverse cardiovascular events (MACE) were analyzed .Results :With rapid metabolism CYP2C19*1／*1 as the base ,there was significant rise in CR risk in medium metabolism (CYP2C19*1／*2 and *1／*3 ,OR＝4. 16 ,5. 03 , P＜0.05 both) and slow metab‐olism (CYP2C19*2／*2 and *2／*3 ,OR＝7.04 ,17. 6 , P＜0.01 both ) ,medium metabolism increased by 4. 16 and 5. 03 times respectively ,while slow metabolism increased by 7. 04 and 17. 60 times respectively .Compared with rapid metabolism genotype ,there were significant rise in MPA and incidence rate of MACE in medium and slow me‐tabolism genotypes , P＜0.05 or ＜0. 01 ;incidence rate of MACE in CR group was significantly higher than that of NCR group (20. 8% vs.5. 3%, P＝0.02).Conclusion : CYP2C19 gene polymorphism possesses certain influence on CR after PCI in CHD patients .Those with medium or slow metabolism genotypes are more likely to suffer from CR ,higher MPA and incidence rate of MACE .

Research progress of acupuncture and moxibustion for endometrial receptivity in recent 10 years / 中国针灸

The research of acupuncture and moxibustion for endometrial receptivity in recent 10 years was reviewed. CNKI and PubMed databases were retrieved with "acupuncture" "moxibustion" and "endometrial receptivity" as key words. The retrieving time was from January of 2007 through December of 2016. As a result, 63 relevant papers were collected and 28 papers regarding clinical and experimental researches of acupuncture for endometrial receptivity were included into analysis. It was found that acupuncture and moxibustion could improve endometrial morphology (including the expression of pinopodes, endometrial thickness and the rate of endometrial type A), reduce the endometrial microcirculation (including endometrial pulsatility index, resistance index and hemodynamic index), increase the levels of estrogen and progesterone and the expressions of their receptors, and regulate the expression of molecular biological regulator (such as integrin, leukemia inhibitory factor, vascular endothelial growth factor and HOXA10). As a result, the endometrial receptivity was improved to provide good environment for embryo implantation and improve the pregnancy rate, which had significant advantage in the field of assisted reproductive technology. However, detections of pinopodes and integrin were invasive. Its application for clinical use had limitations. In addition, the evidence of acupuncture improving endometrial receptivity was still insufficient. By reviewing related research result, this paper further summarized and analyzed the action mechanism of acupuncture for endometrial receptivity to provide references for the clinical treatment.

Application of multi-channel video electroencephalogram in neonatal brain injury / 中国新生儿科杂志

Objective To study the value of multi-channel video electroencephalogram (VEEG) in evaluating the severity and the prognosis of hypoxic-ischemic encephalopathy (HIE) in full-term neonates.Method From September 2015 to December 2016,full-term newborns of suspected brain damage were admitted to Kunming Children's Hospital and received multi-channel VEEG within 6 hours after birth and MRI within one week.6 months after treatment,mental development index (MDI) and psychomotor development index (PDI) score were calculated.Finally,the relationship of VEEG and the prognosis of HIE was evaluated.Result Among 123 cases in our study,the total anomaly rate of VEEG was 59.3％(73/123).The anomaly rate of VEEG was 29.5％ (18/61) in mild HIE,82.1％ (32/39) in moderate HIE,and 100％ (23/23) in severe HIE.The result of VEEG at birth was related to MDI and PDI scores,the worse the VEEG the lower scores of the MDI and PDI.The incidence of sequelae increased significantly in HIE infants with severely abnormal VEEG.Conclusion Neonatal VEEG can reflect the extent of brain damage in infants with HIE.Continuous and multiple monitoring is very valuable in evaluating the prognosis of the infants.

Discussion on teaching swstrategies of human anatomy for undergraduates of medical related majors / 中华医学教育探索杂志

Human body structure,as a national excellent course,is a professional basic course for the students in medical related majors.After years of teaching practice,many teaching experience are collected,however,some problems in teaching practice still occurre such as how to carry out teaching methods specific for different majors,how to accomplish the course for teachers and how to grasp the macro-and micro-cosmic human structures for students in fewer class hours,and how to improve the students' self-regulation of learning.Aiming at the problems above,the human body structure teaching team improves teaching methods,teaching content and assessment system,and effectively enhance the teaching effectivene.

Clinicopathological significance and biological behavior of ANGPTL1 expression in human colorectal cancer / 中华普通外科杂志

Objective To study the clinicopathological significance and biological behavior of human colorectal cancer (CRC) with the expression of angiopoietin-like protein 1 (ANGPTL1).Methods The expression of ANGPTL1 protein in 98 paraffin embedded CRC specimens and paired adjacent non cancerous tissues were detected by immunohistochemistry.The relationship between the protein expression and clinicopathological features was analyzed.Western blot and qRT-PCR were used to examine the expression of ANGPTL1 protein and mRNA levels in 24 paired fresh CRC and adjuvant non-cancerous tissues.Finally,ANGPTL1 expression in CRC cell lines with different metastatic capabilities was detected by WB.Cell invasion and migration were detected using ANGPTL1 siRNA.Results ANGPTL1 expression in CRC tissues was much lower than that in non-cancerous tissues (44％ vs.76％,P ＜ 0.01).ANGPTL1 expression was negatively associated with T stage (x2 =5.766,P =0.016),lymph node metastasis (x2 =5.571,P =0.018) and TNM stage (x2 =7.773,P =0.005).Moreover,CRC patients with ANGPTL1 positive expression had a better prognosis.ANGPTL1 protein and mRNA levels in CRC tissues were higher than in non-cancerous tissues (t =3.126,P =0.005;t =2.523,P =0.019).ANGPTL1 interference promoted cell invasion and migration of HCT116 cells.Conclusion ANGPTL1 expression is closely associated with tumor T stage,lymph node metastasis,TNM stage and worse prognosis of CRC patients.ANGPTL1 inhibits cell invasion and migration of CRC cells.

Role of endoplasmic reticulum stress in arsenic toxicity induced damage: a recent advance / 中华地方病学杂志

Arsenic exposure can cause health problems to our body but arsenic can also be used to treat some diseases through induction of cell apoptosis.These effects are due to arsenic toxicity,but the mechanism is still unclear.Recent studies have showed that cell apoptosis induced by endoplasmic reticulum stress is associated with the mechanism.Therefore,in this paper,the role of endoplasmic reticulum stress in arsenic toxicity has been reviewed and some problems in current studies are pointed out,so as to provide clues and basis for further scientific research.

Postoperative Analgesic Effect of Ultrasonography-guided Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Comparison with Local Wound Infiltration / 中国医科大学学报

Objective To compare the postoperative analgesic effect of ultrasonography-guided transversus abdominis plane (TAP) block and local wound infiltration in laparoscopic cholecystectomy (LC).Methods Fifty patients who underwent LC were randomly assigned to receive TAP block (T group) or local wound infiltration (A group).In group T,40 mL of 0.25％ mpivacaine was administered in TAP block.In group A,0.5％ ropivacaine was injected around the trocar and extraction site.Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline,before incision,and 3 min after pneumoperitoneum.The dosages of remifentanil and sufentanil and the incidence of postoperative nausea and vomiting (PONV) were also recorded.Visual analogue scale (VAS) scores for resting and coughing states were assessed at 0,1,2,6,and 24 hours after operation.Results Compared with group A,the dosage of remifentanil was less,and MAP and HR at 3 min after pneumoperitoneum were significantly lower in group T (P ＜ 0.05).No significant difference was found in VAS score at resting state.In group T,the VAS scores at coughing state in the postanesthesia care unit immediately,1 h,and 2 h after operation were lower than those in group A (P ＜ 0.05).The sufentanil dosage was less in group T than in group A (P ＜ 0.05).No significant difference was found in the incidence of PONV.Conclusion The postoperative analgesic effect of TAP block is the same as that in local wound infiltration.However,it can reduce the pain score in the movement state and reduce the opioid dosages.

Inhibition of nicotine on apoptosis of chondrocytes induced by monosodium iodoacetate / 中国比较医学杂志

Objective To explore inhibition of nicotine on apoptosis of chondrocytes induced by monosodium iodoacetate ( MIA) .Methods Rat primary chondrocytes were isolated by enzyme digestion, and the cells were treated with 10 -8 , 10 -7 , 10 -6 , 10 -5 mol/L nicotine for 48 h.The cases were randomly divided into five groups, except for normal group, the other four groups were treated with 4μmol/L MIA 24 h, and three groups were treated 10 -8 , 10 -7 , 10 -6 mol/L nicotine.The viability of chondrocytes was detected by MTT assay.The apoptosis of chondrocytes was examed by Annexin V-FITC/PI flow dual-staining method.The activity of cysteinyl aspartate specific proteinase 3 ( Caspase 3 ) was measured by spectrophotography method.The activation of phosphatidylinositol 3 kinase ( PI3K)/protein kinase B ( AKT) and the expression of down-stream molecule Bax, Bcl-2 was assayed by western blot.Results 10 -7 , 10 -6 mol/L nicotine increased chondrocytes' viability (P0.05).10 -8, 10 -7, 10 -6 mol/L nicotine could increase MIA-induced chondrocytes' viability (P<0.05), suppress MIA-induced chondrocytes' apoptosis and the activity of MIA-induced Caspase 3 (P <0.05).Moreover, 10 -7, 10 -6 mol/L nicotine could increase the expression of PI3K and phosphorylation of AKT ( P<0.05) , down-regulate the expression of Bax and up-regulate the expression of Bcl-2 in MIA-induced rat chondrocytes ( P<0.05 ) .Conclusion These results suggested nicotine could exert anti-apoptosis in MIA-induced rat chondrocytes, which might be related to PI3K/AKT signal pathway.