Current status and future perspectives on the methods of prognosis evaluation for intrahepatic cholangiocarcinoma / 中华外科杂志

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary malignant tumor in the liver after hepatocellular carcinoma. Its incidence and mortality rates have increased worldwide in recent years. Surgical resection is the best treatment modality for ICC;however,the overall prognosis remains poor. Accurate evaluation of post operative prognosis allows personalized treatment and improved long-term outcomes of ICC. The American Joint Commission on Cancer TNM staging manual is the basis for the standardized diagnosis and treatment of ICC;however,the contents of stage T and stage N need to be improved. The nomogram model or scoring system established in the analysis of commonly used clinicopathological parameters can provide individualized prognostic evaluation and improve prediction accuracy;however,more studies are needed to validate the results before clinical use. Meanwhile,imaging features exhibit great potential to establish the post operative prognosis evaluation system for ICC. Molecular-based classification provides an accurate guarantee for prognostic assessment as well as selection of populations that are sensitive to targeted therapy or immunotherapy. Therefore,the establishment of a prognosis evaluation system,based on clinical and pathological characteristics and centered on the combination of multidisciplinary and multi-omics,will be conducive to improving the long-term outcomes of ICC after surgical resection in the context of big medical data.

Effect of health management service for hypertension patients under framework of Basic Public Health Service Project: a regression discontinuity design / 中华流行病学杂志

Objective: To evaluate the effect of health management service on hypertension patients (HMSFHP) under the framework of the Basic Public Health Service Project by using regression discontinuity design. Methods: The participants were enrolled from an observational cohort survey in 2015 and followed up was conducted in 2019. The participants with SBP 130-150 mmHg and/or DBP 80-100 mmHg in the baseline survey of the cohort in 2015 were included in the present study. Additionally, we obtained the dates of participants receiving HMSFHP and their blood pressure data from follow-up records, physical examination records and telephone interview. The participants were divided into intervention group and control group based on the cutoff points, i.e. SBP ≥140 mmHg and/or DBP ≥90 mmHg. The local linear regression model were used to estimate the effect of HMSFHP on reducing blood pressure of the participants. Results: After adjusting for age, sex and time length of receiving HMSFHP, the results of the model including participants with 80-100 mmHg for DBP in 2015 indicated that, for the participants who received HMSFHP, the DBP decreased by 6.66 mmHg from 2015 to 2019. For the participants with SBP 130-150 mmHg in 2015, the reduction estimate of the model was -6.17 mmHg, the difference was not significant (P=0.178), suggesting that receiving HMSFHP did not cause change in SBP for the participants who received HMSFHP. Conclusion: Receiving HMSFHP had effect to reduce DBP, and HMSFHP had a positive effect on the control of blood pressure in patients with hypertension.

Analysis of PKP2 gene variants in a child with Arrhythmogenic right ventricular cardiomyopathy / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical and genetic characteristics of a child with Arrhythmogenic right ventricular cardiomyopathy (ARVC).@*METHODS@#A 6-year-old boy with ARVC who had visited Fujian Provincial Children's Hospital on August 23, 2022 was selected as the study subject. Relevant clinical data were collected, and peripheral venous blood samples were collected from the child and his parents for genetic testing through whole exome sequencing (WES). Sanger sequencing was carried out for family verification, and pathogenicity analysis was conducted for the candidate variants.@*RESULTS@#The child had exhibited clinical symptoms including systemic edema, generalized heart enlargement, universal reduction of interventricular septum and ventricular wall movement, reduced left ventricular diastolic and systolic function, and reduced right ventricular systolic function. WES revealed that the child has harbored compound heterozygous variants of the PKP2 gene, namely c.119_122del (p.Leu40ArgfsTer71) and c.1978G>A (p.Gly660Arg), which were verified by Sanger sequencing to be respectively inherited from his father and mother. The c.119_122del variant has not been recorded in the 1000 Genomes, gnomAD and ExAC databases, and was predicted to lead to truncation of the PKP2 protein by SWISS-MODEL and PyMOL online software and classified as likely pathogenic based on the guidelines jointly developed by the American College of Medical Genetics and Genomics (ACMG) and ClinGen. The c.1978G>A variant has also not been recorded in the 1000 Genomes, gnomAD and ExAC databases, and was predicted to be deleterious by online software including REVEL, SIFT, CADD, Mutation Taster, and PolyPhen-2. The amino acid encoded by the variant site was highly conserved among various species by analysis using T-coffee and ESPript v3.0 online servers. The variant may affect the protein function by SWISS-MODEL and PyMOL online server analysis, and was classified as likely pathogenic based on the guidelines jointly developed by the ACMG and ClinGen.@*CONCLUSION@#The compound heterozygous variants of c.119_122del (p.Leu40ArgfsTer71) and c.1978G>A (p.Gly660Arg) of the PKP2 gene probably underlay the ARVC in this child. Above finding has broadened the spectrum of PKP2 gene variants and provided a reference for the diagnosis and genetic counseling.

Novel CD19-KIRS2/Dap12-BB CAR-T Treatment for 3 Patients with Relapsed and Refractory B-Cell Tumors / 中国实验血液学杂志

OBJECTIVE@#To investigate the safety and efficacy of novel CD19-KIRS2/Dap12-BB chimeric antigen receptor T cells (CAR-T cells) in the treatment of relapsed/refractory B-cell malignancy (R/R BCM).@*METHODS@#Three patients with R/R BCM treated with novel CD19-KIRS2/Dap12-BB CAR-T cells from June 2020 to November 2020 were enrolled, including 1 case of B-cell acute lymphoblastic leukaemia (B-ALL) and 2 cases of non-Hodgkin's lymphoma (NHL), and the efficacy and adverse reactions were observed.@*RESULTS@#After CAR-T cells infusion, patient with B-ALL achieved complete remission (CR) and minimal residual disease (MRD) turned negative, and 2 patients with NHL achieved partial remission (PR). Grade 2 cytokine release syndrome (CRS) occurred in B-ALL patient, grade 1 CRS occurred in 2 NHL patients, and grade II to IV hematologic adverse reactions occurred in 3 patients, all of which were controllable and reversible. The progression-free survival (PFS) of the 3 patients was 143, 199, and 91 days, and overall survival (OS) was 282, 430, and 338 days, respectively.@*CONCLUSION@#The novel CD19-KIRS2/Dap12-BB CAR-T cells in treatment of 3 patients with R/R BCM have significant short-term efficacy and controllable adverse reactions, but the long-term efficacy needs to be further improved.

Characterization of an IDS pathogenic variant in a family with mucopolysaccharidosis type Ⅱ / 中华内分泌代谢杂志

Objective:To identify the genetic variation in a mucopolysaccharidosis type Ⅱ(MPS Ⅱ)family, and conduct a functional study of iduronate-2-sulfatase(IDS): c.323A>C.Methods:A five-generation MPS Ⅱ family of 83 individuals including 4 patients from northern China was collected. Urine mucopolysaccharide and Alder-Reilly body were tested to assist the clinical diagnosis of MPS Ⅱ. IDS enzyme activity was detected on core family members. By the whole exome sequencing of a MPS Ⅱ patient in this family and bioinformatics analysis, the variant was screened and further identified by PCR-Sanger sequencing. Finally, to validate the function of the variant in vitro, the wild-type IDS overexpression plasmid(pCMV-hIDS-WT)and the IDS overexpression plasmid carrying the mutation site(pCMV-hIDS-c.323A>C)were transfected into COS-7 cells and the IDS activity was detected. Results:The proband(Ⅳ3)and Ⅳ4 were diagnosed as MPS Ⅱ by urine mucopolysaccharide, Alder-Reilly body, and IDS enzyme activity tests. Ⅳ3, Ⅳ4, Ⅲ19, and Ⅲ32 were determined to carry IDS: c.323A>C missense variant through the whole-exome sequencing, and diagnosed as MPS Ⅱ. Meanwhile, Ⅱ2, Ⅱ4, Ⅱ8, Ⅱ12, Ⅱ14, Ⅲ5, Ⅲ7, Ⅳ14 in the MPS Ⅱ family carried IDS: c.323A>C missense variant, and were excluded as MPS Ⅱ. The in vitro experiment in COS-7 cells showed that the missense mutation led to a significant decrease in IDS enzyme activity. Conclusion:The variant IDS: c.323A>C: p.Y108S significantly decreases the activity of IDS enzyme in vivo and in vitro, and it is identified as a pathogenic variant for MPS Ⅱ.

Correlation between blood lipid level and gastric cancer / 国际肿瘤学杂志

Patients with gastric cancer often have different degrees of dyslipidemia, and the level of lipid changes is closely related to the occurrence, development and prognosis of gastric cancer. The mechanism of lipid metabolism in gastric cancer has also attracted much attention, and it may be related to the reverse cholesterol transport function, antioxidant and anti-inflammatory properties of high-density lipoprotein cholesterol. In addition, statins may reduce the risk of gastric cancer and associated mortality. Further research on the correlation between blood lipid levels and gastric cancer is aimed to provide new ideas for the future prevention and precision diagnosis and treatment of gastric cancer.

Trends in incidence and mortality of stroke in Ningbo Cityfrom 2012 to 2021 / 预防医学

Objective@# To investigate the trends in incidence and mortality of stroke in Ningbo City, Zhejiang Province from 2012 to 2021, so as to provide the evidence for improving the stroke control strategy in Ningbo City.@*Methods@# Data pertaining to the stroke incidence and mortality in Ningbo City from 2012 to 2021 were captured from Ningbo Municipal Chronic Disease Collaborative Management System, and the incidence and mortality of stroke was estimated and standardized by the Sixth National Population Census in 2010. The trends in incidence and mortality of stroke were evaluated using annual percent change (APC) in Ningbo City from 2012 to 2021. @*Results@# A total of 185 747 residents with stroke were reported in Ningbo City from 2012 to 2021. The crude incidence of stroke was 312.78/105 in Ningbo City from 2012 to 2021, which appeared a tendency towards a rise (APC=2.429%, t=5.507, P<0.001), and the standardized incidence of stroke was 188.86/105, with no remarkable changes seen (APC=-0.399%, t=-1.544, P=0.161). There were 47 355 deaths due to stroke in Ningbo City from 2012 to 2021, and the crude and standardized mortality rates were 79.74/105 and 42.79/105, which both appeared a tendency towards a decline (APC=-4.778%, t=-6.867, P<0.001; APC=-8.269%, t=-13.729, P<0.001). Higher standardized incidence and mortality were seen among men (226.05/105 and 50.14/105) than among women (153.37/105 and 35.89/105), and the crude incidence and mortality of stroke appeared a tendency towards a rise with age (χ2trend=3 671.325, 1 419.107, both P<0.001). The standardized incidence and mortality of hemorrhagic stroke were 40.38/105 and 18.56/105, both showing a tendency towards a decline (APC=-5.042%, t=-12.958, P<0.001; APC=-11.570%, t=-14.979, P<0.001), and the standardized incidence of ischemic stroke was 143.91/105, appearing a tendency towards a rise (APC=1.254%, t=3.223, P=0.012), while the standardized mortality of ischemic stroke was 19.65/105, with no obvious changes seen (APC=-2.110%, t=-2.150, P=0.064). @* Conclusions@# The incidence of stroke appeared a tendency towards a rise and the mortality appeared a tendency towards a decline in Ningbo City from 2012 to 2021. Men and the elderly are at high risk of stroke.

Analysis of clinical phenotype and variant of RAG1 gene in a child with B-cell-negative Severe Combined Immunodeficiency / 中华医学遗传学杂志

OBJECTIVE@#To report on a child with B-cell-negative severe combined immunodeficiency (B-SCID) manifesting as fulminant myocarditis and carry out genetic testing for her.@*METHODS@#A child with B-SCID who presented at Fujian Maternity and Child Health Care Hospital on January 31, 2021 was selected as the subject. Whole exome sequencing was carried out for her. Candidate variant was verified by Sanger sequencing.@*RESULTS@#The female infant had developed recurrent skin and lung infections soon after birth, and was admitted due to fulminant myocarditis. Serological examination has disclosed a remarkable reduction in immunoglobulins. Flow cytometric analysis revealed that her peripheral blood T and B lymphocytes and NK cells were significantly reduced. Whole exome sequencing revealed that she has harbored a homozygous c.C3007T (p.Q1003X) nonsense variant of the RAG1 gene, for which both of her parents were heterozygous carriers. The variant has not been recorded in normal population databases. Based on the guidelines from the American College of Medical Genetics and Genomics, the variant was predicted to be pathogenic.@*CONCLUSION@#A case of RAG1 gene associated B-SCID has been diagnosed. Above finding has enriched the spectrum of RAG1 gene variants and enabled early diagnosis and intervention of the disease.

Research Progress of Antibody-drug Conjugates in Advanced Non-small Cell Lung Cancer / 肿瘤防治研究

Although targeted, immune and other therapeutic strategies have become the first-line standard therapy for patients with advanced lung cancer, acquired drug resistance is still inevitable in most cases. The advent of antibody-drug conjugates (ADC) provides a new choice. ADC is a new anticancer drug formed by the coupling of targeted anti-tumor monoclonal antibodies and cytotoxic drugs. Compared with chemotherapeutic drugs, ADC has the advantages of high tolerance, accurate target recognition and little effect on non-cancer cells, and has shown good clinical benefits in the treatment of a variety of malignant tumors. This article reviews the application of ADC in advanced non-small cell lung cancer.

A radiological study between anterior and posterior surgery in patients with basilar invagination and atlantoaxial dislocation / 中华骨科杂志

Objective:To analyze the improvement of patients with basilar invagination and atlantoaxial dislocation that treated by anterior or posterior surgery.Methods:50 patients with basilar invagination and atlantoaxial dislocation that underwent simple anterior or posterior surgery from 2009 to 2021 were included. There were 34 females and 16 males with a mean age of 45.04 years (range, 18-65 years). All patients underwent thin- slice CT scan of the neck. Preoperative and postoperative measurements of atlantoaxial joint distance, atlantoaxial joint angle, atlantoaxial joint displacement, Claus' Height, atlas-dens interval, space available for the cord, cervicomedullary angle, C 0-C 2 angle, and C 2-C 7 angle were measured. Then, the data were analyzed by independent sample t test. Results:25 patients (7 males, 18 females) were included in the anterior surgery group, and 25 patients (9 males, 16 females) were included in the posterior surgery group. The mean age of the two groups was 45.24±9.86 years and 44.72±14.06 years, respectively, showing no statistical difference. The mean last follow-up time of the anterior and posterior surgery group was 6.48±3.14 months and 7.04±2.87 months, respectively. The odontoid distance, atlas-dens interval, space available for the cord and cervicomedullary angle in 2 groups were significantly improved after surgery ( P<0.05), while there were no significant differences in the above parameters between 2 groups ( P>0.05). In the anterior surgery group, the distance and angle of atlantoaxial joint were increased, and the atlantoaxial joint displacement decreased significantly. While in the posterior surgery group, only the atlantoaxial joint space increased ( P<0.05). The C 0-C 2 angle was significantly increased and the C 2-C 7 angle was significantly decreased in the anterior surgery group ( P<0.05), but there was no significant difference in these parameters in the posterior surgery group ( P>0.05). In addition, there was no significant difference in parameters between the two groups at the last follow-up compared with those immediately after surgery. Conclusion:Both anterior and posterior surgery can improve the compression of the spinal cord in patients with basilar invagination and atlantoaxial dislocation. Anterior surgery may be more adequate for the extension and reduction of the atlantoaxial joint space, however, excessive enlargement of the lordosis angle in upper cervical may lead to the reduction of the lordosis in lower cervical.

Value of serum amyloid protein dynamic changes on evaluating condition and prognosis of patients with viral and mycoplasma community-acquired pneumonia / 中华危重病急救医学

Objective:To investigate the predictive role of dynamic changes of plasma biomarkers in patients with viral and mycoplasma community-acquired pneumonia (CAP).Methods:From January 2020 to June 2020, 141 patients with viral and mycoplasma CAP in People's Hospital of Ningxia Hui Autonomous Region were enrolled. Pneumonia severity index (PSI) scores [grade Ⅰ-Ⅱ(PSI score ≤ 70), grade Ⅲ (PSI score 71-90) and grade Ⅳ-Ⅴ(PSI score ≥ 91)], serum amyloid A (SAA), hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) on the 1 day after admission were compared between the different pathogens (viral and mycoplasma) or different disease severity. The change in level of SAA, hs-CRP on the third day (Δ 3 d = 1 d-3 d) were compared among different disease outcome groups (patients were divided into improved group, stable group and exacerbation group based on PSI scores or lung CT images on the third day). The change in the level of SAA, hs-CRP on the seventh day (Δ 7 d = 1 d-7 d) were compared among different disease prognosis groups (patients were divided into survival group and death group based on 28-day survival data). The receiver operating characteristic curve (ROC) were drawn to evaluate the value of SAA in the evaluation of disease and prediction prognosis. Results:The level of SAA in mycoplasma group (43 cases) was significantly higher than that in virus group (98 cases) on the 1 day after admission. There were no significant differences in other plasma biomarkers between the two groups. The more severe the illness, the higher the SAA level on the 1 day after admission. The trends of other plasma biomarkers in the two groups were consistent with SAA. The levels of SAA in the patients with exacerbation of the virus group and mycoplasma group (12 cases, 9 cases) were significantly higher than those of the improved group (57 cases, 26 cases) and the stable group (29 cases, 8 cases). SAA increased gradually in the exacerbation group, decreased gradually in the improved group, and slightly increased in the stable group. ΔSAA 3 d were differences among three groups. The change trend of hs-CPR was consistent with SAA. The level of SAA in the death group was higher than that in the survival group on the seventh day. SAA increased in the death group and decreased in survival group with time from hospital admission. There were differences according to ΔSAA 7 d between death group and survival group. The change trend of hs-CPR was consistent with SAA. ROC curve showed that the value of SAA was better than hs-CRP in assessing the severity of patients on admission day, and the area under ROC curve (AUC) was respectively 0.777 [95% confidence interval (95% CI) was 0.669-0.886], 0.729 (95% CI was 0.628-0.830). The value of ΔSAA 3 d was better than SAA on the third day predicting disease trends, and AUC was respectively 0.979 (95% CI was 0.921-1.000), 0.850 (95% CI was 0.660-1.000). hs-CRP on the third day and Δhs-CRP 3 d had no predictive value. Both SAA on the seventh day and ΔSAA 7 d have predictive value for prognosis. AUC was respectively 0.954 (95% CI was 0.898-0.993) and 0.890 (95% CI was 0.689-1.000). SAA on the seventh day and ΔSAA 7 d were better than hs-CRP on the seventh day. Δhs-CRP 7 d have no predictive value. Conclusions:SAA is a sensitive and valuable indicator for CAP patients with viruses and mycoplasma. Dynamic monitoring of SAA can evaluate the patient's progression, prognosis, and assist diagnosis and treatment.

Inhibition of activated K-opioid receptor to myocardical hypertrophy induced by ET-1 in neonatal rats by extracellular signal-regulated kinase pathway / 中国药理学通报

Aim To investigate the inhibitory effect of kappa-opioid receptor(κ-OR)stimulation on extracellular signal-regulated kinase pathway on ET-1-induced cardiomyocyte hypertrophy in vitro cultured myocardial cells from neonatal rats.Methods Myocardial cells of neonatal rats were cultured in vitro.The hypertrophic myocytes were induced by ET-1(10 nmol·L-1)before κ-OR agonist U50488H(1 μmol·L-1)was administered.The antihypertrophic effect of κ-OR stimulation was observed in the presence of U0126(1μmol·L-1), Ro-31-8220(50 nmol·L-1)and PTX(5 mg·L-1).The cardiomyocytes volume was measured by computer photographalysis system.The relative expression of ERK1/2 was determined by Western blot.The morphological changes in cardiomyocytes were observed under an inverted phase contrast microscope.The expression of mRNA of atrial natriuretic peptide(ANP)was determined by RT-PCR.Results Compared with normal control group, ET-1 could induced cardiomyocyte hypertrophy.Compared with ET-1 model group, U50488H(1 μmol·L-1)could obviously inhibit ET-1-induced increase of the cardiomyocytes volume, expression of ANPmRNA and expression of ERK1/2, which was similar to U0126(1 μmol·L-1)and Ro-31-8220(50 nmol·L-1); however, the inhibitory effects of U50488H were partly lost when preincubated with U0126(1 μmol·L-1)and Ro-31-8220(50 nmol·L-1); the inhibitory effects of U50488H, U0126(1 μmol·L-1)and Ro-31-8220(50 nmol·L-1)were lost when preincubated with NOR-BNI.Conclusion The stimulation of kappa-opiod can inhibit myocardial hypertrophy induced by ET-1, which is possibly via attenuating ERK1/2.

Clinical effectiveness of different types of boneanchored maxillary protraction devices for skeletal Class III malocclusion: Systematic review and network meta-analysis / 대한치과교정학회지

Objective@#This study aimed to estimate the clinical effects of different types of bone-anchored maxillary protraction devices by using a network meta-analysis. @*Methods@#We searched seven databases for randomized and controlled clinical trials that compared bone-anchored maxillary protraction with tooth-anchored maxillary protraction interventions or untreated groups up to May 2021. After literature selection, data extraction, and quality assessment, we calculated the mean differences, 95% confidence intervals, and surface under the cumulative ranking scores of eleven indicators. Statistical analysis was performed using R statistical software with the GeMTC package based on the Bayesian framework. @*Results@#Six interventions and 667 patients were involved in 18 studies. In comparison with the tooth-anchored groups, the bone-anchored groups showed significantly more increases in Sella-Nasion-Subspinale (°), Subspinale-Nasion-Supramentale(°) and significantly fewer increases in mandibular plane angle and the labial proclination angle of upper incisors. In comparison with the control group, Sella-NasionSupramentale(°) decreased without any statistical significance in all treated groups. IMPA (angle of lower incisors and mandibular plane) decreased in groups with facemasks and increased in other groups. @*Conclusions@#Bone-anchored maxillary protraction can promote greater maxillary forward movement and correct the Class III intermaxillary relationship better, in addition to showing less clockwise rotation of mandible and labial proclination of upper incisors. However, strengthening anchorage could not inhibit mandibular growth better and the lingual inclination of lower incisors caused by the treatment is related to the use of a facemask.

The clinical value of fluorescence quantitative assay and G6PD/6PGD ratio method in the diagnosis of glucose-6-phosphate dehydrogenase deficiency and gene mutation / 中华检验医学杂志

Objective:To investigate the diagnostic value of fluorescence quantitative method and G6PD/6PGD ratio method in glucose-6-phosphate dehydrogenase (G6PD) deficiency and the type of gene mutation.Methods:A total of 1 201 patients (711 males and 490 females) with suspected G6PD deficiency in Shanghai Children′s Hospital were collected from June 2018 to March 2021. Fluorescence quantification method, G6PD/6PGD ratio method and multicolor melting curve were used to detects enzyme activity, ratio and gene mutation type. Comparison of each index and evaluation of its diagnostic efficiency were performed.Results:Among 1 201 suspicious samples, 163 cases (135 males and 28 females) were finally diagnosed. 156 cases were diagnosed by fluorescence quantitative method with a detection rate of 95.71%, and 140 cases were diagnosed by G6PD/6PGD ratio method with a detection rate of 85.89%. enzymatic activity of G6PD and ratio of G6PD/6PGD in male were significantly lower than female, and the differences were statistically significant ( U=642.5, 734.5, P<0.001). 112 cases received G6PD gene mutation detection and 92 cases were diagnosed, 74 were hemizygous mutations, 1 were homozygous mutations, 15 were heterozygous mutations, and 2 were compound heterozygous mutations. Among 15 cases of heterozygous mutations, 11 cases were diagnosed by fluorescence quantitative method, the diagnosed rate was 73.33%, 4 cases were diagnosed by G6PD/6PGD ratio method, and the diagnosed rate was 26.67%. A total of 7 mutation sites were detected and the proportions were c.1388G>A (32.22%), c.1376G>T (30.00%), c.871G>A (13.33%), c.1024C>T (11.11%). c.95A>G (7.78%), c.487G>A (4.44%), c.392G>T (1.11%). The enzymatic activities of c.1376G>T and c.1024C>T, c.487G>A were statistically significant ( P<0.001,0.015); the G6PD/6PGD ratios of c.1024C>T and c.1388G>A, c.1376G>T were statistically significant ( P=0.017,0.002,0.011,0.013). Fluorescence quantitative method had sensitivity of 100%, specificity of 95.65%, and the area under the curve (AUC) is 0.972. The sensitivity of the G6PD/6PGD ratio method was 100%, the specificity was 94.57%, and the AUC was 0.979. The sensitivity of fluorescence quantitative method combined with G6PD/6PGD ratio was 96.7%, the specificity was 100%, and the AUC was 0.992. Conclusions:Compared with fluorescence quantification, the G6PD/6PGD ratio method might not be able to diagnose female heterozygotes effectively; The panel of G6PD fluorescence quantification and G6PD/6PGD ratio was helpful to reduce the missed diagnosis. Combined with gene mutation analysis, it could improve the diagnosis rate of G6PD deficiency in the children.

A clival-cervical plate fixation for the craniovertebral instability: a biomechanical study / 中华骨科杂志

Objective:To develop a specialized clival-cervical plate fixation (CCPF) for anterior surgery to treat craniovertebral instability, and to compare it with a posterior occipitocervical fixation (POCF) in biomechanical validation.Methods:Based on the measurement of 40 adult dry bones and 30 volunteers CT images, the clival-cervical plate was designed and manufactured. 8 cadaveric specimens (occiput-C 3) were tested in five conditions including the intact status, the intact+CCPF status, the injury status, the injury+CCPF status, and the injury+POCF status. Specimens were applied a pure moment of 1.5 N·m in flexion, extension, lateral bending, and axial rotation. Calculating and comparing the range of motion (ROM) and neutral zone (NZ) for the occiput to C 2. The effects of different fixation methods on the distribution of ROMs at the occipitocervical region were compared. Results:The injury+CCPF status constrained ROMs to 1.7° in flexion ( q=4.68, P=0.055) , 1.2° in extension ( q=0.39, P=0.9922) , 2.8° in lateral bending ( q=1.25, P=0.814) , and 4.3° in axial rotation ( q=5.08, P=0.035) , resulted in larger ROM in axial rotation but similar ROMs in other directions ( P>0.05) when compared with the injury+POCF status. There were no significant differences between the above two fixation methods in flexion-extension ( q=1.94, P=0.554) , lateral bending ( q=1.79, P=0.611) and axial rotation ( q=2.14, P=0.478) for the NZs. For the flexion, extension,lateral bendingand axial rotation direction, the proportion of the C 1, 2 ROM to the overall ROM was 28%, 25%, 34% and 56% respectively in the injury+CCPF status, and it was 59%, 53%, 42% and 71% respectively in the injury+POCF status. Conclusion:CCPF is a biomechanically effective alternative or supplemental method of POCF for the craniocervical instability.

Biomechanical Study of Posterior Dynamic Fixation at Atlantoaxial Joints / 医用生物力学

Objective To evaluate the influence of dynamic fixation (rotating and sliding pedicle screws) on stability of the atlantoaxial joint. Methods A series of in vitro biomechanical tests were performed using six fresh adult cervical spines (occipital bone-C4 segment) to simulate different conditions in surgery， including the intact state, the injury state, rigid fixation, rotating pedicle screw fixation, sliding pedicle screw fixation. The repeated measurement design was employed, and under intact, injury and different fixation states, the pure moment of 1.5 N·m in flexion-extension, left-right lateral bending, left-right axial rotation directions were applied using the spinal testing machine. The movement of atlantoaxial spine was measured consecutively by three-dimensional （3D） measurement system in order to analyze the range of motion (ROM) and neutral zone (NZ) of atlantoaxial joints. Results Under injury state, ROM of atlantoaxial joints was significantly larger than that under intact state during flexion, extension, lateral bending and rotation, leading to the instability of atlantoaxial joints. ROM of fixation segments was significantly reduced during flexion, extension, lateral bending and rotation after rigid and dynamic fixation. Compared with rigid fixation, dynamic fixation showed a significant ROM increase during lateral bending. NZs of fixation segments after dynamic fixation were significantly reduced. There were no significant ROM differences between rigid fixation and dynamic fixation. Conclusions The stability of atlantoaxial joints by dynamic fixation during flexion, extension and rotation was comparable to that by rigid fixation, but weaker during lateral bending. Dynamic screw fixation can maintain the relative stability of atlantoaxial joints.

Related factors of troublemaking among patients with mental disorders caused by amphetamine-type stimulants / 四川精神卫生

ObjectiveTo explore the related factors of troublemaking behaviors among patients with mental disorders induced by amphetamine-type stimulants （ATS）， and to provide references for the formulation of relevant intervention measures for ATS-induced mental disorders. MethodsA total of 105 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for ATS-induced mental disorders were included， and classified into troublemaking group and non-troublemaking group. The general demographic data and clinical data of the selected individuals were collected， and all patients were assessed using Social Support Rating Scale （SSRS）. Then univariate analysis and multivariate Logistic regression model were used to screen the related factors of troublemaking behaviors. ResultsThe scores of SSRS， objective support dimension and social support utilization dimension were significantly lower in troublemaking group than those in non-troublemaking group， with statistical differences ［（24.10±6.59） vs. （28.94±5.59）， t=3.364， P=0.001； （5.50±1.96） vs. （8.20±2.13）， t=5.183， P<0.01； （4.60±2.26） vs. （6.28±1.90）， t=3.435， P=0.001］. Multivariate Logistic regression analysis showed that male （OR=6.061， P=0.014） was a risk factor， while high social support level （OR=0.873， P=0.018） was the protective factor for troublemaking behaviors among patients with ATS-induced mental disorders. ConclusionPatients with ATS-induced mental disorders of the males and with low social support level are at high risk of troublemaking behaviors.

The current situation and influencing factors of occupational stress among undergraduate interns / 中华医学教育探索杂志

Objective:To investigate the status of occupational stress and its influencing factors among undergraduate interns.Methods:Three hundred and seventeen interns in Subei People's Hospital of Jiangsu Province were collected as research objects. In this study, the Job Content Questionnaire (JCQ), Effort-Reward Imbalance (ERI) Questionnaire and self-compiled general information questionnaire were used to evaluate the status of occupational stress and its influencing factors, and the regression analysis was carried out.Results:The results showed that 101 (31.9%) and 115 (36.3%) undergraduate interns were in significantly higher level occupational stress according to the JCQ and the ERI questionnaire respectively. Logistic regression analysis showed that the risk factors of the included occupational stress included the planning of further studies, more than 40 hours per week for internship, high score of intrinsic engagement and low score of social support. Exercise of more than three times a week was a protective factor for interns' occupational stress.Conclusion:The occupational stress of the undergraduate interns is at a high level and affected by many factors. Schools and hospitals should provide targeted mental health education for interns and improve relevant management policies.

Role of macrolides resistance in children with refractory Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective:To study the macrolides resistance of Mycoplasma pneumoniae(MP) in Suzhou area, and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia (MPP) from October 2013 to September 2014 in Suzhou area, 48 children were treated with Azithromycin (10 mg/kg, once a day, intravenous drip for 5-7 days), and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP, and 34 children who were successfully treated with macrolides antibiotics (MA) were clinically diagnosed as general MPP (GMPP). MP DNA was extracted from the airway secretion of children in the two groups, and the point mutations of 2063 and 2064 of 23S rRNA were sequenced, and according to the MP 23S rRNA sequencing results, the children were divided into macrolides antibiotic resistant MP group (MRMP) and macrolides antibiotic sensitive MP group (MSMP). The clinical characteristics of the two groups were compared. Results:In the MRMP group, the incidence of RMPP was 62.2% (46/74 cases), while in MSMP group, the incidence of RMPP was 25.0% (2/8 cases). The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP ( χ2=2.719, P=0.099). Compared with MRMP group, MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination, as well as some laboratory results, including the total number and classification of white blood cell (WBC), C-reactive protein (CRP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB). Conclusions:The fever duration of MPP lasted more than 1 week, suggesting the possibility of macrolides resistance of MP, but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.

Dosimetric study of helical tomotherapy and volumetric modulated arc therapy simultaneous integrated boost for patients receiving breast-conserving surgery of left breast / 国际肿瘤学杂志

Objective:To compare the dosimetric characteristics of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) after left breast conserving surgery.Methods:Twenty-four patients with left breast cancer after breast-conserving surgery who were admitted to the Department of Radiation Oncology of Tumor Hospital of Yunnan Province from May 2016 to May 2019 were selected. The HT plan and the VMAT plan were designed for the same patient. The target dose and the dose volume parameters of organs at risk were compared and analyzed in the two radiotherapy plans.Results:There were significant differences in the D 2% [(59.68±0.46) Gy vs. (60.06±0.20) Gy, t=-4.229, P<0.001], D 98% [(57.46±0.44) Gy vs. (57.20±0.07) Gy, t=2.912, P<0.001], conformity index (CI) (0.80±0.05 vs. 0.76±0.04, t=4.079, P<0.001) and homogeneity index (HI) (0.04±0.01 vs. 0.05±0.00, t=-5.505, P<0.001) of the planning gross tumor volume (PGTV) between the HT and VMAT plans. However, there was no significant difference in the D 50% [(58.77±0.46) Gy vs. (58.75±0.11) Gy, t=0.179, P=0.859]. There were significant differences in the D 50% [(51.99±0.39) Gy vs. (52.39±0.36) Gy, t=-5.278, P<0.001], D 98% [(49.46±0.29) Gy vs. (48.35±0.46) Gy, t=9.538, P<0.001] and HI (0.19±0.01 vs. 0.21±0.01, t=-7.538, P<0.001) of the planned target volume (PTV) between the two plans. However, there were no significant differences in the D 2% [(59.13±0.64) Gy vs. (59.09±0.46) Gy, t=0.511, P=0.614] and CI (0.83±0.04 vs. 0.82±0.04, t=1.637, P=0.115). In terms of organs at risk, there were significant differences in the V 5 [(57.90±1.42)% vs. (52.40±5.74)%, t=4.812, P<0.001], V 20 [(22.40±2.17)% vs. (18.40±3.16)%, t=5.573, P<0.001] and D mean [(12.71±0.55) Gy vs. (11.46±1.26) Gy, t=4.963, P<0.001] of left lung, D mean of right lung [(3.42±0.27) Gy vs. (2.49±0.24) Gy, t=13.310, P<0.001], D mean of right breast [(4.41±0.50) Gy vs. (3.12±0.65) Gy, t=10.326, P<0.001], V 30 [(0.55±0.37)% vs. (1.24±1.11)%, t=-4.020, P=0.001] and D mean of heart [(4.68±0.62) Gy vs. (3.83±0.88) Gy, t=7.335, P<0.001], D mean of left atrium [(2.53±0.31) Gy vs. (2.16±0.28) Gy, t=5.488, P<0.001], D mean of right atrium [(2.77±0.43) Gy vs. (2.20±0.30) Gy, t=7.103, P<0.001], D mean of right ventricle [(5.10±0.72) Gy vs. (3.72±0.94) Gy, t=9.802, P<0.001] and D 2% of spinal cord [(14.79±2.73) Gy vs. (5.42±2.23) Gy, t=14.788, P<0.001] between HT and VMAT plans. There was no significant difference in the D mean of left ventricle [(5.10±1.19) Gy vs. (4.80±1.54) Gy, t=1.250, P=0.224]. Conclusion:Both the HT plan and the VMAT plan can meet the treatment requirements. The HT plan can provide better target area conformity and dose uniformity. The VMAT plan has more advantages in terms of organs at risk. The HT plan shows an advantage only in exposure to high-dose area.