Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of acupuncture and moxibustion therapy (AMT) for cancer-related psychological symptoms (CRPS) of insomnia, depression and anxiety. METHODS: Seven databases were searched for randomized controlled trials (RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia, depression, and anxiety before April 2020. Two independent reviewers performed the data extraction and assessed the risk of bias. RESULTS: A total of 30 RCTs involving 2483 cancer patients were enrolled. The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [= 1.29, 95% (1.12, 1.49), 0.0004], the quality of life (QOL) [1.11, 95% (0.80, 1.42), 0.000 01], and reducing Self-rating Anxiety Scale (SAS) [ï¹£7.75, 95% (ï¹£10.44, ï¹£5.05), 0.000 01]. But there was no statistically significant difference between two groups in improving the insomnia effective rate [= 1.18, 95% (0.93, 1.51), 0.18]. The subgroup analysis showed the effectiveness of different intervention on CRPS. Compared with routine care, AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), and Self-rating Depression Scale (SDS), and depression effective rate. Compared with conventional drug, AMT performs better evaluated by SDS, depression effective rate and QOL. Moreover, the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT. Compared to conventional drug, AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI, HAMD, SDS, and SAS, and also had a meaningful improvement on insomnia effective rate, depression effective rate and QOL. Fewer published reports were found on the adverse events of AMT than the conventional drug. CONCLUSION: The results suggested that AMT might be effective in improving CPRI; however, a definite conclusion could not be drawn because the quality of trials are low. Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.

Supervision of Electronic Informed Consent in International Clinical Research and Its Implications for China / 中国医学伦理学

At present, China is still in the exploratory stage in the field of electronic informed consent (eIC), and relevant policies, regulations and application guidelines have not yet been established and improved. While the traditional informed consent supervision system is difficult to meet the needs of the innovative development of eIC, such as subject privacy and data security. Through sorting out and analyzing the legal norms and construction system of eIC supervision in Europe and the United States, combined with the current development status, problems, and challenges of eIC in China, this paper targeted proposed the path to construct the supervision of eIC in clinical research in China from the aspects of restricting the signing form and process of eIC, adjusting the ethical review paradigm of eIC, enhancing the strength of eIC ethical review, improving the construction of eIC legal system, and strengthening the training of relevant researchers.

Challenges and Suggestions for Improvement of the Electronic Informed Consent System in Clinical Application / 中国医学伦理学

The electronic informed consent (eIC) system is a product of modernization development of electronic and intelligent technology. In the context of COVID-19, the eIC system can adapt to the epidemic prevention and control requirements, showing its time-space advantages. By introducing the concept, form and the use of eIC system, this paper analyzed the challenges of acceptance, understanding, consent and information security faced by the eIC system. Based on this, some suggestions were put forward, including strengthening the training of the relevant personnel involved in the eIC system, enhancing and improving the functions of the eIC system, and perfecting the relevant laws and regulations of the eIC system, so as to provide reference for the future research and application of eIC.

Analysis of a cohort study on myopia among primary and secondary school students in Henan Province, 2019-2020 / 中国学校卫生

Objective@#To track and investigate the changes in visual acuity of primary and secondary school students in Henan Province during the COVID-19 pandemic home confinement, so as to provide theoretical basis for the prevention and control of myopia.@*Methods@#A cohort study design was employed for this research. In September 2019, visual acuity tests were conducted among 2 222 primary and secondary school students by Multi stage random cluster sampling method from four cities in Henan Province, including Zhengzhou, Xinxiang, Zhoukou, and Pingdingshan. A follow up study was conducted in June 2020, with on site visual acuity tests and questionnaire surveys. Wilcoxon rank sum test, Kruskal Wallis rank sum test, Chi square test, one way analysis of variance, and multiple linear regression model were used to analyze the changes in visual acuity of primary and secondary school students and the influencing factors from 2019 to 2020.@*Results@#Compared with 2019, the overall myopia rate of students increased in 2020, and the difference was statistically significant (55.7%, 64.9%, χ 2=1 035.91, P <0.01), and the difference between mild, moderate and severe myopia rates occurred at 2 years (2019:32.4%, 18.8%, 4.4%, 2020:36.7%, 22.5%, 5.7%, χ 2= 8.43, 9.23, 3.94, P <0.05). The myopia incidence rate of primary and secondary school students in 2020 was 28.3%. As presented in multiple linear regression analysis, middle school, grade 4th-6th and grade 1st-3rd of primary school, low economic level, using television for online classes, the study desk being not bright on sunny days, without looking far away during breaks, the brightness of the study desk and desktop which was average on sunny days, and using roof lamp only when studying at night were associated with myopia progression among students ( B=-0.16, -0.18, -0.20, -0.06, -0.21, -0.13, -0.11, -0.40, P <0.05).@*Conclusions@#During 2019-2020, primary and secondary school students in Henan Province experience a progression towards myopia, which is comprehensively influenced by education stage, economic level, the habit of using eyes, and visual environment. Myopia prevention and control should be actively intervened and strengthened to improve the eye environment for primary and secondary school students, in order to slow down the development of myopia.

Clinical Effect of Fangfeng Tongshengsan on Post-chemoembolization Syndrome with Primary Liver Cancer or Postoperative Liver Metastases of Colorectal Cancer / 中国实验方剂学杂志

ObjectiveTo observe the effect of the Fangfeng Tongshengsan on post-chemoembolization syndrome with primary liver cancer or postoperative liver metastases of colorectal cancer. MethodSeventy-two patients suffered from post-chemoembolization syndrome after transcatheter hepatic arterial chemoembolization were randomly divided into 2 groups， including a Fangfeng Tongshengsan group and a control group， with 36 patients in each group. The patients in Fangfeng Tongshengsan group orally took the decoction for consecutive 7 d. The patients in the control group were physically cooled down with alcohol rub bath and ice pack for consecutive 7 d. Furthermore， the difference of fever， Karnofsky performance status （KPS）， pain in the liver region， nausea vomiting， constipation， and liver function between these two groups were observed. ResultCompared with the control group， Fangfeng Tongshengsan significantly relieved fever， reduced the body temperature （P<0.05）， and shortened the duration of fever （P<0.05）， indicating that Fangfeng Tongshengsan remarkably improved the KPS （P<0.05）. Meanwhile， Fangfeng Tongshengsan obviously alleviated nausea， vomiting， and constipation status and shortened the duration time compared with the control group （P<0.05）. In addition， the parameters of liver function including alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ-glutamyl transpeptidase （GGT）， and total bilirubin （TBIL） were significantly decreased in the Fangfeng Tongshengsan group （P<0.05）， which indicated that Fangfeng Tongshengsan alleviated liver dysfunction of patients with post-chemoembolization syndrome. ConclusionFangfeng Tongshengsan can be used to treat post-chemoembolization syndrome with primary liver cancer and postoperative liver metastases of colorectal cancer.

Hedgehog pathway orchestrates the interplay of histone modifications and tailors combination epigenetic therapies in breast cancer

Epigenetic therapies that cause genome-wide epigenetic alterations, could trigger local interplay between different histone marks, leading to a switch of transcriptional outcome and therapeutic responses of epigenetic treatment. However, in human cancers with diverse oncogenic activation, how oncogenic pathways cooperate with epigenetic modifiers to regulate the histone mark interplay is poorly understood. We herein discover that the hedgehog (Hh) pathway reprograms the histone methylation landscape in breast cancer, especially in triple-negative breast cancer (TNBC). This facilitates the histone acetylation caused by histone deacetylase (HDAC) inhibitors and gives rise to new therapeutic vulnerability of combination therapies. Specifically, overexpression of zinc finger protein of the cerebellum 1 (ZIC1) in breast cancer promotes Hh activation, facilitating the switch of H3K27 methylation (H3K27me) to acetylation (H3K27ac). The mutually exclusive relationship of H3K27me and H3K27ac allows their functional interplay at oncogenic gene locus and switches therapeutic outcomes. Using multiple in vivo breast cancer models including patient-derived TNBC xenograft, we show that Hh signaling-orchestrated H3K27me and H3K27ac interplay tailors combination epigenetic drugs in treating breast cancer. Together, this study reveals the new role of Hh signaling-regulated histone modifications interplay in responding to HDAC inhibitors and suggests new epigenetically-targeted therapeutic solutions for treating TNBC.

Identification of a 5-gene-based signature to predict prognosis and correlate immunomodulators for rectal cancer.

BACKGROUND: Specific tumor markers have yet to be identified in rectal cancer. This study aims to identify a novel genetic signature in rectal cancer to provide clues for survival and immunotherapy. METHODS: DEGs were obtained from two GEO datasets of rectal cancer. By using data from TCGA and GSE133057, two cohorts of rectal cancer were applied to establish and evaluate the signature. A nomogram was constructed for training and validation. We integrated the risk-score with clinicopathological features and assessed its interplay with immune cells and molecules. Finally, our study performed functional annotations, gene-targeted miRNAs, and single-cell analysis. RESULTS: A total of 468 DEGs were identified, and a signature consisting of 5 genes (CLIC5, ENTPD8, PACSIN3, HGD, and GNG7) was selected to calculate the risk-score. The model exhibited high performance in time-dependent ROC and a nomogram. Further results showed that overall survival was significantly worse in the high-risk group. As an independent prognostic factor, the risk-score was associated with vascular invasion. There was a dramatic difference in nonregulatory CD4+ and CD8+ T cells between the high and low-risk groups, and the 5 genes were correlated with immune inhibitors. There was a considerable difference in autophagy, immune, cell cycle, infection, and apoptosis-associated terms and pathways in GO and KEGG. The functional states of differentiation, apoptosis, and quiescence were closely related to the 5-gene signature in single-cell analysis. CONCLUSION: Our results suggest that the signature could serve as a novel prognostic biomarker in rectal cancer, which might benefit decision-making regarding immunotherapy.

New susceptibility loci for severe COVID-19 by detailed GWAS analysis in European populations

Given the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), a deeper analysis of the host genetic contribution to severe COVID-19 is important to improve our understanding of underlying disease mechanisms. Here, we describe an extended GWAS meta-analysis of a well-characterized cohort of 3,260 COVID-19 patients with respiratory failure and 12,483 population controls from Italy, Spain, Norway and Germany/Austria, including stratified analyses based on age, sex and disease severity, as well as targeted analyses of chromosome Y haplotypes, the human leukocyte antigen (HLA) region and the SARS-CoV-2 peptidome. By inversion imputation, we traced a reported association at 17q21.31 to a highly pleiotropic [~]0.9-Mb inversion polymorphism and characterized the potential effects of the inversion in detail. Our data, together with the 5th release of summary statistics from the COVID-19 Host Genetics Initiative, also identified a new locus at 19q13.33, including NAPSA, a gene which is expressed primarily in alveolar cells responsible for gas exchange in the lung.

Progress of the pathogenesis of radiation enteritis / 肿瘤研究与临床

Radiation enteritis is a common complication of malignant tumors after radiotherapy, which seriously affects the quality of life of patients. At present, there are increasing researches on the disease, but the pathogenesis is not clear, and the treatment methods are also different. Therefore, starting from the pathological changes of radiation enteritis, this article reviews the mechanism of the acute and chronic radiation enteritis, hoping to provide clinical reference.

Depression as the first manifestation of primary hyperparathyroidism: A case report and literature review / 中华内分泌代谢杂志

We report a case of primary hyperparathyroidism(PHPT) with depressive symptoms as initial manifestation. Literature review was conduct to further analyze the etiology, clinical manifestations, diagnosis, treatment and prognosis of the disease. The initial symptoms of the patients was the mental system depression and kidney stones was found by physical examination. She first visited a doctor in the urology department after a kidney stones was found. Blood calcium 2.86 mmol/L was found. At second visit, a doctor from endocrinology department conducted a comprehensive examination on the patient′s coexisting mental and renal system symptoms, clearly identified, her as PHPT. The clinical manifestations of PHPT are diverse. Symptoms such as depression, anxiety, mood swings, etc. are rarely evaluated. PHPT patients with onset or accompanied by psychiatric symptoms should be paid attention to by doctors, Measures should be taken to improve the quality of life and prognosis of patients through early screening of blood calcium and parathyroid hormone for timely diagnosis.

Prediction of adverse cardiovascular events in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention / 中国基层医药

Objective:To investigate the application value of combined detection of hypoxia-inducible factor-1α (HIF-1α), N-terminal proBNP (NT-proBNP) and thromboxane B 2 (TXB 2) in the prediction of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction. Methods:The clinical data of 136 patients with acute ST-elevation myocardial infarction who received treatment in Jinhua Municipal Central Hospital, China between February 2018 and September 2019 were retrospectively analyzed. These patients were assigned to MACE group ( n = 33) and no MACE group ( n = 103) according to whether MACE occurred. The basic data was compared between the two groups. Serum levels of HIF-1α, NT-proBNP and TXB 2 prior to PCI were analyzed. The receiver operating characteristic (ROC) curve was plotted to investigate the application value of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of acute ST-elevation myocardial infarction after PCI. Results:At 6 months after PCI, MACE occurred in 33 out of 136 patients with acute ST-elevation myocardial infarction, with the incidence of 24.26%. There were no significant differences in age, sex and accompanied diseases between MACE and no MACE groups (all P > 0.05). Serum HIF-1α level in the MACE group was significantly lower than that in the no MACE group [(31.54 ± 5.26) ng/L vs. (37.18 ± 6.94) ng/L, t = 4.286, P < 0.05]. Serum levels of NT-proBNP and TXB 2 in the MACE group were (1 246.83 ± 243.71) μg/L and (125.13 ± 20.16) ng/L, respectively, which were significantly higher than those in the no MACE group [(876.92 ± 173.04) μg/L, (95.73 ± 18.24) ng/L, t = 9.617, 7.835, both P < 0.05]. ROC curve analysis showed that the optimal cutoff values of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 32.67 ng/L, 1 018.27 μg/L and 112.19 ng/L, respectively. The sensitivity and specificity of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 69.70% (23/33) and 98.06% (101/103), respectively. The specificity of the combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was higher than that of detection of serum HIF-1α, NT-proBNP or TXB 2 level alone. The area under the curve (AUC) plotted regarding the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI by combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was 0.901, which was significantly higher than the AUC obtained for detection of serum HIF-1α, NT-proBNP or TXB2 level alone ( Z = 2.007, 1.991 and 2.217, all P < 0.05). Conclusion:Combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels exhibits a higher value in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI than detection of serum HIF-1α, NT-proBNP or TXB 2 level alone.

Clinical characteristics and prognosis analyses of metastatic sites symptom as the first manifestation in esophageal carcinoma patients with stage T 1 and T 2 / 肿瘤研究与临床

Objective:To explore the clinical characteristics and prognosis of metastatic sites symptom as the first manifestation in esophageal carcinoma patients with stage T 1 and T 2, and to provide a reference for clinical practice. Methods:The clinical data of 50 esophageal carcinoma patients with stage T 1 and T 2 who had lymph node or distant metastasis as the first symptom in Anyang Tumor Hospital of Henan Province from November 2007 to December 2019 were retrospectively analyzed. Survival analysis was performed by using Kaplan-Meier method. Univariate analysis was performed by using log-rank test. Results:Among 50 patients with esophageal carcinoma, lymph node metastases as the first symptom were found in 42 cases and distant organ metastases as the first symptom were found in 8 cases. The 1-, 3-, 5-year overall survival rates of patients with stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ were 58.7%, 49.0%, 16.3% and 56.1%, 12.2%, 0, respectively, and there was no statistically significant difference in OS of both groups ( P = 0.094). The 1-, 3-, 5-year overall survival rates of patients with stage N 1 and stage N 2-N 3 were 63.5%, 34.7%, 17.3% and 52.2%, 11.9%, 0, respectively, and there was no statistically significant difference in OS of both groups ( P = 0.083). The 1-, 3-, 5-year overall survival rates were 64.6%, 30.5%, 18.3%, respectively in radiotherapy group and 38.2%, 0, 0, respectively in non-radiotherapy group, and there was a statistically significant difference in OS of both groups ( P = 0.008); the progression-free survival in radiotherapy group was better than that in non-radiotherapy group ( P = 0.028). The 1-, 3-, 5-year overall survival rates were 70.8%, 35.5%, 21.3% and 33.3%, 0, 0 and 35.4%, 0, 0, respectively in concurrent chemoradiotherapy group, radiotherapy group and chemotherapy group, and there was a statistically significant difference in overall survival among three groups ( P = 0.004). The results of univariate analysis showed that radiotherapy ( χ2 = 7.112, P = 0.008) and concurrent chemoradiotherapy ( χ2 = 10.940, P = 0.004) were the main factors affecting the prognosis. Conclusions:Lymph node and distant metastasis could occur in esophageal carcinoma patients with stage T 1 and T 2. Radiotherapy can prolong the progression-free survival time and concurrent chemoradiotherapy could benefit overall survival of these patients.

Value of coagulation function related indicators in the prognosis of non-small cell lung cancer / 中华检验医学杂志

Objective:To investigate the clinical significance of coagulation function related indicators in the prognosis of non-small cell lung cancer.Methods:The clinical data of 248 patients with non-small cell lung cancer from June 2014 to December 2017 in the Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to determine the best cutoff values of prognostic indicators,the Cox regression model was used for multivariate analysis, and the Kaplan-Meier method was used for survival analysis.Results:ROC curve analysis showed that the best cutoff values for D-dimer (D-D), fibrinogen (FIB) and prothrombin time (PT)were 0.18 mg/L, 4.25 g/L and 12.0 s, respectively. Cox multivariate regression analysis showed that increased expression of D-D ( HR=1.197, 95% CI 1.100-1.303), PT ( HR=1.111, 95% CI 1.049-1.176) and FIB ( HR=1.510, 95% CI 1.276-1.788) were risk factors for the prognosis of non-small cell lung cancer ( P<0.001). Kaplan-Meier survival analysis results showed that the overall survival in the high expression group of D-D, FIB and PT was shorter than in of the low expression group ( P<0.001). Conclusion:D-D, PT and FIB are independent factors affecting the prognosis of non-small cell lung cancer.

Analysis of virus subtype variation among HIV/AIDS in Wuxi city, 2014-2016 / 中华微生物学和免疫学杂志

Objective:To investigate the variation characteristics and influencing factors of HIV/AIDS subtypes in Wuxi city of Jiangsu Province from 2014 to 2016.Methods:HIV/AIDS population in Wuxi city in 2014 was selected as the research object, and the HIV molecular epidemiology and follow-up study were carried out. Collect epidemiological information, extract DNA from blood samples, amplify pol gene fragment by nest-PCR and sequence, use ChromasPro 1.6 software and MEGA 7.0 software to construct the HIV-1 sequence database, and use FastTree2.1.10 software to construct the phylogenetic tree to confirm the subtype; in 2016, the same population was followed up, and the HIV subtype variation was analyzed, and the influencing factors of subtype variation were explored by multivariate logistic regression. Results:A total of 612 HIV/AIDS cases in 2014 and 2016 were collected. The age of the subjects was mainly 30 years old or above (85.46%, 523/612), and the proportion of people over 50 years old was higher (228/612, 37.25%). The main route of transmission was homosexuality, accounting for 49.67%. A total of 1224 samples were detected and CRF01 _ AE、CRF07_ BC、B、CRF08_ BC、CRF67_ 01B、CRF55_ 01B、CRF68_ 01B, 7 subtypes of HIV-1 and 5 unique recombinant types (URFs) was detected. CRF01_ AE and CRF07_ BC was still the main genotype in Wuxi, Jiangsu Province, accounting for 66.75%. There were 29 cases (3.56%) of URFs recombinant strains. During 2014-2016, the variation rate of subtypes was 14.63%, and the most common variation was CRF01_ AE changes to CRF07_ BC(13.95%). Marital status (OR=0.363, 95% CI: 0.137-0.964) and baseline CD4 level (OR=0.414, 95% CI: 0.192-0.891) were associated with subtype variation.Conclusions:The HIV-1 subtypes of HIV/AIDS patients in Wuxi city are diverse and complex, the proportion of recombinant subtypes is rising, the URFs that are difficult to determine the genotype increase significantly, and the variation rate of HIV-1 subtypes among HIV/AIDS infected people is high. It is necessary to strengthen the monitoring of HIV-1 subtypes.

Effect of miR-133b on radiosensitivity of colon cancer SW620 cells by targeting HER-2 / 中华放射肿瘤学杂志

Objective:To evaluate the effect of miR-133b on the apoptosis and radiosensitivity of colon cancer cell line (SW620 cells), and to explore its mechanism.Methods:SW620 cells were transfected with miR-con (miR-con group), miR-133b mimics (miR-133b group), si-con (si-con group) and si-HER-2(si-HER-2 group) by the liposome method, and then irradiated with 0, 2, 4, 6, 8 Gy. The miR-133b protein expression, HER-2 protein expression, apoptosis, cell survival fraction and cytofluoroactivity in each group were evaluated by qRT-PCR, Western blot, flow cytometry, colony formation assay and dual luciferase reporter gene assay, respectively.Results:Compared with the pre-irradiation group, the expression level of miR-133b was significantly down-regulated ( P<0.05), whereas that of HER-2 was significantly up-regulated in SW620 cells after irradiation ( P<0.05). Overexpression of miR-133b and knockdown of HER-2 remarkably reduced the survival fraction (both P<0.05), and significantly promoted the apoptosis of SW620 cells ( P<0.05). miR-133b could considerably inhibit the fluorescent activity of wild-type HER-2 cells ( P<0.05) and negatively regulate the expression of HER-2 protein. Conclusion:miR-133b can inhibit the survival of colon cancer cells, promote the apoptosis and enhance the sensitivity of radiotherapy probably via the mechanism of targeting HER-2.

Neuroinflammation Mediates Faster Brachial Plexus Regeneration in Subjects with Cerebral Injury / 神经科学通报·英文版

Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel's test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.

Neuroinflammation Mediates Faster Brachial Plexus Regeneration in Subjects with Cerebral Injury / 神经科学通报·英文版

Our previous investigation suggested that faster seventh cervical nerve (C7) regeneration occurs in patients with cerebral injury undergoing contralateral C7 transfer. This finding needed further verification, and the mechanism remained largely unknown. Here, Tinel’s test revealed faster C7 regeneration in patients with cerebral injury, which was further confirmed in mice by electrophysiological recordings and histological analysis. Furthermore, we identified an altered systemic inflammatory response that led to the transformation of macrophage polarization as a mechanism underlying the increased nerve regeneration in patients with cerebral injury. In mice, we showed that, as a contributing factor, serum amyloid protein A1 (SAA1) promoted C7 regeneration and interfered with macrophage polarization in vivo. Our results indicate that altered inflammation promotes the regenerative capacity of the C7 nerve by altering macrophage behavior. SAA1 may be a therapeutic target to improve the recovery of injured peripheral nerves.

Case Report: Refractory Hypotension of GABA B Receptor Autoimmune Encephalitis.

Introduction: With the development of antibody detection technology, Gamma-Aminobutyric Acid (GABA) B receptor encephalitis is a known autoimmune disease. This paper describes a patient with refractory hypotension who suffered GABA B receptor autoimmune encephalitis. Case Report: We describe a 63-year-old man with GABA B receptor autoimmune encephalitis who had hypotension on day 17 of the disease onset. Despite two rounds of immunoglobulin administration, high-dose intravenous steroid injections and immunosuppressive therapy on day 35 of hospitalization, psychiatric symptoms and seizures were significantly improved; however, the patient's blood pressure remained low. Conclusion: This case study and literature review investigated the impairment of autonomic nerve function and its subsequent management in patients with GABA B receptor autoimmune encephalitis.

HLA-C* 04:01 is a Genetic Risk Allele for Severe Course of COVID-19

BackgroundSince the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been increasing demand to identify predictors of severe clinical course in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Human leukocyte antigen alleles (HLA) have been suggested as potential genetic host factors. We sought to evaluate this hypothesis by conducting an international multicenter study using HLA sequencing with subsequent independent validation. MethodsWe analyzed a total of 332 samples. First, we enrolled 233 patients in Germany, Spain, and Switzerland for HLA and whole exome sequencing. Furthermore, we validated our results in a public data set (United States, n=99). Patients older than 18 years presenting with COVID-19 were included, representing the full spectrum of the disease. HLA candidate alleles were identified in the derivation cohort (n=92) and tested in two independent validation cohorts (n=240). ResultsWe identified HLA-C* 04:01 as a novel genetic predictor for severe clinical course in COVID-19. Carriers of HLA-C* 04:01 had twice the risk of intubation when infected with SARS-CoV-2 (hazard ratio 2.1, adjusted p-value=0.0036). Importantly, these findings were successfully replicated in an independent data set. Furthermore, our findings are biologically plausible, as HLA-C* 04:01 has fewer predicted bindings sites with relevant SARS-CoV-2 peptides as compared to other HLA alleles. Exome sequencing confirmed findings from HLA analysis. ConclusionsHLA-C* 04:01 carriage is associated with a twofold increased risk of intubation in patients infected with SARS-CoV-2. Testing for HLA-C* 04:01 could have clinical implications to identify high-risk patients and individualize management.

Exploration on the "Doctoring" training for eight-year medical education / 中华医学教育探索杂志

Zhejiang University began to recruit eight-year clinical students since 2005. Since then, Zhejiang University learned from the experience of foreign medical education, reformed and innovated and formed a distinctive curriculum system and training pattern for eight-year medical training, that named as "Doctoring". "Doctoring" is a course that focuses on the education of students' comprehensive quality and ability. Its main contents are the basic knowledge about human health, disease and medical development. With the use of advanced and scientific teaching concept and teaching mode, students were able to study the doctor-patient communication and interpersonal skills, and use medical knowledge and practice skills required for clinical work. And the students also had the opportunity to demonstrate the ability to solve problems in the foundation of life-long learning. "Doctoring" is more than a simple course for teaching medical professional knowledge.