Subclassification and clinical treatment options of refractory atlantoaxial dislocation / 中华骨科杂志

Objective:To subdivide clinical classification of refractory atlantoaxial dislocation, and evaluate the reliability of new subdivide clinical classification of refractory atlantoaxial dislocation.Methods:From January 2010 to December 2018, 48 patients with refractory atlantoaxial dislocation were treated, including 19 males and 29 females, aged 16 to 65 years, with an average of 39.2±13.3 years. According to the changes of relative anatomical position of C 1 and C 2 under general anesthesia with heavy traction of 1/6 body weight, subdivide clinical classification of refractory atlantoaxial dislocation were proposed, and refractory atlantoaxial dislocation was divided into traction loosening type (atlantoaxial angle≥5°) and traction stabilization type (atlantoaxial angle<5°). The traction loosening type was directly reduced by posterior atlantoaxial screw-rod fixation and fusion without anterior or posterior soft tissue release. For traction stabilization type, transoral soft tissue release was performed first, and then transoral anterior reduction plate fixation and fusion or posterior atlantoaxial screw-rod fixation and fusion were performed. Atlantodental interval (ADI) and atlantoaxial angle (AAA) were measured and collected before and after surgery to evaluate atlantoaxial reduction. The space available for the spinal cord (SAC) were measured to evaluate spinal cord compression. Visual analogue score (VAS) was used to evaluate the neck pain levels, and Japanese Orthopaedic Association (JOA) scores was used to evaluate the neurological function. American Spinal Cord Injury Association impairment scale (AIS) was used to evaluate the degree of spinal cord injury. One week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT scan were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results:Among all 48 cases, 22 cases were traction loosening type, of which posterior atlantoaxial screw-rod fixation and fusion were performed in 16 cases and occipitocervical fixation and fusion in 6 cases. 26 cases were traction stabilization type, and they all underwent anterior transoral release, and then, anterior TARP fixation and fusion were performed in 24 cases and posterior screw-rod fixation and fusion in the other 2 cases. X-ray, CT and MRI images and of all patients 1 week after surgery showed good atlantoaxial reduction and decompression of spinal cord. In each of the two types, there was one case lost to follow-up. For 46 cases in follow-up, the follow-up time ranged from 6 to 72 months, with an average of 38.0±17.2 months. Among 46 cases, 21 cases of traction loosening type showed that, ADI reduced from preoperative 9.9±2.2 mm to 2.3±0.9 mm at 3 months after surgery and 2.3±1.0 mm at the last follow-up, AAA increased from preoperative 57.9°±12.3° to 91.0°±2.2° at 3 months after surgery and 90.9°±2.2° at the last follow-up, SAC increased from preoperative 9.8±1.3 mm to 15.1±0.7 mm at 3 months after surgery and 14.9±0.7 mm at the last follow-up, VAS score reduced from preoperative 1.5±2.1 to 0.7±1.0 at 3 months after surgery and 0.3±0.6 at the last follow-up, and JOA score increased from preoperative 10.2±1.7 to 13.3±1.3 at 3 months after surgery and 14.9±1.5 at the last follow-up. Twenty-five cases of traction stabilization type presented that, ADI reduced from preoperative 9.7±2.0 mm to 2.1±1.4 mm at 3 months after surgery and 2.1±1.3 mm at the last follow-up, AAA increased from preoperative 55.8°±9.2° to 90.9°±1.4° at 3 months after surgery and 90.9°±1.3° at the last follow-up, SAC increased from preoperative 10.5±1.0 mm to 15.4±0.5 mm at 3 months after surgery and 14.8±2.8 mm at the last follow-up, VAS score reduced from preoperative 1.7±2.1 to 0.7±0.9 at 3 months after surgery and 0.3±0.5 at the last follow-up, and JOA score increased from preoperative 10.1±1.3 to 12.9±1.5 at 3 months after surgery and 14.4±1.3 at the last follow-up. In the traction loosening type, all the 10 grade D patients were improved to grade E at the last follow-up. In the 2 grade C patients of traction stabilization type before surgery, 1 patient was improved to grade E, 1 patient was improved to grade D, and all 11 patients with grade D were improved to grade E at the last follow-up. Bony fusion was obtained in all patients from 3 to 6 months, with an average of 4.4±1.5 months. During follow-up period, no looseness of internal fixation or redislocation happened.Conclusion:Refractory atlantoaxial dislocation can be divided into traction loosening type and traction stabilization type. For traction loosening type, satisfactory reduction can be achieved by using posterior atlantoaxial screw-rod system without soft tissue release. For traction stabilization type, anterior release is preferable, and then anterior TARP or posterior screw-rod can be used to achieve satisfactory reduction.

Practice of reflective teaching method based on Bloom's educational theory in the standardized residency training of gynecology / 中华医学教育探索杂志

Objective:To explore the practical role of reflective teaching based on Bloom's educational theory in the standardized residency training of gynecology.Methods:A total of 31 residents who participated in the standardized residency training in the Gynecology Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from July 2019 to January 2020 were classified as the control group, and 33 residents who participated in the standardized training from March 2020 to September 2020 were assigned to the observation group. The control group was given routine teaching, and the observation group was given reflective teaching based on Bloom's educational theory. The theoretical test scores and skill operation test scores before and after the training were compared between the two groups, and the clinical ability and teaching satisfaction of the two groups of residents were compared. SPSS 25.0 was used for t-test and Chi-square test. Results:After the standardized training, the scores of theoretical examination [(88.78±5.69) vs. (84.56±5.23)] and skill operation test [(89.37±5.75) vs. (85.22±5.34)] in the observation group were higher than those in the control group, with statistically significant differences. After the standardized training, the team cooperation ability, diagnosis and treatment technology operation ability, problem analysis and solving ability, clinical thinking ability and doctor-patient communication ability of the observation group were higher than those of the control group, and the differences were statistically significant. After the standardized training, the satisfactions with teaching mode, stimulating learning interest, improving self-study ability, improving diagnosis and treatment thinking ability, and improving problem analysis and solving ability in the observation group were higher than those in the control group, and the differences were statistically significant.Conclusion:Reflective teaching based on Bloom's educational theory can improve the professional theoretical knowledge level, clinical operation level, clinical ability and satisfaction of the gynecological residents, and help them to adapt to the clinical work faster.

CRISPR Screens Identify Essential Cell Growth Mediators in BRAF Inhibitor-resistant Melanoma / 基因组蛋白质组与生物信息学报·英文版

BRAF is a serine/threonine kinase that harbors activating mutations in ∼7% of human malignancies and ∼60% of melanomas. Despite initial clinical responses to BRAF inhibitors, patients frequently develop drug resistance. To identify candidate therapeutic targets for BRAF inhibitor resistant melanoma, we conduct CRISPR screens in melanoma cells harboring an activating BRAF mutation that had also acquired resistance to BRAF inhibitors. To investigate the mechanisms and pathways enabling resistance to BRAF inhibitors in melanomas, we integrate expression, ATAC-seq, and CRISPR screen data. We identify the JUN family transcription factors and the ETS family transcription factor ETV5 as key regulators of CDK6, which together enable resistance to BRAF inhibitors in melanoma cells. Our findings reveal genes contributing to resistance to a selective BRAF inhibitor PLX4720, providing new insights into gene regulation in BRAF inhibitor resistant melanoma cells.

Analysis and Study in Testing of Infrared Therapy Equipment / 中国医疗器械杂志

This article summarizes the common problems in registration and supervision testing of infrared therapy equipment, combines YY 0306-2008 Particular requirements for the safety of heat radiation therapy equipment, GB 9706.1-2007 Medical electrical equipment-Part 1:General requirements for safety, Registration technical review guidelines for infrared treatment equipment, etc. This paper analyzes and discusses the following aspects, including classification and applicable standards, performance indicators and overtemperature protection. Some suggestions and solutions are given to provide some guidance for medical equipment manufacturers in design, research and development and registration, in order to avoid the problem effectively and improve the passing rate of testing.

Progress in genetic research on primary pulmonary hypertension / 中华医学遗传学杂志

Primary pulmonary hypertension (PPH) consisting of hereditary pulmonary arterial hypertension and idiopathic pulmonary arterial hypertension is an obstructive pulmonary hypertension caused by primary pulmonary artery hyperplasia. Both environmental and genetic factors are involved in the pathogenesis of PPH. Genes associated with TGF-β signaling pathway including BMPR2, ALK1, ENG, SMAD8 and other genes including NFU1, CAV1, KCNK3 and TopBPl have been associated with PPH. In this review, the function and mechanism of the above genes in the pathogenesis PPH are summarized.

Effect of the 20° trendelenburg position on hypotension during induction of general anesthesia of patients undergoing gastrectomy / 临床麻醉学杂志

Objective To explore the effect of 20°trendelenburg position on hemodynamics during induction of general anesthesia of patients under gastrectomy.Methods One hundred and eighteen patients (77 males and 41 females,aged 50-60 years,ASA physical status Ⅰ or Ⅱ),scheduled for elective radical gastrectomy,were randomly divided into group A (n=40),group B (n=38) and group C (n=40).In group A,patients were placed in the supine position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In group B,patients were placed in the supine position during induction of anesthesia and was placed in the 20°trendelenburg position when hypotension occurred,and vasopressor would be administered if blood pressure was not restored.In group C,patients were placed in the 20°trendelenburg position during induction of anesthesia,and vasopressors was administered when hypotension occurred.In all groups Lactated Ringer′s was infused at 15 ml·kg-1·h-1in 30 min before induction.Anesthesia was induced with propofol 2 mg/kg,sufentanil 0.5 μg/kg,rocuronium 0.9 mg/kg.The occurrence of hypotension and the total amounts of drug administrations were doccumented.Results Nineteen patients (47.5%) in group A,fourteen patients (36.8%) in group B and six patients (15.0%) in group C developed hypotention.The incidence of hypotension in group A and B was significantly higher than that in group C (P<0.05).In all groups the total dosage of ephedrine was used.Phenylephine was only used in the group A at a dose of 26.5±0.14 μg.The amounts of drug administrations in group B and C were significantly lower than that in group A (P<0.05).Two patients in group A went into a refractory hypotensive state.However,no patients in all groups fell into a serious arrhythmia state,so atropine was not used.Conclusion The 20°trendelenburg position during induction of general anesthesia of patients during gastrectomy can prevent hypotension during induction.This position is effective in the management of hypotension after the induction of general anesthesia and can decrease the amounts of drug administrations during induction of general anesthesia.

Research progress on mechanism of autophagy in intestinal mucosal barrier function / 基础医学与临床

Autophagy is a biological process in which cells maintain homeostasis through degradation of cytoplasmic macromolecules and damaged organelles by membrane vesicle structure .Autophagy plays a critical role in maintai-ning survival of intestinal epithelial cells during intestinal mucosal barrier dysfunction .A negative regulator of auto-phagy may lead to intestinal inflammation and tumorigenesis .

Challenge and present status of fecal microbiota transplantation in the treatment of ulcerative colitis / 中国医师进修杂志

Ulcerative colitis (UC) is a subtype of inflammatory bowel disease. Its pathogenesis is not clear and the pathogenesis is complex. Moreover, it is recurrent and its healing is delayed. It is a kind of refractory disease. Its incidence and recurrence rate showed a trend of increasing year by year in our country at present. At the present stage, the main treatment focuses on glucocorticoids, aminosalicylic acid, immunosuppressor and biological agent. Although biological agent can greatly improve the efficacy, there are many problems in clinical treatment for a small amount of refractory patients. The comprehensive intervention combined with non-drug treatment should be performed, so as to achieve the curative effect. Fecal microbiota transplantation (FMT) has attracted people′s attention in recent years. It displays a certain therapeutic effect on the treatment of UC in the active stage, especially refractory recurrent UC. Therefore, the domestic and overseas FMT treatment are summarized in the paper.

Posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis / 中华骨科杂志

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.Methods From January 2011 to December 2015,15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated,including 6 males and 9 females,aged 35 to 75 years (mean 55 years).All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction,fixation and autogenous bone grafting under general anesthesia.Atlantodental interval (ADI) was measured and collected before and after surgery.Visual Analogue Scale/Score (VAS),American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect.1 week,3,6,12 months postoperatively and the annual review of the X-ray and CT were checked,in order to evaluate the reduction,internal fixation and bone graft fusion.Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery.The patients were followed up for 3 to 24 months (average,15 months).Atlantoaxial solid bony fusion was obtained from 3 to 6 months.ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm,VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0,ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery,JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery,and the statistical significance was revealed between preoperation and postoperation.Nine cases were in D grade of ASIA,3 cases improved from D to E grade after surgery,2 cases reached E grade in the other 6 cases after 6 months,2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery.Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre.Posterior screw-rod fixation and autogenous bone grafting can gain satisfying clinical efficacy.

Research progress on molecular genetics of male homosexuality / 中华医学遗传学杂志

Sexual orientation is influenced by both environmental factors and biological factors. Family and twin studies have shown that genetic factors play an important role in the formation of male homosexuality. Genome-wide scan also revealed candidate chromosomal regions which may be associated with male homosexuality, but so far no clearly related genes have been found. This article reviews the progress of relevant studies and candidate genes which are related to male homosexuality.

Wu Liangcun’s Analysis about Clinical Experience of Ovarian Cancer’s Treatment / 浙江中医药大学学报

Objective] To summarize national famous doctor of traditional Chinese medicine-Wu Liangcun ’s experience about the clinical treatment of ovarian cancer. [Method] By studying and following Professor Wu Liangcun to diagnose, this paper discusses Professor Wu ’s academic views and clinical experience of diagnosis and treatment of ovarian cancer respectively from the aspects such as etiology and pathogenesis, and treatment based on syndrome differentiation. It expounds the characteristics of his prescription and also gives proven cases. [Result]Professor Wu Liangcun proposes that the pathogenesis of ovarian cancer is mainly congenital deficiency and physical weakness resulted from cold coagulation, qi stagnation, blood stasis and phlegmatic hygrosis. All these remain a standstill, gather together and become a disease. He uses the syndrome differentiation method to divide the common ovarian cancer into four types:blood stasis and vital energy retardation, phlegm dampness condensation, deficiency of liver-yin and kidney-yin, asthenia of qi and blood. In the treatment, he organically combines the dialectics and the differentiation of disease; In the selection of drugs, he streamlines the prescription and the drug, which maximizes the efforts of the drugs and has good efforts in clinic.[Conclusion] Professor Wu Liangcun is good at making a diagnosis and giving treatment of ovarian cancer in combination with disease and syndrome, and he uses medicine flexibly. It has a very good effect and practical value for guiding clinic, and it should be promoted.

Research progress on tumor multidrug resistance regulated by au-tophagy / 中国肿瘤临床

Multidrug resistance (MDR) limits the clinical application and efficacy of chemotherapy drugs. Thus, MDR is the big-gest obstacle to the success of chemotherapy. Complex and diverse MDR mechanisms exist, including the following:adenosine triphos-phate-binding cassette membrane transport protein family, anti-apoptotic or enhanced DNA repair, mutations in drug targets or metabol-ic enzymes, microRNA, and cancer stem cells. Autophagy can degrade organelles and proteins that have been damaged in the cyto-plasm through the formation of autolysosome and recycle metabolites. Maintaining intracellular homeostasis and a balanced internal en-vironment is highly significant. Recent studies found that autophagy is closely related to the pathophysiology of MDR. The interaction between autophagy and MDR and the possible molecular mechanisms underlying these phenomena are reviewed. This paper elucidates the occurrence of MDR in relation to autophagy in order to provide new information on chemotherapy MDR.

Enhanced radiosensitivity of H22 ascitic tumor to 12C6+ ions radiation in ultra-filtration extract mixture from Astragalus mongholicus-treated mice / 药学学报

This study was designed to investigate the impact of ultra-filtration extract mixture from Astragals mongholicus (UEMAM) o radiosensitivity of H22 ascitic tumor in mice to 12C6+ ions radiation. The H22 ascitic tumor model was established in mice by intraperitoneal injection of 0.2 mL H22 ascitic cells. The animals were subsequently divided into 4 groups randomly, treated with normal saline, UEMAM, heavy ion beam radiotherapy and UEMAM plus heavy ion beam radiotherapy, respectively. The body weights, abdomen circumference of the mice were measured and the mouse behavior was monitored every day; survival time was recorded to evaluate life extension effect; flow cytometry technique was used to detect H22 cell apoptosis and cell cycle; protein levels of p53, Bax, Bcl-2 and cleaved Caspase-3 were analyzed by Western blot; the single cell gel electrophoresis was used to detect the level of deoxyribonucleic acid damage (DNA damage). The results suggest that UEMAM significantly increased survival time, and decreased body weights and abdomen circumference over the saline control group. The treatment increased cell apoptosis, cycle arrest and DNA damage compared to the saline control group. UEMAM significantly enhanced the therapeutic effect of heavy ion beam radiation in survival time, and decreased body weights and abdomen circumference in the tumor-baring mice. The combination increased cell apoptosis, cycle arrest and DNA damage compared to the radiotherapy group. The results of Western blot suggest that the treatment significantly enhanced p53-induced apoptotic signals. The experiment discovered that UEMAM could improve radiosensitivity of H22 ascitic tumor through activation of p53-mediated apoptotic signal pathway.

Clinical significance of serum levels of brain-derived neurotrophic factor in vascular cognitive impairment / 中国综合临床

Objective To investigate the clinical significance of brain-derived neurotrophic factor (BDNF) from peripheral serum in patients of vascular cognitive impairment (VCI).Methods Forty VCI subjects (including 10 mild cognitive impairment vascular(MCI-V) and 30 vascular dementia(VD)),and the control group for the same period in 40 healthy persons.Enzyme-linked immunosorbant assay (ELISA) was used to measure the serum levels of BDNF,statistical analysis was performed.Results The peripheral serum levels of BDNF in VCI (0.175 ±0.056) ng/L were lower than those of control group (0.211 ±0.061) ng/L,and there were significant differences (t =-2.752,P ＜ 0.05).The levels of BDNF showed no significant difference between MCI and VD ((0.195 ± 0.067) ng/L vs.(0.168 ± 0.052) ng/L,t =1.310,P ＞ 0.05).But they were both significantly lower than the control group (F =4.590,P =0.013).No significant differences were observed in the levels of BDNF between subcortical small vessel dementia (0.178 ± 0.057) ng/L and big vascular dementia (0.154 ± 0.042) ng/L (t =1.278,P =0.212).Conclusion BDNF participate in pathophysiology of VCI,and the serum levels of BDNF may be a candidate marker for clinical diagnosis of VCI.But serum levels of BDNF could not reflect the severity or the type of the VCI.

A study of carotid atherosclerotic plaque and serum levels of YKL-40 and ox-LDL in patients with cerebral infarction / 中国医师杂志

Objective To investigate the relationship of serum levels of human cartilage glycoprotein 39 (YKL-40) and oxidized low density lipoprotein (ox-LDL) with carotid atherosclerotic plaque in patients with cerebral infarction.Methods The levels of serum YKL-40 and ox-LDL were measured by enzyme immunoassay in 35 normal controls and 130 patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into intima media thickness (IMT) of the common carotid group (30 cases),intima media thickened group (30 cases),plaque group (70 cases) according to their carotid artery sonography.Patients in the plaque group were divided into stable plaque group (33 cases) and unstable plaque group (37 cases).The serum levels of YKL-40 and ox-LDL were determined and compared among different groups.Results Serum levels of YKL-40 and ox-LDL in patients with acute cerebral infarction were (53.61 ± 27.63) ng/ml and (526.58 ± 207.39) mg/L,respectively; which were significantly increased compared to normal control subjects [(25.18 ± 12.69) ng/ml and (301.43 ± 107.53) mg/L,P ＜0.01].Among patients with acute cerebral infarction,the serum levels of YKL-40 and ox-LDL in carotid artery atherosclerosis group were (66.75 ± 28.29) ng/ml and (647.05 ± 198.54) mg/L,respectively;which were significantly increased compared to those of IMT of the common carotid group [(33.23 ±13.06) ng/ml and (366.43 ± 77.51) mg/L,P ＜ 0.01].The serum levels of YKL-40 and ox-LDL in unstable plaque group were (94.87 ± 20.86) ng/ml and (812.47 ± 150.12) mg/L,respectively; which were significantly increased compared to stable plaque group [(59.34 ± 19.17)ng/ml and (609.66 ± 112.96)mg/L,P ＜ 0.01].Serum levels of YKL-40 was significantly linearly correlated with those of ox-LDL (r =0.45,P ＜ 0.05).Conclusions The serum levels of YKL-40 and ox-LDL were significantly increased in patients with cerebral infarction compared to the normal the degree of carotid artery atherosclerosis and instability of atherosclerotic plaque.Patients with serious carotid artery atherosclerosis and instable plaque had higher serum levels of YKL-40 and ox-LDL.The serum levels of YKL-40 were positively correlated with oxLDL.

A novel 5' splice site mutation in ACTC1 gene may play an important role in congenital ventricular septal defect / 中国组织工程研究

BACKGROUND: As a candidate gene of congenital heart disease, ACTC1 gene is related to congenital atrial septal defect inhumans.OBJECTIVE: To perform a mutation screen of ACTC1 gene in 110 nuclear families of congenital heart disease.METHODS: A case-control study was conducted based on 110 nuclear families of congenital heart disease and 300 normalhuman beings with no reported cardiac malformation. Six fragments in the coding region of ACTC1 gene was amplified by PCR invitro using five primers pairs. PCR products were screened for gene mutations.RESULTS AND CONCLUSION: A novel G-to-A variant was found at the third nucleotide of the intron downstream from exon 5.This mutation existed in a 5-year-old female with an isolated ventricular septal defect and her 30-year-old father, who had noreported cardiac anomalies. This mutation was not detected in 300 normal controls. These findings indicate that the mutation maybe related with congenital ventricular septal defects in humans.