Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement.

RATIONALE AND OBJECTIVES: Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS: A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS: The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION: The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.

Fexaramine improves non-alcoholic fatty liver disease in mice by stimulating intestinal FXR / 药学学报

Non-alcoholic fatty liver disease (NAFLD) is considered to be a manifestation of metabolic syndrome and has become one of the chronic diseases that endanger health around the world. There is still a lack of effective therapeutic drugs in clinical practice. Farnesoid X receptor (FXR) has been a popular target for NAFLD research in recent years. Fexaramine (Fex) is a potent and selective agonist of FXR, and its mechanism of action to improve NAFLD is unclear. Therefore, in this study, a mouse model of NAFLD was constructed using a high-fat, high-cholesterol diet and treated with Fex orally for 6 weeks. We evaluated the ameliorative effect of Fex on disorders of glucolipid metabolism in NAFLD mice, and preliminarily explored its potential mechanism of action. The animal experiments were approved by the Animal Ethics Committee of Shanghai University of Traditional Chinese Medicine (approval number: PZSHUTCM210913011). In this study, it was found that 100 mg·kg-1 Fex significantly inhibited body weight gain, alleviated insulin resistance, improved liver injury and lipid accumulation in NAFLD mice. The effect of Fex on the expression of hepatic intestinal FXR and its target genes in NAFLD mice was further examined. Analysis of serum and hepatic bile acid profiles and expression related to hepatic lipid metabolism. It was found that Fex could stimulate intestinal FXR, promote fibroblast growth factor 15 (FGF15) secretion, inhibit the expression of cytochrome P450 family 7 subfamily A member 1 (CYP7A1), the rate-limiting enzyme of bile acid synthesis in liver, regulate bile acid synthesis by negative feedback, and improve the disorder of bile acid metabolism. At the same time, Fex reduces liver lipid synthesis and absorption, increases fatty acid oxidation, thus improving liver lipid metabolism. This study shows that Fex can improve NAFLD by activating intestinal FXR-FGF15 signal pathway and regulating liver lipid metabolism.

Thoughts on path of R&D and registration of innovative traditional Chinese medicine with synchronous transformation of "series prescriptions" / 中国中药杂志

Since the implementation of drug registration in China, the classification of Chinese medicine has greatly met the needs of public health and effectively guided the transformation, inheritance, and innovation of research achievements on traditional Chinese medicine(TCM). In the past 30 years, the development of new Chinese medicine has followed the registration transformation model of " one prescription for single drug". This model refers to the R&D and registration system of modern drugs, and approximates to the " law-abiding" medication method in TCM clinic, while it rarely reflects the sequential therapy of syndrome differentiation and comprehensive treatment with multiple measures. In 2017, Opinions on Deepening the Reform of Review and Approval System and Encouraging the Innovation of Drugs and Medical Devices released by the General Office of the CPC Central Committee and the General Office of the State Council pointed out that it is necessary to " establish and improve the registration and technical evaluation system in line with the characteristics of Chinese medicine, and handle the relationship between the traditional advantages of Chinese medicine and the requirements of modern drug research". Therefore, based on the development law and characteristics of TCM, clinical thinking should be highlighted in the current technical requirements and registration system of research and development of Chinese medicine. Based on the current situation of registration supervision of Chinese medicine and the modern drug research in China, the present study analyzed limitations and deficiency of " one prescription for single drug" in the research and development of Chinese medicine. Additionally, a new type of " series prescriptions" was proposed, which was consistent with clinical thinking and clinical reality. This study is expected to contribute to the independent innovation and high-quality development of the TCM industry.

Analysis of gastrointestinal symptoms in 80 patients with coronavirus disease 2019 / 中华危重病急救医学

Objective:To investigate the clinical characteristics of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) during the whole disease process, and provide reference for etiological diagnosis and treatment.Methods:The clinical data of patients with COVID-19 admitted in the Infectious Diseases Branch of the First Affiliated Hospital of University of Science and Technology of China from January 22nd, 2020 to March 8th, 2020 were analyzed retrospectively. According to whether there were gastrointestinal symptoms (poor appetite, nausea/vomiting and diarrhea), all patients were divided into gastrointestinal symptom group and asymptomatic group. The characteristics of gastrointestinal symptoms, such as poor appetite, nausea, vomiting and diarrhea were counted and analyzed, and the correlation between gastrointestinal symptoms and gender, age, basic diseases, disease severity, laboratory examination and drug treatment were analyzed.Results:A total of 80 COVID-19 patients were involved, 43 cases (53.8%) presented with poor appetite, 17 cases (21.3%) had nausea and vomiting, and 33 cases (41.3%) had diarrhea. Among them, 5 cases, 1 case and 4 cases respectively preformed poor appetite, nausea/vomiting and diarrhea before admission, while the others experienced gastrointestinal symptoms within 48 hours after admission. Duration of poor appetite, nausea/vomiting and diarrhea (days) of all patients were 5.3±2.1, 2.2±1.0 and 1.4±0.9, respectively. The patients with poor appetite were older than those without symptoms (years old: 48.2±17.6 vs. 39.3±15.1), albumin (Alb) level and the lymphocytes ratio were lower than those in asymptomatic group [Alb (g/L): 39.8 (35.7, 45.1) vs. 46.1 (42.6, 49.4), lymphocytes ratio: 0.19 (0.09, 0.28) vs. 0.28 (0.17, 0.35)], while the neutrophil ratio, the levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were higher than those in asymptomatic group [the neutrophil ratio: 0.74 (0.61, 0.85) vs. 0.64 (0.52, 0.76), CRP (mg/L): 21.4 (3.9, 52.9) vs. 5.6 (2.4, 14.0), D-dimer (mg/L): 0.2 (0.2, 0.5) vs. 0.2 (0.1, 0.3), LDH (μmol·s -1·L -1): 4.49 (3.59, 5.19) vs. 3.12 (2.77, 4.90)]; at the same time, more traditional Chinese medicine was used in the patients with gastrointestinal symptoms [65.1% (28/43) vs. 40.5% (15/37), all P < 0.05]. In addition, 14 cases of 18 patients with cardiovascular diseases presented with poor appetite, 7 patients had nausea and vomiting symptoms. All of the 3 patients with chronic kidney disease presented with poor appetite, nausea and vomiting, and 2 of them had diarrhea. Conclusions:The gastrointestinal symptoms in patients with COVID-19 are common. Whether it is caused by the virus or related drugs, diet and mental conditions, clinicians should analyze the causes of these symptoms timely, and then provide a better treatment for patients with COVID-19.

Effect of auricular point pressing combined with electroacupuncture on postoperative pain and inflammatory cytokines in children with hernia / 中国针灸

OBJECTIVE@#To explore the clinical efficacy and action mechanism of auricular point pressing combined with electroacupuncture (EA) on postoperative pain in children with hernia.@*METHODS@#A total of 93 children with inguinal hernia were randomly divided into an auricular point group, an EA group and a combination group, 31 cases in each group. All the three groups were treated with routine postoperative treatment and nursing, and analgesic and sedative drugs were used when necessary. After awaking, the children in the auricular point group were treated with auricular point pressing at Shenmen (TF), Jiaogan (AH) and Pizhixia (AT); the seeds of cowherb were placed at the auricular points and the same nurse used index finger and thumbs to press the points for 2 min, and repeated after 30 min. The pressing time was 8-11 AM and 14-17 PM for 3 days. The children in the EA group were treated with EA at Sanyinjiao (SP 6) and Zusanli (ST 36); the needles were perpendicularly inserted with mild reinforcing-reducing method; EA instrument was connected with needles and the current intensity was under the maximal tolerance of children; the needles were retained for 20 min, three times a day for continuous 3 days. The children in the combination group were treated with auricular point pressing and EA for 3 days. The Wong-Baker facial expression evaluation method was used to observe the pain scores 1-3 h, 4-24 h, 25-48 h and 49-72 h after operation; the contents of TNF-α, IL-6 and IL-8 were compared 1 day, 2 days and 3 days after operation; the number of cases using sedative drugs and average hospitalization days were compared among the three groups.@*RESULTS@#①Among the children aged 8-15 years old, the pain scores 4-24 h and 25-48 h after operation in the combination group were lower than those in the auricular point group and the EA group (all 0.05). ②The contents of TNF-α, IL-6 and IL-8 in serum 1 day, 2 days and 3 days after operation in the combination group were lower than those in the auricular point group and the EA group (all <0.05). ③The number of cases using analgesic and sedative drugs after operation in the combination group was fewer than that in the auricular point group and the EA group (all <0.05). ④The average hospitalization days in the combination group were shorter than those in the auricular point group and the EA group (all <0.05).@*CONCLUSION@#Compared with auricular point pressing or EA alone, the combination of auricular point pressing and EA could not only effectively relieve the postoperative pain, but also reduce the expression of inflammatory cytokines in children with hernia, improving the clinical efficacy.

Advances in Study on Hyperbaric Oxygen in Treatment of Ulcerative Colitis / 胃肠病学

Ulcerative colitis(UC)is a chronic non-specific intestinal inflammatory disease,and its etiology is not completely clear. UC is difficult to cure,and often recurred,which seriously affects the quality of patients'life. Hyperbaric oxygen(HBO)therapy is a method of treating disease by breathing pure oxygen or high concentration oxygen in high pressure environment,and the effect of HBO on UC has been confirmed. This article reviewed the advances in study on HBO in treatment of UC.

Results of low-dose computed tomography (LDCT) screening for early lung cancer: prevalence in 4 690 asymptomatic participants / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To report the results of low-dose computed tomography (LDCT) screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital, Chinese Academy of Medical Sciences between July 2007 and June 2012.</p><p><b>METHODS</b>After informed consent and questionnaire forms were obtained, 4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning. According to the National Comprehensive Cancer Network (NCCN) guideline for lung cancer screening (version 1.1, 2012), all participants were assigned to three groups, namely high-risk, moderate-risk and low-risk groups. In terms of gender, smoking history and second-hand tobacco smoking exposure history, two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated. The positive results were identified as at least one solid or part-solid nodule measuring ≥ 5 mm, or non-solid nodule ≥ 8 mm in diameter. LDCT scanning protocol, criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program (I-ELCAP). TNM staging of all lung cancers were based on the clinical evidence and pathological findings.</p><p><b>RESULTS</b>In various risk status group of the participants, the percentage of positive results of baseline CT were 27.0% (86/319), 19.3% (199/1 029) and 11.3% (377/3 342), respectively. A total of 26 participants (27 lesions) were diagnosed as lung cancer (11 in men, 15 in women). The detection rate of lung cancer was 0.6% (26/4 690). Besides a SCLC (limited-disease, LD), 25 cases (76.0%) were stage I including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5% (23/26). The diameter of resected cancers was 6.9-29.5 mm (median, 16.3 mm). For female never smokers aged 40 years or older who were exposed to second-hand smoking, the detection rate of lung cancer was higher than that of the high-risk and male never smokers who were exposed to second-hand smoking (1.4% vs. 0.9%, 0.4%).</p><p><b>CONCLUSIONS</b>The results indicate that LDCT can detect small lung cancers and most of the cancers are detected at an early stage. Emphasis should be placed on the non-smoking female individuals who are exposed to second-hand smoking in China.</p>