Association between early-life factors and pubertal timing in girls / 中国当代儿科杂志

OBJECTIVES@#To study the association between early-life factors (including birth weight, method of birth, gestational age, and history of gestational metabolic disorders) and pubertal timing in girls.@*METHODS@#The stratified cluster sampling method was used to select the girls in grades 2-3 and 7-8 from three primary schools and three middle schools in Guangzhou, China from March to December, 2019, and breast development was examined for all girls. A questionnaire survey was performed to collect the information on early-life factors. The multivariate logistic regression model was used to evaluate the association of gestational metabolic disorders, birth weight, method of birth, and gestational age with pubertal timing in girls. The Bootstrap method was used to assess the mediation effect of body mass index (BMI) (Z score) between high birth weight (≥4 000 g) and pubertal timing.@*RESULTS@#A total of 1 665 girls were enrolled, among whom 280 (16.82%) were judged to have early pubertal timing. The multivariate logistic regression analysis showed that high birth weight was associated with the increased risk of early pubertal timing (OR=2.12, 95%CI: 1.19-3.66, P=0.008). Nevertheless, no significant association was observed between other early-life factors and pubertal timing (P>0.05). The OR for the mediation effect of BMI (Z score) between high birth weight and early pubertal timing was 1.25 (95%CI: 1.09-1.47), accounting for 29.33% of the total effect of high birth weight on early pubertal timing.@*CONCLUSIONS@#High birth weight is associated with the increased risk of early pubertal timing in girls, and overweight/obesity may play a partial mediating role in the association between high birth weight and early pubertal timing in girls.

Toxic Epidermal Necrolysis Induced by Sintilimab: A Case Report

Sintilimab is an anti-programmed cell death receptor-1 antibody. The phase III clinical trial ORIENT-12 confirmed the safety of sintilimab combined with pemetrexed/platinum in the treatment of advanced squamous non-small cell lung cancer. Skin reactions are the most commonly reported adverse events of immune checkpoint inhibitors and are rarely severe.We describe a case of toxic epidermal necrolysis related to sintilimab in an elderly oncologic patient. 3 weeks after immunotherapy, the patient developed an extensive rash and diffuse itching, rapidly evolving into macules, blisters, bullae and erosions. Causal evaluation was performed based on the algorithm of drug causality for epidermal necrolysis and national Food and Drug Administration qualitative analysis. The patient responded to high-dose glucocorticosteroid and supportive therapy, alongside with local wound care. If immune checkpoint inhibitors need to be extrapolated clinically, strictly following evidence-based research, promptly detecting and treating adverse reactions is crucial.

Risk Prediction Model for Pulmonary Fungal Infections in Patients with Lung Cancer / 中山大学学报(医学科学版)

ObjectiveTo investigate the risk factors for pulmonary fungal infection in lung cancer patients， construct and validate a risk prediction model using available clinical data to predict the risk of pulmonary fungal infections in patients with lung cancer. MethodsWe conducted a retrospective study and collected information of 390 lung cancer patients treated at Zhongshan People's Hospital from January 2021 to March 2023. Demographic and clinical characteristics of the patients with and without pulmonary fungal infections were used to construct column line graphs to predict the occurrence of pulmonary fungal infections. All enrolled patients were randomly assigned to training set and internal validation set in the ratio of 7：3. For the modelling group， LASSO regression was applied to screen variables and select predictors， and multivariate logistic regression with a training set was used to construct the Noe column line graph model. The judgment ability of the model was determined by calculating the area under the curve （AUC）， and in addition， calibration analysis and decision curve analysis （DCA） were performed on the model. ResultsLASSO regression identified 14 potential predictive factors， and further logistic regression analysis showed that hepatic injury， surgery， anemia， hypoalbuminemia， illness course， invasive operation， hospital stay at least 2 weeks and glucocorticoid used for at least 2 weeks were independent predictors for the occurrence of pulmonary fungal infection in lung cancer patients. A predictive model was established based on these variables， with an AUC95%CI of 0.980 （0.973， 0.896） for the training set and an AUC95%CI of 0.956 （0.795， 1.000） for internal validation， indicating high discriminative ability. The calibration curves for both the training set and validation set were distributed along the 45°line， and the decision curve analysis （DCA） showed net benefit for threshold probabilities greater than 0.03. ConclusionsThe construction and validation of a predictive model for the risk of lung fungal infections in lung cancer patients will help clinical practitioners to identify high-risk groups and give timely intervention or adjust treatment decisions.

Correlation analysis of contrast-enhanced ultrasound Liver Imaging Reporting and Data System classification with hepatocellular carcinoma differentiation and Ki-67 index / 中华超声影像学杂志

Objective:To investigate the correlation of hepatocellular carcinoma (HCC) classified by contrast-enhanced ultrasound (CEUS) Liver Imaging Data and Report System (LI-RADS) with differentiation degree and Ki-67 index.Methods:A multicenter, retrospective study was conducted.The clinical and CEUS imaging data of 208 patients with 208 HCC lesions from December 2017 to December 2020 in China CEUS database were included and analyzed. According to the CEUS LI-RADS version 2017 proposed by the American College of Radiology, the HCC was classified. The diagnosis and pathological information of all lesions were confirmed by pathology. The differentiation degree of HCC and the distribution of Ki-67 index in different LI-RADS categories were evaluated, and their correlation was analyzed.Results:The degree of differentiation and Ki-67 index among HCC of different CEUS LI-RADS were statistically significant ( P<0.001, P=0.009). LI-RADS M HCC was more likely to be poorly differentiated and showed a higher Ki-67 index. The category of LI-RADS was positively correlated with the degree of tumor differentiation (tau-b=-0.250, P<0.001) and the Ki-67 index (tau-b=0.178, P=0.002), that is, the higher the category of LI-RADS, the lower differentiation degree and the higher the Ki-67. Conclusions:The CEUS LI-RADS classification of HCC is correlating with the degree of differentiation and Ki-67 index.

Exploration and practice of hierarchical training model for improving professional ability of primary pediatricians / 中华医学教育探索杂志

At present, the routine specialized training for primary pediatricians (focusing on theoretical learning of public subjects) cannot meet the needs of primary pediatricians. In order to promote the development of children's medical care at the grassroots level and improve the quality, medical and clinical research abilities of regional pediatric medical personnel, the Children's Hospital of Chongqing Medical University has designed and built a "hierarchical training model for improving the professional ability of pediatricians" from the aspects of training objectives, training contents, training methods, construction and evaluation of training programs, and quality control. In addition, the 8-month "Pediatric Professional Basic Training" and the 9-month "Pediatric Professional Ability Improvement Training" were respectively carried out in Xianyang Children's Hospital. In the "Professional Basic Training", 88 trainees were comprehensively evaluated after training, 53 of whom were qualified or above. In the "Ability Improvement Training", 26 of the 29 students actually participated in the evaluation and reached the qualified level or above. Learners provided feedbacks that they have effectively improved their own knowledge structure, expanded their clinical diagnosis and treatment thinking and clinical research ideas, and provided some guidance for clinical work.

Relationship between tube voltage kV value for head and neck CT angiography and body weight / 中国基层医药

Objective:To investigate the relationship between tube voltage kV value for head and neck CT angiography and body weight.Methods:A total of 120 patients with suspected vascular disease of the head and neck who underwent CT angiography of the head and neck in Beihai People's Hospital from January 2020 to May 2022 were included in this study. Patients were divided into three groups according to different tube voltages: group A (tube voltage 120 kV, n = 45), group B (tube voltage 100 kV, n = 45) and group C (tube voltage 80 kV, n = 30). Patients in group A were divided into group A1 (< 70 kg, n = 15), group A2 (70-85 kg, n = 15) and group A3 (> 85 kg, n = 15) according to different body weights. Patients in group B were divided into group B1 (< 70 kg, n = 15), group B2 (70-85 kg, n = 15) and group B3 (> 85 kg, n = 15) according to different body weights. Patients in group C were divided into group C1 (< 70 kg, n = 15) and group C2 (70-85 kg, n = 15) according to different body weights. Group C3 was not used. The contrast medium used was Loversol. The CT value, image noise, signal-to-noise ratio, contrast to noise ratio, and effective radiation dose of arterial vessels in each group were measured. The images were subjectively evaluated by two physicians who had senior professional titles using a 5-point rating scale. Results:Subjective score of image quality was all ≥ 3 grade in each group. There was no significant difference in image quality rating between groups A1 and A2 and groups B1, B2, and C1. There was a remarkable difference in image quality rating between groups A3, B3, and C2 and the other groups. There was a significant difference in the CT value of blood vessels at four different levels between groups A1, B1 and C1 ( F = 76.82, 64.62, 98.79, 71.85, all P < 0.001). There was a significant difference in CT value of blood vessels at four different levels between groups A2, B2 and C2 ( F = 159.82, 112.33, 108.22, 135.18, all P < 0.001). There was a significant difference in CT value of blood vessels at four different levels between groups A3 and B3 ( t = 4.40, 4.27, 3.91, 3.59, all P < 0.05). In groups B3 and C2, the image noise was remarkably increased, signal to noise ratio and contrast to noise ratio were remarkably decreased compared with those in the other groups. The effective radiation dose of arterial vessels in group B1 was 47% lower than that in group A1 and the effective radiation dose of arterial vessels in group C1 was 73% lower than that in group A1 ( F = 116.18, P < 0.001). The effective radiation dose of arterial vessels in group B2 was 49% lower than that in group A2, and the effective radiation dose of arterial vessels in group C2 was 66% lower than that in group A2 ( H = 35.40, P < 0.001). The effective radiation dose in group B3 was 35% lower than that in group A3 ( t = 3.59, P < 0.05). Conclusion:In CT angiography of the head and neck, the selection of tube voltage kV value is related to body weight. Tube voltage 80 kV is suitable for patients with a body weight < 70 kg, tube voltage 100 kV for patients with a body weight of 70-85 kg, and tube voltage 120 kV for patients with a body weight > 85 kg. These tube voltages can decrease effective radiation dose and ensure image quality, meeting the requirement for clinical diagnosis.

Overview of technical advances in the diagnosis of pulp and periapical diseases / 中华口腔医学杂志

Pulp and periapical diseases are common and frequently occurring diseases of which diagnosis and treatment must be dealt with by the dental clinicians. The diagnostic techniques of these diseases include evaluation of pulp vitality, measurement of pulp blood circulation and analysis and judgment of root canal anatomy. With the continuous emergence of digital and imaging technologies, the correct application of these technologies in clinic will help clinicians improve their abilities in diagnosis and treatment of related diseases. The present article summarizes and reviews the progress of assistant technology for diagnosing dental pulp and periapical diseases in recent years and puts forward some suggestions for its application.

Microwave ablation of early-stage hepatocellular carcinoma affects survival prognostic factors / 中华超声影像学杂志

Objective:To identify the risk factors for survival prognosis of patients with early-stage hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (US-PMMA), and to compare the overall survival (OS), cancer specific survival (CSS) and disease-free survival (DFS) between different early-stage HCC patients.Methods:A total of 1 563 patients with early-stage hepatocellular carcinoma (HCC) who underwent MWA in the interventional ultrasound department of the Chiese PLA General Hospital from January 2002 to December 2017 were retrospectively analyzed. Propensity score matching (PSM) balanced the baseline parameters between the elderly group (≥60 years) and the young group (<60 years). Multivariate Cox regression analysis was used to identify the risk factors of OS, CSS and DFS. OS, CSS and DFS probabilities for different patients stratified by respective predictors were calculated with Kaplan-Meier method and compared using the Log-Rank test.Results:All parameters were balanced except for age after PSM.Tumor diameter(95% CI=1.1-1.4, P<0.001), number of tumors(95% CI=1.2-1.9, P<0.001), γ-GT (95% CI=1.0-1.0, P<0.001) and AFP (HR=1.5, 95% CI=1.2-1.8, P<0.001) were shared predictors for OS, CSS and DFS. Age (95% CI=1.2-1.8, P<0.001) and neutrophile to lymphocyte ratio (NLR) (95% CI=1.0-1.0, P=0.043) were another two predictors for both OS and CSS. Albumin predicted OS only, and sex and cirrhosis just predicted DFS. Over the follow-up period (12-156 months), log-rank tests showed that all predictors significantly affected the corresponding OS, CSS or DFS(all P<0.01). Among them, multiple tumors had the greatest impact on OS, CSS and DFS. Compared with patients with single lesion, OS, CSS and DFS in patients with multiple lesions decreased by 9.2%, 2.5% and 4.1% respectively at the 12 years of follow-up, and the median survival time was shortened by 12.3 months, 25.0 months and 11.3 months, respectively (log-rank P=0.049 for OS; P=0.007 for CSS; P<0.001 for DFS). Conclusions:The prognostic benefits from MWA treating early-stage HCC in patients with different survival risk factors are different. Clinically feasible correction of hypoproteinemia and liver disfunction are of great significance to improve the prognosis of early-stage HCC patients after US-PMMA.

Epidemiological analysis of 952 venomous snake bite in Wuzhou City of Guangxi Zhuang Autonomous Region / 中华危重病急救医学

Objective:To improve the prevention and treatment of venomous snake bites by analyzing the epidemiological characteristics of venomous snake bite in Wuzhou City, Guangxi Zhuang Autonomous Region.Methods:A retrospective analysis was conducted. The medical records of 1 091 patients with venomous snake bites admitted to the department of snake wound of Wuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2020 were collected, including snake species, gender and age of patients, bite time, bite site and local symptom.Results:The medical records of 952 patients with a definite clinical diagnosis of snake bite were enrolled. Among the 952 patients with venomous snake bites, the main bites were from Ovophis (32.98%), Trimeresurus (27.84%) and Naja (26.26%), followed by Bungarus multicinctus (6.51%), Ophiophagus Hannah (3.15%) and Agkistrodonhalys (1.58%), and few bites were from Rhabdophis subminiatus (0.73%), Bungarus fasciatus (0.42%), viper (0.32%) and Agkistrodon (0.21%). Of the 952 patients with venomous snake bites, there were almost twice as many males as females [647 cases (67.96%) vs. 305 cases (32.04%), with male to female ratio of 2.12∶1]. The age of patients ranged from 0.8 to 87.0 years old, with 40-59 years old as the majority (42.44%), followed by ≥ 60 years old (27.31%). Snake bites mainly occurred from April to November (93.59%), with a peak in October (16.39%). The incidence time was mainly afternoon (12:00-17:59, 30.88%) and evening (18:00-23:59, 33.30%), followed by morning (06:00-11:59, 24.69%), and early in the morning (00:00-05:59, 11.13%). The incidence time of Ovophis and Bungarus multicinctus mainly concentrated in 18:00-23:59, the time of Trimeresurus was in 06:00-11:59, and that of Naja and Ophiophagus hannah was in 12:00-17:59. Most cases of snake bite were on limbs (98.53%), and mainly on the right limbs (53.57%). The lower limbs mainly were bitten by Ovophis, while the upper limbs mainly were bitten by Naja and by Ophiophagus hannah. The local symptoms of the bite of Ovophis and Trimeresurus were similar, mainly including pain, swelling, tenderness, high temperature of skin around the wound, bleeding and exudation, etc. And the local symptoms of the bite of Naja were pain, swelling, bruising, tenderness, bleeding and exudation, red skin, etc. Numbness and mild pain were the main symptoms of the bite of Bungarus multicinctus and Bungarus fasciatus, but other local characteristics were not obvious.Conclusions:The majority of venomous snake bite patients in Wuzhou City of Guangxi were middle-aged and elderly males, and the majority of venomous snakes were Ovophis, Trimeresurus, and Naja. Most venomous snake bite occurs from April to November, and the incidence time was concentrated between 12:00 and 23:59. The majority of venomous snake bite was limb bites. The local symptoms were pain, swelling, tenderness, high temperature of skin around the wound, bruising, etc. To reduce the incidence rate, disability rate and mortality of snake bite disease, a snake bite prevention system should be established, the education and publicity of snake bite prevention knowledge should be strengthened, the awareness of snake bite prevention should be improved, and clinical diagnosis and treatment should be assisted, based on the epidemiological characteristics of snake bite in Wuzhou area.

Effect of Mankuining Decoction on Expression of Inflammatory Factors and Intestinal Flora in Mice with Ulcerative Colitis / 中国实验方剂学杂志

ObjectiveTo investigate the therapeutic effect and the possible mechanism of Mankuining decoction on dextran sulfate sodium （DSS）-induced ulcerative colitis （UC） in mice. MethodA total of 90 male SPF C57BL/6 mice were randomly classified into normal group， model group， mesalazine group （0.266 g·kg-1）， and high-， and medium-， low-dose （20， 10， 5 g·kg-1） Mankuining decoction groups， with 15 rats in each group. Mice， except the normal group， drank 3% DSS solution for 7 days to induce UC， and administration （ig） started on the day of modeling. The model group and the normal group were given equivalent amount of 0.9% normal saline once a day for 7 days. The general conditions of mice were recorded every day and the disease activity index （DAI） was calculated. On the 8th day， mice were killed by cervical dislocation. All the colons and feces were collected. The length of colon was recorded， and the histopathological changes of colon were observed based on hematoxylin-eosin （HE） staining. The content of inflammatory factors in colon was detected by enzyme-linked immunosorbent assay （ELISA）， and the changes of intestinal flora in mouse feces were determined based on 16SrRNA sequencing. ResultCompared with the normal group， the model group had severe colon damage， reduction in colon length （P<0.01）， increase in DAI （P<0.01）， decrease in interleukin-10 （IL-10） and transforming growth factor-β1 （TGF-β1） in colon（P<0.01）， rise of interleukin-1β （IL-1β）， interleukin-6 （IL-6）， interleukin-17α （IL-17α）， and tumor necrosis factor-α （TNF-α） in colon （P<0.05， P<0.01）， and decrease in abundance and diversity of intestinal flora. Compared with the model group， mesalazine and high-， medium-， low-dose Mankuining decoction alleviated the colon injury， recovered the length of colon （P<0.01）， decreased DAI （P<0.01）， increased IL-10 and TGF-β1 in colon （P<0.01）， and decreased IL-1β， IL-6， IL-17α， and TNF-α in colon （P<0.01）. Moreover， they raised the abundance and diversity of intestinal flora compared with the model group， as manifested by the increase in the abundance of Firmicutes， Akkermansia， Dubosiella， and Blautia and the decrease in the abundance of Bacteroidetes， Muribaculaceae， Clostridia_UCG-014， and Alistipes. ConclusionMankuining decoction has definite effect in treating UC mice， and the effect is positively correlated with the concentration. In addition， different concentration has different influence on the structure of flora. The mechanism is the likelihood that it alleviates the disorder of intestinal flora to restore intestinal immune balance and further promote the recovery of colonic mucosa.

Analysis of Chemical Constituents in Different Parts of Gentiana straminea Based on UPLC-Q-TOF-MS/MS / 中国实验方剂学杂志

ObjectiveUltra-performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry （UPLC-Q-TOF-MS/MS） was used to analyze the chemical constituents in the aerial part and roots of Gentiana straminea from different areas of Qinghai province， and the main chromatographic peaks and differential components of different parts were identified. MethodThe chromatographic separation was performed on a Waters ACQUITY UPLC HSS T3 column （2.1 mm×100 mm， 1.8 μm） with 0.1% formic acid aqueous solution （A）-acetonitrile （B） as the mobile phase for gradient elution （0-1 min， 1%-13%B； 1-5 min， 13%-18%B； 5-7 min， 18%-50%B； 7-9.5 min， 50%-60%B； 9.5-11 min， 60%-99%B； 11-14 min； 99%B； 14-15 min， 99%-1%B； 15-16 min， 1%B）， the column temperature at 40 ℃， and the flow rate of 0.3 mL·min-1. Electrospray ionization （ESI） and negative ion full scan mode were selected for the mass spectrometric conditions to analyze the samples， and the detection range was m/z 50-1 200. Chemical constituents of the aerial part were qualitatively analyzed with the reference substances， literature information and ChemSpider. Principal component analysis （PCA） and orthogonal partial least squares discriminant analysis （OPLS-DA） were used to analyze the classification trend， correlation and differential chemical components between aerial part and roots of G. straminea. ResultA total of 68 components， including 24 iridoids， 13 flavonoids， 8 triterpenoids， 6 xanthones， 5 fatty acids， 4 saccharides， 3 phenolic glycosides， 2 alkaloids， 2 sterols and 1 lignan， were preliminarily identified from the aerial part of G. straminea. Among them， 42 components were firstly reported in 4 Gentiana species included in the 2020 edition of Chinese Pharmacopoeia. Eight differential components were screened out， namely sucrose， maltotriose， loganic acid， shanzhiside methyl ester， 6′-O-β-D-glucosylgentiopicroside， swertiamarin， gentiopicrin and isovitexin. ConclusionThe aerial part of G. straminea is rich in chemical constituents and has good medicinal potential. There were significant differences in the chemical components between the aerial part and roots of G. straminea， and the main differential components were iridoids， which could provide a basis for exploring efficacy differences in different parts of G. straminea.

Clinical characteristics and prognostic features of 63 HIV-associated diffuse large B-cell lymphoma: a single-center real-world study in China / 中华血液学杂志

Objective: This study aimed to look into the clinical characteristics and prognosis of patients with human immunodeficiency virus (HIV) -associated diffuse large B-cell lymphoma (DLBCL) . Methods: Retrospective review of the clinical data of 63 HIV-infected patients with DLBCL diagnosed at Chongqing University Cancer Hospital between July 2008 and August 2021. The Kaplan-Meier method was used to calculate survival curves, and the log-rank test method was used to compare survival between groups. The Cox proportional hazards model was used for multivariate analysis. Results: In 63 patients with HIV-associated DLBCL, 57 (90.5% ) were men, and the median age was 49 (23-87) years. The most common pathological subtype was the germinal center B-cell-like lymphoma (74.6% ) ; 46.0% (29/63) were combined with extranodal lesions. Seventeen of 63 (27.0% ) patients had large masses (≥7.5 cm) . Twenty of 63 (31.7% ) patients had B symptoms. The median CD4(+) T cell count was 203 (4-1022) ×10(6)/L. A total of 49% (25/51) patients had CD4(+) cell count <200×10(6)/L, 56.9% (33/58) had high (3-5) International Prognostic Index (IPI) scores, and 43.1% (25/58) had low (0-2) IPI scores. Further, 78% (46/59) were diagnosed with Ann Arbor Stage Ⅲ/Ⅳ, and 25.4% (16/63) didn't receive chemotherapy. A total of 22.2% (14/63) of patients received less than four cycles of chemotherapy, and 52.4% (33/63) received four or more cycles of chemotherapy. Among patients undergoing chemotherapy, 61.7% (29/47) received R-CHOP-like regimens, and 38.3% (18/47) used CHOP-like regimens. The 1-, 2-, 3-, and 5-year overall survival (OS) rates were 65.0% , 53.8% , 47.1% , and 43.5% , respectively. Univariate analysis revealed that age ≥ 60 years (P=0.012) , Eastern Cooperative Oncology Gruop Performance Status (ECOG-PS) score 2-4 points (P=0.043) , IPI score 3-5 points (P=0.001) , β(2)-MG elevation (≥5.5 mg/L) (P=0.007) , and systemic chemotherapy cycles less than four times (P<0.001) were the negative prognostic factors affecting the OS of patients. The Cox multivariate analysis depicted that age ≥60 years (HR=2.272, 95% CI 1.110-4.651, P=0.025) , IPI score 3-5 points (HR=3.562, 95% CI 1.794-7.074, P<0.001) , ECOG-PS score 2-4 points (HR=2.675, 95% CI 1.162-6.153, P=0.021) , and number of cycles of chemotherapy<4 (HR=0.290, 95% CI 0.176-0.479, P<0.001) were independent risk factors for adverse prognosis of OS. Conclusion: HIV-associated DLBCL is the most common HIV-related tumor, is most commonly seen in men, and has a high 1-year mortality rate. Chemotherapy combined with antiretroviral therapy can improve patient prognosis.

Efficacy and Safety of Immune Checkpoint Inhibitors Therapy on Advanced Gastric Cancer or Gastroesophageal Junction Cancer: A Meta-analysis / 肿瘤防治研究

Objective To systematically evaluate the efficacy and safety of immune checkpoint inhibitors in the treatment of advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC). Methods CNKI, Wanfang, PubMed, EMBASE, ClinicalTrials, Cochrane Library and other databases were searched to collect the clinical trials of immune checkpoint inhibitors in the treatment of advanced GC/GEJC. The retrieval time was from the inception to Nov. 2019. Outcome measures mainly included ORR, DCR, PFS, OS and toxicities. The adoption rate difference and hazard ratio were effect measures. Meta-analysis was performed using RevMan 5.3 software. Results We included seven literatures with a total of 1949 patients. Meta-analysis showed that for the patients with advanced GC/GEJC, the second-line or later immune checkpoint inhibitor therapy improved the overall survival rate at 12 and 18 months; the OS of the patients was prolonged, compared with chemotherapy/placebo therapy (all P < 0.05). The incidence of adverse reactions of any grade or ≥grade 3 caused by immune checkpoint inhibitor therapy was lower than that caused by chemotherapy/placebo. Conclusion Immune checkpoint inhibitor treatment could improve survival endpoints in some patients with advanced GC/GEJC, and the incidence of common adverse reactions is low.

Report of a case of Leuconostoc lactis bacteremia following intestinal perforation with literature review / 中华全科医师杂志

A 24-year female with abdominal pain and fever for 4 days was admitted. The blood culture showed Leuconostoc growth, and sputum culture showed positive Acinetobacterbaumannii. The diagnosis Leuconostoclactis bacteremia following small intestinal perforation was confirmed; surgical treatment was performed and the infection was controlled by piperacillin sodium and tazobactam combined with tegacycline. Wanfang database, CNKI, PubMed and Embase database up to September 2020 were searched with the keywords of " Leuconostoc lactis" "infection" "bacteraemia" for relevant literature. A total of 32 cases were reported in the literature, of whom 13 (39.4%) were infants, 17 (51.5%) had catheter-related bloodstream infection, and one healthy adult male had bacteremia through gastrointestinal perforation. In 20 patients treated with penicillins-based antibiotics, 18 were cured with an effective rate of 90.0%. The results suggest that Leuconostoc infection is likely to occur in the infants, but adults can still get community-acquired Leuconostoc infection. Most β-lactams are susceptible to Leuconostoc, but some exhibit resistance, so it is recommended to select antimicrobial agents based on drug susceptibility.

Progress of diagnosis and treatment of PIEZO2-related diseases / 国际儿科学杂志

As a basic mechanism of cell function, mechanical transduction plays a key role in human growth and development, physiological and pathological processes.And its molecular mechanism has always been a research hotspot.In recent years, Piezo2 has been identified as a mechanically sensitive cationic channel, which serves as an important component of mechanical transduction participating in regulating and maintaining of respiratory rhythm, bowel movement, cartilage stress, tactile sense and multiple other physiological processes.PIEZO2-related diseases have been reported in recent years before which are characterized by distal joint contracture, scoliosis, low muscular tension, and delayed motor development.In this review, we summarizes the clinical phenotype and progress in diagnosis and possible treatment of PIEZO2-related diseases, hoping to improve the recognition of this disease which is essential for long-term management of patients, and provide ideas for the gene research and development of drug targets.

Advances in pathogenic mechanism of respiratory syncytial virus / 国际儿科学杂志

Respiratory syncytial virus is a leading cause of acute lower respiratory infection(ALRI)in infants and young children, remains a significant burden to global health.Unfortunately, no effective treatments or vaccine has been developed.However, in recent years, there has been substantial advance in understanding the pathogenic mechanism of RSV, which is always a research hotspot to seek drug and vaccine targets.This review summarizes the progress in the RSV particles structure, viral protein function and the host immune response, and hopes to describe a clearer understanding of RSV pathogenic mechanism which is essential for developing interventions.

Research Advance of CXCR4 Inhibitors in the Treatment of Acute Myeloid Leukemia--Review / 中国实验血液学杂志

CXCL12/CXCR4 axis composed of chemokine CXCL12 and its specific ligand CXCR4 can regulate and control the adhesion of leukemia cells to protective bone marrow niche, promote cell survival, and resist apoptosis induced by signal transduction inhibitors and chemotherapeutic drugs. Therefore, CXCL12 /CXCR4 axis has become a new target for the treatment of acute myeloid leukemia. At present, CXCR4 inhibitors that have been developed are in different clinical trials, showing good anti-leukemia effect. In this review, the research advance of CXCR4 inhibitors in the treatment of acute myeloid leukemia is summarized briefly.

The Diagnostic Value of Peripheral Blood Cell Parameters for Early Recognition of Myelodysplastic Syndrome / 中国实验血液学杂志

OBJECTIVE@#To evaluate the diagnostic value of peripheral blood cell parameters for early recognition of myelodysplastic syndrome (MDS) patients.@*METHODS@#The clinical and laboratory data of 86 patients with MDS and 72 patients with non-malignant clonal anemia treated in first diagnosed in the Second Hospital of Hebei Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. The peripheral blood cell parameters of the patients in two groups were analyzed, generated the receiver operator characteristic curve (ROC curve) from the statistically significant parameters, the binary logistic model was build to calculate and compare the area under the ROC curve (AUC) combined with multiple indicators and individual indicators, sensitivity, specificity, positive and negative likelihood ratio, and diagnostic accuracy, the diagnostic efficacy of the patients was analyzed.@*RESULTS@#Compared with patients in the non-malignant clonal anemia group ,white blood cell count (WBC), neutrophil percentage (NE%), eosinophil percentage (E%), eosinophil absolute value (E#), platelet count (PLT), platelet specific volume (PCT%) in the MDS patients were significantly reduced; while percentage of lymphocytes (LY%), basophilic percentage (B%), and the width of platelet distribution (PDW) significantly increased. The several ROC curves with the above indicators were established, which showed that AUC@*CONCLUSION@#PDW, B% and LY% in peripheral blood cell parameters have certain diagnostic value for early recognition of MDS.

Effect of thymosin a1 on complications after laparoscopic pancreaticoduodenectomy in elderly patients / 临床肝胆病杂志

ObjectiveTo investigate the association between perioperative immune status and postoperative infectious complications in elderly patients undergoing laparoscopic pancreaticoduodenectomy (LPD), as well as the effect of thymosin a1 on postoperative complications. MethodsRelated clinical data were collected from 43 elderly patients, aged 66-83 years, who underwent LPD in The Second Affiliated Hospital of Army Medical University, PLA from June 2014 to June 2018, and the patients were divided into combination group with 22 patients (with the application of thymosin a1 in the perioperative period) and control group with 21 patients (without the application of thymosin a1). Immune function parameters were observed before surgery and on days 3 and 7 after surgery, including serum levels of IgG, IgA, and IgM, peripheral blood neutrophil-lymphocyte ratio (NLR), changes in CD3+, CD4+, CD8+, and CD4+/CD8+ ratio, and the incidence rate of postoperative infectious complications (pulmonary infection, pancreatic leakage, and abdominal infection). In addition, the serum levels of C-reactive protein, interleukin-2 (IL-2), interleukin-10 (IL-10), tumor necrosis factor-α, and interferon-γ (IFN-γ) were measured before surgery and on days 3 and 7 after surgery. The t-test was used for comparison of continuous data between two groups; a repeated measures analysis of variance was used for comparison within each group at different time points, and the Duncan’s new multiple range test was used for further pairwise comparison. The chi-square test was used for comparison of categorical data between groups. ResultsCompared with the control group on days 3 and 7 after surgery, the combination group had significantly higher serum levels of IgG, IgA, IgM, CD3+, CD4+, CD8+, and CD4+/CD8+ ratio (all P＜0.05) and a significantly lower NLR (P＜0.05). From admission to day 7 after surgery, the control group had significant reductions in the serum levels of IgG, IgA, IgM, CD3+, CD4+, CD8+, and CD4+/CD8+ ratio (all P＜0.05) and a significant increase in NLR (P＜0.05). The combination group had significantly lower incidence rates of postoperative pulmonary infection and abdominal infection than the control group (χ2=1.44，1.65,all P＜0.05). Compared with the control group on days 3 and 7 after surgery, the combination group had significant increases in the serum levels of IL-2, IL-10, and IFN-γ (all P＜0.05). ConclusionSurgical trauma can further reduce the immune function of elderly patients, and the use of thymosin a1 during the perioperative period can enhance the immune function of patients and reduce the incidence rate of postoperative infectious complications.

A case report of SCN8A-related infantile spasm and literature review / 中华实用儿科临床杂志

To study the clinical features, diagnosis, and treatment of SCN8 A-related infantile spasm, one 21-month-boy identified a de novo mutation of SCN8 A-related infantile spasm was admitted to West China Second University Hospital, Sichuan University in September 2019 and was enrolled as a research subject.The clinical manifestation and diagnosis process were analyzed by carrying out the retrospective analysis method.This case is the first report on SCN8 A-related infantile spasm in China.This child had hiatal hernia, which has never been reported in SCN8 A gene mutation people.The boy shows marked developmental regression after the onset of seizures at 8-month-old, and a variety of antiepileptic drugs are ineffective.Recently, seizure types have changed into infantile spasm.Levetiracetam was stopped, and provided adrenocorticotropic hormone (ACTH). After treatment, the spasm was relieved.Hiatal hernia may be a phenotype of SCN8 A gene mutation.Sodium channel blockers display high efficacy in SCN8 A-related epilepsy.ACTH therapy for SCN8 A-related infantile spasm is effective.