Summary of the evidence for the prevention of lower limb ischemic complications associated with venous-arterial extracorporeal membrane oxygenation patients / 中国实用护理杂志

Objective:To retrieve, evaluate and integrate the relevant evidence of prevention of lower limb ischemic complications in venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients, and provide reference for the development of scientific and complete prevention and management of lower limb ischemic complications.Methods:According to the evidence-based methodology, clinical decisions, guidelines, expert consensus, evidence summary, systematic review, randomized controlled trials and experimental studies related to lower limb ischemia complications in VA-ECMO patients were searched from CNKI, Wanfang, PubMed, Cochrane Library and other domestic and foreign databases as well as relevant professional websites. The literature search period was from the establishment of the database to August 2023. Two researchers independently evaluated the literature quality, and then extracted and summarized the evidence according to the theme.Results:A total of 27 004 articles were obtained in the preliminary search, and 11 articles were finally included after screening, including 1 guide, 2 expert consensus, 2 systematic reviews and 6 original studies. Through literature reading, evidence extraction and classification, and expert group meetings, a total of 24 best evidences were concluded in four dimensions, including team training and management, VA-ECMO pre-computer evaluation, VA-ECMO catheter selection, and the monitoring and management of lower limb ischemia.Conclusions:This study summarized the best evidence for the prevention of lower limb ischemia complications associated with VA-ECMO patients, and can provide reference for healthcare providers in clinical practice. In order to ensure the safety of VA-ECMO treatment and reduce the incidence of related complications, healthcare professionals should carefully select and apply evidence according to the clinical context and patients′ wishes.

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery / 대한배뇨장애요실금학회지

Purpose@#This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. @*Methods@#We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. @*Results@#The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. @*Conclusions@#In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

The beginnings and evolution of a pancreatic surgeon: a technical morphological analysis in first 5 years / 中华外科杂志

Objective: To explore the development of the pancreatic surgeon technique in a high-volume center. Methods: A total of 284 cases receiving pancreatic surgery by a single surgeon from June 2015 to December 2020 were retrospectively included in this study. The clinical characteristics and perioperative medical history were extracted from the medical record system of Zhongshan Hospital,Fudan University. Among these patients,there were 140 males and 144 females with an age (M (IQR)) of 61.0 (16.8) years(range: 15 to 85 years). The "back-to-back" pancreatic- jejunal anastomosis procedure was used to anastomose the end of the pancreas stump and the jejunal wall. Thirty days after discharge,the patients were followed by outpatient follow-up or telephone interviews. The difference between categorical variables was analyzed by the Chi-square test or the CMH chi-square test. The statistical differences for the quantitative data were analyzed using one-way analysis of variance or Kruskal-Wallis H test and further analyzed using the LSD test or the Nemenyi test,respectively. Results: Intraoperative blood loss in pancreaticoduodenectomy between 2015 and 2020 were 300,100(100),100(100),100(0),100(200) and 150 (200) ml,respectively. Intraoperative blood loss in distal pancreatectomy was 250 (375),100 (50),50 (65), 50 (80),50 (50),and 50 (100) ml,respectively. Intraoperative blood loss did not show statistical differences in the same operative procedure between each year. The operative time for pancreaticoduodenectomy was respectively 4.5,5.0(2.0),5.5(0.8),5.0(1.3),5.0(3.3) and 5.0(1.0) hours in each year from 2015 to 2020,no statistical differences were found between each group. The operating time of the distal pancreatectomy was 3.8 (0.9),3.0 (1.5),3.0 (1.8),2.0 (1.1),2.0 (1.5) and 3.0(2.0) hours in each year,the operating time was obviously shorter in 2018 compared to 2015 (P=0.026) and 2020 (P=0.041). The median hospital stay in 2020 for distal pancreatectomy was 3 days shorter than that in 2019. The overall incidence of postoperative pancreatic fistula gradually decreased,with a incident rate of 50.0%,36.8%,31.0%,25.9%,21.1% and 14.8% in each year. During this period,in a total of 3,6,4,2,0 and 20 cases received laparoscopic operations in each year. The incidence of clinically relevant pancreatic fistula (grade B and C) gradually decreased,the incident rates were 0,4.8%,7.1%,3.4%,4.3% and 1.4%,respectively. Two cases had postoperative abdominal bleeding and received unscheduled reoperation. The overall rate of unscheduled reoperation was 0.7%. A patient died within 30 days after the operation and the overall perioperative mortality was 0.4%. Conclusion: The surgical training of a high-volume center can ensure a high starting point in the initial stage and steady progress of pancreatic surgeons,to ensure the safety of pancreatic surgery.

Risk factors associated with malignant vasovagal syncope in children / 中华儿科杂志

Objective: To analyze the clinical characteristics and risk factors of malignant vasovagal syncope (VVS) in children. Methods: This was a case-control study. The data of 368 VVS patients who were treated in the Department of Cardiology, Children's Hospital, Capital Institute of Pediatrics from June 2017 to December 2021 was collected and analyzed. They were divided into malignant VVS group and non-malignant VVS group according to the presence of sinus arrest, and then their demographic characteristics were compared. The children with malignant VVS and complete clinical information were recruited into the case group and were matched by age and sex (1∶4 ratio) with non-malignant VVS patients during the same period.Their clinical characteristics and lab tests were compared. Independent sample t test, Mann Whitney U or χ2 test was used for comparison between groups.Logistic regression was used to analyze the risk factors for malignant VVS in children. Results: Eleven malignant VVS and 342 non-malignant VVS met the inclusion and exclusion critera. Eleven malignant VVS and 44 non-malignant children were recruited in the case-control study. Ten patients of the 11 malignant VVS had a cardiac arrest occurring at 35 (28, 35) minutes of the head-up tilt test, and the duration of sinus arrest was (9±5) s. One patient had syncope occurring while waiting for drawing blood, and the duration of sinus arrest was 3.4 s. The children with malignant vasovagal syncope were younger than non-malignant VVS patients (9 (7, 10) vs. 12 (10, 14) years old, P<0.05), and had higher mean corpuscular hemoglobin concentration (MCHC) and standard deviation of the mean cardiac cycle over 5-minute period within 24 hours ((347±9) vs. (340±8) g/L, (124±9) vs. (113±28) ms, both P<0.05). Logistic regression analysis showed that MCHC was an independent risk factor for malignant VVS in pediatric patients (OR=1.13, 95%CI 1.02-1.26, P=0.024). Conclusions: The onset age of malignant VVS was younger, with no other special clinical manifestations. MCHC was an independent risk factor for malignant VVS.

Effects of moxa smoke through olfactory pathway on learning and memory ability in rapid aging mice / 中国针灸

OBJECTIVE@#To observe the effects of moxa smoke through olfactory pathway on learning and memory ability in rapid aging (SAMP8) mice, and to explore the action pathway of moxa smoke.@*METHODS@#Forty-eight six-month-old male SAMP8 mice were randomly divided into a model group, an olfactory dysfunction group, a moxa smoke group and an olfactory dysfunction + moxa smoke group, with 12 mice in each group. Twelve age-matched male SAMR1 mice were used as the blank group. The olfactory dysfunction model was induced in the olfactory dysfunction group and the olfactory dysfunction + moxa smoke group by intraperitoneal injection of 3-methylindole (3-MI) with 300 mg/kg, and the moxa smoke group and the olfactory dysfunction + moxa smoke group were intervened with moxa smoke at a concentration of 10-15 mg/m3 for 30 min per day, with a total of 6 interventions per week. After 6 weeks, the emotion and cognitive function of mice was tested by open field test and Morris water maze test, and the neuronal morphology in the CAI area of the hippocampus was observed by HE staining. The contents of neurotransmitters (glutamic acid [Glu], gamma-aminobutyric acid [GABA], dopamine [DA], and 5-hydroxytryptamine [5-HT]) in hippocampal tissue of mice were detected by ELISA.@*RESULTS@#The mice in the blank group, the model group and the moxa smoke group could find the buried food pellets within 300 s, while the mice in the olfactory dysfunction group and the olfactory dysfunction + moxa smoke group took more than 300 s to find them. Compared with the blank group, the model group had increased vertical and horizontal movements (P<0.05) and reduced central area residence time (P<0.05) in the open field test, prolonged mean escape latency on days 1-4 (P<0.05), and decreased search time, swimming distance and swimming distance ratio in the target quadrant of the Morris water maze test, and decreased GABA, DA and 5-HT contents (P<0.05, P<0.01) and increased Glu content (P<0.05) in hippocampal tissue. Compared with the model group, the olfactory dysfunction group had increased vertical movements (P<0.05), reduced central area residence time (P<0.05), and increased DA content in hippocampal tissue (P<0.05); the olfactory dysfunction + moxa smoke group had shortened mean escape latency on days 3 and 4 of the Morris water maze test (P<0.05) and increased DA content in hippocampal tissue (P<0.05); the moxa smoke group had prolonged search time in the target quadrant (P<0.05) and increased swimming distance ratio, and increased DA and 5-HT contents in hippocampal tissue (P<0.05, P<0.01) and decreased Glu content in hippocampal tissue (P<0.05). Compared with the olfactory dysfunction group, the olfactory dysfunction + moxa smoke group showed a shortened mean escape latency on day 4 of the Morris water maze test (P<0.05). Compared with the moxa smoke group, the olfactory dysfunction + moxa smoke group had a decreased 5-HT content in the hippocampus (P<0.05). Compared with the blank group, the model group showed a reduced number of neurons in the CA1 area of the hippocampus with a disordered arrangement; the olfactory dysfunction group had similar neuronal morphology in the CA1 area of the hippocampus to the model group. Compared with the model group, the moxa smoke group had an increased number of neurons in the CA1 area of the hippocampus that were more densely packed. Compared with the moxa smoke group, the olfactory dysfunction + moxa smoke group had a reduced number of neurons in the CA1 area of the hippocampus, with the extent between that of the moxa smoke group and the olfactory dysfunction group.@*CONCLUSION@#The moxa smoke could regulate the contents of neurotransmitters Glu, DA and 5-HT in hippocampal tissue through olfactory pathway to improve the learning and memory ability of SAMP8 mice, and the olfactory is not the only effective pathway.

Case-problem-based learning of pathophysiology based on inquiry-based learning and process management / 中华医学教育探索杂志

Based on the teaching concept of constructivism, this study aims to promote independent inquiry-based learning and clinical thinking among students and establish the guiding ideology of "full participation, process control, in-depth discussion, and expansion of thinking". A blending learning model was adopted with offline inquiry-based group learning and in-class defense and comment, as well as online teacher-student interaction and supervision to promote learning. Case-problem-based learning (CPBL) of pathophysiology was carried out among the medical students in the class of 2017, and process management was strengthened to effectively manage the two key links of data retrieval and group discussion. The analysis of 176 teaching evaluations collected at the end of the semester show that in terms of the overall evaluation of CPBL teaching, 162 students (92.05%) had high evaluation on teaching objectives, organization, cases, and personal gains and held a very or relatively favorable attitude. There were more negative feedbacks on "appropriate time allocation"; 21 students (11.93%) held a relatively or very disapproving attitude, and 149 students (84.66%) "felt very tired". In terms of teaching effect evaluation, 150 students (85.23%) strongly or relatively agreed that CPBL teaching may help to understand professional knowledge, stimulate learning enthusiasm and initiative, improve problem solving ability, emphasize clinical practice to cultivate clinical thinking, supervise and promote learning, and enhance team cooperation and teacher-student communication. In terms of the evaluation of teachers, 167 students (94.89%) thought that teachers were rigorous, responsible, and enthusiastic in teaching, attached importance to process management, and did well in effective guidance and thinking inspiration (strongly or relatively agree). The above results suggest that the CPBL teaching reform of pathophysiology based on process management can effectively promote in-depth inquiry-based independent learning and the cultivation of clinical thinking and improve teaching effectiveness, but further improvement is needed for teaching arrangement and time allocation.

Clinical features and risk factors of left ventricular hypertrophy in children with primary hypertension / 中华儿科杂志

Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.

Correlation of plasma prolactin and cortisol with vasovagal syncope in children / 中华实用儿科临床杂志

Objective:To investigate the changes of plasma prolactin (PRL) and cortisol (Cor) in the head up tilt test (HUT) in children with vasovagal syncope (VVS), and their correlation with VVS.Methods:From May 2019 to May 2020, 75 children diagnosed as VVS through positive HUT in the Children′s Hospital, Capital Institute of Pediatrics were retrospectively recruited as VVS group, while 29 healthy children with negative HUT during the same period were collected in healthy control group.Heart rate (HR) and blood pressure [systolic and diastolic blood pressure (SBP, DBP)] were monitored using a noninvasive continuous blood pressure monitor.The changes of HR, SBP and DBP were analyzed and their differences between the supine position and positive reaction of HUT were compared.The contents of PRL and Cor in the supine position and positive reaction of HUT were measured using the electrochemiluminescence, and their changes (ΔPRL and ΔCor) were calculated.Differences between groups were analyzed by the two-tailed Student′s t-test or the Mann- Whitney test.Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of ΔPRL on VVS. Results:There were no significant differences in the age, gender, body mass index, blood electrolyte, syncope frequency and syncope course between VVS group and healthy control group (all P>0.05). There was no significant difference in syncope frequency and course of syncope among subtypes of VVS group (vasodepressor syncope, mixed syncope, cardioinhibitory syncope)(all P>0.05). Compared with healthy control group, PRL after HUT was significantly higher in VVS group[36.23 (22.08, 61.97) μg/L vs.11.47 (8.00, 23.25 ) μg/L, Z=-5.40, P<0.01]. Both ΔPRL [25.36( 9.92, 48.93) μg/L vs.-0.10(- 2.67, 9.32) μg/L, Z=-5.39, P<0.01] and ΔCor [(84.4±43.6) μg/L vs.(57.6±64.6) μg/L, t=-2.44, P<0.05 ] were significantly higher in VVS group than those of healthy control group.PRL at HUT positive reaction was negatively correlated with SBP and DBP ( r=- 0.46, -0.45, all P<0.01). In VVS group, PRL at HUT positive reaction was negatively correlated with SBP ( r=-0.38, -0.24, all P<0.05). In VVS group, ΔCor after HUT was negatively correlated with SBP ( r=-0.25, P<0.05). ROC curves revealed that the cut-off value of ΔPRL in predicting HUT was 4.03 μg/L, with the sensitivity of 89.3% and specificity of 72.4%. Conclusions:Plasma PRL and Cor increase during syncope in VVS children, and plasma PRL is correlated with blood pressure drop.The increased plasma level of PRL in VVS children with positive HUT is correlated with blood pressure, and ΔCor is correlated with SBP.Plasma PRL and Cor may be involved in the pathogenesis of VVS and ΔPRL presents the diagnostic potential of VVS in children.

Safety evaluation of hyperthermic intraperitoneal chemotherapy in patients with local advanced gastric cancer after radical resection for prevention of peritoneal metastasis / 中华胃肠外科杂志

Objective: Patients with advanced gastric cancer have a poor prognosis and a possibility of peritoneal metastasis even if receiving gastrectomy. Hyperthermic intraperitoneal chemotherapy (HIPEC) can effectively kill free cancer cells or small lesions in the abdominal cavity. At present, preventive HIPEC still lacks safety evaluation in patients with locally advanced gastric cancer. This study aims to explore the safety of radical resection combined with HIPEC in patients with locally advanced gastric cancer. Methods: A descriptive case series study was carried out. Clinicopathological data of 130 patients with locally advanced gastric cancer who underwent radical resection + HIPEC at the Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2020 to February 2021 were retrospectively analyzed. Inclusion criteria: (1) locally advanced gastric adenocarcinoma confirmed by postoperative pathology; (2) no distant metastasis was found before surgery; (3) radical resection; (4) at least one HIPEC treatment was performed. Exclusion criteria: (1) incomplete clinicopathological data; (2) tumor metastasis was found during operation; (3) concomitant with other tumors. HIPEC method: all the patients received the first HIPEC immediately after D2 radical resection, and returned to the ward after waking up from anesthesia; the second and the third HIPEC were carried out according to the patient's postoperative recovery and tolerance; interval between two HIPEC treatments was 48 h. Observation indicators: (1) basic information, including gender, age, body mass index, etc.; (2) treatment status; (3) perioperative adverse events: based on the standard of common adverse events published by the US Department of Health and Public Health (CTCAE 5.0), the adverse events of grade 2 and above during the treatment period were recorded, including hypoalbuminemia, bone marrow cell reduction, wound complications, abdominal infection, lung infection, gastroparesis, anemia, postoperative bleeding, anastomotic leakage, intestinal obstruction, pleural effusion, abdominal distension, impaired liver function, and finally a senior professional title chief physician reviewed the above adverse events and made a safety evaluation of the patient; (4) association between times of HIPEC treatment and adverse events in perioperative period; (5) analysis of risk factors for adverse events in perioperative period. Results: Among the 130 patients, 79 were males and 51 were females with a median age of 59 (54, 66) years and an average body mass index of (23.9±7.4) kg/m(2). The tumor size was (5.4±3.0) cm and 100 patients (76.9%) had nerve invasion. All the 130 patients received radical resection + HIPEC and 125 (96.2%) patients underwent laparoscopic surgery. The mean operative time was (345.6±52.3) min and intraoperative blood loss was (82.0±36.5) ml. One HIPEC treatment was performed in 54 patients (41.5%), 2 HIPEC treatments were in 57 (43.8%), and 3 HIPEC treatments were in 19 (14.6%). The average postoperative hospital stay was (13.1±7.5) d. A total of 57 patients (43.8%) had 71 cases of postoperative complications of different degrees. Among them, the incidence of hypoalbuminemia was 22.3% (29/130), and the grade 2 and above anemia was 15.4% (20/130), lung infection was 3.8% (5/130), bone marrow cell suppression was 3.7% (4/130), abdominal cavity infection was 2.3% (3/130), and liver damage was 2.3% (3/130), wound complications was 1.5% (2/130), abdominal distension was 1.5% (2/130), anastomotic leakage was 0.8% (1/130), gastroparesis was 0.8% (1/130) and intestinal obstruction was 0.8% (1/130), etc. These adverse events were all improved by conservative treatments. There were no statistically significant differences in the incidence of adverse events during the perioperative period among patients undergoing 1, 2, and 3 times of HIPEC treatments (all P>0.05). Univariate and multivariate logistic analyses showed that age > 60 years (OR: 2.346, 95%CI: 1.069-5.150, P=0.034) and neurological invasion (OR: 2.992, 95%CI: 1.050-8.523, P=0.040) were independent risk factors for adverse events in locally advanced gastric cancer patients undergoing radical resection+HIPEC (both P<0.05). Conclusions: Radical surgery + HIPEC does not significantly increase the incidence of perioperative complications in patients with advanced gastric cancer. The age >60 years and nerve invasion are independent risk factors for adverse events in these patients.

Factors associated with pathological complete response and construction of scoring system in patients with rectal cancer after neoadjuvant chemoradiotherapy / 中华普通外科杂志

Objective:To identify the clinical factors associated with pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced middle and low rectal cancer and establish a scoring system.Methods:In this retrospective analysis the clinical data of patients with locally advanced middle and low rectal cancer treated with nCRT combined with surgery at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from Jan 2016 to Jan 2020 were studied. Patients were divided into pCR group and non-pCR group. Single factor analysis and Logistic multivariate regression analysis were performed to explore pCR related factors after nCRT, and a pCR prediction scoring system was established.Results:The pCR was achieved in 33 patients (20.8%). Univariate analysis showed that the maximum thickness of the tumor≤25mm before nCRT ( P=0.046), concurrent oxaliplatin-combined intensive chemotherapy ( P=0.013), the NLR≤1.65 before nCRT ( P=0.004) and the serum CEA≤5 ng/ml before nCRT ( P=0.016) were significantly associated with pCR. In multivariate analysis, concurrent oxaliplatin-combined intensive chemotherapy, the NLR before nCRT and serum CEA before nCRT were independent related factors of pCR. The probability of pCR for patients with score of 0, 1, 2, and 3 was 42% (10/24), 30% (19/63), 5% (3/57) and 7% (1/15), respectively. The probability of pCR in patients with score≤1 point was 33% (29/87), and 6% (4/72) for score?1 point ( P?0.001). The area under the curve of the scoring system is 0.729 (95% CI: 0.638-0.820, P?0.001). Conclusions:Concurrent oxaliplatin-combined intensive chemotherapy, NLR≤1.65 before nCRT and serum CEA≤5 ng/ml before nCRT are independent predictors of pCR in locally advanced middle and low rectal cancer and the scoring system constructed in combination with above indicators can effectively predict pCR.

Discussion and analysis on the necessity of setting up the training system of stomatological clinical pharmacist / 中华医学教育探索杂志

At present, there is still no stomatology specialty in the training system of clinical pharmacists in China and the relevant research is still blank. The development of stomatological clinical pharmacy is also slow due to the lack of clinical pharmacists. By analyzing the national oral health policies, the characteristics of oral diseases and the clinical needs of stomatology, this paper provides theoretical basis for the setting of clinical pharmacist training specialty of stomatology specialty in China. This paper also makes a preliminary discussion on the construction of the training system of clinical pharmacists in the specialty of stomatology, so as to provide advice and references for the design and specific plan of the training system in the specialty of stomatology.

Echinacoside regulates prohibitin expression and inhibits MPP -induced apoptosis in SH-SY5Y ceils / 中国药理学通报

Aim To investigate the effeet of Eehinaeo- side ( ECH ) regulating the expression of prohibitin (PHB) on MPP+ -induced apoptosis of SH-SY5Y eells and the underlying mechanism.Methods SH-SY5Y eells were seleeted and divided into control group, MPP+ group, MPP+ + ECH group, NC + MPP + group, NC + MPP+ + ECH group, PHB-RNAi + MPP + + ECH group.Cell survival rate was determined by CCK-8 assay.Cell morphology was observed using an inverted phase contrast mieroscope; the apoptotie eells were observed by Hoechst33342 fluorescence staining, whereas apoptotie rate, reactive oxygen speeies eon- tent, and mitochondrial membrane potential were ana¬lyzed by flow eytometry.The relative protein expres¬sions of PHB, Akt, p-Akt, Bel-2, Bax, and cleaved- easpase3 were determined by Western blot.Results Compared with eontrol group, the eell survival rate of MPP+ group signifieantly deereased.The growth state of the eells beeame significantly worse.Intracellular ROS content inereased, mitoehondrial membrane po tential decreased, apoptosis-related protein expression increased and the apoptotic rate increased.Compared with MPP+ group, MPP+ + ECH group significantly increased cell viability.The growth status of cells was significantly improved.Intracellular ROS content de¬creased, mitochondrial membrane potential increased, apoptosis-related protein expression decreased, and the apoptotic rate decreased significantly.The expression levels of PHB and p-Akt significantly increased.Com¬pared with NC + MPP+ + ECH group, p-Akt level de¬creased and the cell apoptotic rate increased in PHB- RNAi +MPP+ + ECH group.Conclusions Echino- side can reduce MPP + - induced apoptosis of SH-SY5Y cells, which may be realized by upregulating PHB ex¬pression and phosphorylation of Akt to protect mito¬chondrial function.

Clinical therapeutic effects of intravitreal injection of Conbercept for macular edema in different types of retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the therapeutic efficacy of intravitreal injection of conbercept for macular edema in different types of retinal vein occlusion(RVO).<p>METHODS: Retrospective cohort study of 79 patients 79 eyes in different types of RVO(BRVO:54; non-ischemic CRVO: 16; ischemic CRVO: 9)received intravitreal injection of conbercept. After 3mo injection of conbercept(IVIC), a pro re nata(PRN)strategy was adopted. The best-corrected visual acuity(BCVA,LogMAR)and central macular thickness(CMT)were recorded at baseline and at 1d, 1, 2, 3, 4, 5, 6mo post-treatment.<p>RESULTS: At 6mo, in different types of RVO, the BCVA were improved significantly than baseline(0.22±0.23 <i>vs</i> 0.70±0.32; 0.24±0.19 <i>vs</i> 0.73±0.27; 1.20±0.37 <i>vs </i>1.92±0.23; all <i>P</i><0.05). CMT were decreased significantly than baseline(199±27 <i>vs </i>422±162μm; 195±16 <i>vs </i>550±158μm; 231±55 <i>vs</i> 583±152μm; all <i>P</i><0.05). In three different treatment time groups, CMT in different types of RVO were decresed than the baselineat different time points after treatment(<i>P</i><0.05), and there was no difference between groups(<i>P</i>>0.05). In three different treatment time groups, BCVA in BRVO and non-iCRVO were improved than the baseline in three groups(<i>P</i><0.05), but in iCRVO there were little improved in >90d group.<p>CONCLUSION: Intravitreal injection of conbercept can effectively treat macular edema caused by RVO. Early and timely treatment of anti-VEGF may help improve and maintain the stability of long-term vision, and delayed anti-VEGF treatment may reduce the space for the improving vision.

Study of blood pressure variability in children with H-type hypertension / 中华实用儿科临床杂志

Objective:To summarize characteristics and rules of blood pressure variability (BPV) in children with H-type hypertension, in an attempt to explore some basis for further selection of the time points of treatment.Methods:A total of 117 children diagnosed as essential hypertension in Children′s Hospital Affiliated to Capital Institute of Pediatrics from March 2018 to September 2019 were selected as the research objective.According to the serum level of homocysteine (Hcy), those children were divided into the simple essential hypertension group (74 cases, Hcy≤13.9 μmol/L) and the H-type hypertension group (43 cases, Hcy>13.9 μmol/L). All children received 24 h ambulatory blood pressure monitoring (24 h ABPM), and BPV indexes were recorded and subject to group comparison.Meanwhile, the serum Hcy level was monitored.Besides, the demographic data and such blood biochemical indexes as blood glucose, blood fat and renal function were recorded or measured for an analysis of the correlation between BPV and each index.Results:There were no significant differences in gender, age, body mass index (BMI) and biochemical indexes between the simple essential hypertension group and the H-type hypertension group (all P>0.05). Compared with the simple essential hypertension group, the H-type hypertension group had a significantly higher 24 h systolic blood pressure standard deviation [24 h SSD, (11.21±3.23) mmHg vs.(9.64±2.73) mmHg, 1 mmHg=0.133 kPa, t=-2.806, P<0.05], nighttime systolic blood pressure standard deviation [nSSD, (10.79±3.89) mmHg vs.(9.26±3.23) mmHg, t=-2.292, P<0.05], and nighttime diastolic blood pressure standard deviation [nDSD, (10.23±3.53) mmHg vs.(8.73±2.93) mmHg, t=-2.617, P<0.05]. Pearson correlation analysis showed that the serum Hcy level was significantly positively correlated with 24 h, SSD, nSSD and nDSD ( r=0.194, 0.183, 0.182, all P<0.05). Conclusions:24 h SSD in children with H-type hypertension is significantly higher, with an obvious increase in both nSSD and nDSD, and the serum Hcy level was significantly positively correlated with BPV, which suggested that it was required to effectively control the serum Hcy level, reduce the range of blood pressure fluctuation and select the optimal time points of treatment, thus delaying the progress of hypertension.

Preparation and quality evaluation of fluorocarbon microemulsion-based gel loaded with both 5-aminolevulinic acid and carbon dioxide / 药学学报

To improve the efficacy of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT), a fluorocarbon microemulsion-based gel (FMBG) loaded with both 5-ALA and carbon dioxide (CO2) was prepared in this study. Its physical and chemical properties such as particle size, zeta potential, morphology, pH value and viscosity were characterized. Acid-base titration experiment was used to determine the CO2 loading, a fluorescence derivatization method was established to determine the content of 5-ALA, and the confocal laser scanning microscope and Franz diffusion cell method were carried out to investigate its transdermal ability. Through the laser speckle contrast imaging, the CO2-affected blood flow perfusion of skin was measured. Finally, the skin irritation test was tested by hematoxylin-eosin staining (H&E) method. These results showed that the prepared FMBG was a milky white gel, with an average particle size of 202.4 nm, a zeta potential of -25.3 mV, a pH of 6.0, and a viscosity of 1 062.0 mPa·s. It can be stored stably for seven days at room temperature. The 5-ALA content of FMBG was measured to be approximately equal to 20% (w/w). At room temperature and normal pressure, the CO2 loading content of FMBG was 5.016 mg·L-1, which was 1.5 times as much as that of water. The transdermal absorption experiment and blood perfusion results showed that the FMBG can effectively enable the transdermal delivery of 5-ALA and CO2, and significantly increased the blood perfusion of skin. H&E staining results indicated that FMBG had negligible skin irritation (all animal tests were approved by the Ethics Committee of 900 Hospital of the Joint Logistics Team). In this study, a safe and stable FMBG loaded with both 5-ALA and CO2 was successfully prepared. It was suitable for transdermal application, having the potential of enhancing the efficacy of 5-ALA-mediated PDT.

Clinical characteristics and prognosis of primary gastrointestinal stromal tumors with PDGFRα mutation / 中华普通外科杂志

Objective:To investigate the clinicopathological characteristics of primary gastrointestinal stromal tumors (GIST) with PDGFRα mutation and analyze the prognosis of different subtypes.Methods:From Jun 2010 to Jun 2019, the clinicopathological data of 35 patients with primary PDGFRα mutation GIST, who underwent surgical therapy in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively.Results:The main symptoms was abdominal pain (28 cases, 80%), followed by abdominal mass (6 cases, 17%), and hemafecia (1 case, 3%). 31 primary lesions (89%) were located in the stomach and 4 (11%) in other than stomach. 13 cases (37%) were of epithelioid cells, 14 cases (40%) were of spindle cells and 8 cases (23%) were of mixed cells. 27 cases (77%) were CD117 positive , 28 cases (80%) CD34 positive , and 30 cases (86%) were DOG-1 positive. 19 cases (54%) had D842V mutation and 16 cases (46%) had non-D842V mutation. Complete surgical resection was performed in all patients, with no perioperative death. The 3-year recurrence-free survival rate of the D842V mutation group was lower than that of the non-D842V mutation group (84% vs. 100%, P=0.045). Conclusions:The mutation rate of PDGFRα gene was low, mostly derived from the stomach. PDGFRα mutation GIST presents inert biological behavior and the overall prognosis was good.

Analysis of imatinib trough concentration at steady state in adjuvant therapy of patients with high risk gastrointestinal stromal tumor / 中华胃肠外科杂志

Objective@#To explore the features of imatinib mesylate (IM) plasma concentration during adjuvant therapy and clinical factors associated with IM plasma concentration in patients with high risk gastrointestinal stromal tumors (GIST), and to determine whether IM plasma concentration <1100 μg/L influences the efficacy of adjuvant therapy.@*Methods@#A retrospective case control study method was used. Case inclusion criteria: (1) complete resection of lesion and GIST confirmed by pathology; (2) high risk classified according to modified National Institutes of Health classification system (2008); (3) administration of IM 400 mg/d for at least 1 month; (4) not taking the medication likely affecting IM pharmacokinetic, such as rifampicin, dilantin, and carbamazepine, within 1 month before blood collection. Data of GIST patients who visited GIST Disease - Oriented Outpatient, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2015 to December 2018 were retrospectively analyzed. After taking IM for 22-26 hours, 5 ml of peripheral venous blood was collected into EDTA anticoagulant tube. IM plasma concentration was detected by using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Patients were divided into <1100 μg/L group and ≥1100 μg/L group according to plasma concentration. Linear regression was used to analyze the relevance between clinical features and IM plasma concentration. Parameters with normal distribution were analyzed by Pearson correlation coefficient, and parameters with non-normal distribution were analyzed by Spearman correlation. Kaplan-Meier survival curves and COX regression model were used for survival analysis.@*Results@#Among the 85 patients enrolled in the study, 49 patients (57.6%) were male and 36 (42.4%) were female, with mean age of (51.9±11.0) years. The body mass index was (22.5±2.9) kg/m2 and body surface area was (1.6±0.2) m2. Thirty patients received gene test, including 23 patients with c-Kit exon 11 mutation, 4 with c-Kit exon 9 mutation, 1 with c-Kit exon 11 and 17 mutation and 2 without c-Kit or PDGFRA gene mutation. The mean IM plasma concentration was (1391.4±631.3) μg/L, and there were 32 patients with plasma concentration <1100 μg/L and 53 patients with plasma concentration ≥1100 μg/L. There were no statistically significant differences between the two groups in gender, age, body mass index, body surface area, hematological examination (white blood cells, albumin, alanine aminotransferase, aspartate aminotransferase and serum creatinine), tumor location, tumor size, mitotic counts, duration of adjuvant therapy and methods of operation (all P>0.05). Positive correlation between IM plasma concentration and serum creatinine was observed in linear regression analysis (r=0.297, P=0.007), but there were no correlations between IM plasma concentration and age (r=0.044, P=0.686), body mass index (r=0.066, P=0.547), body surface area (r=-0.010, P=0.924), white blood cells (r=-0.080, P=0.478), albumin (r=-0.065, P=0.563), alanine aminotransferase (r=0.114, P=0.308), aspartate aminotransferase (r=0.170, P=0.127) and duration of adjuvant therapy (ρ=0.060, P=0.586). There was no statistically significant difference in IM plasma concentration between patients with different genders (t=0.336, P=0.738) and patients with different surgical methods (F=0.888, P=0.451). Up to March 1, 2019. the median follow-up time was 30 (range 4-49) months. Tumor recurrence was detected in two patients with plasma concentration <1100 μg/L and two with plasma concentration ≥1100 μg/L. One recurrent patient with plasma concentration <1100 μg/L was detected to harbor c-Kit exon 11 and exon 17 mutations, and the other did not receive gene detection. Two recurrent patients with plasma concentration ≥1100 μg/L were both detected to harbor c-Kit exon 9 mutation. The 3-year relapse-free survival rate was 96.4% in the cohort, 96.2% in patients with plasma concentration <1100 μg/L, and 96.6% in patients with plasma concentration ≥1100 μg/L. No significant difference in relapse-free survival was observed between the two groups (P=0.204). Univariate Cox analysis showed that IM plasma concentration <1100 μg/L was not a risk factor for patients with high risk GIST (HR=0.238, 95% CI: 0.022-2.637, P=0.242).@*Conclusions@#IM plasma concentration of adjuvant therapy in patients with high risk GIST varies with individual. Patients with higher level of serum creatinine are more likely to have a higher plasma concentration. A blood drug concentration standard of less than 1100 μg/L for advanced GIST patients may not influence the prognosis of patients with high risk GIST.

Changes in heart rate deceleration capacity and variability in resting children with vasovagal syncope / 中华实用儿科临床杂志

Objective To investigate the changes in heart rate deceleration capacity( DC)and heart rate va-riability(HRV)parameters in children with vasovagal syncope(VVS),to assess the basic autonomic function of children with VVS,and to explore the reference value of DC for the diagnosis of VVS in children. Methods VVS group included 62 patients diagnosed with VVS in the Cardiovascular Department of Children＇s Hospital Affiliated to Capital Institute of Pediatrics from June 2015 to December 2017,56 outpatients undergoing physical examination were selected as the healthy control group,and the changes in DC and HRV matched to age and gender were analyzed respectively. Indexes of DC and HRV of both groups of children in health control group and children with VVS were compared among different age groups or different genders. Results (1)Analysis of DC and HRV based on age or gender:whether in healthy children or in children with VVS,DC and HRV parameters varied significantly in the range of different ages,while they were the same in children with different genders.(2)Comparison of DC and HRV in school-age and puberty children between VVS group and healthy control group:in school-aged children,DC of VVS group was significantly higher than that of healthy control group[(6. 8 ± 1. 0)ms υs.(6. 0 ± 0. 7)ms,t= -2. 412,P<0. 01]. Mean square root rates of succe-ssive normal sinus RR interval differences(rMSSD)increased,and the difference was significant( P<0. 05). In chil-dren at puberty,DC in children of VVS group was significantly higher than that in the healthy control group[(7. 4 ± 1. 2)ms υs.(6. 6 ± 1. 1)ms,t= -2. 742,P<0. 01],rMSSD,LF and HF value were significantly higher compared with those of the healthy control group(all P<0. 05).(3)Predictive value of DC on VVS:the binary Logistic regression analysis found that only DC was associated with VVS in different age groups. By using receiver operating characteristic curve to analyze the predictive value of DC on VVS,it was found that when making DC 6. 5 ms for school age and 7. 0 ms at puberty as the threshold,a better prediction of VVS could be achieved with good sensitivity and specificity. Conclusions Children＇s autonomic nervous function changes with age,and DC and HRV parameters change signifi-cantly during adolescence and at school age. Children with VVS may have abnormally increased vagal tone. When DC≥6. 5 ms at school age or DC≥7. 0 ms at puberty,it may have a reference value for the diagnosis of VVS.

Relationship between blood pressure variability and target organ damage in children with essential hypertension / 中华儿科杂志

Objective@#To investigate the correlation between blood pressure variability (BPV) and target organ damage in children with essential hypertension.@*Methods@#A retrospective review identified 144 children (104 boys (72.2%) and 40 girls (27.8%), age (11.7±2.5)years) diagnosed with essential hypertension at Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2013 to June 2018. Data on indicators for assessing fundus, cardiac, and renal damages obtained included 24-hour ambulatory blood pressure monitoring, BPV, fundus oculi examination, electrocardiogram, echocardiography, renal function, 24-hour urine protein quantitation, urine microalbumin, serum and urine β2-microglobulin. According to the existence of target organ damage, subjects were divided into target organ damage group and non-target organ damage group. Comparison between groups was analyzed using independent sample t test, chi square test and pearson correlation analysis.@*Results@#The study included 144 children. There were 108 children (75.0%) diagnosed with phase 1 hypertension and 36 children (25.0%) diagnosed with phase 2 hypertension. Patients in target organ damage group (n=86, 59.7%) had a higher coefficient of 24 h diastolic BPV (14.5%±3.2% vs. 13.2%±2.5% t=2.558, P=0.012), a higher coefficient of daytime systolic BPV (8.2%±2.1% vs. 7.4%±2.0%, t=2.253, P=0.026) and a higher coefficient of daytime diastolic BPV (12.8%±3.4% vs.11.1%±2.4%, t=3.188, P=0.002) compared with patients in non-target organ damage group (n=58, 40.3%). The coefficients of daytime systolic BPV and daytime diastolic BPV were significantly associated with cardiac damage (r=0.190, P=0.023; r=0.366, P<0.01) and renal damage (r=0.167, P=0.046; r=0.167, P=0.045). The coefficient of daytime diastolic BPV was positively correlated with left ventricular mass index (r=0.366, P<0.01).@*Conclusions@#There is a correlation between BPV and target organ damage in children with essential hypertension. Daytime BPV is strongly associated with cardiac and renal damage, and daytime diastolic BPV may predict early cardiac hypertrophy. As a noninvasive method, daytime BPV can provide evidence for early identification of hypertensive target organ damage.

Changes in heart rate deceleration capacity and variability in resting children with vasovagal syncope / 中华实用儿科临床杂志

Objective@#To investigate the changes in heart rate deceleration capacity(DC) and heart rate va-riability(HRV) parameters in children with vasovagal syncope(VVS), to assess the basic autonomic function of children with VVS, and to explore the reference value of DC for the diagnosis of VVS in children.@*Methods@#VVS group included 62 patients diagnosed with VVS in the Cardiovascular Department of Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2015 to December 2017, 56 outpatients undergoing physical examination were selected as the healthy control group, and the changes in DC and HRV matched to age and gender were analyzed respectively.Indexes of DC and HRV of both groups of children in health control group and children with VVS were compared among different age groups or different genders.@*Results@#(1)Analysis of DC and HRV based on age or gender: whether in healthy children or in children with VVS, DC and HRV parameters varied significantly in the range of different ages, while they were the same in children with different genders.(2)Comparison of DC and HRV in school-age and puberty children between VVS group and healthy control group: in school-aged children, DC of VVS group was significantly higher than that of healthy control group [(6.8±1.0) ms vs.(6.0±0.7) ms, t=-2.412, P<0.01]. Mean square root rates of succe-ssive normal sinus RR interval differences(rMSSD) increased, and the difference was significant (P<0.05). In children at puberty, DC in children of VVS group was significantly higher than that in the healthy control group [(7.4±1.2) ms vs.(6.6±1.1) ms, t=-2.742, P<0.01], rMSSD, LF and HF value were significantly higher compared with those of the healthy control group (all P<0.05). (3)Predictive value of DC on VVS: the binary Logistic regression analysis found that only DC was associated with VVS in different age groups.By using receiver operating characteristic curve to analyze the predictive value of DC on VVS, it was found that when making DC 6.5 ms for school age and 7.0 ms at puberty as the threshold, a better prediction of VVS could be achieved with good sensitivity and specificity.@*Conclusions@#Children′s autonomic nervous function changes with age, and DC and HRV parameters change significantly during adolescence and at school age.Children with VVS may have abnormally increased vagal tone.When DC ≥6.5 ms at school age or DC≥7.0 ms at puberty, it may have a reference value for the diagnosis of VVS.