Geographic distribution and impacts of climate change on the suitable habitats of Rhamnus utilis Decne in China.

BACKGROUND: Rhamnus utilis Decne (Rhamnaceae) is an ecologically and economically important tree species. The growing market demands and recent anthropogenic impacts to R. utilis forests has negatively impacted its populations severely. However, little is known about the potential distribution of this species and environmental factors that affect habitat suitability for this species. By using 219 occurrence records along with 51 environmental factors, present and future suitable habitats were estimated for R. utilis using Maxent modeling; the important environmental factors affecting its distribution were analyzed. RESULTS: January water vapor pressure, normalized difference vegetation index, mean diurnal range, and precipitation of the warmest quarter represented the critical factors explaining the environmental requirements of R. utilis. The potential habitat of R. utilis included most provinces from central to southeast China. Under the climate change scenario SSP 245, Maxent predicted a cumulative loss of ca. 0.73 × 105 km2 in suitable habitat for R. utilis during 2041-2060 while an increase of ca. 0.65 × 105 km2 occurred during 2081-2100. Furthermore, under this climate change scenario, the suitable habitat will geographically expand to higher elevations. CONCLUSIONS: The findings of our study provide a foundation for targeted conservation efforts and inform future research on R. utilis. By considering the identified environmental factors and anticipating the potential impacts of climate change, conservation strategies can be developed to preserve and restore suitable habitats for R. utilis. Protecting this species is not only crucial for maintaining biodiversity but also for sustaining the economic benefits associated with its ecological services.

Safety and efficacy of anlotinib in patients with unresectable or metastatic bone and soft-tissue sarcomas:a retrospective institution study / 肿瘤

Objective:This study aims to analyze the efficacy and safety of anlotinib in the real world for patients with unresectable or metastatic bone and soft-tissue sarcomas(STSs). Methods:Clinical data of 124 patients with unresectable or metastatic bone and STSs treated with anlotinib in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were retrospectively analyzed.Information on age,sex,performance status,lines of anlotinib,surgical history,reduction of anlotinib,adverse reaction,metastatic site,tumor location,pathological subtypes and combination chemotherapy was collected and analyzed.The objective response rate(ORR)and disease control rate(DCR)was analyzed for short-term efficacy.Kaplan-Meier method was performed for survival analysis,and the evaluation indexes were median progression-free survival(mPFS)and median overall survival(mOS). Results:The main pathological subtypes of 124 patients were Synovial sarcoma(SS),Leiomyosarcoma(LMS),liposarcoma(LPS).The median age was 48.5 years(9-83 years).The ORR and DCR of anlotinib used in first-line therapy were 26.8％and 82.1％,but in second-line therapy and beyond,the ORR and DCR only were 5.9％and 64.7％.There were improvement in mPFS and mOS with anlotinib in first-line therapy compared to second-line therapy and beyond(mPFS:22.0 months vs 7.0 months,P=0.001;mOS:51.0 months vs 32.0 months,P=0.035).Adverse reactions of anlotinib were well tolerated,and the main grades of adverse reactions were grade Ⅰ and Ⅱ.No new anlotinib-related adverse reactions were identified. Conclusion:Anlotinib has shown a definite effect in the treatment of unresectable or metastatic bone and STSs.The adverse events of anlotinib are minor and well tolerated,and the efficacy of first-line treatment is better.

Pediatric anti-N-methyl-D-aspartate receptor encephalitis with MOG-Ab co-existence: Relapse propensity and treatability.

OBJECTIVES: To investigate the clinical characteristics of the anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis with anti-myelin oligodendrocyte glycoprotein antibody(MOG-Ab)positivity serostatus in pediatric patients. METHODS: The clinical manifestations, treatments, and outcomes of patients with anti-NMDAR encephalitis with positive MOG-Ab were elaborated. The annualized relapse rates (ARRs) were compared before and during treatment with disease-modifying drugs (DMDs). RESULTS: Twelve patients were included. In the prospective cohort(Cohort A), MOG-Ab positivity was associated with relapse (p = 0.028, OR = 1.677). Eight cases relapsed, of which six cases were treated with DMDs. The median ARR reduced significantly following DMDs treatments (z = 1.992, P = 0.046). CONCLUSIONS: The anti-NMDAR encephalitis patients with MOG-Ab co-existence are prone to relapse. Long-term DMDs therapy can reduce ARRs.

Application of the ArcherQA three-dimensional dose verification system in intensity-modulated radiotherapy plans for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective:To investigate the feasibility of applying the ArcherQA three-dimensional (3D) dosimetric verification system in intensity-modulated radiotherapy (IMRT) plans for nasopharyngeal carcinoma (NPC).Methods:A retrospective analysis was conducted for 105 NPC patients′ IMRT plans developed using the Eclipse treatment planning system (TPS). Dose verification was conducted using the ArcherQA system and through portal dosimetry (PD). Moreover, this study compared γ passing rates (criteria: 3 mm/3%, TH = 10%) between ArcherQA and PD and the doses delivered to the target volume ( Dmean, D90%) and organs at risk (OARs) ( Dmean) between ArcherQA and TPS, and analyzed the 3D γ passing rates of each organ at risk calculated by ArcherQA. Results:The average 3D γ passing rate calculated by ArcherQA was (99.04±1.01)%, and the average 2D γ passing rate measured by PD was (99.49±0.78)%, with statistically significant differences ( t=-3.35, P< 0.05). The dosimetric differences to the target volume between ArcherQA and TPS were as follows: the average difference in Dmean to the gross tumor volume (GTV) was (0.57±0.48)%, and the average difference in D90% was (0.65±0.56)%. For the target volume, the average γ passing rate was (97.67±3.43)% for GTV, (97.80±4.35)% for GTVnd-L, (97.82±4.07)% for GTVnd-R, (97.88±2.44)% for CTV1, and (96.64±4.32)% for CTV2. The mean dose difference of each target volume was CTV1 (0.57±0.46)%, GTVnd-L (0.85±0.55)%, GTVnd-R (0.73±0.55)%, and CTV2 (0.88±0.52)%. For OARs, the mean γ passing rate was (99.93±0.22)% for the brainstem, (99.17±2.82)% for the optic chiasm, (100±0)% for the lens, (99.56±1.05)% for the spinal cord, (99.00±2.06)% for the thyroid, and (87.86±10.42)% for the trachea. Statistically significant differences in the average doses to OARs were observed ( t=-14.62 to 4.82, P<0.05), except for those to the left optic nerve, the right hippocampus, and the right parotid gland. Conclusions:Based on the high-performance GPU platform and the Monte Carlo dose algorithm, ArcherQA can provide accurate 3D dose distribution and 3D γ passing rates inside patients according to CT images and provide the dose volume histogram (DVH) of various regions of interest (ROIs). Therefore, the ArcherQA three-dimensional dose verification system can be applied to IMRT plans for NPC. Moreover, it is inducive to improve the treatment efficiency since it does not occupy the accelerator operation time.

Influence of three combined exercise programs on improving sleep quality among college students with sleep disorders / 中国学校卫生

Objective@#To explore the improvement influence of three combined exercise programs on sleep quality among college students with sleep disorders, so as to provide reference for the construction of exercise intervention programs for sleep disorder.@*Methods@#A total of 35 college students with sleep disorders were randomly divided into AR group ( n =10), AM group ( n =8), RM group ( n =9) and CG group ( n =8). The three exercise groups were provided with exercise intervention for 8 weeks, 3 times/week , 60 min/time, and the CG group maintained previous lifestyle.Before and after the intervention,evaluation of subjective sleep quality and reduction rate of sleep disorder by PSQI, and Actigraph GT3X+ was used to monitor the changes in the objective sleep quality.@*Results@#After the intervention,the total score of PSQI ( t =3.49, 2.31, 2.73), sleep quality score ( t =2.71, 3.00 , 5.29),sleep duration of AR group ( t =2.74), daytime dysfunction of AM group ( t =2.64) and sleep duration of RM group ( t = 2.29) significantly decreased ( P ＜0.05); The scores of sleep duration in AM group were significantly lower than those in AR group, and the scores of PSQI,sleep quality and daytime dysfunction in AM group were significantly lower than those in CG group (P<0.05). After intervention,TST ( t =-4.41, -8.37, -6.79) and SE ( t =-4.40, -5.86, -4.91) of AR group, AM group and RM group significantly increased( P <0.05), SOL ( t =4.18, 9.93), WASO ( t =2.91, 3.46) and NA ( t =4.80, 3.37) of AM group and RM group significantly decreased ( P <0.05). The changes of TST,SE and WASO in RM group were significantly higher than those in CG group, and SOL was significantly lower than those in CG group ( P <0.05).@*Conclusion@#The three kinds of combined exercise programs can improve the subjective and objective sleep quality of college students with sleep disorders, and reduce the incidence of sleep disorders; different combined exercise programs have different influence on the improvement of sleep quality of college students with sleep disorders, aerobic combined meditative movement exercise program has a prominent influence on the improvement of subjective sleep quality, and resistance combined meditative movement exercise program has a prominent influence on the improvement of objective sleep quality.

Clinical application of the new classification criteria in children with Miller Fisher syndrome and clinical characteristics analysis of different types of Miller Fisher syndrome / 中华实用儿科临床杂志

Objective:To investigate the clinical application of the new classification criteria in children with Miller Fisher syndrome (MFS), and to analyze clinical characteristics of different types of MFS.Methods:Clinical data of MFS patients hospitalized in the Department of Neurology, Beijing Children′s Hospital, Capital Medical University from January 2015 to December 2019 were collected and analyzed retrospectively, including demographic characteristics, clinical symptoms, neurological examination findings, laboratory examination data, diagnosis and treatment, and prognosis.The counting data was described by percentage, and the measurement data was described by median.Results:A total of 23 patients were included in the research, including 14 males and 9 females, with a median age of 4 years and 8 months.There were 3 cases of pure MFS; 5 cases of incomplete MFS, including 1 case of acute ptosis and 4 cases of acute ataxia neuropathy; 15 cases of overlapping syndrome, including 13 cases of MFS/Guillain Barre syndrome (GBS), 1 case of MFS/pharyngocervical brachial variant GBS(PCB GBS)and 1 case of MFS/GBS/Bickertaff brainstem encephalitis (BBE). In addition to Ⅲ, Ⅳ and Ⅵ cranial nerve palsy, 11 cases had the involvement of other cra-nial nerves, including 2 cases in pure MFS, 8 cases in MFS/GBS and 1 case in MFS/GBS/BBE.Autonomic nervous dysfunction occurred in 6 cases.Respiratory muscle paralysis occurred in 6 cases, including 5 cases in MFS/GBS and 1 case in MFS/GBS/BBE.Graded by the Hughes scoring system (HG score), 3 cases with pure MFS were graded 4 points; 1 case with acute ptosis was graded 0; 3 cases with acute ataxia neuropathy were graded 2 points, and the other one was graded 3 points; 1 case with MFS/PCB GBS was graded 3 points; 10 cases with MFS/GBS were graded 4 points, 1 case was graded 3 points, and the other 2 cases were graded 2 points; 1 case with MFS/GBS/BBE was graded 4 points.Twenty-two patients were treated with intravenous immunoglobulin.The HG of all patients at discharge decreased at varying degree, which was graded 0 at 6 months of follow-up.Conclusions:The clinical application of the new diagnostic classification method is helpful to the accurate diagnosis of different types of MFS.More than half of MFS cases will develop into the overlapping syndrome.The overlapping of MFS and GBS or BBE is prone to the involvement of cranial nerves except for the external ophthalmic muscles, autonomic nerve dysfunction and respiratory muscle paralysis.The disease course of MFS varies, and its diagnosis should be comprehensively made.All cases of MFS in this study have a satisfactory prognosis.

Risk Factors and Clinical Management of Prolonged Upper Gastrointestinal Transit Time in Capsule Endoscopy / 胃肠病学

Capsule endoscopy is one of the main diagnostic methods of small bowel diseases. In small bowel capsule endoscopy, the main factors that influence the diagnostic rate of diseases include gastrointestinal examination completion rate and intestinal preparation, etc. The upper gastrointestinal transit time is one of the main influence factors of examination completion rate. This article reviewed risk factors and clinical management of prolonged upper gastrointestinal transit time in capsule endoscopy.

Clinical imaging features and prognosis of 40 children with influenza associated encephalopathy / 中华实用儿科临床杂志

Objective:To analyze the clinical and imaging features of influenza associated encephalopathy(IAE) in children, thus contributing to enhance the efficacy of early identification, timely treatment and prognosis.Methods:Clinical data, laboratory examination, imaging data, treatment and outcomes of 40 children with IAE diagnosed and treated in the Beijing Children′s Hospital, Capital Medical University from December 2016 to January 2020 were retrospectively analyzed.Clinical features were summarized and they were further classified according to clinical imaging features.The prognosis was compared and analyzed.Results:A total of 20 boys and 20 girls were recruited, with the age of attending hospital at (4.0±2.3) years (median, 3.2 years). There were 28 children with influenza A and 12 with influenza B. All children initially had fever, and the interval between fever and symptoms of neurological onset was 24 hours (0-120 hours). The most-common symptom of neurological onset was seizures(32 cases), among which 17 patients showed continuous seizures.All children presented encephalopathy at varying degrees, including 33 cases in coma and 7 in drowsiness or cognitive decline.Thirty cases developed central respiratory failure and received mechanical ventilation.Examination results showed 30 cases had elevated aspartate transaminase (AST), 18 cases had elevated alanine transaminase (ALT), 14 cases had elevated creatinine, 31 cases had elevated lactate dehydrogenase, 16 cases had elevated blood glucose and 1 case had significantly lowered blood glucose.Blood ammonia testing was performed in 38 children and 9 cases had elevated level.The whole exon sequencing in 6 cases showed de novo heterozygous mutation of the SCN1A gene in 1 case, and heterozygous mutation of the ATP1A2 gene inherited from the mother in another case.Lumbar puncture was performed in 35 cases, and all of them had a normal range of cerebrospinal fluid leukocyte counts, while 12 cases had elevated cerebrospinal fluid proteins.Abnormal image findings were examined in 33 cases and the acute necrotizing encephalopathy was the most common one (14 cases). All children received Peramivir or Oseltamivir after admission.A total of 28 cases were treated with glucocorticoids, and 29 cases were treated with immunoglobulin.Seventeen cases died, 9 cases had disability at varying degrees, and 14 cases recovered to the baseline.Patients were divided into good prognosis group and poor prognosis group.(1) Patients in good prognosis group presented significantly shorter interval between fever and first neurological symptoms[(22.7±12.2) h vs.(38.6± 30.9) h], higher Glasgow score on admission[(7.6±2.5) points vs.(4.5 ± 1.6) points], lower ALT [15.6 (9.0-1 631.5) U/L vs.140.2 (12.3-3 232.4) U/L] and lower AST [47.6 (25.4-1 721.3) U/L vs.251.8 (21.7-4 991.6) U/L] than those in poor prognosis group (all P<0.05). (2) Glucocorticoids were applied to 17 and 11 cases in good prognosis group and poor prognosis group, while immunoglobulins were applied to 17 and 12 cases, respectively ( P>0.05). (3) Patients were further classified into cytokine storm group, excitotoxicity group and unclassifiable group according to clinical imaging findings.The Glasgow score [ (4.6±1.7) points vs.(7.6±2.2) point vs.(7.3±2.8) points] and median modified Rankin Scale score (6.0 points vs.1.5 points vs.0) were significantly different among 3 groups (all P<0.01). Conclusions:Influenza associated encephalopathy is common in infants and young children.Fever, convulsions and rapidly progressing disturbance of consciousness are the most common clinical manifestations.Acute necrotizing encephalopathy is the most common subtype of clinical imaging syndrome.Acute onset and rapid progression predict the poor prognosis of influenza associated encephalopathy.

Clinical analysis of 13 cases with acute pandysautonomia / 中华实用儿科临床杂志

Objective:To summarize the clinical data of patients with acute pandysautonomia (APD) and discuss the treatment and prognosis of them.Methods:A total of 13 patients with APD in the Department of Neurology, Beijing Children′s Hospital, Capital Medical University, from January 2010 to December 2019, were investigated retrospectively.The general data, clinical symptoms, autonomic nerve examination and function test, laboratory examination, treatment and follow-up were collected and analyzed.Results:There were 4 males and 9 females in 13 patients with APD, with an average age was 8 years and 5 months (3 years and 8 months to 12 years and 5 months ). The average course of disease was 94.5 d (14-410 d). The common initial symptoms were gastrointestinal motility disorder (11 cases), dysuria (3 cases), and upright syncope/vertigo (3 cases). During the course of the disease, all the patients manifested with gastrointestinal motility disfunction and dyshidrosis, glands involvement and orthostatic hypotension in 12 cases, abnormal pupil in 9 case and urinary retention in 7 case.Other symptoms included fatigue in 9 cases, emotional disorder in 4 cases, limb weakness in 2 cases, and sensory disturbance in 2 cases.All the patients were treated with intravenous immunoglobulin (IVIG), and 3 cases combined with glucocorticoid.Six patients with severe gastrointestinal symptoms were treated with intravenous nutrition; 4 patients were fed with jejunum, 3 cases of whom returned to normal diet within 1-12 months, and 1 patient was followed up for 5 years and 2 months.Hyponatremia was found in 7 cases, which recovered in 2-30 d. Nine cases were followed up for 1 month to 9 years.Seven cases were normal in daily work and study, with satisfactory nutritional status, stable mood and no relapse.Conclusions:The clinical manifestations of APD are varied.The initial symptoms are gastrointestinal motility disorders, orthostatic hypotension, urinary retention and hyponatremia.Individualized multi-disciplinary comprehensive management for symptoms, especially the comprehensive treatment of gastrointestinal motility disorders, management of postural hypotension, and the urinary system diagnosis and individualized treatment of can shorten the length of hospital stay and improve the prognosis effectively.

Clinical effect of tacrolimus in the treatment of myasthenia gravis in children / 中国当代儿科杂志

OBJECTIVE@#To evaluate the efficacy and safety of tacrolimus in the treatment of children with myasthenia gravis (MG).@*METHODS@#A total of 28 children with MG were treated with tacrolimus. MG-Activities of Daily Living (MG-ADL) scale was used to assess clinical outcome and safety after 1, 3, 6, 9, and 12 months of treatment.@*RESULTS@#After tacrolimus treatment, the MG-ADL score at 1, 3, 6, 9 and 12 months was lower than that at baseline (P<0.05), and the MG-ADL score showed a gradually decreasing trend. The response rates to tacrolimus treatment at 1, 3, 6, 9, and 12 months were 59%, 81%, 84%, 88%, and 88% respectively. At 6, 9, 12, and 18 months of treatment, 4, 13, 14, and 15 children respectively were withdrawn from prednisone. No recurrence was observed during treatment. Major adverse reactions/events were asymptomatic reduction in blood magnesium in 5 children and positive urine occult blood in 1 child, which turned negative without special treatment, and tacrolimus was not stopped due to such adverse reactions/events. One child was withdrawn from tacrolimus due to recurrent vomiting. According to CYP3A5 genotypes, all of the patients were divided into two groups: slow metabolic type (n=19) and non-slow metabolic type (fast metabolic type + intermediate type; n=9). The non-slow metabolism group received a higher dose of tacrolimus, but had a lower trough concentration of tacrolimus than the slow metabolism group (P<0.05). The slow metabolism group had a higher response rates to tacrolimus treatment than the non-slow metabolism group (P<0.05).@*CONCLUSIONS@#Tacrolimus appears to be effective and safe in the treatment of children with MG and is thus an option for immunosuppressive therapy. CYP3A5 genotyping has a certain guiding significance for determining the dosage of tacrolimus.

Recent advances of traditional Chinese medicine on the prevention and treatment of COVID-19 / 中国天然药物

Coronavirus disease-2019 (COVID-19) is a new highly infectious disease caused by a novel coronavirus. Recently, the number of new cases infected pneumonia in the world continues to increase, which has aroused great concern from the international community. At present, there are no small-molecule specific anti-viral drugs for the treatment. The high mortality rate seriously threatens human health. Traditional Chinese medicine (TCM) is a unique health resource in China. The combination of TCM and Western medicine has played a positive and important role in combating COVID-19 in China. In this review, through literature mining and analysis, it was found that TCM has the potential to prevent and treat the COVID-19. Then, the network pharmacological studies demonstrated that TCM played roles of anti-virus, anti-inflammation and immunoregulation in the management of COVID-19 via multiple components acting on multiple targets and multiple pathways. Finally, clinical researches also confirmed the beneficial effects of TCM on the treatment of patients. This review may provide meaningful and useful information on further drug development of COVID-19 and other viral infectious diseases.

Single-balloon Enteroscopy for Diagnosis of Meckel Diverticulum in Adults / 胃肠病学

Background: Meckel diverticulum is one of the most common congenital malformations of the gastrointestinal tract. It is relatively rare in adults and is difficult to make a preoperative diagnosis. Aims: To analyze the clinical characteristics of Meckel diverticulum in adults and to investigate the diagnostic value of single-balloon enteroscopy for adult Meckel diverticulum. Methods: A retrospective study was performed in patients diagnosed as adult Meckel diverticulum by single-balloon enteroscopy at Renji Hospital, School of Medicine, Shanghai Jiao Tong University from Apr. 2011 to Jan. 2019. Results: A total of 30 adult Meckel diverticulum patients were enrolled. Of them, 26 were male and 4 were female with a mean age of (36.1±14.6) years. The mean duration of symptoms ranged from 6 days to 30 years. The prevalence of gastrointestinal bleeding, abdominal pain/diarrhea, and anemia was 73.3% (22/30), 40.0% (12/30), and 50.0% (15/30), respectively. All the diverticula were detected by retrograde single-balloon enteroscopy. The mean distance of diverticulum from the ileocecal valve was (98.7±29.5) cm, and the size of diverticulum opening was 3.25 cm on average. Ulcer was found in 11 cases. Sixteen cases underwent surgical resection, and 12.5% and 18.8% of them were proved to contain ectopic gastric mucosa and ectopic pancreas, respectively. The diagnostic yield of capsule endoscopy and imaging modalities were relatively low (39.1% and 20.7%, respectively). Conclusions: Single-balloon enteroscopy has a high diagnostic value for Meckel diverticulum in adults and may provide guidance for clinical treatment. For adults suspected of Meckel diverticulum, retrograde single-balloon enteroscopy is recommended.

Clinical features of central nerve system inflammatory demyelinating diseases associated with anti-myelin oligodendrocyte glycoprotein antibodies in children / 中华实用儿科临床杂志

Objective@#To describe the clinical manifestations of central nerve system inflammatory demyelinating disease associated with anti-myelin oligodendrocyte glycoprotein antibody (MOG-IDD) in children, and to explore the clinical characteristics of the children.@*Methods@#The clinical and laboratory characteristics of the patients diagnosed in Beijing Children′s Hospital, Capital Medical University, from October 2016 to August 2018 were described, and the clinical data of the patients with unipolar and recurrent diseases were compared.@*Results@#A total of 50 patients were included, among whom the ratio of male to female was 24:26, and the average age of onset was (6.7±3.1) years old (0.4-12.6 years old). There was no significant difference in the age of onset between boys and girls(t=0.712, P=0.480). The main symptoms included fever (31/50 cases), encephalopathy (26/50 cases) and optic neuritis (22/50 cases), etc.In the last follow-up, 26 patients (52.0%) had a monophasic course and 24 patients (48.0%) had a recurrent course.There were age differences in encephalopathy and ataxia in the first episode of [(5.7±2.8) years old vs.(8.1±3.0) years old, (5.0±2.5) years old vs. (7.7±3.0) years old](t=2.746, P=0.009; t=2.837, P=0.007). The average number of recurrence was (2.1±1.4) times (1-7 times), in which 17 cases (70.8%) of recurrence presented within 12 months and 20 cases (83.3%) of recurrence presented within 24 months after onset.Convulsion incidences of recurrent cases were 10 cases and 13 cases respectively in the first episode and recurrent courses, which were significantly higher than those of monophasic cases (4 cases, 4 cases)(χ2=7.912, P=0.005; χ2=8.365, P=0.004). All patients were sensitive to first-line immunotherapy.Seven patients with recu-rrence were treated with mycophenolatemofetil, and 17 patients with repeated first-line therapy.In the last follow-up, all patients were in remission and 2 patients had mild neurological dysfunction.@*Conclusions@#MOG-IDD can occur in childhood.Encephalopathy and optic neuritis are the most common symptoms.Encephalopathy and ataxia are more common in young children.Convulsions may indicate the course of recurrence.

Diagnosis and treatment of 40 cases of gastritis cystica profunda / 中华消化内镜杂志

Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.

Clinical characteristics and follow-up of Hashimoto encephalopathy in children / 临床儿科杂志

Objective To explore the clinical characteristics of Hashimoto encephalopathy (HE) in children. Methods The clinical data of 4 children with HE were analyzed retrospectively. Results All the 4 cases were school-age children and 3 of them were girls. They were physically healthy before onset. The main clinical manifestations were epileptic seizures in 3 cases, mental symptoms in 2 cases, disturbance of consciousness in 2 cases, stroke like symptoms in 1 case, decreased memory and decreased sleep in 1 case. Electroencephalogram showed that the background activity was decreased in 4 cases, and MRI showed abnormal in 3 cases. Serum thyroid antibodies were significantly increased in 4 cases, and were returned to normal in 2 cases when clinical symptoms disappeared, while they were significantly reduced, but not completely back to normal in another 2 cases. Only one out of 4 cases had abnormal thyroid function. All the 4 cases responded well to corticosteroid therapy. One of them relapsed after discontinuation of the therapy, but it was still effective when the therapy was reassumed. Conclusions HE is rare in children. When there are manifestations of unknown cause, such as epileptic seizures, mental disorders, cognitive impairment, movement disorders and disturbance of consciousness, HE should be considered. In addition, the increase of serum thyroid antibody should be considered as a necessary condition for diagnosis.

TWEAK/Fn14 signaling: a promising target in intervertebral disc degeneration.

Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) is a potent chemoattractant cytokine with various biological functions, such as stimulation of angiogenesis, induction of proinflammatory cytokines, regulation of cellular proliferation and apoptosis. Therefore, it has also been implicated in several pathological processes, from cancer to inflammatory diseases. Remarkably, TWEAK and its receptors, fibroblast growth factor inducible 14 (Fn14), are also present in intervertebral disc (IVD) tissue, where they play a role in the pathogenesis of IVD degeneration. The interaction of TWEAK with Fn14 is involved in physiological and pathological activities of IVD degeneration patients, which includes apoptosis of endplate chondrocytes, extracellular matrix degradation, reduction in proteoglycan synthesis and so on. The blockade of this interaction results in suppressing over-production of proinflammatory factors and cell death in in vivo or in vitro experiments, suggesting that TWEAK/Fn14 signaling may be therapeutically relevant in IVD degeneration, and the targeting of TWEAK or Fn14 has been proposed as a potential therapeutic approach for autoimmune diseases such as Rheumatoid arthritis (RA). In this article, we discuss the biological features of TWEAK/Fn14 signaling and summarize recent advances in our understanding of the role of TWEAK/Fn14 signaling in the pathogenesis and treatment of IVD degeneration. We think that the blockade of TWEAK/Fn14 signaling may be a promising therapeutic strategy for IVD degeneration in the near future.

Serum expression of PIVKA-Ⅱand SA in patients with chronic renal insufficiency / 国际检验医学杂志

Objective To investigate the impact of chronic renal insufficiency on serum levels of protein induced by vitamin K absence or antagonist‐Ⅱ(PIVKA‐Ⅱ) and sialic acid (SA) .MethodsThe levels of serum PIVKA‐Ⅱ ,SA ,urea and creatinine(Cr) were detected in 127 cases of chronic renal insufficiency ,32 cases of renal disease with normal renal function ,57 healthy controls un‐dergoing the physical examination and 120 cases of hepatocellular carcinoma (HCC ) by using the chemiluminescent and enzymatic methods respectively .The serum urea and creatinine levels were also measured .The estimated GFR (eGFR) was calculated .Results The serum PIVKA‐Ⅱ level had no statistical difference in among the healthy control group ,renal disease with normal renal func‐tion group and renal disease with renal insufficiency group (H=2 .902 ,P> 0 .05) ,moreover significantly lower than that in the HCC group (U=319 .5 ,203 .00 ,665 .50 respectively ,P0 .05) .However ,serum SA levels had statistical differences among the healthy control group ,disease complicating normal renal function group and disease complicating renal insufficiency group( H = 63 .685 ,P0 .05) .Conclusion The renal insufficiency has no obvious im‐pact on serum PIVKA‐Ⅱexpression ,but could significantly increase the SA expression level ,moreover is closely related with the se‐verity of renal function impairment ,thus indicating that the SA level increase not only has the assisted diagnosis value on HCC and multiple malignant tumors ,but also better reflects the renal function status in the patients with chronic renal insufficiency .

Transoral Orvil EEA stapler (OrVil) in laparoscopy-assisted total gastrectomy for cardiac carcinoma / 中华普通外科杂志

Objective To evaluate transoral Orvil EEA stapler (OrVil) procedure in laparoscopic total gastrectomy for cardiac carcinoma compared with conventional anvil head method (purse-string suture).Methods From May 2014 to December 2014 20 cases were included into OrVil group,and 25 cases into purse-string suture group.Results The two groups had similar mean numbers of dissected lymph nodes [(25 ± 3) vs.(24 ± 4),t =1.067,P =0.292],the mean time of operation,intraoperative blood loss,and postoperative complications (5 vs.6,P =0.938).The length of incision was significantly shorter [(5 ±1) cm vs.(11 ± 2) cm,t =-10.724,P ＜ 0.0l] and the esophagojejunostomy time was significantly less [(28 ± 4) min vs.(39 ± 5) min,t =-7.996,P ＜ 0.01] with the use of OrVil.The time to first flatus and postoperative hospital stay were (3.7 ± 0.9) d vs.(4.4 ± 1.0) d,t =-2.485,P =0.017 and (13 ± 5) d vs.(16 ±4) d,t =-2.184,P =0.035.Conclusions OrVil is a technically safe and feasible surgical procedure for esophagojejunostomy in laparoscopy assisted total gastrectomy in the treatment of cardiac carcinoma.

Chemical constituents from whole plant of Gynura procumbens (I) / 中草药

Objective: To investigate the chemical constituents from the whole plants of Gynura procumbens. Methods: The chemical constituents were isolated and purified by repeated silica gel column chromatography, Sephadex LH-20 gel column chromatography, medium pressure column chromatography, and semi-preparative HPLC, and their structures were elucidated by chemical properties and spectroscopic analyses. Results: Sixteen compounds were identified to be quercetin (1), apigenin (2), luteolin (3), kaempferol (4), astragaline (5), kaempferol-5-O-(6″-O-acetyl)-β-D-glucopyranoside (6), negletein (7), 4-methoxycinnamic acid (8), benzyl-O-β-D-glucopyranoside (9), 2-phenylethyl-O-β-D-glucopyranoside (10), 3,5-dicaffeoylquinic acid methyl ester (11), 3,5-dicaffeoylquinic acid ethyl ester (12), 3,4-dicaffeoylquinic acid methyl ester (13), 4,5-dicaffeoylquinic acid methyl ester (14), protocatechuic acid (15), and eugenol glucoside (16). Conclusion: Compounds 7, 8, 12, 14, and 16 are obtained from the plants in Gynura Cass. for the first time, and compounds 3, 6, 9-11 and 13 are obtained from this plant for the first time.

The unqualified cause analysis of unpaid blood donation blood test from 2008 to 2012 in Dianjiang County / 重庆医学

Objective To analyse the unqualified cause of unpaid blood donation blood test in Dianjiang County .Methods The screening results of ALT ,HBsAg ,HCV antibody ,HIV antibody ,TP antibody ,of blood donors ,and their personal information from 2008 to 2012 were collected .The statistics method was used to comparative analysis .Results Rate of unqualified of unpaid blood donation blood test was 4 .06% ;Rate of unqualified of ALT was 2 .37% ,anti-TP was 0 .85% ,HBsAg was 0 .77% ,anti-HCV was 0 .15% ,anti-HIV was 0 .07% .The rate of unqualified was higher among the blood donors ,young male person ,whose level of educa-tion was junior high school and below junior high school .Conclusion It should strength preliminary screening of blood donors and screening of high-risk donors .Collecting flood from low-risk and regular donors in case to improve the quality of blood donors and decrease the waste of blood .