Application of the 3t sensorial saturation in femoral vein blood collection of premature infants / 中国实用护理杂志

Objective:To investigate the effect of the 3t sensorial saturation in the application of relieving pain and comfort due to femoral vein blood sampling in preterm infants, so as to provide the reference for the selection of clinical nursing plans.Methods:This was a quasi experimental study. A total of 110 preterm infants admitted to the neonatal unit of Shanxi Children′s Hospital from August 2021 to March 2022 were selected and divided into the control group and intervention group with 52 cases respectively by the random number table method. The control group implemented conventional care, and the intervention group implemented the 3t sensorial saturation method including taste, touch and talk on the basis of the control group. The pain and comfort of two groups were evaluated by the Premature Infant Pain Profile (PIPP) and COMFORTneo Scale at 3 min before, during, and 3 min after blood, and the heart rate and SpO 2 of the two groups were compared. Results:Finally, 52 premature infants were included in both groups. The PIPP score, the total score of the COMFORTneo Scale, the heart rate and SpO 2 were 2.00 (1.00, 3.00), 6.50 (6.00, 7.75), 4.00 (3.00, 5.00), 7.00 (6.00, 8.00), 17.00 (15.00, 19.00), 9.50 (9.00, 10.00) points, (137.29 ± 8.58), (148.31 ± 8.89), (143.06 ± 7.61) times/min, 0.980 (0.970, 0.990), 0.960 (0.950, 0.970), 0.980 (0.970, 0.990) in the intervention group, 2.00 (1.25, 3.00), 12.00 (11.00, 13.00), 7.00 (6.00, 8.00), 7.00 (6.00, 9.00), 25.00 (23.00, 27.00), 20.00 (19.00, 22.00) points, (141.54 ± 10.57), (179.71 ± 14.62), (162.00 ± 14.32) times/min, 0.980 (0.960, 0.990), 0.940 (0.920, 0.958), 0.960 (0.940, 0.978). The results of generalized estimating equation analysis showed that the PIPP score, total COMFORTneo Scale score and SpO 2 via different time points, subgroups, and subgroups with time points were statistically significant (Wald χ2 values were 16.72-2 489.71, all P<0.05). The results of two-factor repeated measures ANOVA showed that the interaction effects of heart rate via different time points, subgroups, and subgroups with time points were statistically significant ( F=253.08, 105.02, 77.17, all P<0.05). Conclusions:The 3t sensorial saturation method can effectively reduce pain during femoral vein blood sampling in preterm infants, can improve the comfort level of preterm infants, is conducive to the stabilization of vital signs in preterm infants, and is suitable for promotion and application in clinical care.

The current situation of paternal self-efficacy of support breastfeeding of late prematurity and its influencing factors / 中国实用护理杂志

Objective:To investigate the current situation of paternal self-efficacy of support breastfeeding of late prematurity and analyze the factors affectingpaternal self-efficacy of support breastfeeding.Methods:This study was a cross-sectional survey. From July to October 2021, the fathers of 210 late prematurity in Neonatology and NICU wards of Shanxi Children′s Hospital, were selected by convenience sampling method for the research object. The survey was carried out using the General Information Questionnaire, Iowa Infant Feeding Attitude Scale and Father Support Breastfeeding Self-Efficacy Scale-Short Form, multiple linear regression was used to analyze the influencing factors of paternal self-efficacy of support breastfeeding of late prematurity.Results:The total score of Father Support Breastfeeding Self-Efficacy Scale-Short Form was 46.22 ± 10.03, and the total score of Iowa Infant Feeding Attitude Scale was 59.31 ± 5.65, which were positively correlated ( r = 0.224, P<0.01). In the multiple linear regression analysis, whether or not to receive breastfeeding education, feeding methods, family opinions, and fathers′ attitudes towards breastfeeding were the main factors affecting fathers′ self-efficacy in supporting breastfeeding ( t values were - 3.07 to 2.35, all P<0.05). Conclusions:The paternal support breastfeeding of late prematurity level was at a lower level. It is suggested that medical staff should not only pay attention to puerpera and baby, but also pay attentionto father and family, and construct personalized health education based on co-parenting theory.

Effect of self-made Bushen Jiangu Decoction combined with conventional western medicine therapy on the postoperative efficacy and bone transformation markers of osteoporotic vertebral compression fracture in the elderly / 国际中医中药杂志

Objective:To investigate the effect of self-made Bushen Jiangu Decoction on bone transformation markers in elderly patients with osteoporotic vertebral compression fracture after operation, and to evaluate the clinical efficacy.Methods:Prospective cohort study. A total of 92 patients with osteoporotic vertebral compression fracture after operation in Fangshan Hospital of Beijing University of Chinese Medicine from April 2020 to December 2021 who met the inclusion criteria were divided into 2 groups by random drawing method, with 46 in each group. The control group was treated with routine western medicine after operation, and the observation group was treated with self-made Bushen Jiangu Decoction on the basis of the control group. Both groups were treated for 3 months. TCM symptom scores were performed before and after treatment, and the prognosis of the patients was evaluated with the Chinese Osteoporosis Quality of Life (COQOL), VAS scale, and the Oswestry Dysfunction Index (ODI). The levels of amino terminal propeptide (PINP), cross-linked terminal peptide β special sequence (β-CTX) and bone morphogenetic protein 6 (BMP6) of type Ⅰ procollagen were determined by contrast chromogenic method with o-benzaldehyde. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 95.7% (44/46) in the observation group and 82.6% (38/46) in the control group, and there was a significant difference between the two groups ( χ 2=4.04 , P=0.044). After treatment, the scores of fracture nonunion, pain in back and loin, chilliness and lassitude, and pallor in the observation group were significantly lower than those in the control group ( t values were 4.84, 4.09, 4.87, 4.14, respectively, P<0.01). The scores of COQOL, VAS and ODI in the observation group were significantly lower than those in the control group ( t values were 6.26, 10.57 and 6.15, respectively, P<0.01). The levels of PINP [(44.93±5.86)μg/L vs. (49.76±6.02)μg/L, t=3.90] and β-CTX [(0.49±0.17) μg/L vs. (0.68±0.20) μg/L, t=4.91] in observation group were significantly lower than those in the control group after treatment ( P<0.05). The level of BMP6 [(81.23±9.14) μg/L vs. (75.14±8.25) μg/L, t=3.36] in observation group was significantly higher than that of the control group ( P<0.05). During the treatment,the incidence of adverse reactions in the observation group was 13.0% (6/46), while that in the control group was 8.7% (4/46), and there was no significant difference between the two groups ( χ 2=0.45, P=0.503). Conclusion:The self-made Bushen Jiangu Decoction combined with conventional western medicine therapy can adjust the level of bone transformation markers in elderly patients with osteoporotic vertebral compression fractures, improve the lumbar function and quality of life, and improve the clinical efficacy.

Analysis of early hemorrhage from pancreaticojejunal anastomosis after pancreaticoduodenectomy / 国际外科学杂志

Objective:To explore the therapeutic experience of early postoperative hemorrhage (EPOH) from pancreaticojejunal anastomosis after pancreaticoduodenectomy (PD).Methods:A retrospective review was conducted to summarize the clinical data of a typical case of EPOH from pancreaticojejunal anastomosis after PD in Binzhou Second People′s Hospital, and the main causes and treatment of EPOH were analyzed.Results:Due to reasons such as the slender pancreatic duct, the pancreatic duct was not found after twice transections of the pancreas during the surgery. To prevent poor pancreatic fluid drainage and related complications, the pancreatic stump was not effectively sutured, and a vertical mattress suture method was used for the pancreaticojejunal anastomosis. The patient developed severe EPOH on the surgery day. Due to the fact that the digestive tract reconstruction was a biliary pancreatic separation method, the cause of EPOH was diagnosed from pancreaticojejunal anastomosis through imaging and endoscopy. After active medical treatment, the patient recovered and was discharged.Conclusion:For the treatment of pancreatic stump after PD, precise suturing should be performed on the stump while ensuring smooth pancreatic duct drainage, in order to avoid EPOH from pancreaticojejunal anastomosis to the greatest extent possible.

The correlation between the expression levels of vitamin D receptor in bile duct epithelial cells and the prognosis of biliary atresia / 国际儿科学杂志

Objective:To investigate the expression of vitamin D receptor(VDR)in biliary epithelial cells of children with biliary atresia(BA)and explore the correlation between VDR epression levels and clinical pathological prognosis.Methods:A total of 48 BA patients who underwent Kasai surgery in the Pediatric Surgery Department of the Second Affiliated Hospital of Xi′an Jiaotong University from January 2017 to December 2020 with confirmed pathological results were selected as the study subjects.Immunohistochemistry was used to determine the expression of VDR in biliary epithelial cells, and Masson staining was used to determine the degree of liver tissue fibrosis.Based on the VDR expression levels, the 48 BA patients were divided into the significantly low VDR expression group(30 cases)and the normal/high expression group(18 cases).Laboratory testing results within 1 week before Kasai surgery and liver shear wave elastography(SWE)data were collected for all patients.Follow-up was conducted for a period of 0 to 60 months after Kasai surgery or liver transplantation, meanwhile, the occurrence of refractory cholangitis and auto-liver survival time were collected.Results:There was a negative correlation between the degree of liver fibrosis and SWE value in children with BA( r=-0.805, P<0.01).In comparison between the two groups, the significantly low VDR expression group had higher SWE values[(20.57±1.28)kPa vs.(18.02±1.41)kPa, P<0.05], higher liver injury biochemical indicators[ALT(215.8±24.7)U/L vs.(182.6±21.2)U/L, P=0.021; AST(165.4±22.3)U/L vs.(139.6±21.4)U/L, P=0.014], a higher frequency of post-Kasai surgery refractory cholangitis(60.00% vs.22.22%, P=0.037), and a shorter median autologous liver survival time(27.00 months vs.36.00 months, P=0.032)than those in the normal/high expression group. Conclusion:The significant decrease in VDR expression in biliary epithelial cells may serve as an indicator of poor prognosis in BA.

Progress on biomarkers of Mycoplasma pneumoniae pneumonia / 国际儿科学杂志

Mycoplasma pneumoniae pneumonia is an important component of community-acquired pneumonia, which can cause severe extrapulmonary complications of digestive, cardiovascular, blood, urinary and other systems.Accurate and effective biomarkers are significant for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia.Recent studies have shown that new biomarkers such as IL-35, IL-17, neutrophil to lymphocyte ratio(NLR) and S100 protein are involved in the development of Mycoplasma pneumoniae pneumonia.In order to provide reference for the clinical diagnosis and treatment of Mycoplasma pneumoniae pneumonia, this paper reviews the progress of new biomarkers in Mycoplasma pneumoniae pneumonia.

Research Progress on Combination of Radiotherapy and Immunotherapy on Advanced Non-small Cell Lung Cancer with Negative Driver Genes / 肿瘤防治研究

A large proportion of patients with non-small cell lung cancer (NSCLC) are diagnosed with metastatic and incurable advanced lung cancer at the time of discovery, so these patients are given no surgical opportunity and have a low 5-year survival rate. In the era of immunotherapy, many kinds of immune checkpoint inhibitors (ICIs) have been approved as the first/second-line treatment for patients with advanced NSCLC with negative driving genes and have been combined with radiotherapy as an important treatment strategy for patients with advanced NSCLC. The innovative strategy of combining radiotherapy and immunotherapy has shown feasibility as supported by practical evidence in clinical research. A preclinical experiment of observing the immune mechanism at the molecular and cellular levels preliminarily revealed the interaction among tumor, radiation, and immune system. This paper briefly reviews the progress of combined radiotherapy and immunotherapy in the treatment of advanced NSCLC with negative drvier genes.

Assessment of liver transplant benefit and a novel strategy for liver donor allocation in acute-on-chronic liver failure / 中华肝脏病杂志

Acute-on-chronic liver failure (ACLF) is a type of complex clinical syndrome that is mainly characterized by acute deterioration of liver function based on chronic liver disease, hepatic and extrahepatic organ failures, and a high short-term mortality rate. The comprehensive medical treatment efficacy of ACLF is currently limited; thus, liver transplantation is the only viable potential treatment method. However, considering the severe liver donor shortage, economic and social costs, as well as the differences in disease severity and prognosis of different disease courses, it is particularly important to accurately assess the benefits of liver transplantation in patients with ACLF. Early identification and prediction, timing, prognosis, and survival benefits are discussed here by combining the latest research findings so as to optimize the liver transplantation treatment strategy for ACLF.

Clinicopathological features of fibrin-associated diffuse large B-cell lymphoma: a report of six cases / 中华病理学杂志

Objective: To investigate the clinical, pathological and immunophenotypic features, molecular biology and prognosis of fibrin-associated large B-cell lymphoma (LBCL-FA) in various sites. Methods: Six cases of LBCL-FA diagnosed from April 2016 to November 2021 at the Beijing Friendship Hospital, Capital Medical University, Beijing, China and the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China were collected. The cases were divided into atrial myxoma and cyst-related groups. Clinical characteristics, pathological morphology, immunophenotype, Epstein Barr virus infection status, B-cell gene rearrangement and fluorescence in situ hybridization of MYC, bcl-2, bcl-6 were summarized. Results: The patients' mean age was 60 years. All of them were male. Three cases occurred in atrial myxoma background, while the others were in cyst-related background, including adrenal gland, abdominal cavity and subdura. All cases showed tumor cells located in pink fibrin clot. However, three cyst-related cases showed the cyst wall with obviously fibrosis and inflammatory cells. All cases tested were non germinal center B cell origin, positive for PD-L1, EBER and EBNA2, and were negative for MYC, bcl-2 and bcl-6 rearrangements, except one case with MYC, bcl-2 and bcl-6 amplification. All of the 5 cases showed monoclonal rearrangement of the Ig gene using PCR based analysis. The patients had detailed follow-ups of 9-120 months, were treated surgically without radiotherapy or chemotherapy, and had long-term disease-free survivals. Conclusions: LBCL-FA is a group of rare diseases occurring in various sites, with predilection in the context of atrial myxoma and cyst-related lesions. Cyst-related lesions with obvious chronic inflammatory background show more scarcity of lymphoid cells and obvious degeneration, which are easy to be missed or misdiagnosed. LBCL-FA overall has a good prognosis with the potential for cure by surgery alone and postoperative chemotherapy may not be necessary.

Study of the urban-impact on microbial communities and their virulence factors and antibiotic resistance genomes in the Nandu River, Haikou / 中华流行病学杂志

Objective: To explore the changes in bacterial community structure, antibiotic resistance genome, and pathogen virulence genome in river water before and after the river flowing through Haikou City and their transmission and dispersal patterns and to reveal anthropogenic disturbance's effects on microorganisms and resistance genes in the aquatic environment. Methods: The Nandu River was divided into three study areas: the front, middle and rear sections from the upstream before it flowed through Haikou City to the estuary. Three sampling sites were selected in each area, and six copies of the sample were collected in parallel at each site and mixed for 3 L per sample. Microbial community structure, antibiotic resistance, virulence factors, and mobile genetic elements were analyzed through bioinformatic data obtained by metagenomic sequencing and full-length sequencing of 16S rRNA genes. Variations in the distribution of bacterial communities between samples and correlation of transmission patterns were analyzed by principal co-ordinates analysis, procrustes analysis, and Mantel test. Results: As the river flowed through Haikou City, microbes' alpha diversity gradually decreased. Among them, Proteobacteria dominates in the bacterial community in the front, middle, and rear sections, and the relative abundance of Proteobacteria in the middle and rear sections was higher than that in the front segment. The diversity and abundance of antibiotic resistance genes, virulence factors, and mobile genetic elements were all at low levels in the front section and all increased significantly after flow through Haikou City. At the same time, horizontal transmission mediated by mobile genetic elements played a more significant role in the spread of antibiotic-resistance genes and virulence factors. Conclusions: Urbanization significantly impacts river bacteria and the resistance genes, virulence factors, and mobile genetic elements they carry. The Nandu River in Haikou flows through the city, receiving antibiotic-resistant and pathogen-associated bacteria excreted by the population. In contrast, antibiotic-resistant genes and virulence factors are enriched in bacteria, which indicates a threat to environmental health and public health. Comparison of river microbiomes and antibiotic resistance genomes before and after flow through cities is a valuable early warning indicator for monitoring the spread of antibiotic resistance.

Epidemiological characteristics of public health emergencies in Zhoushan City from 2004 to 2021 / 预防医学

Objective@#To analyze the epidemiological characteristics of public health emergencies in Zhoushan City from 2004 to 2021, so as to provide insights into the prevention and control of public health emergencies. @*Methods @#Data pertaining to public health emergencies and their associated data in Zhoushan City from 2004 to 2021 were retrieved from Emergency Public Health Management Information System of Chinese Disease Prevention and Control Information System. The type, date of occurrence and places of public health emergencies were descriptively analyzed.@*Results@#Sixty public health emergencies were reported in Zhoushan City from 2004 to 2021, during which 1 527 cases were reported and 52 661 individuals were involved, with an attack rate of 2.90% (95%CI: 2.78%-3.02%). There were 3 Ⅲ-level (5.00%), 13 Ⅳ-level (21.67%) and 44 unclassified public health emergencies (73.33%), and no Ⅰ- or Ⅱ-level emergencies were reported. The reported public health emergencies peaked in January (9), August (6) and December (9), and there were 47 infectious disease emergencies (78.33%), 10 food poisoning emergencies (16.67%) and 3 chemical gas poisoning emergencies (5.00%), respectively. The four most common infectious disease emergencies included other infectious diarrhea (25.53%), COVID-19 (17.02%), influenza (14.89%) and chickenpox (14.89%). School and kindergarten were predominant places where public health emergencies occurred (39, 65.00%), and the three most common public health emergencies reported by schools and kindergartens included other infectious diarrhea (28.21%), influenza (17.95%) and chickenpox (17.95%).@*Conclusions@#Infectious disease emergencies were predominant public health emergencies in Zhoushan City from 2004 to 2021, and Ⅳ-level and unclassified emergencies were predominant. Public health emergencies mainly occurred in schools and kindergartens.

Research advances in role of angiogenesis in diabetic ulcer and traditional Chinese medicine intervention / 中国中药杂志

Diabetic ulcer(DU) is one of the common complications of diabetes often occurring in the peripheral blood vessels of lower limbs or feet with a certain degree of damage. It has high morbidity and mortality, a long treatment cycle, and high cost. DU is often clinically manifested as skin ulcers or infections in the lower limbs or feet. In severe cases, it can ulcerate to the surface of tendons, bones or joint capsules, and even bone marrow. Without timely and correct treatment, most of the patients will have ulceration and blackening of the extremities. These patients will not be able to preserve the affected limbs through conservative treatment, and amputation must be performed. The etiology and pathogenesis of DU patients with the above condition are complex, which involves blood circulation interruption of DU wound, poor nutrition supply, and failure in discharge of metabolic waste. Relevant studies have also confirmed that promoting DU wound angiogenesis and restoring blood supply can effectively delay the occurrence and development of wound ulcers and provide nutritional support for wound healing, which is of great significance in the treatment of DU. There are many factors related to angiogenesis, including pro-angiogenic factors and anti-angiogenic factors. The dynamic balance between them plays a key role in angiogenesis. Meanwhile, previous studies have also confirmed that traditional Chinese medicine can enhance pro-angiogenic factors and down-regulate anti-angiogenic factors to promote angiogenesis. In addition, many experts and scholars have proposed that traditional Chinese medicine regulation of DU wound angiogenesis in the treatment of DU has broad prospects. Therefore, by consulting a large number of studies available, this paper expounded on the role of angiogenesis in DU wound and summarized the research advance in traditional Chinese medicine intervention in promoting the expression of angiogenic factors [vascular endothelial growth factor(VEGF), fibroblast growth factor(FGF), and angiopoietin(Ang)] which played a major role in promoting wound angiogenesis in the treatment of DU to provide ideas for further research and new methods for clinical treatment of DU.

Research progress in role of autophagy in diabetic wound healing and traditional Chinese medicine intervention / 中国中药杂志

Diabetic ulcer(DU) is a chronic and refractory ulcer which often occurs in the foot or lower limbs. It is a diabetic complication with high morbidity and mortality. The pathogenesis of DU is complex, and the therapies(such as debridement, flap transplantation, and application of antibiotics) are also complex and have long cycles. DU patients suffer from great economic and psychological pressure while enduring pain. Therefore, it is particularly important to promote rapid wound healing, reduce disability and mortality, protect limb function, and improve the quality of life of DU patients. By reviewing the relevant literatures, we have found that autophagy can remove DU wound pathogens, reduce wound inflammation, and accelerate ulcer wound healing and tissue repair. The main autophagy-related factors microtubule-binding light chain protein 3(LC3), autophagy-specific gene Beclin-1, and ubiquitin-binding protein p62 mediate autophagy. The traditional Chinese medicine(TCM) treatment of DU mitigates clinical symptoms, accelerates ulcer wound healing, reduces ulcer recurrence, and delays further deterioration of DU. Furthermore, under the guidance of syndrome differentiation and treatment and the overall concept, TCM treatment harmonizes yin and yang, ameliorates TCM syndrome, and treats underlying diseases, thereby curing DU from the root. Therefore, this article reviews the role of autophagy and major related factors LC3, Beclin-1, and p62 in the healing of DU wounds and the intervention of TCM, aiming to provide reference for the clinical treatment of DU wounds and subsequent in-depth studies.

Control of Emotion and Wakefulness by Neurotensinergic Neurons in the Parabrachial Nucleus / 神经科学通报·英文版

The parabrachial nucleus (PBN) integrates interoceptive and exteroceptive information to control various behavioral and physiological processes including breathing, emotion, and sleep/wake regulation through the neural circuits that connect to the forebrain and the brainstem. However, the precise identity and function of distinct PBN subpopulations are still largely unknown. Here, we leveraged molecular characterization, retrograde tracing, optogenetics, chemogenetics, and electrocortical recording approaches to identify a small subpopulation of neurotensin-expressing neurons in the PBN that largely project to the emotional control regions in the forebrain, rather than the medulla. Their activation induces freezing and anxiety-like behaviors, which in turn result in tachypnea. In addition, optogenetic and chemogenetic manipulations of these neurons revealed their function in promoting wakefulness and maintaining sleep architecture. We propose that these neurons comprise a PBN subpopulation with specific gene expression, connectivity, and function, which play essential roles in behavioral and physiological regulation.

Development and global validation of a 1-week-old piglet head finite element model for impact simulations / 中华创伤杂志(英文版)

PURPOSE@#Child head injury under impact scenarios (e.g. falls, vehicle crashes, etc.) is an important topic in the field of injury biomechanics. The head of piglet was commonly used as the surrogate to investigate the biomechanical response and mechanisms of pediatric head injuries because of the similar cellular structures and material properties. However, up to date, piglet head models with accurate geometry and material properties, which have been validated by impact experiments, are seldom. We aim to develop such a model for future research.@*METHODS@#In this study, first, the detailed anatomical structures of the piglet head, including the skull, suture, brain, pia mater, dura mater, cerebrospinal fluid, scalp and soft tissue, were constructed based on CT scans. Then, a structured butterfly method was adopted to mesh the complex geometries of the piglet head to generate high-quality elements and each component was assigned corresponding constitutive material models. Finally, the guided drop tower tests were conducted and the force-time histories were ectracted to validate the piglet head finite element model.@*RESULTS@#Simulations were conducted on the developed finite element model under impact conditions and the simulation results were compared with the experimental data from the guided drop tower tests and the published literature. The average peak force and duration of the guide drop tower test were similar to that of the simulation, with an error below 10%. The inaccuracy was below 20%. The average peak force and duration reported in the literature were comparable to those of the simulation, with the exception of the duration for an impact energy of 11 J. The results showed that the model was capable to capture the response of the pig head.@*CONCLUSION@#This study can provide an effective tool for investigating child head injury mechanisms and protection strategies under impact loading conditions.

Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia: a tertiary care center experience / 亚洲男科学杂志(英文版)

Patients with congenital unilateral absence of the vas deferens (CUAVD) manifest diverse symptoms from normospermia to azoospermia. Treatment for CUAVD patients with obstructive azoospermia (OA) is complicated, and there is a lack of relevant reports. In this study, we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA. From December 2015 to December 2020, 33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital (Shanghai, China). Patient information, ultrasound findings, semen analysis, hormone profiles, and treatment information were collected, and the clinical outcomes were evaluated. Of 33 patients, 29 patients were retrospectively analyzed. Vasoepididymostomy (VE) or cross VE was performed in 12 patients, the patency rate was 41.7% (5/12), and natural pregnancy was achieved in one of the patients. The other 17 patients underwent testicular sperm extraction as the distal vas deferens (contralateral side) was obstructed. These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA, even with a relatively low rate of patency and natural pregnancy.

Drug resistance and genomic characteristics of a strain of O139 Vibrio cholerae isolated from human bloodstream infection / 中华预防医学杂志

Objective: To analyze the drug resistance and genomic characteristics of a strain of serogroup O139 Vibrio cholerae producing cholera toxin isolated from the bloodstream of a person with bacteremia. Methods: The broth dilution method and automatic drug sensitivity analyzer were used to determine the antibiotic sensitivity of the strain. The complete genome sequence of the strain was obtained by using second-generation gene sequencing and nanopore sequencing. BLAST software was used for comparison and analysis with CARD, Resfinder, ISfinder, VFDB, and other databases. The drug-resistant genes, insertion sequences and virulence genes carried by the strain were identified. MEGA 5.1 software was used to construct a genetic phylogenetic tree based on the core genomic single nucleotide polymorphisms. Results: V. cholerae SH400, as the toxigenic strain, carried multiple virulence-related genes and four virulence islands. The strain was resistant to streptomycin, tetracycline and cotrimoxazole, carrying corresponding drug-resistant genes. The strain also carried IncA/C plasmid with the size of 172914 bp and contained 10 drug-resistant genes. Combined with the genomic evolutionary relationship, this study found that the drug-resistant genes and drug-resistant plasmids carried among strains showed certain aggregation. The traditional ST type of strain SH400 was ST69, and the cgMLST type was a new type highly similar to cgST-252. Conclusion: This strain of serogroup O139 V. cholerae carries the ctxAB gene, multiple drug-resistant genes and IncA/C plasmid, and there are multiple drug-resistant islands.

Pathological features and immune microenvironment in HER-2 intratumoral heterogeneous breast cancers / 中华肿瘤杂志

Objective: To observe the clinical pathology features, and immune microenvironment of HER-2 intratumoral heterogeneity breast cancer. Methods: Thirty cases of HER-2 intratumoral heterogeneous breast cancer were retrospectively analyzed in Tianjin Medical University Cancer Institute and Hospital from November 2017 to June 2020. HER-2 expression was detected by immunohistochemistry and verified by dual color silver-enhanced in-situ hybridization (D-SISH). HER-2 intratumoral positive and negative regions were divided. The pathological characteristics, subtype, and the level of tumor infiltrating lymphocytes (TILs) and the expression of programmed cell death-ligand 1 (PD-L1) were evaluated respectively. Results: The proportion of HER-2 positive cells of the breast cancer ranged from 10% to 90%. The pathological type was mainly invasive non-special typecarcinoma. Six cases presented different pathological types between HER-2 positive and negative regions. The HER-2-positive areas included 2 cases of carcinoma with apocrine differentiation, and the negative areas included 2 cases of invasive micropapillary carcinoma, 1 case of invasive papillary carcinoma, and 1 case of carcinoma with apocrine differentiation. In HER-2 positive regions, 17 cases were Luminal B and 13 cases were HER-2 overexpressed types. There were 22 cases of Luminal B and 8 cases of triple negative tumors in the HER-2 negative areas. The levels of TILs in HER-2 positive and negative areas accounted for 53.3% (16/30) and 26.7% (8/30), respectively, with a statistically significant difference (P=0.035). The positive expression of PD-L1 in HER-2 positive area and HER-2 negative area were 6 cases and 9 cases, respectively. Among 8 cases with HER-2 negative regions containing triple negative components, 4 cases were positive for PD-L1 expression. Conclusions: In the case of HER-2 intratumoral heterogeneity, it is necessary to pay attention to both HER-2 positive and negative regions, and evaluate subtype separately as far as possible. For HER-2 intratumoral heterogeneous breast cancer containing triple negative components, the treatment mode can be optimized by refining the intratumoral expression of PD-L1.

Investigation and analysis of radiation doses to CT examinees in 11 medical institutions in Shijiazhuang, China / 中国辐射卫生

Objective To investigate radiation doses to examinees undergoing computed tomography (CT) scanning of different body parts (the head, chest, and abdomen) in medical institutions of Shijiazhuang, China, and to provide a reference for optimizing radiation protection for examinees in medical institutions. Methods March 2021 to March 2022, eleven medical institutions of radiation monitoring in Shijiazhuang were surveyed for the basic information, scanning parameters, and dosimetric data of a total of 930 adults and children who received CT examinations. The dosimetric data of the subjects were analyzed and compared with the domestic and international diagnostic reference levels and the results of other cities in China. Results In the above hospitals, the CTDIvol(P50) of CT subjects in children's group were 17.42-50.45 mGy, 2.13-14.01 mGy and 3.58-28.20 mGy, respectively. DLP(P50) ranges from 228.87 to 966.97 mGy·cm, 33.20 to 296.03 mGy·cm, and 74.90 to 926.53 mGy·cm, respectively. In the adult group, the CTDIvol(P50) in the head, chest and abdomen of CT subjects were 37.28-54.05 mGy, 6.43-14.99 mGy and 8.28-18.75 mGy, respectively. DLP(P50) ranges from 372.81 to 630.56 mGy·cm, from 219.77 to 467.93 mGy·cm, and from 313.86 to 689.87 mGy·cm, respectively. The distribution of radiation doses in different-grade hospitals varied greatly. The abdomen dose of the children's hospital was higher than other hospitals. Especially the primary hospitals were significantly higher than the recommended diagnostic reference level (DRL). Conclusion In some secondary and primary hospitals, the setting of CT scanning parameters was simplified, not specific to the subjects’ age and body types. They should strictly comply with the principal of optimizing radiation protection to strengthen radiation dose optimization and supervision, reducing the radiation dose of examinees in future examinations .