Predictive Value of Tumor Mutation Burden for PD-1/PD-L1 Inhibitors Treatment on Non-small Cell Lung Cancer: A Meta-analysis / 肿瘤防治研究

Objective To investigate the relation between TMB and the efficiency of PD-1/PD-L1 inhibitors treatment for non-small-cell lung cancer. Methods Studies were searched from PubMed, Embase, Cochrane Library database, Chinese Biomedical Literature Database and Wanfang Database up to March 25, 2020. RevMan 5.3 software and STATA15.0 were used for analysis. Results Twelve literatures were involved, including 1209 patients. TMB significantly improved PFS (HR=0.54, 95%CI: 0.42-0.70, P < 0.001) but reduced the ORR (OR=4.41, 95%CI: 2.54-7.63, P < 0.001) of NSCLC patients treated with PD-1/PD-L1 inhibitors. The subgroup analyses showed that the predictive value of TMB was significant in non-small cell lung cancer treated by PD-1/PD-L1 inhibitors combined with anti-CTLA-4 therapy or chemotherapy. No significant publication bias was observed by the Begg's test and Egger's test. Conclusion High tumor mutation burden may predict the improved PFS of non-small cell lung cancer by PD-1/PD-L1 inhibitors treatment, but its predictive value for OS, ORR and long-term survival need more exploration.

A preliminary study on the relationship between the length of A2 type objective test questions and the degree of difficulty and discriminative power in medical examination / 中华医学教育探索杂志

Objective In a large-scale clinical medical examination, A2 type best multiple-choice test questions to the same knowledge were used respectively in simple and complex form, to compare the difficulty and discrimination indices of the two forms of test questions and provide evidence to the improve-ment of clinical medical examination. Method In a large-scale clinical medical examination more than 4000 candidates participated, and 20 questions to different knowledge points were randomly selected and used in the examination respectively in simple and complex A2 type best multiple-choice test questions. The difficulty and discrimination indices of the two forms of test questions were compared. Results The average difficulty coefficient of the 20 simple test questions (65.5 words per question in average) is 0.6829, and the average discriminative powers are 0.2675 and 0.2579 respectively using identification index method and point biserial correlation method. The average difficulty coefficient of the 20 complex test ques-tions (135.5 words per question in average) is 0.7095, and the average discriminative powers are 0.3065 and 0.2967 respectively using identification index method and point biserial correlation method. Conclusion To the same knowledge points, the average difficulty of complex A2 type best multiple-choice test questions is slightly lower than the simple ones, while the average discriminative power is increased in the complex questions. The complex A2 type test questions are of higher quality and more in line with the requirements of the medical entrance examination, medical education and examination reform.

Study on the efficacy of CD34 + cells combined with sarpogrelate hydrochlotride tablets for the re-construction of the blood supply of thromboangiitis obliterans / 中国医师杂志

Objective To investigate the effect of autologous peripheral blood stem cell transplanta-tion combined with CD34 + cells and oral sarpogrelate hydrochloride for the treatment of vascular reconstruc-tion and blood supply on the thromboangiitis obliterans. Methods Thromboangiitis obliterans ( TAO) of 262 patients with 262 lower limbs were divided into stem cells CD34 + cells transplantation combined with sarpogrelate hydrochloride group ( group A) with 100 lower limbs, CD34 + stem cell transplantation group ( group B) with 91 lower limbs, and sarpogrelate hydrochloride oral group ( group C) with 71 lower limbs. The degree of lower limb local blood flow variability were calculated at the three levels of skin, blood vessels and blood by preoperative and postoperative use of multi-function monitoring instrument, Doppler detector, transcutaneous oxygen pressure monitor, and digital subtraction angiography ( DSA) , respectively. Results⑴ The degree of shank, foot cyanosis, cool skin, and pain was relieved significantly in groups A and B than in group C for 1 month after the treatment (P<0. 05). ⑵Intermittent claudication distance, the skin temperature of the lower leg and foot to patients in the groups A and B than in group C, with a significant difference (F=7. 01, F=7. 04, P<0. 05) for 3 months after the treatment. ⑶ Among the patients with amputation, 10 cases were in group A, 16 cases in group B, and 31 cases in group C for 6 months after the treatment. ⑷ Transcutaneous oxygen pressure was increased from ( 30. 43 ± 4. 31 ) mmHg to ( 37. 21 ± 9. 01)mmHg (F=5. 69, P<0. 05), ankle brachial index from (0. 32 ±0. 23) to (0. 91 ± 0. 16) (F=6. 71, P<0. 05), the volume of blood flow index from the photoelectric (0. 22 ± 0. 04) to (0. 83 ± 0. 13 (F=5. 69, P<0. 05), oxygen saturation from (42. 41 ±9. 61)％ to (79. 61 ±20. 34)％ (F=5. 74, P<0. 05), and DSA score (0. 23 ± 0. 03) increased to (1. 35 ± 0. 23) (F=7. 14, P<0. 05), which was sig-nificantly higher than group B and group C ( F=7. 01, F=7. 04, F=7. 12, F=7. 08, F=7. 15, P<0. 05) for one year after treatment. Conclusions Treatment of peripheral blood stem cells CD34 + cell transplantation combined with oral sarpogrelate hydrochloride can significantly improve the vascular regener-ation and its blood supply in TAO lower extremity limb.

Problems and Countermeasure of IntroducingMedical Social Workers to Hospitals / 中国医学伦理学

In China, health care system is not perfect,the trust is lack between doctors and patients. Introdu-cing medical social workers to hospitals is to manage social resources as a whole, optimize medical treatment service process,enhance the quality of medical service, and relieve the pressure of doctors and nurses. Under this back-ground, this paper gave an overview of the medical social work and its contents. Then, it analyzed the necessity of introducing medical social workers to hospitals and pointed out the existing plight of medical social work. Finally, it put forward the suggestions and countermeasures to promote medical social work.

The research in the changes of design in the history taking exam of Phased Empirical Medical Licensing Examination / 中华医学教育探索杂志

History taking capability is a basic skill of clinician.During the Phased Empirical Research,NMEC redesigned the test station of History taking.On the basis of the same inquiry,we use SP,enlarge the question amount,score value,exam time,and also add the evaluation of comprehensive quality.By the new test,we can measure the history taking skill,communication talent and medical humanity competence of medical students.This paper raises a claim on humanistic quality education of medical students in order to prompt medical education to attach importance to the cultivation of medical humanity competence,to improve the medical humanistic education model,then improve the overall quality of medical students.

The inspiration of the Chinese clinical medical national licensing examination on the medical educational reform in China / 中华医学教育探索杂志

The Chinese clinical medical national licensing examination is the profession ad-mittance exam, which is undertake the responsibility of selecting qualified physicians. It also promotes the medical education in China. The standard for examination, the examination content, methods for measuring the Chinese clinical medical national licensing examination as well as the reform and de-velopment, has a certaln guiding role to China's medical education and medical education reform. While reviewing the medical students' performance in the examination, we can discover the weakness in medical education, which is then conducive to the promotion of teaching reform and innovation. The competence based medical licensing examination reform in China, advocating the cultivation of clinical comprehensive ability as the core content to tralning and evaluating, is conducive to continuously im-proving the quality of medical education in China, and to tralning more qualified physicians in the country.

hFgl2 protein expression in peripheral blood mononuclear cells in different clinical types of liver disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To detect hFgl2 expression in peripheral blood mononuclear cells in patients with chronic hepatitis B and liver cancer and explore its association with the severity of chronic hepatitis B.</p><p><b>METHODS</b>The protein expression of hFgl2 in peripheral blood mononuclear cells was detected in 78 patients with chronic hepatitis B (including mild, moderate, or severe cases), chronic severe hepatitis, or liver cancer, with 20 healthy volunteers as controls. The data were analyzed in comparison with the patients' alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBiL and) levels.</p><p><b>RESULTS</b>hFgl2 protein expression was significantly higher in patients with chronic severe hepatitis and liver cancer than in the healthy volunteers and patients with chronic hepatitis B. The patients with chronic severe hepatitis had significantly higher hFgl2 protein expression than patients with liver cancer. In severe cases of chronic hepatitis B, hFgl2 protein expression was positively correlated with ALT, AST and TBiL, but these correlations were not found in mild or moderate cases.</p><p><b>CONCLUSIONS</b>Peripheral blood mononuclear cells express hFgl2 protein, whose expression level increases with the severity of chronic hepatitis B.</p>

Exploration of the relationship between the expression level of Th1/Th2 cytokines and the familial aggregation of the hepatocellular carcinoma / 中华微生物学和免疫学杂志

Objective To investigate the effect of Th1/Th2 cytokines and immune state on the occurrence and familial aggregation of hepatocellular carcinoma(HCC).Methods Ninety-five members whose families have had two or even more HCC patients(high-occurrence families) were selected as the case group,by matching with the same nationality,gender,residential area,age±5 years old,95 members whose families had no any cancer were selected as the control.The level of peripheral blood Th1 type cytokines such as interferon-γ(IFN-γ),interleukin-2(IL-2) and Th2 type cytokines such as interleukin-4(IL-4),interleukin-10 (IL-10) were detected by enzyme linked immunosorbent assay(ELISA).Results There was a Th1/Th2 serum cytokine imbalance profile in members of HCC high-occurrence family.The levels of IFN-γ and IL-2 were significantly lower in members of HCC high-occurrence family than that of the controls.The levels of IL-4 and IL-10 were higher in members of HCC high-occurrence family than that of the controls.Conclusion There was a poor cellular immune state in members of HCC in the high-occurrence families.Th1 type cytokines was inhibited,and Th2 type cytokines was enhanced,so more susceptible to HBV chronic infection.It might be the mechanism of HCC occurrence and familial aggregation.

An investigation for the effect of HLA-DRB1*07,13 allelic genes on the immune response to hepatitis B vaccination / 中国免疫学杂志

Objective:To investigate the effect of HLA-DRB1*07,13 allelic genes on the immune response to hepatitis B vaccination.Methods:896 healthy college students of Han nationality from Guangxi province,who had received standard courses of vaccination with recombinant hepatitis B virus vaccine,were tested the level of anti-HBs with ELISA method at the sixth month after their last vaccination.The non- or hypo-responders were selected to receive another 20 μg doses of recombinant vaccine and were examined anti-HBs once more four weeks later.99 non- or hypo-responders and 136 medium or hyper-responders were selected for the study subjects.HLA-DRB1*07,13 allelic genes of the subjects were detected by polymerase chain reaction using sequence specific primer (PCR-SSP) method.Results:The frequencies of HLA-DRB1*07 gene in the non- or hypo-responders group were significantly higher than that in the medium or hyper-responder group (16.16% vs 4.41%,P＜0.05). No significant difference of HLA-DRB1*13 gene between the two groups (1.01% vs 3.68%,P=0.389).Conclusion:There is a close relationship between the expression of HLA-DRB1*07 gene and the non- or hypo-response to HB vaccine;No relationship between HLA-DRB1*13 gene expression and the response to HB vaccine is found.

Study of endovascular abdominal aortic aneurysm repair YANG / 国际外科学杂志

Objective To evaluate short-term curative effect of endovascular abdominal aortic aneurysm repair. Methods Twelve cases of infra-renal abdominal aortic aneurysms were checked. Results The av-erage bleeding in the operation was 245 millimeter, the avenage hospitalization time was 8.6 days, and the average abrosia time was 1.5 days. White blood cell, hemoglobin, thrombocyte, hepatic function, and renal function were in the normal limits. Prothrombin time and activated partial thromboplastin time were post-poned after operation, and recovered normally within one week. Complications of operations were as follows:1 case of pulmonary infection, 2 cases of abdominal distention, and 1 case of intraoperafive endoleak. The former two kinds of complications alleviated after conventional treatment, and the latter disappeared naturally after 3 months. Conclusion Endovascular abdominal aortic aneurysm repair is safe, mini-invasive, and has little disturbance for body internal environment.

Assessment and Curative Effect of Percutem Transilluminated with Negative Pressured on The Potaried Technique on Treatment of Venous Ulcer in Lower Extremity / 中国普外基础与临床杂志

Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity.Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity,who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009,were analyzed.Three hundred cases were randomly divided into potaried group and transfixion group.In potaried group,there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system.In transfixion group,110 cases involving 110 legs treated with percutum transfixion.The clinical indexes of skin infection rate and skin necrosis rate,shrinkage rate of wound area and skin depigmentation rate,ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5,day 20,day 120 and day 360 after operation respectively.Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P0.05).Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P

Insertion of Inferior Vena Cave Filter in Treating Lower Extremity Deep Venous Thrombosis / 中国普外基础与临床杂志

Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis(DVT).Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment,20 in which were treated by therapy with anticoagulation and thrombolysis,and therapy with pressure gradient,and the other 26 patients by operation and thrombolysis therapy,and therapy with pressure gradient.Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy.Results Inferior vena cava filters were placed successfully in all patients,38 cases were implanted permanence inferior vena cava filter,8 cases were implanted temporary inferior vena cava filter.Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment.None of pulmonary embolism was occurred.Follow up 2-24 months(average 13 months) for 36 cases with permanence inferior vena cava filter,there was no complication of the filter and pulmonary embolism occurred.Conclusions The method of inserting inferior vena cava filter is simple and safe,which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.

Long-term monitoring and prediction for settlement and composition of refuse in Shanghai Laogang Municipal Landfill.

Parameters about composition of refuse such as mass percentage of biodegradable matter, volatile solid, organic carbon, cellulose, total sugar, and settlement were monitored and analyzed in a large-scale experimental unit. The empirical formulas between composition and refuse age were established in terms of the data obtained from the experimental unit and verified by comparing with the corresponding parameters of refuse in the closed landfill units from 1991 until 1994 in the Shanghai Laogang Municipal Landfill. Furthermore, the long-term prediction for the composition of refuse was made, and it was predicted that the half-life is 7 to 11 years for biodegradable matter, 9 to 12 years for organic carbon or volatile solid, 7 to 16 years for cellulose, and 4 to 6 years for total sugar. In addition, a mathematical model, based on the mechanism of refuse biodegradation in the landfill, was developed to simulate the relationship between the settlement and the refuse age and manifests the secondary settlement potential. The mathematical model was proved not only to be reliable but also should be accurate for predicting the settlement of the landfill. The secondary settlement, which mainly results from the slow and gradual biodegradation of refuse, is linear with respect to the exponent of refuse age. Finally, according to the settlement model and empirical biodegradation formulas, it may be predicted that, 79.4% of biodegradable matter, 92.9% of total sugar, 72.7% of volatile solid and organic carbon, and 73.1% of cellulose will be biodegraded and that 79% of the maximum secondary settlement potential will occur before the Shanghai Laogang Municipal Landfill is in a high stabilization situation, i.e., approximately 21 years after final closure.

Chemical stabilization of MSW incinerator fly ashes.

In this work, the relationship between heavy metal content of fly ash and that of the solid wastes incinerated was correlated and compared. It is found that the former is a function of the latter. Hence, it is important to prevent heavy metal-rich wastes from being incinerated in order to reduce the content of toxic metals in the fly ash. The leachability of fly ash from incineration was usually beyond the scope of toxicity standard and must be properly treated before discharge. Secondly, chemical stabilization for the heavy metals in fly ash was explored. Among the chemicals used, it was found that sodium hydroxide was not suitable for the adequate extraction of the heavy metals from the fly ash. Ethylenediaminetetraacetic acid disodium salt (EDTA) was also tested and seems to be effective for the leaching of toxic metals from the fly ash. On the other hand, sodium sulfide and thiourea are one of excellent chemicals for the effective treatment of fly ashes, since they convert soluble and leachable toxic metals into non-leachable and insoluble forms such as lead and zinc sulfide or their similar forms of thiourea. These chemical species are supposed to be stable in nature. A comparison between chemical stabilization noted above and cement or asphalt solidification methods is made. Chemical stabilization processes, especially using sodium sulfide as the chemical agent, are strongly recommended for the practical uses, in terms of the volume expansion and environmental safety of the stabilized products and cost balances, in comparison with the traditional cement or asphalt solidification methods.

Effects of chloride channel blocker on hypoxia induced rat pulmonary hypertension / 中国临床药理学与治疗学

AIM: To investigate the therapeutic effect of chloride channel blocker tamoxifen on hypoxia pulmonary hypertension in rats.METHODS: Sixty male Wistar rats were randomly divided into therapeutic group(H/Q group),hypoxia group(H group),normal control group(C group).Mean pulmonary artery pressure(mPAP),the ratio of the weight of right ventricle to that of left ventricle plus septum[RV(LV+S)],and the ratio of the pulmonary arteriole wall area to that of vascular total area(WA/TA),were measured at 4,7,14,21 days.RESULTS:The mPAP began to increase from 7 days,and reached peak at 21 days in hypoxia group,however it is obviously lower in therapeutic group at same time.The ratio of RV(LV+S) began to increase from 14 days,and reached peak at 21 days in hypoxia group,however it is obviously lower in therapeutic group at same time.The ratio of WA/TA at 21 days in hypoxia group was significantly higher than therapeutic group,respectively(P

Evaluation of Residues of Chrysanthemum Ester Pesticides and Heavy Metals in Oolong Tea Samples / 环境与健康杂志

Objective To analyze the residues of chrysanthemum ester pesticides and heavy metals in several typical Oolong tea samples for evaluating the drink safety. Methods The residues of chrysanthemum ester pesticides in the tea samples were extracted with ultrasonic method. Gas chromatography equipped with ECD was applied to determine the pesticide residues. The heavy metals in tea samples were analyzed with an inductively coupled plasma-mass spectrometer (ICP-Mass) and an atomic fluorescence spectrometer. Results The residues of chrysanthemum ester pesticides in the dry tea samples were 0.200-0.780 mg/kg, no residues was detected in the tea water. The content of heavy metals in the dry tea and tea water was very low, under the standard limits. Conclusion The Oolong tea samples chosen in the present investigation have not been polluted by chrysanthemum ester pesticides and heavy metals, according to the results, the Oolong tea made in the area is safe for drink.