An integration of hybrid MCDA framework to the statistical analysis of computer-based health monitoring applications.

The surge in computer-based health surveillance applications, leveraging technologies like big data analytics, artificial intelligence, and the Internet of Things, aims to provide personalized and streamlined medical services. These applications encompass diverse functionalities, from portable health trackers to remote patient monitoring systems, covering aspects such as heart rate tracking, task monitoring, glucose level checking, medication reminders, and sleep pattern assessment. Despite the anticipated benefits, concerns about performance, security, and alignment with healthcare professionals' needs arise with their widespread deployment. This study introduces a Hybrid Multi-Criteria Decision Analysis (MCDA) paradigm, combining the strengths of Additive Ratio Assessment (ARAS) and Analytic Hierarchy Process (AHP), to address the intricate nature of decision-making processes. The method involves selecting and structuring criteria hierarchically, providing a detailed evaluation of application efficacy. Professional stakeholders quantify the relative importance of each criterion through pairwise comparisons, generating criteria weights using AHP. The ARAS methodology then ranks applications based on their performance concerning the weighted criteria. This approach delivers a comprehensive assessment, considering factors like real-time capabilities, surgical services, and other crucial aspects. The research results provide valuable insights for healthcare practitioners, legislators, and technologists, aiding in deciding the adoption and integration of computer-based health monitoring applications, ultimately enhancing medical services and healthcare outcomes.

Development of training program for specialty nurses of traditional Chinese medicine nursing technology / 中国实用护理杂志

Objective:To develop a training program for specialty nurses of traditional Chinese medicine (TCM) technology, in order to provide a basis for the training of traditional Chinese medicine nursing techniques for traditional Chinese medicine speciallty nurses.Methods:Literature review and semi-structured interviews were conducted to preliminarily develop training program outline. From February to April 2022, a total of 18 experts were invited to finish the questionnaire survey. And the items were modified according to the experts′ advice.Results:The response rates of 2 rounds of consultation were both 100%, the authority coefficients of experts were 0.894 and 0.903 respectively, and the kendall harmony coefficients were 0.201 and 0.272 respectively. Finally, the training program was formed, which consists of 6 first-level indexes, 25 second-level indexes and 81 third-level indexes.Conclusions:The training program for specialty nurses of TCM technology constructed in this study is scientific, reliable and practical, which can provide a basis for the training of TCM nursing technology.

Auxiliary diagnostic value of D2-40 in early lung adenocarcinoma and precursor lesions.

AIMS: Objective to investigate whether D2-40 can be used as a marker of early lung adenocarcinoma and precursor lesions. METHODS: In order to explore the value of D2-40, a monoclonal antibody that recognises the podoplanin, as an auxiliary diagnostic marker to aid the diagnosis of these conditions, we performed the immunohistochemical (IHC) staining using early lung adenocarcinoma, infiltrating adenocarcinoma, benign lung lesions and relevant peritumour normal tissues. The microscopic examination was performed to analyse the D2-40 IHC staining. RESULTS: We found that there was no D2-40 staining in 47 cases of early stage lung adenocarcinoma and precursor lesions; only 1 of the 32 cases (3.13%) of infiltrating adenocarcinoma stained positive. There was 100% D2-40 staining in 30 cases of benign lung lesions and 79 cases of peritumour normal tissues. The positivity rate in carcinoma group was 1.27% and the normal tissue group was 100%, (p<0.01). Based on our findings, we concluded that D2-40 IHC staining in lung adenocarcinoma and precursor lesions compared with normal alveolar epithelia displayed the 'none or all' phenomenon. CONCLUSIONS: The results from our study suggested that D2-40 can be sued as auxiliary diagnostic tool in early lung adenocarcinoma and its precursor lesions.

Research progress on antiviral therapy in hepatitis C-negative recipients receiving kidney transplantation from infected donors / 中华临床感染病杂志

Kidney transplantation is the best option for end stage renal disease. Currently, shortage of donor kidneys become a global problem for kidney transplants, partly due to the abandonment of kidneys from donors infected with hepatitis C virus (HCV). With the advent of direct-acting antiviral drugs, the use of HCV infected donor kidneys has become an important measure to expand the donor pool. This article reviews the research progress on the safety, efficacy and timing of antiviral therapy for HCV-negative recipients receiving kidney transplantation from HCV-positive donors.

Effects of interhemispheric multi-target intermittent theta burst stimulation on upper limb function in patients with stroke / 中国康复理论与实践

ObjectiveTo investigate the effect of intermittent theta burst stimulation (iTBS) of the multi-target cerebral cortex after stroke on functional recovery of the upper limb of the hemiplegic side. MethodsFrom November, 2019 to August, 2020, 40 stroke patients in Gansu Provine Hospital Rehabilitation Center were included and randomly divided into single-target stimulation group (n = 20) and multiple-target stimulation group (n = 20). Both groups underwent basic neurorehabilitation drug therapy and conventional rehabilitation exercises. The single-target stimulation group received repetitive transcranial magnetic stimulation (rTMS) (iTBS mode) only in the primary motor cortex (M1) of the affected side. The multi-target stimulation group received rTMS (iTBS mode) in the cerebellar cortex of the healthy brain and M1 of the affected side, once a day, six days a week, for four weeks. Before and after treatment, the scores of Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel Index (MBI), and the latency and amplitude of somatosensory-evoked potentials N20 were compared. ResultsNo serious adverse reaction occurred during treatment. After treatment, the scores of FMA-UE, MBI and ARAT, and the amplitude and latency of N20 improved in both groups (|t| > 3.478, |Z| > 2.243, P < 0.05); and the scores of FMA-UE and ARAT, and the amplitude of N20 were better in the multiple-target stimulation group than in the single-target stimulation group (t > 2.939, Z = -2.697, P < 0.01). ConclusionMulti-target stimulation is superior to single-target stimulation for improving upper limb motor function and N20 amplitude in the hemiplegics after stroke.

Clinical application of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis / 中国胸心血管外科临床杂志

@#Objective    To assess the feasibility and safety of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis. Methods    From March 1, 2018 to February 1, 2021, 90 patients with primary palmar hyperhidrosis who underwent ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy at the Thoracic Surgery Department of the University of Hong Kong-Shenzhen Hospital. There were 47 males and 43 females, with a median age of 26.0 (22.0, 31.0) years. During the operation, T3 and/or T4 thoracic sympathetic nerve chain was transected using an ultra-micro 5 mm single-port incision near the areola or under the axilla. The surgical data of the patients were retrospectively reviewed and analyzed. Results     All patients successfully completed the operation without major bleeding during the operation and no conversion to thoracotomy. There was no death or serious complication during the perioperative period. The operation time was 43.0 (23.0, 60.0) min, and the intraoperative blood loss was 2.0 (1.0, 2.0) mL. In the perioperative period, only one patient needed a tiny chest tube indwelling. The symptoms of hyperhidrosis on the hands all disappeared after the operation. The pain score on the postoperative day was 2.0 (2.0, 2.0) points. The hospital stay after surgery was 1.0 (1.0, 1.0) d. In the first month after the operation, the symptoms of hyperhidrosis on the hands were significantly relieved compared with those before the operation. The surgical incisions healed well, the wounds were concealed, and there was no wound infection or poor healing. The patients' satisfaction with the surgical incisions was 100.0%. After the operation, 14 (15.6%) patients had mild compensatory hyperhidrosis, 5 (5.6%) patients had moderate compensatory hyperhidrosis, and no patient had severe compensatory hyperhidrosis. Overall satisfaction rate was 94.0%. Conclusion     The clinical application of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis is safe and feasible. The surgical wound is extremely small and hidden, the operation time is short, the pain is very slight, and the clinical outcome is good. It can fully meet the patients' pursuit of beauty.

Clinical application of laparoscopic sentinel lymph node mapping in early staged cervical cancer / 中华妇产科杂志

Objective:To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged cervical cancer by laparoscopy.Methods:It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering Cancer Center, and underwent SLN mapping followed by complete pelvic lymphadenectomy. Moreover, all the dissected lymph nodes were stained with hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining micro-metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes metastasis in early-staged cervical cancer.Results:The overall detection rate of SLN in cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN metastasis and 12 none sentinel LN metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated tumor cells (ITC), and 5 SLNs were found to be micro-metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN metastasis in cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of lymph node metastasis by SLN biopsy and postoperative retroperitoneal lymph node metastasis showed that the Kappa value was 1.000 ( P<0.001), indicated that the metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. Conclusions:SLN in early-staged cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN metastasis in early-staged cervical cancer. SLNB may replace systemic pelvic lymphadenectomy.

Role of Drugs Affecting the Renin-Angiotensin-Aldosterone System on Susceptibility and Severity of COVID-19: A Large Case-Control Study from Zheijang Province, China.

The study aimed to investigate whether specific medications used in the treatment chronic diseases affected either the development and/ or severity of COVID-19 in a cohort of 610 COVID-19 cases and 48,667 population-based controls from Zheijang, China. Using a cohort of 578 COVID-19 cases and 48,667 population-based controls from Zheijang, China we tested the role of usage of cardiovascular, antidiabetic and other medications on risk and severity of COVID 19. Analyses were adjusted for age, sex and BMI and for presence of relevant comorbidities. Individuals with hypertension taking calcium channel blockers had significantly increased risk [odds ratio (OR)= 1.73 (95% CI 1.2-2.3)] of manifesting symptoms of COVID-19 whereas those taking angiotensin receptor blockers and diuretics had significantly lower disease risk (OR=0.22; 95%CI 0.15-0.30 and OR=0.30; 95%CI 0.19-0.58 respectively). Among those with type 2 diabetes, dipeptidyl peptidase-4 inhibitors (OR= 6.02; 95% CI 2.3-15.5) and insulin (OR= 2.71; 95% CI 1.6-5.5) were more and glucosidase inhibitors were less prevalent (OR= 0.11; 95% CI 0.1-0.3) among with COVID-19 patients. Drugs used in the treatment of hypertension and diabetes influence the risk of development of COVID-19, but, not its severity. Study highlightsO_ST_ABSWhat is the current knowledge on the topic?C_ST_ABSCardiovascular disease and Diabetes have been highlighted as comorbidities contributing to a more severe form of COVID-19 and medication to treat them may also influence the risk of COVID-19 and its clinical outcomes. What question did this study address?Does specific medications used in the treatment of chronic diseases influence the risk for the susceptibility to SARS CoV-2 infection of severity of COVID-19? What does this study add to our knowledge?The study confirms that higher BMI, diabetes and cardio/ cerebrovascular disease as independent risk factors for the development of COVID-19. Angtiotensin Receptor Blockers (ARBs) and diuretics were associated with reduced risk and Calcium Channel Blockers (CCBs) with increased risk of developing COVID-19. Among those with type 2 diabetes, dipeptidyl peptidase-4 and were associated with increased and glucosidase inhibitors with reduced risk development of COVID-19. None of the antihypertensive or anti-diabetic drugs were associated with increased risk of severe or critical form of the infection. Drugs used in the treatment of hypertension and diabetes influence the risk of development of COVID-19, but are not associated with severity of the disease. How might this change clinical pharmacology or translational science?Findings from the current large case-control study confirmed no evidence to alter ARBs or ACEIs therapy in the context of COVID-19 severity in clinical practice. Hypertension significantly increases the risk of severe or critical SARS-CoV-2 infection indicating that carefully controlled blood pressure should be a priority to reduce the healthcare burden of COVID-19.

Prevention and treatment of COVID-19 with Traditional Chinese Medicine / 药学实践杂志

The novel coronavirus pneumonia is an acute respiratory infectious disease mainly manifested by fever, fatigue and dry cough, caused by new coronavirus 2019-nCoV infection（COVID-19）. Traditional Chinese Medicine played an important role in the prevention and treatment of COVID-19 during this breakout. This article reviews the clinical treatments of SARS-CoV-2 with TCM, the pathogenesis of COVID-19, dialectical treatment with TCM, and the antiviral, anti-inflammatory, immune regulatory effects of TCM. Some TCM with dual immuno-modulatory effects draw special attention, which may shed light on the prevention and treatment of COVID-19.

Clinical analysis of septic shock caused by acute upper and lower gastrointestinal perforation / 中华危重病急救医学

Objective:To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation.Methods:Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared.Results:There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (μg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (μg·kg -1·min -1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHEⅡ or SOFA scores [APACHEⅡ: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). Conclusions:The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.

Effects of Jinshuibao tablet on immune function and chemotherapy efficacy in patients with advanced lung squamous cell carcinoma / 肿瘤研究与临床

Objective:To investigate the influence of Jinshuibao tablet on immune function, therapeutic efficacy and safety in treatment of advanced lung squamous cell carcinoma patients treated by chemotherapy.Methods:The clinical data of 124 patients with stage Ⅳ lung squamous cell carcinoma who were admitted to Shanxi Provincial Cancer Hospital from January 2015 to December 2017 were retrospectively analyzed, including 60 patients treated by Jinshuibao tablet combined with chemotherapy (the observation group) and 64 patients treated by chemotherapy alone (the control group). The changes of immune function, therapeutic effect, and side effects were compared between the two groups.Results:The percentage of CD4 + cells after treatment [(33.4±8.9)% vs. (45.5±11.8)%, t = 2.71, P < 0.05] and CD4 +/CD8 + (0.9±0.3 vs. 1.5±0.4, t = 3.31, P < 0.05) in the observation group was increased compared with that before treatment, CD8 + cells was decreased compared with that before treatment [(30.9±8.6)% vs. (21.1±8.1)%, t = 2.42, P < 0.05], interferon-γ (IFN-γ) [(7.7±2.8)% vs. (14.1±2.4)%, t = 2.74, P < 0.05] and interleukin-2 (IL-2) [(8.8±3.2)% vs. (12.7±1.6)%, t = 2.96, P < 0.05] was increased compared with that before treatment. The percentage of CD3 + cells [(57.9±8.2)% vs. (45.2±10.8)%, t = 2.70, P < 0.05], CD4 + cells [(32.9±9.0)% vs. (22.8±9.6)%, t = 3.19, P < 0.05], NK cells [(14.9±3.1)% vs. (9.3±1.4)%, t = 2.97, P < 0.05] in the control group was decreased compared with that before treatment. Tumor necrosis factor α (TNF-α) was decreased compared with that before treatment [(6.8±1.4)% vs. (4.3±0.5)%, t = 3.23, P < 0.05]. There was a statistically significant difference in the level of T-cell subsets of both groups after treatment (all P <0.05); and the level of CD3 +, CD4 +, CD4 +/CD8 +, NK cells in the observation group was higher than that in the control group; CD8 + cell in the observation group was lower than that in the control group. There was no statistical difference in the level of IFN-γ, IL-2, TNF-α of both groups before treatment (all P > 0.05); the level of IFN-γ, IL-2, TNF-α in the observation group was higher than that in the control group after treatment, and the difference was statistically significant of both groups (all P < 0.05). The total effective rate of the observation group was higher than that in the control group, and the difference was statistically significant [31.3% (20/64) vs. 48.3% (29/60), χ 2 = 4.538, P = 0.033]; and the disease control rate in the observation group was higher than that in the control [56.3% (36/64) vs. 71.7% (43/60), χ 2 = 5.276, P = 0.022]. There was no significant difference between the two groups in adverse reactions of chemotherapy (all P > 0.05). Conclusion:Jinshuibao tablet combined with chemotherapy can improve the immune function and the efficacy of chemotherapy for patients with advanced lung squamous cell carcinoma.

Clinical analysis of different treatment options for cholecysto-choledocholithiasis / 中华消化杂志

Objective To evaluate the efficacy of different treatment options for cholecysto-choledocholithiasis (CCL),and try to find the ideal treatment.Methods From January 2006 to January 2016,a total of 3 107 patients with CCL from the Affiliated Hospital of Inner Mongolia Medical University were enrolled.Among them,1 283 patients were in open cholecystectomy (OC) and open common bile duct exploration (OCBDE) group,964 patients were in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) group,and 860 patients were in endoscopic retrograde cholangiopancreatography (ERCP) + LC group.The clinical data of the three groups were analysed.One-way analysis of variance and chi-square test were performed for statistical analysis.Results From 2006 to 2010,the percentage of patients treated with OC + OCBDE,LC + LCBDE,and ERCP + LC were 56.05％ (829/1 479),25.15％ (372/1 479) and 18.80％ (278/1 479),respectively;from 2011 to 2016,the percentage of patients received the above three treatments were 27.89％ (454/1 628),36.36％ (592/1 628) and 35.75％ (582/1 628),respectively.The difference in the proportion of the same treatment at different times was statistically significant (x2 =4.775,4.168 and 0.669,all P ＜ 0.05).The success rate of surgery in the OC + OCBDE group was 100.00％ (1 370/1 370);while the success rate of surgery in the LC + LCBDE group was 94.26％ (920/976),and 56 patients converted to OC + OCBDE;the success rate of surgery in the ERCP + LC group was 95.00％ (817/860),and 31 patients converted to OC + OCBDE,and 12 patients to LC + LCBDE.The intraoperative complication in OC + OCBDE,LC + LCBDE and ERCP + LC were 2.85％ (39/1 370),3.48％ (32/920) and 1.22％ (10/817),respectively.The incidence rates of postoperative complication were 4.89％ (67/1 370),5.34％ (50/920) and 5.51％ (45/817),respectively.The incidence rates of intraoperative complication of the ERCP + LC group was lower than that of OC + OCBDE group and LC + LCBDE group,and the differences were statistically significant (x2 =6.203 and 3.001;both P ＜ 0.05).However there was no significant difference in incidence rate of postoperative complications among the three groups (all P ＞ 0.05).The hospital stay of the OC + OCBDE group,the LC + LCBDE group and the ERCP + LC group were (6.7 ± 1.3) days,(5.6 ± 1.2) days and (10.9 ± 1.6) days,respectively,and the differences were statistically significant (F =90.010,P ＜ 0.01).The hospitalization expenses of OC + OCBDE group,LC + LCBDE group and ERCP+LC group were (13 720±1 910) yuan,(18 150±1 490) yuan and (25 830 ± 2 430) yuan,respectively,and the differences were statistically significant (F =302.991,P ＜ 0.01).Conclusion The first choice of patients with CCL is endoscopic minimally invasive treatment and open surgery can be used as a remedial method for endoscopic treatment.

Constructing the medical paper evaluation system by bibliometrics / 中华医学科研管理杂志

Objective Constructing a medical paper evaluation system based on bibliometrics.Methods Taking medical papers as the research object,five evaluation indexes were selected by expert investigation,including paper type,periodical type,number of other citations,impact factors and periodical division.The weight of evaluation index is determined by analytic hierarchy process (AHP).At last a high level of peer evaluation index F1000 is used to give an example analysis and verification.Results The score of medical papers evaluation system is basically consistent with the recommendation of F1000 papers.Conclusions It is feasible to replace peer qualitative evaluation with quantitative evaluation system based on Bibliometric index in medical paper evaluation.

Clinical significance of presepsin(sCD14-ST)for diagnosis, severity evaluation and prognostic prediction of acute infections in elderly patients / 中华老年医学杂志

Objective To investigate clinical significance of soluble CD14 subtype presepsin for diagnosing,evaluating severity and predicting prognosis of acute infections in elderly patients.Methods Sixty elderly emergency patients without acute infections as control and 117 elderly emergency patients with acute infections were enrolled.Patients with infections were divided into the systemicinflamatory response syndrome(SIRS) (infection+ SIRS group,n =59),sepsis group (n =41)and septic shock group(n=17),and were further divided into survival group(n=90)and death group (n=27)according to 30-day mortality.Serum levels of presepsin and procalcitonin (PCT)were measured by using enzyme-linked immunosorbent assay(ELISA)within 24 hours after doctors' office visiting.The mortality in emergency department sepsis(MEDS) scores was evaluated.Clinical value and correlations of presepsin and PCT in diagnosis,disease evaluation and prognosis evaluation were compared and analyzed Results Presepsin level was higher in acute infection group than in no-infection group[734.0(422.5,1120.0) ng/L vs.159.50 (119.0,234.3) ng/L,P ＜0.05].Presepsin level was 423.0(266.3,554.0)ng/L in infection+SIRS group,1042.0(854.0,1213.0)ng/L in sepsis group,and 2188.0(1599.5,2946.0) ng/L in septic shock group,with statistically significant differences among infection+SIRS group,sepsis group and septic shock group(P ＜0.05).No significant differences in PCT levels were found between sepsis group and septic shock group[4.4(1.4,16.9)ng/L,vs.8.8 (0.7,51.1)ng/L,P＞0.05].MEDS had no difference between sepsis group and septic shock group [(13.0(11.0,17.5) vs.15.0 (11.5,19.5),P ＞ 0.05].There were significant differences in serum levels of presepsin(554.0ng/L vs.1232.5 ng/L),PCT(1.18 μg/L vs.10.07 μg/L) and MEDS(9.0 vs.18.0)between the survival group and the death group(P＜0.05),and their area under a receiver operating characteristic(ROC) curve was (0.853 ± 0.037),(0.732 ± 0.057) and (0.900 ± 0.034)respectively.Serum level of presepsin was moderately correlated with MEDS(r =0.609,P =0.00)and lowly correlated with PCT(r =0.477,P =0.00).Conclusions Presepsin is a good biomarker for acute infection,which has better clinical value for diagnosis,severity evaluation and prognostic prediction of acute infections in elderly patients.

Immunotherapy for pancreatic ductal adenocarcinoma: Challenges and opportunities / 临床肝胆病杂志

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer, and its micrometastases are commonly seen in clinical practice. Although great progress has been made in immunotherapy for malignancies in recent years, immune checkpoint blockade focusing on programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) has changed the clinical diagnosis and treatment of non-small cell lung cancer, melanoma, urothelial carcinoma, and renal carcinoma. However, the clinical effect of immunotherapy in PDAC is limited by the low immunogenicity and unique tumor microenvironment (TME) of PDAC. With the research advances in PDAC-TME, an in-depth analysis of the highly complex interaction network between immune system, tumor cell, and matrix signal may help to develop a rational combination of immunotherapies for PDAC. By elaborating on the unique immunological features of PDAC-TME, this article reviews the potential treatment opportunities for PDAC and the advances in clinical research.

Premenstrual syndrome on the quality of life of medical staffs and its influencing factors / 中国职业医学

OBJECTIVE: To explore the effect of premenstrual syndrome( PMS) on the quality of life( QOL) of female medical staffs. METHODS: By convenient sampling method,1 007 female medical workers from three Grade A class 3 hospitals were selected as study subjects and investigated by PMS Scale,World Health Organization Quality of Life Assessment Instrument Brief Version,Simplified Coping Style Questionnaire and Social Support Rating Scale. RESULTS: The detection rate of PMS among medical staffs was 52. 0%,and the total score of QOL of PMS medical staffs was lower than that of non-PMS medical staffs [( 84. 3 ± 12. 4) vs( 90. 5 ± 11. 6),P < 0. 01]. The multivariate linear logistic regression analysis results showed that the PMS medical staffs who often stay up late,with higher degree of dysmenorrhea,higher job stress,lower positive coping style score,higher negative coping style score,and poor support have lower QOL( P < 0. 05). The coping style and social support of PMS medical staffs can directly affect the QOL. The social support can also indirectly affect the QOL through coping style. CONCLUSION: Coping style is a mediator of social support and QOL.Adopting coping style can improve the QOL of PMS medical staffs.

Mechanism of extracts from Aspongopus chinensis Dallas on the proliferation and apoptosis of gastric cancer cell through STAT3/Survivin pathway / 国际生物医学工程杂志

Objective To investigate the regulation and mechanism of extracts from Aspongopus chinensis dallas on the proliferation and apoptosis of gastric cancer cells. Methods The human gastric cancer cell line MGC-803 was used in the experiments. The MTT assay and flow cytometry were respectively used to detect the effects of the extracts from aspongopus chinensis dallas on the proliferation and apoptosis of the cancer cells. The nude mouse model of MGC-803 cells was established. The experimental group was injected with 50μl of the extracts (12 mg/L) in the tumor area daily, and the control group was injected with the same volume of physiological saline. The size of tumor was measured regularly, and the expression levels of STAT3 and Survivin were detected by Western blotting. Results The extracts from Aspongopus chinensis dallas significantly inhibited cell proliferation (P<0.05) and promoted cell apoptosis (P<0.05). Both of the results showed a dose-dependent trend. The tumor size of the MGC-803 tumor-bearing nude mice treated with the extracts was significantly smaller than that of the control group at different time points (all P<0.05). The expression levels of STAT3 and Survivin protein in the tumor tissues of experimental groups were significantly lower than those in the control group (all P<0.05). Conclusion The extracts from Aspongopus chinensis Dallas can inhibit proliferation and promote apoptosis of gastric cancer cells. The mechanism may be achieved by reducing the expression of STAT3 and Survivin protein.

Effect of transcranial direct current combined with mirror neuronal rehabilitation training / 中国医师进修杂志

Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.

Expression of death receptor 5 upreguleted by chloroquine enhances the sensitivity of Huh7 cells to tumor necrosis factor related apoptosis-inducing ligand / 肿瘤研究与临床

Objective To explore the effect of chloroquine on death receptor 5 (DR5) expression of hepatocellular carcinoma Huh7 cells and cell proliferation and apoptosis induced by tumor necrosis factor related apoptosis-inducing ligand (TRAIL).Methods Huh7 cells were divided into four groups:the control group (1∶1 000 dimethyl sulfoxide),TRAIL group (50 μg/L),chloroquine group (10 μmol/L) and TRAIL +chloroquine group (TRAIL 50 μg/L + chloroquine 10 μmol/L).Thiazolyl blue tetrazolium bromide (MTT) assay was used to determine the proliferation activity of cells,immunofluorescence was used to detect the expression of DR5,4',6-diamidino-2-phenylindole (DAPI) staining was used to observe cell apoptosis and Western blot was used to detect the expression of cleaved poly ADP-ribose polymerase (PARP).Results TRAIL treatment could decrease Huh7 cells proliferation activity;when compared with the cell viability in the control group,the cell proliferation inhibition rate of chloroquine group,TRAIL group and TRAIL+ chloroquine group was (89±8) ％,(53±10) ％ and (27±7) ％,respectively;compared with TRAIL group alone,cell proliferation activity was decreased in TRAIL+ chloroquine group (t =3.922,P =0.017).The expression of DR5 was upregulated in chloroquine group,and the cell apoptosis signaling was activated in TRAIL + chloroquine group.The cell apoptosis rate of TRAIL group and TRAIL + chloroquine group was (10.0±2.3) ％ and (20.4±4.0) ％,respectively,and there was a statistical difference (t =3.894,P =0.018).Conclusion Chloroquine can enhance the cell chemosensitivity to TRAIL treatment by upregulating the expression of DR5 in Huh7 cells.