Efficacy and Safety of Flumatinib in Treatment of Patients with Chronic Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the efficacy and safety of flumatinib in the treatment of patients with chronic myeloid leukemia (CML).@*METHODS@#The clinical data of 56 CML patients treated with flumatinib from January 2020 to December 2021 in the First Affiliated Hospital of Nanchang University were retrospectively analyzed. Patients were divided into three groups: 35 new diagnosed CML patients treated with flumatinib (group A), 10 patients with imatinib/dasatinib intolerance (group B) and 11 patients with imatinib/dasatinib resistance (group C) switched to flumatinib treatment, respectively. The molecular response and adverse effects of flumatinib treatment were evaluated.@*RESULTS@#In group A, the early molecular response (EMR) at 3 months was 40.0%, and the major molecular response (MMR) at 6 and 12 months was 43.7% and 46.2%, respectively. In group B, the EMR was 50.0% at 3 months, and the MMR was 70.0% and 66.2% at 6 and 12 months, respectively. Among evaluable patients, 6 cases in group B achieved molecular response of 4.5 (MR4.5) at 12 months after switching to flumatinib treatment. In group C, 3 cases who switched from imatinib resistance to flumatinib achieved MR4.5 at 12 months, but 2 cases who switched from dasatinib resistance to flumatinib failed. Subgroup analysis showed significant differences in EUTOS long-term survival (ELTS) scores for patients in the medium-risk/high-risk group compared with those in the low-risk group for 3-month EMR (18.8% vs 57.9%), 6-month MMR (15.4% vs 63.2%) and 12-month MR4.5 (15.4% vs 69.2%) (P =0.036, P =0.012,P =0.015). The most common adverse effect in group A was thrombocytopenia, accounting for 54.5%, and 22.8% (8/35) patients discontinued the drug due to haematological adverse effects. Compared with patients who did not discontinue the drug or whose recovery time from discontinuation due to haematological toxicity was <1 month, patients whose recovery time from discontinuation was ≥1 month had a significantly worse 3-month EMR, 6-month MMR and 12-month MR4.5 (P =0.028, P =0.021, P =0.002).@*CONCLUSIONS@#Flumatinib has better molecular response and tolerance in patients with primary, imatinib/dasatinib-intolerant or resistant CML. Medium-risk/high-risk in ELTS score and time to recovery from discontinuation due to haematological toxicity ≥1 month are important factors influencing achievement of better molecular response in flumatinib treatment.

Choice of medical treatment for renal colic: A survey of Chinese urologists / 北京大学学报(医学版)

OBJECTIVE@#To investigate the status quo of recognition and management of renal colic among urological surgeons in China.@*METHODS@#From November 2021 to March 2022, 725 urological surgeons in China were surveyed in the form of a questionnaire, including their province, hospital grade, professional title, the number of patients with renal colic treated per week, the preferred drugs and the cognition of the disease. This study was approved by the Medical Ethics Committee of Peking University People's Hospital, and all respondents completed informed consent online.@*RESULTS@#During November 2021 and March 2022, urological surgeons across China were surveyed in the form of a questionnaire, and the reliability and validity of the questionnaire were verified before the study was carried out. In the study, 720 valid questionnaires were collected (accounting for 99.31% of the total number), in which 42.4% of the doctors' preferred drugs were non-steroidal anti-inflammatory drugs (NSAIDs), and 40.0% of the doctors' preferred antispasmodic drugs. Opioids were the first choice of 11.0% of the physicians and other treatments were preferred by 6.6% of physicians. In addition, 61.1% of the doctors thought that the mechanism of renal colic was elevated prostaglandin, 32.2% thought it was ureteral spasm, 5.0% thought it was calculi irritation, and 1.7% thought the mechanism was unclear. The doctor of the cognition of the generation mechanism of renal colic pain had a significant influence on the preferred treatment option (χ2=54.399, P < 0.001) that the "elevated prostaglandins" doctor more often preferred NSAIDs than the doctor who thought cramps and ureter stones caused renal colic (51.6% vs. 28.0%, χ2=34.356, P < 0.001;51.6% vs. 19.4%, χ2=13.759, P < 0.001). In addition, hospital class, physician title, and the number of weekly consultations by physicians influenced the choice of medications for renal colic (P < 0.05), tertiary hospitals, middle and senior professional titles and weekly patients with renal colic > 8 cases generally preferred NSAIDs.@*CONCLUSION@#There are deficiencies in the cognition and drug treatment of renal colic among urological surgeons in China. The choice of the preferred drug was related to the doctor's cognition of the disease, the grade of the hospital, the doctor's professional title and the weekly treatment volume.

Effects of delayed ureteral stents removal during the COVID-19 pandemic on the quality of life and psychological status of postoperative patients with urinary calculi / 北京大学学报(医学版)

OBJECTIVE@#To explore the impacts of delayed ureteral stent removal on the quality of life (QoL) and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19) pandemic.@*METHODS@#The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People's Hospital for stent removal from December 2019 to June 2020 were collected. Ureteral stent symptoms questionnaire (USSQ) score and the outcome 20-item self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were collected to estimate the QoL and mental status. The USSQ consisted of 44 questions in 6 domains (including urinary symptom, physical pain, general health, work performance, sexual function, and ureteral stent related infection). For most questions in each domain, its score was a five-point Likert-type scale from 1 to 5, and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale. SAS and SDS both contained 20 questions used to assess a patient's level of anxiety and depression. Its scoring for each item was on a four-point Likert-type scale from 1 to 4. A total score (ranging from 20 to 80) was the main statistical indicator. The level of clinical anxiety and depression was quantified by using standard scores (total score multiplied by 1.25 to produce integers). And the multi-group structural equation model was constructed by analysis of moment structure (AMOS) analysis.@*RESULTS@#Overall, 71 patients were enrolled for analysis. It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32 (30, 33) d and 94.5 (88, 103) d, respectively. The delayed group resulted in higher scores in the USSQ multidimensional, which included urinary symptoms, general health, work performance and ureteral stent related infections. Anxiety and depression were also significantly serious in the delayed group than in the control group. A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance (P=0.029 < 0.05). Among them, the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time (CR=2.619>1.96).@*CONCLUSION@#Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status. Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19. To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19, it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.

Efficacy and Survival of Venetoclax Based Regimen in the Treatment of Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explore the efficacy and survival of venetoclax based (VEN-based) regimen in the treatment of acute myeloid leukemia（AML）.@*METHODS@#A retrospective study was conducted in patients who received VEN-based regimen and completed at least 1 course of efficacy evaluation at the The First Affiliated Hospital of Nanchang University from July 2019 to July 2022. The incidence of complete remission （CR）/CR with incomplete hematologic recovery （CRi） rate, objective remission rate（ORR） and survival of patients with different risk strati- fication and gene subtypes were analyzed.@*RESULTS@#A total of 79 patients were enrolled, including 43 patients with newly diagnosed unfit AML （unfit AML） and 36 relapsed/refractory AML (R/R AML). The median age of the patients was 62(14-83) years old. 36 out of 79 patients achieved CR/CRi and the ORR of the whole cohort was 64.6%. The CR/CRi rate of unfit AML patients was significantly higher than that of R/R AML patients (60.5% vs 27.8%, P=0.004). In unfit AML cohort, the patients with NPM1 and IDH1/2 mutations were benefited, 8 out of 9 patients ahcieved CR/CRi, 7/8 and 5/8 patients achieved minimal residual disease (MRD) negativity, respectively. Six out of 9 patients with TET2 mutation achieved CR/CRi, 3/6 patients achieved MRD negativity. In R/R AML cohort, 2 out of 3 patients with RUNX1 mutation achieved CR/CRi, without MRD negative, while the CR/CRi rate of patients with other gene mutations was lower than 40%. The median follow-up time was 10.1(95%CI: 8.6-11.6) months. In whole cohort, the median overall survival (mOS) time was 9.1 months and the relapse free survival (RFS) time was not reached. The mOS and RFS of unfit AML patients were significantly longer than those of R/R AML patients (14.1 vs 6.8 months, P=0.013; not reached vs 3.3 months, P=0.000). In unfit AML cohort, the mOS of patients with NPM1 or IDH1/2 mutations was not reached, while that of patients without NPM1 or IDH1/2 mutations was 8.0 months (P=0.009; P=0.022). Furthermore, the mOS of patients with TP53 mutaion was significantly shorter than that of patients without TP53 mutation (5.2 vs 14.1 months， P=0.049). In R/R AML cohort, there was no significant difference in mOS between patients with mutation in each gene subtype and those without gene mutation (P>0.05). All patients had hematology adverse reactions, 91.1% patients had AE grade≥3. The most common non-hematology adverse reactions was infection, with an incidence of 91.1%. VEN-based regimen was tolerable for AML patients.@*CONCLUSION@#VEN-based regimen can achieve a high response rate, especially in unfit AML with acceptable safety, and some patients can achieve MRD negative. It is also effective in NPM1-, IDH1/2-positive patients with long survival time.

Effect of Shugan Tiaoshen acupuncture combined with western medication on depression-insomnia comorbidity due to COVID-19 quarantine: a multi-central randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of Shugan Tiaoshen acupuncture (acupuncture for soothing the liver and regulating the mentality) combined with western medication on depression and sleep quality in the patients with depression-insomnia comorbidity due to COVID-19 quarantine, and investigate the potential mechanism from the perspective of cortical excitability.@*METHODS@#Sixty patients with depression-insomnia comorbidity due to COVID-19 quarantine were randomly divided into an acupuncture group and a sham-acupuncture group, 30 cases in each one. The patients of both groups were treated with oral administration of sertraline hydrochloride tablets. In the acupuncture group, Shugan Tiaoshen acupuncture was supplemented. Body acupuncture was applied to Yintang (GV 24+), Baihui (GV 20), Hegu (LI 4), Zhaohai (KI 6), Qihai (CV 6), etc. The intradermal needling was used at Xin (CO15), Gan (CO12) and Shen (CO10). In the sham-acupuncture group, the sham-acupuncture was given at the same points as the acupuncture group. The compensatory treatment was provided at the end of follow-up for the patients in the sham-acupuncture group. In both groups, the treatment was given once every two days, 3 times a week, for consecutive 8 weeks. The self-rating depression scale (SDS) and insomnia severity index (ISI) scores were compared between the two groups before and after treatment and 1 month after the end of treatment (follow-up) separately. The cortical excitability indexes (resting motor threshold [rMT], motor evoked potential amplitude [MEP-A], cortical resting period [CSP]) and the level of serum 5-hydroxytryptamine (5-HT) were measured before and after treatment in the two groups.@*RESULTS@#After treatment and in follow-up, SDS and ISI scores were decreased in both groups compared with those before treatment (P<0.05), and the scores in the acupuncture group were lower than those in the sham-acupuncture group (P<0.05), and the decrease range in the acupuncture group after treatment was larger than that in the sham-acupuncture group (P<0.05). After treatment, rMT was reduced (P<0.05), while MEP-A and CSP were increased (P<0.05) in the acupuncture group compared with that before treatment. The levels of serum 5-HT in both groups were increased compared with those before treatment (P<0.05). The rMT in the acupuncture group was lower than that in the sham-acupuncture group, while MEP-A and CSP, as well as the level of serum 5-HT were higher in the acupuncture group in comparison with the sham-acupuncture group (P<0.05).@*CONCLUSION@#Shugan Tiaoshen acupuncture combined with western medication can relieve depression and improve sleep quality in the patients with depression-insomnia comorbidity due to COVID-19 quarantine, which is probably related to rectifying the imbalanced excitatory and inhibitory neuronal functions.

Development of dose verification methods for boron neutron capture therapy / 中华放射医学与防护杂志

To summarize the progress in BNCT dose verification method in the world and discusses their development prospects. Boron neutron capture therapy (BNCT) utilizes the specific capture reaction between the neutrons and boron drugs enriched in tumor cells to selectively kill tumor cells. In order to verify the accuracy of the radiotherapy plan and ensure the therapeutic effect on patients, it is necessary to measure the dose before treatment and compare the experimental radiation dose with the planned dose. The current BNCT dose measurement method mainly include point dose measurement method based on ionization chambers, thermoluminescence dosimeters and activation foils, two-dimensional dose measurement method based on films, and three-dimensional dose measurement method based on gel dosimeters.

Analysis of risk factors related to death within 1 year after non-operative treatment of hip fractures in the elderly / 中华老年医学杂志

Objective:To analyze the risk factors for death within one year after non-operative treatment of hip fractures in the elderly.Methods:Clinical data of 83 elderly patients with hip fractures treated non-operatively from March 2012 to March 2017 who had met the criteria of inclusion and exclusion were included.They were divided into the death group and the survival group according to whether they had died within one year after non-operative treatment.Univariate and multivariate regression analysis were used to screen risk factors for death within one year after non-operative treatment.Results:Of the 83 patients, 26(31.3%)died within one year, including 10(38.5%)from pulmonary infections and 6(23.1%)from acute myocardial infarction.Univariate analysis showed that age, gender, walking ability before a fracture, number of comorbidities, coronary heart disease and COPD each had a significant impact on the death of patients within one year after receiving non-operative treatment( P<0.05). Multivariate Logistic regression analysis showed that age(≥76 years old)( OR=12.704, P=0.001), COPD( OR=5.870, P=0.042)and coronary heart disease( OR=7.451, P=0.007)were independent risk factors for death within one year after non-operative treatment. Conclusions:The mortality is as high as 31.3% in elderly patients with hip fractures within one year after non-operative treatment.The main cause of death is pulmonary infections.Age(≥76 years old), COPD and coronary heart disease are independent risk factors for death within one year after non-operative treatment.

Research Progress on the Application of Artificial Intelligence in Rehabilitation Medicine in China / 中国医学科学院学报

The development of science and technology and the increasing demand of rehabilitation have driven the integration between artificial intelligence and rehabilitation medicine.In this study,statistical methods,document visualization tools,and other analysis methods were used in the Citespace software to analyze China's research status of artificial intelligence in the field of rehabilitation medicine with the key words of co-occurrence,emergence,and clustering.The relevant research hot spots were then classified and expounded.The results demonstrated that the current hot spots of artificial intelligence related to rehabilitation medicine included robots,brain-computer interfaces,human-computer interaction,and motor imagery.According to the clustering of key words and literature analysis,the five themes of artificial intelligence in rehabilitation medicine were determined as robot,brain-computer interface,intelligent rehabilitation training system,human-computer interaction,and assisted diagnosis and remote rehabilitation.Robotics and human-computer interaction would still be the research hot spots in the long future,and brain-computer interfaces,motor imagery,and remote rehabilitation would be new ones.This study analyzed the current hot spots,predicted the development trends,discussed the limitations,and proposed suggestions,aiming to provide reference for other scholars focusing on the application of artificial intelligence in rehabilitation medicine.

Evaluation of the consistency and detection capability of seven domestic 2019-nCoV nucleic acid detection kits / 中华检验医学杂志

Objective:To compare the consistency and detection capability of seven 2019-nCoV nucleic acid detection kits, and provide reference for detection method selection of clinical laboratory and diagnosis of new coronavirus pneumonia.Methods:Two batches of pharyngeal swab samples were collected from tenpatients with confirmed infection of 2019-nCoV and 10 suspected patients with negative 2019-nCoV test results during January 29 to February 5, 2020 in Shenzhen Luohu People′s Hospital. Seven kinds of kits were labeled as ato g and used for nucleic acid detection respectively to evaluate the consistency of the test results of the clinical samples. A 2019-nCoV positive specimen was selected and diluted to 5-concentration gradient plates (Level-1 to 5) with RNase-free water. The positive detection rate and intra-batch repeatability of different brands of kits were compared.Results:The negative and positive coincidence rates of twenty clinical samples tested by six kinds of kits were 100%, and the positive and negative coincidence rate was 8/10 and 10/10 for the other kit, respectively. The results of intra-batch repeatability showed the CVs of viral loads tested by these seven kits were all less than 5%. In the concentration range of Level-1 to 3, the detection capability for open reading frame (ORF)1ab gene of Kit b,d and f was lower than Kit a,c,e and g, and the detection capability of kit e and g was the highest (14/15). The detection capability for N gene of Kit a (15/15) was higher than the other 5 kits. The comprehensive analysis of the detection capability for ORF1ab and N gene showedthat Kit d had the lowest detection capability (ORF1ab:40%,N:53%), and there was no significant difference in the detection capability of Kit a, b, c, e, and f.Conclusions:There was no significant difference in the accuracy and repeatability of the seven kits for positive samples with high viral loads, and the detection performance was good; but some kits had poor detection capability for weak positive samples. It is suggested that the weak positive samples should be rechecked by at least two manufacturers′ kits to ensure the accuracy of the results.

Primary hepatic lymphoma misdiagnosed as hepatic hemangioma: a case report and domestic literature review / 第二军医大学学报

Objective To explore the characteristics of diagnosis, treatment and prognosis of primary hepatic lymphoma (PHL), so as to better understand the tumor. Methods The diagnosis and treatment of a patient with PHL misdiagnosed as hepatic hemangioma were reported, and the domestic literatures were reviewed from 1975 to 2019 to sum up the diagnosis, treatment and prognosis characteristics of PHL. Results This patient had no specific clinical manifestations, and was misdiagnosed as hepatic hemangioma in other hospital. Magnetic resonance imaging (MRI) examination in our hospital showed that the tumor had malignant features and vessel floating sign, suggesting the possibility of malignancy. The patient was treated with resection of multiple hepatic tumors +hepatoduodenal lymph node dissection +cholecystectomy. Postoperative pathological results showed that the tumor was composed of large patches of lymphoid cells with few cytoplasm and atypical nuclei; the tumor had no obvious envelope; and the peripheral liver tissues were infiltrated. Immunohistochemical staining showed that the cells in follicular zone were mostly CD20 (+), and the cells in germinal center were CD10 (+), Bcl-6 (+) and Bcl-2 (+), Ki-67 (80%). Primary hepatic B-cell non-Hodgkin lymphoma (B-NHL) was diagnosed finally. A total of 376 PHL patients were reported in 91 domestic literatures, with an average age of 48.8±9.6 years and a male-to female ratio of 1.69:1. The imaging was characterized by single lesion and vessel floating sign, lack of blood supply. The levels of lactic dehydrogenase were increased in 146 cases (38.8%). Totally 132 cases (35.1%) were misdiagnosed and the final diagnosis depended on pathological findings. Survival analysis results showed that the prognosis of B-NHL patients was significantly better than that of T-cell non-Hodgkin lymphoma (T-NHL) patients (median overall survival time: 36.4 months vs 20.7 months, P=0.009); the prognosis of mucosa-associated lymphoid tissue lymphoma patients was significantly better than that of diffuse large B-cell lymphoma patients (52.0 months vs 30.0 months, P=0.049); and the prognosis of B-NHL patients treated with surgery combined with postoperative chemotherapy was significantly better compared with those treated with surgery alone and those treated with chemotherapy alone (45.6 months vs 23.9 months and 7.7 months, P=0.016). Conclusion Primary hepatic lymphoma is a rare tumor without characteristic clinical features, and its diagnosis needs to be combined with medical history, clinical manifestations, and imaging and laboratory examination. Once PHL is confirmed, it should be treated actively by surgery combined with chemotherapy or comprehensive chemotherapy..

Interference research of umbilical cord mesenchymal stem cells on the pulmonary fibrosis in silicosis rats / 中华劳动卫生职业病杂志

Objective@#To explore the effect of the umbilical cord mesenchymal stem cells(UC-MSCs) on the pulmonary fibrosis in silicosis rats.@*Methods@#SPF male Sprague Dawley rats were randomly divided into control group, silica model group and UC-MSCs treatment group with 12 rats each group. SiO2 intra-tracheal injection(0.5 ml of 50 mg/ml/rat) were applied to silica model group and UC-MSCs treatment groups. After that UC-MSCs treatment group received 1 ml UC-MSCs suspension (3×106 cells/ml) by tail vein injection on the 29th, 36th, 43th and 50th day after exposure to the first silica suspension. On the 60th and 75th day after exposure to silica suspension, all animals were examed for pulmonary CT. Then the rats were euthanized on 75th day after the first exposure to silica.Lung's histopathological examination of the rats from all the groups were carried out. The content of hydroxyproline in lungs, TGF-β1 and IL-6 in serum were examined.@*Results@#The lung's histopathological examination showed no obvious inflammatory cell and no fibrosis in the lung tissue of the control group, there were a lot of inflammatory cell aggregation and collagen fiber deposition in silica model group, while in the UC-MSCs intervention group and treatment group, there were less inflammatory cells and collagen fiber. The rats from silica model groups had higher HYP, TGF-β1 and IL-6 than the rats from UC-MSCs treatment group and control group. Lung fields of rats in the control group were clear and no obvious high-density shadow. Different-sized granular high-density shadows or reticular fibrous shadows were found diffusely distributed in the lungs of the rats in silica model group. Lung field of rats in UC-MSCs intervention group and treatment group were less high density shadows, and more clear.@*Conclusion@#UC-MSCs can alleviate the pulmonary fibrosis in silica model rats through regulating the secretion of some fibrosis related cytokines.

Effect of mobile phone light for human retinal pigment epithelium cells / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To research the morphological and fuctional change of human retinal pigment epithelium ( RPE ) induced by mobile phone screen light in vitro and the mRNA express of apoptotic inhibitor B-cell lymphoma (Bcl-2), Bcl2-Associated X(Bax) and apoptotic actuators Caspase-3 in different groups. ·METHODS: Cultured human RPE cells were divided into different group in random. According to the time of exposing, the four groups were 3h group, 6h group, 12h group and no light-exposed group. Cells of different groups were exposed to the opening mobile phone that was kept high-light brightness and playing on the colorful picture on silent mode. The morphological and functional change of RPE was quantified after exposed by HE staining, TUNEL staining, MTT, and use the technology of polymerase chain reaction ( PCR) to detect the mRNA express of apoptotic inhibitor Bcl-2, Bax and apoptotic actuators Caspase-3 in different groups. ·RESULTS: The different was not statistically significant (P>0. 05) in the way of HE staining, TUNEL staining and MTT. The expression of Bcl - 2, Bax and Capase - 3 intracellular was no difference statistically significant in 3h, 6h group to no exposure group on the way of PCR (P>0. 05). But as the time of exposed increased to 12h, the expression of apoptotic inhibitor Bcl-2 decreased, at the same time the expression of apoptotic actuators Bax and Caspase - 3 increased, and the different was statistically significant (P<0. 05). ·CONCLUSION: The human RPE would be injured under the constantly high- light brightness of mobile phone screen as the man-made light source.

The latest progression for treatment of hip fracture in the elderly / 中华老年医学杂志

The treatment of elderly hip fracture becomes one of key points and difficulties in clinical work in traumatic orthopedics department due to its increasing incidence rate and complicated situation. In this article ,the key points and features of prevention ,diagnostic classification and treatment of hip fracture in the elderly were briefly overviewed. And the new ideas and models in the field of elderly hip fracture therapy were summarized in order to provide a reference for the prevention and treatment of hip fracture in the elderly.

Efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly / 中华老年医学杂志

Objective To observe the efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly.Methods T he elderly patients w ith osteoporotic intertrochanteric fracture meeting inclusion and exclusion criteria were recruited. They received proximal femoral nail anti-rotation(PFNA)surgery with the combined intakes of calcium of 600 mg/day and 1-alpha ,25-(OH)2-vitamin D3 analogs of 0.5 μg/day as a basic standard treatment protocol(BSTP).The study subjects included control group(n= 10)who underwent PFNA surgery plus oral calcium and vitamin D supplements without teriparatide (20 μg/d) ,and the observation group who received PFNA surgery plus oral calcium and vitamin D supplements with teriparatide (20 μg/d) , for more than twelve months or over at our department from October 2012 to February 2016. Gender ,age ,socio-demographics and clinical values of the American Society of Anesthesiologists (ASA )score ,fracture types ,preoperative serum albumin level ,preoperative BM I ,bone mineral density 1 week postoperatively ,serum N-terminal propeptide of type I collagen (PINP) and C-terminal telopeptides of type 1 collagen(β-CTX)1 week postoperatively were matched between the two groups , no statistically significant difference was found(all P＞0.05).Levels of PINP and β-CTX 3 ,6 and 12 months postoperatively ,BMD 1 year postoperatively ,fracture healing time and complications were compared between the two groups. The prognosis of 1 case of patient undergoing conservative treatment was observed. Results There was no significant difference between the two groups in serum levels of PINP and β-CTX 1 week postoperatively(P=0.362 and 0.517 ,respectively).Serum level of PINP was significantly increased in observation group at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively(P= 0.008 ,0.001 and 0.004 ,respectively) ,while serum level of PINP had no significant difference in control group at 3 ,6 and 12 months postoperatively versus at 1week postoperatively(P＞ 0.05).Serum levels of PINP 3 ,6 and 12 months postoperatively were higher in the observation group than in control ( P= 0. 002 ,0. 002 and 0. 000 ,respectively ). In the observation group ,serum β-CTX level reached the peak at 6 months after surgery ,which was higher than that at 1 week after surgery(P=0.041) ,and slowly decreased at 12 months after surgery.In the control group ,β-CTX slowly increased at 3 ,6 and 12 months postoperatively versus at 1 week postoperatively ( P ＞ 0.05 ). There was no significant difference in BMD of lumbar spine and contralateralhipbetweenthetwogroupsat1weekpostoperatively(P=0.440and0.325).At1year postoperatively versus at 1 week postoperatively ,the BMD of lumbar spine and contralateral hip was increased(P=0.039 and 0.009)in the observation group ,while was decreased(P＞ 0.05)in control group. The fracture healing time was shorter in observation group than in control group (13.6 ± 2.2 weeks vs.17.6 ± 3.4 weeks ,P=0.033).No one had a delayed fracture healing in observation group and 1 patient showed a delayed fracture healing in the control group. There were no complications such as lag screw sliding ,refracture ,pressure ulcer and deep vein thrombosis in both groups. The fracture nonunion was found in the patient undergoing conservative treatment after 20 months of teriparatide treatment. Conclusions The medium-and long-term of teriparatide treatment can significantly promote bone formation ,improve BMD of the lumbar spine and hip ,and shorten fracture healing time in patients with osteoporotic intertrochanteric fracture ,but it is not a substitute for surgical treatment.

Causes and therapeutic effects of conservative treatment for hip fracture in the elderly / 中华老年医学杂志

Objective To investigate the causes and prognosis of conservative treatment for hip fracture in the elderly. Methods The 47 elderly patients undergoing conservative treatment for hip fracture were recruited and retrospectively analyzed in our hospital from July 2014 to June 2017. The causes of conservative treatment and corresponding therapeutic methods were analyzed ,and hip joint function ,complications ,survival situation at 12-36 months after fracture were followed up. Results A total of 47 hip fracture patients aged(80.0 ± 7.2)years(range ,63-92 years)with 25 females and 22 males included 30 cases with femoral neck fractures and 17 cases with intertrochanteric fractures.Details of prognosis of treatments in all (100% )patients followed for 12-36 months after fracture were as follows :(1 ) In treatment methods ,43 patients were treated with bed-rest immobilization after discharge from hospital and 4 patients were rehospitalized for surgery due to pain and intolerance of long-term bedridden. (2)There were 40 patients with three comorbidities or more , accounting for 85.1% of the total.11 cases had surgical contraindications.27 cases choose conservative treatment due to the high risk of surgery.9 cases gave up surgery due to psychological or economic reasons. (3)In complications and death ,complications were found in 43(91.5% ,43/47)patients with conservative treatment ,including pneumonia(37.2% ,16/43 cases ,)and bedsore(51.2% ,22/43 cases). (4)In fracture healing and hip joint function ,among the 43 patients receiving conservative treatment , hip fractures were not healed in 31 patients ,and fractures were malunited in 12 patients. Hip Harris score was poor in 31 cases and fair in 12 cases. The mortality rate within 1 year after fracture is high in the elderly hip fracture patients with conservative treatment and complication incidence rates are also high.Most of them have poor function recovery of hip joint ,and clinical results are not good. Conclusions The elderly hip fracture patients with conservative treatment have a high rate of complications and mortality within 1 year after fracture.Most of them have poor hip joint function recovery.

Analysis of risk factors for postoperative respiratory and circulatory complications in elderly patients with hip fracture / 中华老年医学杂志

Objective To investigate the risk factors for postoperative cardiorespiratory complications within one month after operative treatment of hip fracture in the elderly. Methods Data of clinical examination ,samples test ,CT or MRI images were collected in 665 hip fracture patients aged 60 years and over who were admitted to our hospital from January 2010 to December 2014. Risk factors for postoperative cardiorespiratory complications within one month after operation were analyzed by correlation analysis and multiple regression analysis. Results The incidence of postoperative complications in cardiovascular system was 4.5% (30/665)in all patients.The risk factors for postoperative circulatory complications included gender ,high white blood cell(WBC)counts before operation ,hypoalbuminemia ,a low hemoglobin level (＜ 35 g/L ) ,renal insufficiency , hyponatremia ,pulmonary arterial hypertension ,segmental ventricular wall abnormal motion ,abnormal ST segment changes. The incidence of postoperative complications in respiratory system was 6.9% (46/665)in all patients. The risk factors for postoperative respiratory complications included high WBC counts before operation ,hypoalbuminemia ,chronic obstructive pulmonary disease (COPD ) , bronchiectasis and emphysema ,history of respiratory failure and abnormal lung markings (P＜0.05 or P＜ 0.01 ). Conclusions The elderly hip fracture patients have high incidence of postoperative respiratory and circulatory complications , and risk factors for these complications include accompanying diseases ,hypoalbuminemia ,abnormal echocardiography and electrocardiogram and hyponatremia.

Economic value of using partially hydrolysed infant formula for risk reduction of atopic dermatitis in high-risk, not exclusively breastfed infants in Singapore

<p><b>INTRODUCTION</b>Previous trials have demonstrated reductions in atopic dermatitis (AD) incidence when healthy, high-risk, non-exclusively breastfed infants were fed until four months of age with 100% whey-based partially hydrolysed formula (PHF-W) versus standard cow's milk formula (CMF). We assessed the cost-effectiveness of this intervention in Singapore.</p><p><b>METHODS</b>Modelling techniques were used to simulate, from birth to Month 30, the incidence and clinical/economic burden of AD in high-risk, non-exclusively breastfed infants fed with PHF-W or CMF for up to four months. Epidemiologic and clinical data were from a local comparative trial. Expert opinion informed AD treatment patterns and outcomes. Outcomes included reduction in AD risk, time spent with AD, days without AD flare, quality-adjusted life years (QALYs) and direct/indirect costs. Multivariate probabilistic sensitivity analysis was used to assess model parameter uncertainty.</p><p><b>RESULTS</b>Over 30 months, with the use of PHF-W instead of CMF, the proportion of children who developed AD and the time spent with AD decreased by 16.0% (28.3% vs. 44.3%) and 6.4 months, respectively, while time without AD flare and QALYs increased by 14.9 days and 0.021 QALYs per patient, respectively. Estimated AD-related discounted costs per child for PHF-W and CMF were SGD 771 and SGD 1,309, respectively (net savings: SGD 538). PHF-W was less expensive and more effective than CMF for 73%, and cost less than SGD 50,000 per QALY for 87% of all multivariate simulations.</p><p><b>CONCLUSION</b>Early short-term nutritional intervention with PHF-W instead of CMF may reduce AD incidence and costs for healthy, high-risk, non-exclusively breastfed infants in Singapore.</p>

Identification and Quantification of Chlorpyrifos Metabolites in Urine Samples by Ultra Performance Liquid Chromatography-Triple Quadrupole-Linear Ion Trap Mass Spectrometry / 分析化学

A method was established for the determination of chlorpyrifos metabolites employing QuEChERS method and ultra performance liquid chromatography-triple quadrupole-linear ion trap mass spectrometry (UPLC-QTRAP). The urine samples were extracted by acetonitrile and then cleaned up with PSA and GCB. The samples were separated with the gradient elution of acetonitrile-0.2% ammonia water on ZORBAX Eclipse Plus C18column. The analytes were detected by tandem mass spectrometry under negative ion mode with electrospray ionization (ESI) source and MRM-IDA-EPI mode. Under the optimized conditions, the calibration curve was linear in range of 1.0-100.0 μg/L,and the limits of detection were 0.10-0.73 μg/L. The average recoveries were 80.3%-90.1%, and RSDs were all within 10%. The developed method was simple,sensitive,accurate,and repeatable,and could avoid false positive result of samples effectively. The established method was successfully applied to determine the exposure level of chlorpyrifos metabolites in real samples of human health risk analysis. The results showed that the maximum concentration of chlorpyrifos metabolites was 54.6 μg/L. This method provided technic support for simultaneous identification and quantification of chemicals in complex matrix.

Association between Plasma Metal Levels and Diabetes Risk: a Case-control Study in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Many metals, some of which have been classified as environmental endocrine disruptors, are used extensively in everyday consumer products and are ubiquitous in our living environment. In the present study, we aimed to explore the associations between the prevalence risk of type 2 diabetes and plasma levels of 20 trace elements as well as those of heavy metals in a Han Chinese population.</p><p><b>METHODS</b>We conducted a case-control study to investigate the associations between plasma concentrations of 20 metals and diabetes in Jiangsu province. A total of 122 newly diagnosed cases of type 2 diabetes and 429 matched controls were recruited from community physical examinations in Suzhou City of Jiangsu Province. Plasma metal levels were measured by inductively-coupled plasma mass spectrometry.</p><p><b>RESULTS</b>After adjusting for confounders, plasma vanadium, chromium, manganese, copper, zinc, arsenic, selenium, strontium, palladium, cadmium, cesium, and barium were associated with diabetes risk (P < 0.05). The adjusted OR increased with increasing concentration of vanadium, manganese, copper, zinc, and cesium.</p><p><b>CONCLUSION</b>Many metals, including manganese, copper, zinc, arsenic, selenium, and cadmium in plasma, are associated with the morbidity of diabetes. Monitoring of environmental metal levels and further studies are urgently needed.</p>

Role of glucose-regulated protein 78 in early brain injury after experimental subarachnoid hemorrhage in rats / 华中科技大学学报（医学）（英德文版）

Early brain injury (EBI) plays a key role in the pathogenesis of subarachnoid hemorrhage (SAH). This study investigated the role of glucose-regulated protein 78 (GRP78) in EBI after SAH. Male Sprague-Dawley rats (n=108) weighing 260±40 g were divided into control, sham-operated, and operated groups. Blood was injected into the prechiasmatic cistern of rats in the operated group. Neurological scores, ultrastructures of neurons, apoptosis, and GRP78 expression in the hippocampus were examined using Garcia scoring system, transmission electron microscopy, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling, and Western blotting at 1, 6, 12, 24, 48, and 72 h after SAH, respectively. The results showed that neurological scores were significantly decreased in the operated group as compared with those in control and sham-operated groups at 12, 24, 48, and 72 h. Metachromatin, chromatin pyknosis at the edge, endoplasmic reticulum swelling, and invagination of nuclear membrane were observed at 24 h in the operated group, indicating the early morphological changes of apoptosis. The number of apoptotic cells was significantly increased in the operated group as compared with that in control and sham-operated groups at 6, 12, 24, 48, and 72 h. The GRP78 protein expression levels in the operated group were significantly elevated at all time points and reached the peak at 12 h. GRP78 expression was positively associated with apoptosis cells and negatively with neurological scores. In conclusion, EBI was demonstrated to occur after SAH and GRP78 was involved in the development of EBI after SAH.