Distribution characteristics and health risk assessment of elements in drinking water from endemic fluorosis areas with water improvement in Xi'an City / 中华地方病学杂志

Objective:To analyze the types and distribution characteristics of elements in drinking water from endemic fluorosis areas with water improvement in Xi'an City, understand the relationship between fluoride and various elements, and conduct health risk assessment on potential high-risk elements.Methods:From May to June 2017, one endemic fluorosis area with water improvement (Gaoling District, Huyi District, Lintong District) was selected according to the northeast, the southwest and the due east directions of Xi'an City as the survey area. Sixteen endemic fluorosis villages were selected from each endemic area, and 2 water samples were collected from each endemic village to detect fluoride and 12 elements such as chromium, manganese, ferrum, copper, zinc, arsenic, selenium, molybdenum, cadmium, antimony, barium, and lead. Hygienic evaluation was conducted according to national standards, and the potential high-risk elements (arsenic, molybdenum) were assessed for health risk through the health risk assessment model recommended by the National Environmental Protection Agency of the United States.Results:The water samples from the endemic fluorosis areas in Xi'an City mainly contained seven elements: barium, ferrum, molybdenum, arsenic, zinc, manganese, and chromium. The content of copper and selenium was relatively low, while the content of cadmium, antimony, and lead was extremely low. The fluoride content in water samples from Gaoling District and Lintong District was relatively high, and the fluorine, arsenic, molybdenum elements was pairwise positively correlated ( P < 0.05). The molybdenum element in water samples from Lintong District exceeded 9.38% (3/32). The fluoride in the water samples of Huyi District was relatively low, and the arsenic, molybdenum elements was positively correlated ( r = 0.84, P < 0.001), and the arsenic element exceeded the standard by 25.00% (8/32). The main health risk of drinking water in endemic fluorosis areas with water improvement in Xi'an City was arsenic exposure, with children at a higher risk than adults, and the areas of Huyi District, Lintong District, and Gaoling District declined, the risk of cancer (CR) of Gaoling District was < 10 -4 and hazard quotient (HQ) was < 1. However, in the areas of Huyi District and Lintong District (except HQ of adults), there was a higher risk (CR > 10 -4, HQ > 1). Children in one endemic fluorosis village in Lintong District had a higher non carcinogenic risk of molybdenum (HQ > 1). Conclusions:The drinking water in endemic fluorosis areas with water improvement in Xi'an City mainly contains 7 elements, especially arsenic and molybdenum, which need to be regularly monitored. Some areas have high health risks of arsenic in water, and monitoring, management, and related epidemiological investigations need to be strengthened. At the same time, it is necessary to actively monitor other toxic and harmful substances that may be introduced during the water improvement process to prevent the occurrence of secondary health problems.

Construction and validation of an early predictive model for intraoperative massive transfusion of red blood cells in patients with Stanford type A aortic coarctation / 中国输血杂志

【Objective】 To analyze the risk factors for intraoperative massive red blood cell (RBC) transfusion in patients with Stanford type A aortic dissection (TAAD), in order to develop a risk-prediction model and validate its predictive effect. 【Methods】 The clinical data of 233 patients with TAAD admitted to our hospital from July 2018 to June 2021 (modeling set) were retrospectively analyzed. They were divided into routine transfusion group (n=128, RBC≤8 U) and massive transfusion group (n=105, RBC>8 U). Risk factors for intraoperative massive RBC transfusion in TAAD patients were analyzed by multivariate logistic regression and a risk prediction model was developed. Calibration curve and receiver operating characteristic (ROC) curve were used to assess the accuracy and discrimination of the model. In addition, 61 TAAD patients admitted to our hospital from July 2021 to May 2022 (validation set) were used for external validation. 【Results】 The rate of intraoperative massive RBC transfusion in 233 TAAD patients was 45.06% (95% CI: 38.59%-51.69%). Logistic analysis showed that women, age >50 years, preoperative Hb≤131.50 g/L, intraoperative bleeding >720 mL, and CPB time >155 min were independent risk factors for massive intraoperative RBC transfusion (P<0.05). The intraoperative risk prediction model formula for massive RBC infusion was: -4.427+ 0.925×gender+ 1.461×age+ 2.081×preoperative Hb+ 1.573×bleeding volume+ 2.823×CPB time. The area under the ROC curve of the modeling set and validation set were 0.904 (95% CI: 0.865-0.943) vs 0.868 (95%CI: 0.779-0.958), and the slopes of the calibration curves all converged to 1, indicating that the model predicted the risk of intraoperative massive RBC infusion in TAAD patients in good consistency with the actual risk of massive infusion. The decision curve shows that the model exhibits a positive net benefit with a threshold probability of 0.15-0.67 and has a high clinical application value. 【Conclusion】 The prediction model constructed based on the risk factors of intraoperative massive RBC infusion in TAAD patients can effectively predict the risk of intraoperative massive RBC infusion with high clinical predictive efficacy.

Optimization of the new Plates-B&T method for nucleated cell separation in cord blood / 中国输血杂志

【Objective】 To optimize the bottom and top(B&T) method for nucleated cell separation in cord blood in order to reduce the disturbance and improve the nucleated cell yield. 【Methods】 A new device comprised of two plastic plates and connection units was developed. B&T Cord blood bag was put between the plates, which were then centrifuged and put into the serum expresser together to go through serum and red blood cells separation simultaneously. After centrifugation parameter adjustment, the new Plates-B&T method was compared with traditional method in parallel. 【Results】 New Plates-B&T method could avoid buffy coat movement and disturbance. Compared to conventional PRP method, Plates-B&T method reduced centrifugation and separation time from(29.12±2.79)min to(14.91±2.12)min(P<0.05). Using new method, the recovery rate of total nucleated cell(TNC) was (89.04±5.19)%, the removal rate of red blood cell(RBC) was(55.56±22.57) %, and hematocrit(HCT) in buffy coat was(0.48±0.09)L/L. RBC removal was enhanced significantly, especially for cord blood samples with medium-low volume. 【Conclusion】 Based on B&T method, we established a new device and method, which increased the efficiency and quality of cord blood nucleated cell separation.

Evidence-based practice of the puncture management in hemodialysis patients with difficult new arteriovenous fistula / 中国实用护理杂志

Objective:To explore the puncture management in hemodialysis patients with difficult new arteriovenous fistula based on the finest evidence-based best practice evidence and evaluate the clinical effects.Methods:A team was formed, according to theoretical framework basing on the evidence of continuous quality improvement model, the best evidence-based interventions were obtained by adopting evidence-based practice. Formulated review indicators, evaluated obstacles and promoting factors in the process of practice, and took corresponding action strategies. From February 2020 to June 2020, 30 patients admitted to the dialysis center of Sir Run Run Shaw Hospital of Zhejiang University were recruited in the baseline review group by convenience sampling method. From September 2020 to January 2021, 30 patients from September 2020 to January 2021 were recruited in the after-effect evaluation group. The baseline review group adopted the original difficult new arteriovenous fistula puncture management scheme, and the after-effect evaluation group adopted the difficult autologous new internal fistula puncture management scheme based on the best evidence. The success rate of one puncture of fistula, the incidence rate of hematoma during puncture and dialysis, the incidence rate of discontinuation of treatment and the compliance with examination indexes were compared in the patients before and after applying for the evidences.Results:Compared with the baseline review group, the success rate of one-time puncture of internal fistula in the aftereffect evaluation group increased from 36.7% (11/30) to 73.3% (22/30), the incidence rate of hematoma during puncture and dialysis were decreased from 33.3%(10/30) to 6.67%(2/30) and 40%(12/30) to 0, the incidence rate of discontinuation of treatment were decreased from 40%(12/30) to3.33% (1/30), the difference was statistically significant ( χ2 values were 6.67-11.88, P<0.05). The implementation rate of review indexes in the aftereffect evaluation group was higher than that in the baseline review group, and the difference was statistically significant ( P<0.05). Conclusions:Evidence-based practice can improve the success rate of difficult new arteriovenous fistula, and reduce the incidence of arteriovenous fistula hematoma, reduce treatment interruption, and better maintain the lifeline of patients.

A survey of benefit finding of caregivers in senile dementia patients and analysis of influencing factors / 中国实用护理杂志

Objective:To investigate the status of caregivers' benefit finding of senile dementia patients in Shiyan city, Hubei Province, and to analyze its influencing factors, so as to provide basis for carrying out targeted intervention measures.Methods:Totally 252 caregivers of senile dementia patients who visited Taihe Hospital, Shiyan People′s Hospital and Sinopharm Dongfeng General Hospital in Shiyan City, Hubei Province from July 2019 to July 2021 were selected as the research objects by convenience sampling method. The general Information Questionnaire, the Caregiver benefit finding questionnaire, the General self-efficacy Scale (GSES) and the Perceived Social Support Scale (PSSS) were used. The Pearson correlation analysis method was used for the correlation between caregivers' self-efficacy, social support and perceived benefit. Catreg was used to analyze the influencing factors of caregivers' benefit finding in senile dementia patients.Results:The total score of caregiver benefit questionnaire for 252 caregivers of senile dementia patients was (104.74 ± 14.82), the item "made me realize the significance of my health to my family and society" received the highest score (4.70 ± 0.55), while the item "made me quit bad habits" received the lowest score (3.22 ± 1.17). The GSES and PSSS scores of 252 caregivers of senile dementia patients were (24.74 ± 7.02) and (54.21 ± 13.32), which were positively correlated with the benefit finding ( r=0.565, 0.459, both P<0.01). The catreg analysis showed that the age of the caregiver, the average monthly income of the family, self-efficacy and social support were the influential factors of the perceived benefit level of the caregiver of senile dementia patients ( F values were 3.30-104.92, all P<0.05), which could explain 42.4% of the variance. Conclusions:The benefit finding of caregivers of senile dementia patients still needs to be improved. Medical staff should pay attention to the evaluation of benefit finding of caregivers of senile dementia patients, and provide personalized intervention measures to relieve caregivers' care pressure, maintain their physical and mental health, and improve the care quality of caregivers of senile dementia patients.

Role of exosomes in respiratory diseases / 环境与职业医学

Respiratory diseases are a group of different conditions affecting the airways, including acute lung injury, asthma, chronic obstructive pulmonary disorder, and idiopathic pulmonary fibrosis. Recent studies have demonstrated the extracellular vesicles (EVs) produced and secreted by autologous cells are able to induce inflammatory responses and immune activation in respiratory diseases. Exosomes, a type of EVs (30-150 nm) containing nuclear acids, proteins, lipids, and metabolites, can transfer bioactive cargo and have potential implications for disease pathogenesis. Although the biological functions of exosomes in cancer and cardiovascular diseases have been widely addressed, their pathophysiological mechanisms in respiratory disorders are still not completely understood. In this review, we first presented current methodologies in use for exosomes isolation and characterization from biological fluids, such as bronchoalveolar lavage fluid, nasal lavage fluid, exhaled breath condensate, sputum supernatant, and blood. And then, we critically discussed the crucial role of exosomes in respiratory diseases, not only focusing on their involvement in the development of airway diseases, but also on their diagnostic and therapeutic potential. A better understanding of these mechanisms will provide opportunities for research on respiratory diseases induced by environmental and occupational exposure to particulate matter in which exosomes contribute to the disease development.

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Neoadjuvant chemoimmunotherapy combined with surgery for patients with non-small-cell lung cancer staged as ⅢA / 中华胸心血管外科杂志

Objective:To explore the efficacy and safety of neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients.Methods:Six patients with NSCLC who were diagnosed as ⅢA and received two cycles of neoadjuvant chemoimmunotherapy and surgery between September 2019 and January 2020 were described in this study.Results:Five of them experienced AEs during neoadjuvant therapy. All of them received surgery and achieved an MPR of 50%. No viable tumor cells were found in the tissues of one patient. One patient with a small bronchopleural fistula after lobectomy.Conclusion:Neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients is safe and efficient. Long-term outcomes of neoadjuvant chemoimmunotherapy combined with surgery should be further validated.

Pathogenicity evaluation and splicing correction of COL4A5 splice mutation in X-linked Alport syndrome / 中华肾脏病杂志

Objective:To analyze the splicing mutation site of COL4A5 gene in a family with X-linked dominant Alport syndrome and explore the possibility of exon specific U1 small nuclear RNA (snRNA) gene therapy. Methods:The clinical data of the proband and family members of Alport syndrome were collected, and the gene mutations in the whole exon of a series of nephropathy genes in the proband were detected by high-throughput sequencing. The splice site changes and pathogenicity caused by COL4A5 c.546+5G>A mutation were analyzed by online software. Minigene experiment was used to verify and analyze the effect of COL4A5 gene mutation site c.546+5G>A in the proband of Alport syndrome family, and transient transfection and introduction of modified U1 snRNA to correct splicing mutation. Results:The results of gene sequencing showed that there was a hemizygous variation of COL4A5 gene in the proband and his half brother, and the variation site was c.546+5G>A. The results of online software for analyzing the pathogenicity of splice variation showed that the original donor splicing site could not be detected after mutation, suggesting that there was a great possibility of affecting splicing. The abnormal splicing mode of COL4A5 gene with c.546+5G>A mutation—deletion of exon 9 was verified by hybridized small gene detection. The abnormal splicing mutation could be partially corrected by the modified U1 snRNA. The correction ratios of ExSpeU1 (MT), ExSpeU1(E9+1), ExSpeU1(E9+9) and ExSpeU1(E9+11) to exon 9 deletion caused by c.546+5G>A were 0, 43.81%, 52.09% and 48.12%, respectively. Conclusions:The pathogenicity of the new splicing mutation of COL4A5 is verified, and the modified U1 snRNA can partially correct the abnormal splicing.

Nursing care of patients with cardiogenic shock combined with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation and transferred outer-hospital in long distance / 中国实用护理杂志

Objective:To summarize the nursing experience in 2 patients with cardiogenic shock combined with acute respiratory distress syndrome(ARDS) treated by extracorporeal membrane oxygenation (ECMO) and transferred outer-hospital in long distance.Methods:There were many risk factors in this transport: high parameters of ECMO included V-A mode, 100% oxygen, and a flow of oxygen from 6 L/min to 10 L/min. High ventilator parameters included oxygen concentration of 100% and positive end-expiratory pressure of 15-17 cmH 2O(1 cmH 2O=0.098 kPa). Transport distance was up to 196 km. And the transport time was up to 2 h 36 min. In this regard, we carried out adequate preparations before transport and professional cares during transport. The main points were as follows: setted up a professional transport team; prepared adequate power and oxygen supply; reduced the number of interruption of ECMO and ventilator support during transport; provided the reasonable remedial actions when ECMO and ventilator support were interrupted. Results:Two patients arrived at the destination safely.Conclusions:Adequate preparations before transport and professional cares during transport could effectively avoid and respond to the occurrence of adverse events, and it is feasible and safe to patients supported by ECMO for long distance outer-hospital transport.

Observation on the effect of traditional Chinese Health Qigong Ba Duan Jin in the treatment of patients with stable chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the effect of traditional Chinese Health Qigong Ba Duan Jin in the treatment of patients with stable chronic obstructive pulmonary disease.Methods:From June 2017 to June 2019, 68 patients with stable chronic obstructive pulmonary disease admitted to Hangzhou Traditional Chinese Medicine Hospital were divided into control group and observation group according to the random number table method, with 34 cases in each group.The control group was treated with terbutaline sulfate and given routine interventions such as disease knowledge, diet guidance, psychological counseling, and oxygen therapy.The observation group was trained with the traditional Chinese Health Qigong Ba Duan Jin on the basis of the control group.The pulmonary function, blood gas analysis and St.George's respiratory score were measured before and after intervention.The 6-minute walking distance before and after intervention was recorded, and the clinical efficacy of the two groups was evaluated.Results:The lung function indicators of the two groups were significantly improved after intervention(all P<0.05). The improvement of lung function indexes in the observation group were significantly higher than those in the control group(all P<0.05). The PaO 2 levels of the two groups after intervention were significantly higher than those before intervention(all P<0.05). The PaO 2 levels in the observation group was significantly higher than that in the control group( P<0.05), and the PaCO 2 levels in the observation group was significantly lower than that in the control group( P<0.05). The symptoms, activity and life impact scores of the two groups were significantly lower than those before interventionp(all P<0.05). The decrease of the St.George's respiratory score in the observation group after intervention was more significant than that in the control group( P<0.05). The 6-minute walking distance of the observation group was (442.63±14.85)m, which was significantly longer than that of the control group[(417.28±13.07)m]( t=7.472, P=0.000). The total effective rate of the observation group was 88.24%(30/34), which was significantly higher than that of the control group[64.71%(22/34), χ 2=10.299, P=0.006]. Conclusion:The traditional Chinese Health Qigong Ba Duan Jin exercise combined with drugs and routine intervention can improve the lung function and blood gas index of patients with stable chronic obstructive pulmonary disease, slow down the decline of lung function, improve their exercise capacity and relieve breathing difficulties.Finally, improve the efficacy to improve their quality of life.

Exendin-4 alleviates oxidative stress and liver fibrosis by activating Nrf2/HO-1 in streptozotocin-induced diabetic mice / 南方医科大学学报

OBJECTIVE@#To investigate the effects of exendin-4 on hepatic lipid metabolism, fibrosis and oxidative stress in mice with streptozotocin (STZ)-induced diabetes and explore the underlying mechanisms.@*METHODS@#C57BL/6J mice were fed with high-fat diet (HFD) for 4 weeks and received intraperitoneal injections of 120 mg/kg STZ to induce diabetes. After successful modeling, the mice were randomized into diabetic control group and exendin-4 treatment group (DM+E4), and in the latter group, the mice were given a daily dose of 1 nmol/kg of exendin-4 for 8 weeks. The changes in the body weight (BW) and random blood glucose (RBG) in the mice were recorded. The mRNA expressions of the genes related with liver lipid metabolism, fibrosis and oxidative stress were analyzed using RT-PCR, and the structural changes of the liver tissues were observed with HE, Sirius red and oil red O staining; the expressions of TGF-β1, Nrf2 and HO-1 proteins in the liver tissues were detected using Western blotting.@*RESULTS@#The diabetic mice showed significantly higher RBG levels and BW with obvious lipid deposition, fibrosis and oxidative stress in the liver as compared with the normal control mice ( < 0.001). Exendin-4 treatment of the diabetic mice did not significantly lessened liver lipid deposition but obviously reduced the levels of RBG and TG ( < 0.05), lowered the expression levels of liver fibrosis-related genes TGF-β, -SMA and Col-Ⅰ ( < 0.05), increased the expression levels of the antioxidant genes Nrf2, HO-1 and GPX4 ( < 0.01), and enhanced the protein expressions of Nrf2 and HO-1 in the liver tissues ( < 0.01).@*CONCLUSIONS@#Exendin-4 improves liver fibrosis and oxidative stress in diabetic mice by activating Nrf2/HO-1 pathway without significantly reducing liver lipid deposition.

Effect of dexmedetomidine on HMGB1/TLRs signaling pathway during lung injury in septic rats / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on high-mobility group box 1 protein (HMGB1)/Toll-like receptors (TLRs) signaling pathway during lung injury in septic rats.Methods Twenty-four SPF healthy adult male Wistar rats,aged 15-18 weeks,weighing 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),sepsis group (group Sep) and dexmedetomidine group (group D).Dexmedetomidine 25 μg/kg was intraperitoneally injected in D group,while the equal volume of normal saline was given instead in S and Sep groups.Sepsis was produced by cecal ligation and puncture in Sep and D groups.The rats were sacrificed at 24 h after operation,and the right lung was removed for examination of the pathological changes which were scored and for determination of myeloperoxidase (MPO) activity,content of interleukin-1β (IL-1β),IL-6 and tumor necrosis factor-α (TNF-α) in lung tissues (by enzyme-linked immunosorbent assay),wet to dry weight ratio (W/D ratio) and expression of HMGB1,TLR2 and TLR4 in lung tissues (by Western blot).Results Compared with group S,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly increased in Sep and D groups (P＜0.05).Compared with group Sep,the MPO activity,lung injury score,W/D ratio,content of IL-1β,IL-6,TNF-α and expression of HMGB1,TLR2 and TLR4 were significantly decreased in group D (P＜0.05).Conclusion Dexmedetomidine reduces lung injury through inhibiting HMGB1/TLRs signaling pathway in septic rats.

Application of Team Strategies & Tools to Enhance Performance and Patient Safety for hyperphosphatemic dietary management in outpatients on maintenance hemodialysis / 中国实用护理杂志

Objective To explore the effectiveness of Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing hyperphosphatemia of outpatients on maintenance hemodialysis.Methods A total of 56 outpatients on hemodialysis received traditional dietary management from April to June,2016 were as control group,and 60 patients from October to December,2016 with TeamSTEPPS implemented in hyperphosphatemic dietary management were as observation group.The difference of the incidence rate of hyperphosphatemia and hypoproteinemia,grasp of knowledge of hyperphosphatemic dietary management were compared between two groups and medical staffs.Results The incidence rate of hyperphosphatemia were dropped from 60.7％(34/56) in control group to 41.7％(25/60) in observation group,difference between two groups had statistical significance(x2=4.20,P=0.036).The hypoproteinemia had no statistical difference between two group(x2=2.72,P=0.102),but still dropped from 39.3％ (22/56) in control group to 25.0％ (15/60) in observation group.Grasp of knowledge of hyperphosphatemic dietary management were rised from (75.1±5.1) points and (69.7 ±6.4)points in control group and medical staffs to (88.4±2.6) points and (80.1±6.5) points in observation group and medical staffs respectively,and there were significant differences(t=15.82,-8.84,P=0.00).Conclusions The application of TeamSTEPPS for hyperphosphatemic dietary management in outpatients on maintenance hemodialysis can effectively decrease the incidence of the hyperphosphatemia.

Comparison of epidermal growth factor receptor (EGFR) gene T790M mutation by droplet digital PCR and Super-ARMS PCR in plasma ctDNA samples of non-small cell lung cancer patients with the resistance to EGFR-tyrosine kinase inhibitor / 中华病理学杂志

Objective@#To compare droplet digital PCR (ddPCR) and Super-amplification refractory mutation system (ARMS) in the detection of T790M mutation of epidermal growth factor receptor (EGFR) in the plasma of non-small cell lung cancer patients who had developed resistance to EGFR tyrosine kinase inhibitor (TKI) , and to investigate the clinical application of ddPCR.@*Methods@#Plasma samples were collected from non-small cell lung cancer patients who had acquired EGFR-TKI resistance at Shanghai Pulmonary Hospital, Tongji University, from May 2017 to November 2017. Extracted ctDNA was analyzed by ddPCR and Super-ARMS to evaluate the T790M mutation status of EGFR gene.@*Results@#A total of 37 patients with activating EGFR mutation that acquired resistance to EGFR-TKI were selected in the study, including 17 male and 20 female with a median age of 64 years (range 40-83 years). Before TKI treatment, all the patients harbored EGFR inhibitor sensitive mutations but without T790M mutation. After acquiring resistance to EGFR-TKI treatment, the T790M mutation rate detectable by ddPCR was 45.9% (17/37). In contrast, the mutation rate of T790M detectable by Super-ARMS was 35.1% (13/37, P<0.05). For the 13 positive cases detected by Super-ARMS (ΔCt<8), they were all positive by ddPCR assay; Among the 10 negative cases detected by Super-ARMS (ΔCt≥8), there were 3 cases positive by ddPCR assay. For patients without ΔCt by Super-ARMS assay, there was one weak positive case detectable by ddPCR assay. Among 17 EGFR T790M positive patients, 9 received EGFR inhibitor Osimertinib treatment, and 7 of them had good therapeutic response after the treatment.@*Conclusions@#While a significant correlation between the two methods is shown. ddPCR is more sensitive than Super-ARMS in the detection of EGFR T790M mutation, indicating that it is a better method in guiding target drug therapy of non-small cell lung cancer patients after acquiring the resistance to EGFR-TKI.

Prospective study of anterior uterocervical angle for prediction of preterm birth in second trimester with transperineal ultrasound / 中华超声影像学杂志

Objective To explore the possibility and value of the anterior uterocervical angle ( ACA) and cervical length for prediction of preterm birth in second trimester with the transperineal ultrasound . Methods This study retrospectively reviewed the relevant medical records of single birth primiparas undergoing prenatal ultrasonographic evaluation in Wuxi People′s Hospital Affiliated to Nanjing Medical University from January 2016 to December 2016 . The pregnant women were divided into preterm group and term group according to the pregnancy outcomes ( with or without preterm birth) . The ACA and cervical length of these pregnancies were measured in the second trimester ( between 22 -24 weeks gestation) with the transperineal ultrasound . Results A total of 1064 pregnant women were enrolled in the study ,with 84 cases in preterm group ( 78 .9％ ,84/1064) and 980 cases in term group ( 92 .11％ ,980/1064) . Age of women in the two groups had no statistics difference( P =0 .86) . The mean ACA and cervical length of preterm group were ( 112 .48 ± 15 .83)° and ( 30 .94 ± 6 .32) mm ,and the mean ACA and cervical length of term group were (103 .52 ± 13 .78)° and (37 .28 ± 6 .74)mm ,there were statistically difference( P <0 .05) . The area under ROC curve of the ACA was 0 .882 ,of the cervical length was 0 .664 ,the corresponding cutoff value were 113°and 27 mm ,respectively . The sensitivity of the ACA and cervical length in predicting preterm birth were 86 .90％ and 71 .43％ ,the specificity were 75 .00％ and 62 .14％ ,the accuracy were 75 .94％ and 62 .66％ ,respectively . Conclusions The ACA is an objective and effective indicator to predict preterm birth in the second trimester with transperineal ultrasound . The diagnostic value of measuring the ACA is better than that of measuring the cervical length in the same period .

Clinicopathologic features and genetic profile of the redefined large cell lung carcinoma / 中华病理学杂志

Objective@#To investigate the clinicopathologic features and genetic profile of large cell lung carcinoma (LCC) redefined by new classification.@*Methods@#Basing on 2015 WHO classification criteria in redefining large cell lung carcinoma, the expression of specific markers (TTF1, Napsin A, p40, CK5/6, CK, vimentin and ZEB1) was detected by immunohistochemistry and D-PAS staining in 303 surgically-removed lung specimens previously diagnosed as large cell lung carcinoma. The clinicopathologic and genetic characteristics (including EGFR, KRAS, BRAF, ALK and ROS1 gene mutation) were analyzed.@*Results@#Based on the new definition of LCC, 116 cases (116/303, 38.3%) of LCC formerly diagnosed were reclassified as solid adenocarcinoma, 49 cases (49/303, 16.2%) as squamous cell carcinoma, 6 cases (6/303, 2.0%) as adenosquamous carcinoma, 22 cases (22/303, 7.3%) as spindle cell carcinoma and only 110 cases (110/303, 36.3%) as large cell carcinoma. Redefined LCCs were characterized as middle-age (range 40-80), male (102/110, 92.7%) and smoking patients (64/110, 58.2%) with intermediate-advanced stage. Among 110 cases, 9 cases with EGFR mutation and 10 cases with KRAS mutation and 1 case with ALK fusion were found. No BRAF and ROS1 alterations were identified.@*Conclusions@#According to the new classification, LCCs formerly diagnosed are mostly reclassified as adenocarcinoma and non-keratinizing squamous cell carcinoma. The newly defined LCC may significantly benefit from clinical therapy.

Analysis of cognition and motivation of blood donation for blood donors in blood collection vehicles / 中国输血杂志

Objective To investigate the status of blood donation in Shanghai streets,understanding the motivation of the donors for blood donation and how many times they had donate their blood.Here,we intend to improve work efficiency in order to better serve the blood donators and to provide a theoretical basis.Methods To gain insight into the understanding and attitude of citizens for blood donation,we analyzed the volunteer blood donors in 387 vehicles and 436 outdoor pre mobilization object by six months,questionnaire in blood collection vehicle or at scene etc.Results The survey specifically reflected the understanding,attitude and motivation of citizens and foreign workers for blood donation in Shanghai.Conclusion There existed many problems such as wrong recognition,diversified motivation among many citizens for blood donation.More publicity and education for the knowledge of blood donation are needed and it plays significant and longlasting role for blood donation.

Data analysis of hearing of 719 recruited students from teenager flying school and discussion of relative standards / 军事医学

Objective To analyze the data on hearing of recruited students from a teenager aviation school according to both the standards of PLA and those of the US Armed Forces , to learn about their differences in hearing standards in medi-cal selection, and to raise suggestions on establishing hearing standards for medical selection of flying cadets from teenager aviation schools .Methods The data collected on the first hearing test about hearing of students from Hebei Teenager Aviation School were collected .The validity of the data was determined according to the medical selection standards both of PLA and of the US Armed Forces respectively .The cases of qualified or unqualified recruits at high frequency and middle -low frequency were counted respectively and analyzed statistically .Results The unqualified recruits determined by PLA′s standards tended to be unqualified too when determined by the US Armed Forces standards .During the screening of high frequency hearing and the general hearing condition , the proportion of unqualified cases determined by the US selection standards was higher than that determined by PLA′s selection standard .In the screening of middle-low frequency hearing , no statistically significant difference was found in the proportion of unqualified cases when the two different selection standards were used.Conclusion The hearing standard for medical selection of flying cadets at high frequency in the US Armed Forces is stricter than that in the PLA .Meanwhile, the hearing standard at middle-low frequency in the US Armed Forces is different from that in the PLA , though there are no statistically significant differences in the proportion of unqualified cases.The hearing standards of the US Armed Forces are recommended in recruiting flying cadets for teenager flying schools .

The design and clinical application of a new type of disposable heparin free dialysis tube / 中国实用护理杂志

Objective To investigate the clinical effect of a new type of disposable heparin freedialysis tube in uremic patients without heparin dialysis. Methods A total of 110 patients withoutheparin dialysis were divided into control group and observation group by random digits table method with55 cases each. Based on the same pre dialysis and dialysis for heparin saline flushing of discontinuoussaline on the control group using the traditional dialysis pipe for hemodialysis without heparin, theobservation group used disposable non heparin dialysis pipe for hemodialysis without heparin. The numberof patients with venous catheter blockage, blood loss and completion of dialysis time in two groups wasrecorded. Results The number of patients with venous catheter blockage, blood loss and completion ofdialysis time was 6, 6, 47 cases in control group and 0, 0, 54 cases in observation group. The differences were statistically significant (χ2=4.407, 4.407, 4.356, P<0.05). Conclusions The new disposableheparin free dialysis tube can reduce the loss of blood and prolong the treatment time, and the operation issimple, safe and effective, and has good application value and application prospect.