Serological analysis of anti-K and anti-Wra detected in patient treated with daratumumab: a case report / 中国输血杂志

【Objective】 To investigate the reasonable serological detection method by analyzing the characteristics of anti-K and anti-Wra from a patient who received treatment with daratumumab. 【Methods】 Unexpected antibody screening and identification were performed by saline method, polybrene, cardioagglutinin, dithiothreitol (DTT) treatment, trypsin treatment and papain treatment in the patient's plasma and acid elution solution. Heat elution test was detected after absorbing patient serum with K antigen negative red blood cells. The characteristics of antibodies were analyzed and their titer was continuously detected. Cross matching was performed after excluding interference of daratumumab. 【Results】 Anti-K and anti-Wra were detected in saline and polybrene in the patient's plasma. The patient's elution solution contained daratumumab. DTT or trypsin treatment excluded interference of daratumumab but papain treatment did not. DTT treatment destroyed K antigen and missed the detection of IgG antibodies in the Kell system. Trypsin treatment did not affect K antigen and can detect IgG antibodies of Kell system(anti-k)in the serum of the patient treated with daratumumab. Anti K was IgM and the titer was 4 by saline method and it decreased to no agglutination in room temperature after 39 days. Anti-Wra was IgG and the titer by polybrene method was 4, and it decreased to 1 after 39 days. After 76 days, neither anti-K nor anti-Wra could be detected. Transfusions of K and Wra antigen negative red blood cells were safe and effective. 【Conclusion】 DTT treatment can exclude interference of daratumumab, but attention should be paid to missed detection of anti-K. To avoid interference of daratumumab and identify unexpected antibody, multiple methods such as DTT treatment, polybrene and trypsin treatment in combination are recommended.

Preliminary experience of robotic-assisted kidney transplantation in a single center / 器官移植

<b>Objective</b> To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). <b>Methods</b> Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. <b>Results</b> All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (<i>P</i>=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both <i>P</i>>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (<i>P</i>>0.05). <b>Conclusions</b> Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

Diagnostic value of pelvic floor ultrasound combined with electromyographic physiological parameters for postpartum SUI of different degrees and pelvic floor function of primipara / 中国医学装备

Objective:To investigate the diagnostic value of pelvic floor ultrasound combined with electromyography physiological parameters for postpartum stress urinary incontinence(SUI)of different degrees and pelvic floor function of primipara.Methods:A total of 160 SUI patients who admitted to Yan'an hospital of Kunming City from January 2019 to January 2022 were selected,and they were divided into abnormal group(110 cases)and normal group(50 cases)according to pelvic floor function(the muscle voltage values of different muscle fibers).The SUI was graded according to the Chinese Guidelines for Diagnosis of Urological Diseases and the International Incontinence Advisory Committee's Incontinence Questionnaire(ICI-Q-SF).The posterior horn(α)of bladder and urethra at rest,the displacements of the bladder neck on y-axis(△y)and x-axis(△x)after the rest to the fatigue action,the proximal urethral rotation angle after the rest to the fatigue action(γ),the posterior horn of bladder and urethra(β)after the fatigue action were observed.The electromyography was used to draw and record the pelvic floor myoelectric activity signals of the patients of two groups at five stages(pre baseline rest period,class II muscle fiber systole period,class II and I muscle fiber systole period,class I muscle fiber systole period and post baseline rest period).And then,the muscle voltage values of different muscle fibers on the surface of pelvic floor were quantified.Results:There was no statistically significant difference in Δ x between patients with postpartum SUI of different degrees.There were significant differences in △y,α,β and γ between patients with postpartum SUI of different degrees(F=7.162,7.655,14.998,2.758,P<0.05).The differences of the means of muscle voltages of pre and post baseline rest period,and class I muscle fiber systole period among patients with postpartum SUI of different degrees were not significant.The differences of the means of muscle voltages of class II,and the class II and I muscle fiber systole period among patients with postpartum SUI of different degrees were significant(F=12.062,24.501,P<0.05),respectively.There was no statistically significant difference in △x between the two groups.The △y,α,β and γ of abnormal group were significantly higher than those of normal group(t=8.991,8.691,9.389,27.552,P<0.05),respectively.There were no statistically significant differences in the means of muscle voltage values of the pre and post baseline rest period,and class I muscle fibers systole period between the two groups.The means of muscle voltage values of class II,and class II and I muscle fibers systole period in the abnormal group was significantly higher than them in the normal group(t=9.613,14.452,P<0.05),respectively.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 71.60%,79.40%,81.40%,91.20%,83.30%and 82.40%,and the specificities of them were respectively 41.40%,37.90%,37.90%,60.30%,41.40%,and 44.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivity and specificity of the combined diagnosis of them were respectively 92.20%and 82.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 79.10%,77.30%,88.20%,89.10%,77.30%,87.30%,and the specificities of them were respectively 64.00%,64.00%,52.00%,46.00%,70.00%and 66.00%in diagnosing pelvic floor function of primipara.The sensitivity and specificity of the combined diagnosis were respectively 98.20%and 80.00%in diagnosing pelvic floor function of primipara.Conclusion:Pelvic floor electromyography physiological parameters and pelvic floor ultrasonic parameters have a certain value in diagnosing postpartum SUI of different degrees and pelvic floor function,and the value of the combined diagnosis of them is higher.

Correlation between serum homocysteine and quantitative electroencephalogram and prognosis of cerebral hemorrhage / 中国综合临床

Objective:To explore the predictive value of admission serum homocysteine levels and quantitative electroencephalogram (qEEG) indicators for adverse outcomes in patients with cerebral hemorrhage.Methods:A retrospective study was conducted on 89 patients, who were collected as the study objects with hemorrhagic stroke treated in the neurology intensive care unit at Kailuan General Hospital from January 2017 to December 2022. Patients were categorized into two groups based on modified Rankin Scale (mRS) scores at discharge: a good prognosis group (mRS≤2) and a poor prognosis group (mRS 3-6). Clinical data and qEEG monitoring of various brain regions were collected. The impact factors of hemorrhagic prognosis were analyzed using multifactorial logistic regression. ROC curve analysis was performed to assess the predictive value of qEEG and admission homocysteine levels for adverse outcomes in hemorrhagic stroke patients.Results:(1) The age of the poor prognosis group was higher than that of the good prognosis group((66.51+13.64) to (60.53+11.69), t=2.15, P=0.034) and admission serum homocysteine levels were significantly higher in the poor prognosis group than in the good prognosis group (17.28(15.52,24.72)mmol/L to 14.50(10.28,16.00)mmol/L, Z=4.14, P<0.001). (2) In the poor prognosis group, power values of δ brain waves in leads Fp1-2, F4, C4, P4, F8, and T4 were higher than those in the good prognosis group (87.99(41.57,196.69) to 50.67(26.64,54.75), Z=2.76, P=0.006); (79.17(40.71,200.00) to 45.06(20.22,61.00), Z=2.10, P=0.036); (72.64(34.97,219.78) to 34.42(19.81,63.4), Z=2.03, P=0.043); (65.06(33.36,177.45) to 28.12(15.88,63.36), Z=2.08, P=0.038); (52.92(25.64,187.91) to 23.61(11.67,43.26), Z=2.21, P=0.027); (66.67(32.56,180.76) to 36.31(17.2,53.78), Z=2.46, P=0.014); (57.30(25.24,127.04) to 29.57(11.91,41.89), Z=2.26, P=0.024). Power values of θ brain waves in leads Fp1-2, F3, F4, C3, C4, P3-4, O1, F7-8, and T3-4 were higher in the poor prognosis group(77.45(47.63,138.72)比35.88(20.92,44.81), Z=3.50, P<0.001); (77.05(35.16,120.22) to 38.74(19.86,58.09), Z=2.27, P=0.023); (85.24(52.53,147.90) to 35.42(14.7,52.59), Z=2.61, P=0.009); (75.81(37.90,124.97) to 36.85(17.92,55.43), Z=2.30, P=0.021); (72.00(43.92,123.54) to 28.37(14.02,51.9), Z=2.22, P=0.027); (67.08(32.01,104.05) to 31.32(17.98,45.28), Z=2.10, P=0.035); (55.33(32.29,94.30) to 25.64(11.87,34.01), Z=2.24, P=0.025); (48.84(20.64,96.28) to 19.85(9.83,28.58), Z=2.30, P=0.022);(48.46(25.06,81.78) to 23.95(8.80,29.16), Z=2.51, P=0.012); (64.46(39.38,112.44) to 26.85(15.74,39.58), Z=2.80, P=0.005); (65.68(31.78,102.00) to 31.09(15.98,46.96), Z=2.38, P=0.017); (45.26(28.34,73.14) to 21.45(10.57,36.59), Z=2.04, P=0.042); (43.50(22.58,78.67) to 25.45(11.91,32.26), Z=2.22, P=0.027). Power values of slow-wave index in leads Fp1-2, F3-4, C3-4, P4, F7-8, and T4, as well as the overall brain average, were higher in the poor prognosis group (6.64(2.98,10.42) to 3.65(2.31,4.30), Z=2.65, P=0.01); (6.53(3.96,11.65) to 3.53(2.56,4.51), Z=2.30, P=0.022); (7.38(4.62,13.12) to 3.83(1.70,4.71), Z=2.38, P=0.017); (5.88(4.02,12.15) to 3.18(2.21,4.46), Z=2.29, P=0.022); (6.13(3.83,11.22) to 2.97(1.53,4.58), Z=2.01, P=0.044); (6.07(3.53,9.39) to 2.74(2.00,3.81), Z=2.40, P=0.016);(4.11(2.51,9.23) to 2.18(1.37,2.82), Z=2.25, P=0.024); (5.71(3.81,10.44) to 3.22(1.86,4.04), Z=2.28, P=0.023); (6.00(3.65,10.37) to 3.04(2.00,4.00), Z=2.39, P=0.017); (4.08(2.56,8.33) to 2.08(1.60,3.14), Z=2.50, P=0.013), with significant statistical differences noted (5.45(3.31,10.08) to 3.17(2.02,4.88), Z=3.62, P=0.005). (3) Logistic regression results showed that admission homocysteine levels ( OR 1.311,95% CI 1.008-1.705, P=0.044), admission NIHSS scores ( OR 1.588,95% CI 1.074-2.349, P=0.020), and overall brain average slow-wave index were influencing factors for poor prognosis in cerebral hemorrhage ( OR 8.596,95% CI 1.088-67.889, P=0.041). (4) ROC curve analysis revealed that the AUC for predicting adverse outcomes in cerebral hemorrhage was 0.768 (95% CI (0.665, 0.872)) for admission homocysteine levels, 0.743 (95% CI (0.634, 0.852)) for the overall brain average slow-wave index, and 0.896 (95% CI (0.827, 0.965)) for admission NIHSS. The cutoff values were 15.67, 3.62, and 8.5, respectively. Sensitivity was 77.8%, 71.1%, and 68.9%, and specificity was 59.4%, 68.7%, and 100%, respectively. The Youden indices were 0.372, 0.398, and 0.689. Conclusion:In the acute phase of cerebral hemorrhage, electroencephalographic physiological changes manifest shows an increase in the δ, θ, and slow-wave index throughout the entire brain. Higher admission homocysteine levels suggest a worse prognosis in patients with cerebral hemorrhage. Admission homocysteine levels and overall brain average slow-wave index have certain predictive value for adverse outcomes in acute cerebral hemorrhage.

Lower urinary tract injury in transvaginal reconstructive pelvic surgery / 中华妇产科杂志

Objective:To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS).Methods:A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals.Results:(1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder.Conclusions:Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

Risk factors for prolonged length of stay in post-anesthesia care unit and development of a prediction model in patients undergoing radical esophagectomy / 中华麻醉学杂志

Objective:To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy.Methods:The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model.Results:A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease ( OR=4.900, 95% confidence interval [ CI] 2.512-9.556), increasing age ( OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation ( OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation ( OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block ( OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy ( P<0.05). The area under the receiver operating characteristic curve (95% CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test, P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions:Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.

Factors influencing the progression of diabetes retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the related factors influencing the progression of diabetes retinopathy(DR).METHODS: This study retrospectively collected the patients with nonproliferative diabetes retinopathy(NPDR)and followed up at the same time. A total of 77 patients in the cohort who progressed from NPDR to proliferative diabetes retinopathy(PDR)were taken as the disease progression group, while 115 NPDR patients who did not progress to PDR were selected as the observation group for a nested case-control study, comparing the general information and laboratory indicators of NPDR and PDR groups, taking general data and laboratory indicators as independent variables and PDR as outcome variables; Finally, diagnostic tests were conducted to evaluate the independent influencing factors of DR progression.RESULTS: PDR group was younger than patients in the NPDR group(P=0.001), and the course of diabetes was longer(P=0.01); Glycated hemoglobin(HbA1c; P=0.001), blood urea nitrogen(BUN; P=0.003), erythrocyte sedimentation rate(ESR; P&#x003C;0.001), and homocysteine(HCY; P=0.001)in the PDR group were significantly higher than those in the NPDR group, while mean red blood cell hemoglobin(MCH; P=0.043)and mean red blood cell hemoglobin concentration(MCHC; P=0.002)were significantly lower than those in the NPDR group. The independent influencing factors for screening DR progression include HbA1c(OR=1.587, P&#x003C;0.001), BUN(OR=1.456, P=0.008), MCH(OR=0.540, P=0.038), ESR(OR=1.122, P=0.005), and HCY(OR=1.838, P=0.002). ROC curve was analyzed to determine the optimal diagnostic cut-off point for the influencing factors of DR progression: HbA1c: 8.18%; BUN: 5.46 mmol/L; ESR: 8.93 mm/h; HCY: 13.95 μmol/L.CONCLUSION: Research has shown that HbA1c, BUN, MCH, ESR, and HCY are independent risk factors for DR progression. Among them, HbA1c, BUN, ESR, and HCY are independent risk factors for DR progression, while MCH is an independent protective factor for DR progression.

Concept of Osler’s patient view and doctor-patient narrative community in narrative medicine / 中国医学伦理学

In the context of modern medicine， it’s difficult for doctors lacking narrative thinking to get into the hearts of patients and offer high-quality medical service. Precise classification terms and decontextualized abstract language have become communication barriers between doctors and patients， creating an atmosphere of unusual indifference and fear during the medical process. William Osler， the father of modern medicine， emphasized that doctors should respect the individuality of patients， and advocated that doctors should use life-oriented language to provide humanistic care to patients. This echoes the concept of the “doctor-patient narrative community” in the construction of the Chinese narrative medicine system. As a brand new clinical humanistic practice path， narrative medicine focuses on the keyword “narrative” and revolves around the theme of “inter-subjective relationship” in the medical context， advocates that doctors switch flexibly in the two references of science and life， achieve visual fusion with patients and their families， pay attention to patients’ life experiences， and establish narrative connections with them. On this basis， it can achieve two-way narrative interaction， build a harmonious doctor-patient narrative community， and thus enhance the patient’s medical experience.

Clinical study of double plate system in the treatment of complex proximal humeral fractures in the elderly / 中国骨伤

OBJECTIVE@#To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery.@*METHODS@#From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups.@*RESULTS@#All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups.@*CONCLUSION@#Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.

Effect of graded motor imagery combined with repetitive transcranial magnetic stimulation on upper limb function of stroke patients / 中国康复理论与实践

ObjectiveTo explore the effects of graded motor imagery (GMI) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb function and activities of daily living of stroke patients. MethodsFrom June, 2022 to February, 2023, 45 stroke patients from Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital were recruited and divided into control group (n = 15), GMI group (n = 15) and combined group (n = 15) randomly. All the groups received conventional rehabilitation, in addition, GMI group received GMI and the combined group received GMI and rTMS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and Hong Kong version of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) before and after treatment. ResultsThe scores of FMA-UE, ARAT and MBI, and grades of FTHUE-HK improved in all the groups after treatment (|t| > 9.681, P < 0.001), and all these indexes were the best in the combined group (F > 13.241, P < 0.001). ConclusionGMI combined with rTMS can further improve the motor function of upper limbs and activities of daily living of stroke patients.

Textual Research on Tibetan Medicinal Herb Lamiophlomis Herba / 中国实验方剂学杂志

Lamiophlomis Herba， one of the medicinal herbs commonly used by the Tibetan ethnic minority， has the effect of activating blood， stopping bleeding， dispelling wind， and relieving pain and is frequently used to treat trauma， traumatic bleeding， rheumatic arthralgia， and dampness and dampness-heat. By a review of ancient Tibetan medicine classics， materia medica classics， and modern literature， this paper systematically analyzed the name， nature， taste， original plant， medicinal part， harvest， processing， efficacy， and indications of Lamiophlomis Herba. The textual research showed that Lamiophlomis Herba was first recorded in the Somaratsa （《月王药诊》） in the middle of the eighth century. This medicinal herb was mainly recorded with a plain and warm nature and a sweet， bitter， and astringent taste. The herb was recorded as non-toxic in other books except the Tibetan Medicinal Plants in Gannan of Qinghai-Tibet Plateau （《青藏高原甘南藏药植物志》）. In the books of the past dynasties， the aboveground part of Lomiophlomis rotatd was used as medicine. In addition， there were also records of using the whole herbs of Ajuga ovalifolia， A. ovalifolia var. calantha， and Oreosolen wattii as the medicine. In ancient times， the herb was mainly harvested before Frost's Descent in the 8th-9th months of the lunar calendar， while it was mainly harvested during the flowering-fruiting stage in autumn in modern times. Due to the decreased reserve of Lamiophlomis Herba， the medicinal part evolved from whole herb or fresh leaves to the aboveground part. According to the ancient and modern records， this herb mainly has the functions of nourishing bone and marrow， eliminating dampness and dampness-heat， stopping bleeding， and relieving pain. In ancient times， it was used for treating parasitic diseases， menostaxis， spermatorrhea， diarrhea， and nourishing the body. This paper aims to provide a basis for further development and study of Lamiophlomis Herba through the textual research.

Gene mutation profiles and clinicopathological features of patients with non-small cell lung cancer harboring KRAS G12C mutation: a single-center retrospective study / 中华病理学杂志

Objective: To accurately screen non-small cell lung cancer (NSCLC) patients with KRAS G12C mutation and to evaluate their clinicopathological features, prognostic factors and current treatment status. Methods: A total of 19 410 NSCLC cases diagnosed at the Department of Pathology of Shanghai Chest Hospital, Shanghai, China from January 2018 to September 2021 were retrospectively reviewed, and the cases with KRAS gene mutation detected by next-generation sequencing were included. The clinicopathological and genetic mutation data of these cases were collected and analyzed. Results: A total of 1 633 (8.4%) NSCLC patients carried a KRAS gene mutation, among whom G12C was the most frequent (468 cases, 28.7%) mutant subtype. The mutation was more commonly found in males (414/468, 88.5%), patients with a history of smoking (308/468, 65.8%), and patients with a pathological type of invasive adenocarcinoma (231/468, 49.4%). The most common co-mutated genes in KRAS G12C mutant NSCLC were TP53 (52.4%, 245/468), STK11 (18.6%, 87/468) and ATM (13.2%, 62/468). The proportion of PD-L1 expression (≥1%) in KRAS G12C mutant NSCLC was significantly higher than that in patients without G12C mutation [64.3% (90/140) vs. 56.1% (193/344), P=0.014]. Immune checkpoint inhibitors (ICIs) treatment significantly prolonged progression-free survival (PFS) in NSCLC patients (10.0 months vs. 5.0 months, P=0.011). However, combination of chemotherapy and ICIs with anti-angiogenesis inhibitors or multi-target inhibitors did not significantly improve PFS in patients with KRAS G12C mutant NSCLC (P>0.05). Patients with KRAS G12C mutation NSCLC treated with ICIs and KRAS G12C patients with TP53 mutation had significantly longer median PFS than those with STK11 mutation (9.0 months vs. 4.3 months, P=0.012). Conclusions: Patients with KRAS G12C mutant NSCLC have relatively higher levels of PD-L1 expression and can benefit from ICIs treatment. The feasibility of chemotherapy, ICIs therapy and their combination needs further investigation.

Hepatocellular carcinoma segmentation and pathological differentiation degree prediction method based on multi-task learning / 生物医学工程学杂志

Hepatocellular carcinoma (HCC) is the most common liver malignancy, where HCC segmentation and prediction of the degree of pathological differentiation are two important tasks in surgical treatment and prognosis evaluation. Existing methods usually solve these two problems independently without considering the correlation of the two tasks. In this paper, we propose a multi-task learning model that aims to accomplish the segmentation task and classification task simultaneously. The model consists of a segmentation subnet and a classification subnet. A multi-scale feature fusion method is proposed in the classification subnet to improve the classification accuracy, and a boundary-aware attention is designed in the segmentation subnet to solve the problem of tumor over-segmentation. A dynamic weighted average multi-task loss is used to make the model achieve optimal performance in both tasks simultaneously. The experimental results of this method on 295 HCC patients are superior to other multi-task learning methods, with a Dice similarity coefficient (Dice) of (83.9 ± 0.88)% on the segmentation task, while the average recall is (86.08 ± 0.83)% and an F1 score is (80.05 ± 1.7)% on the classification task. The results show that the multi-task learning method proposed in this paper can perform the classification task and segmentation task well at the same time, which can provide theoretical reference for clinical diagnosis and treatment of HCC patients.

The value of abnormal protein and C-reactive protein levels in predicting human papillomavirus infection and cervical lesions in patients with peripheral blood tumors / 中国基层医药

Objective:To investigate the value of abnormal protein (TAP) and C-reactive protein (CRP) levels in the prediction of human papillomavirus (HPV) infection and cervical lesions in patients with peripheral blood tumors.Methods:A total of 216 patients with cervical lesions who received treatment in Shan County Central Hospital from June 2019 to May 2021 were included in this cross-sectional study. According to HPV results, these patients were divided into a high-risk HPV infection group ( n = 122), a low-risk HPV infection group ( n = 76), and an HIV-uninfected group ( n = 18). TAP and CRP levels in peripheral blood were determined in each group and analyzed. Results:TAP and CRP levels in the high-risk HPV infection group were (243.29 ± 19.43) μm 2 and (37.49 ± 10.50) mg/L, respectively, and they were (125.46 ± 10.37) μm 2 and (26.27 ± 7.28) mg/L in the low-risk HPV infection group, and (74.51 ± 9.29) μm 2 and (74.51 ± 9.29) mg/L in the HIV-uninfected group. There were significant differences in TAP and CRP levels among the three groups ( F = 12.40, 6.34, both P < 0.001). TAP and CRP levels in the low-risk HPV infection group were significantly higher than those in the HIV-uninfected group ( t = 4.02, 3.26, both P < 0.05). TAP and CRP levels in the peripheral blood of patients with chronic cervicitis were (63.25 ± 5.80) μm 2 and (13.37 ± 5.29) mg/L, which were significantly different from those in patients with cervical intraepithelial neoplasia or cervical cancer ( F = 21.35, 8.26, both P < 0.05). TAP and CRP levels in the peripheral blood of patients with cervical intraepithelial neoplasia grade II and cervical intraepithelial neoplasia grade III were significantly higher than those in patients with cervical intraepithelial neoplasia grade I (both P < 0.05). TAP and CRP levels in the peripheral blood of patients with cervical cancer were significantly higher than those in patients with various grades of cervical intraepithelial neoplasia (all P < 0.05). The Pearson correlation analysis results showed that the load of high-risk human papillomavirus deoxyribonucleic acid (HPV-DNA) was positively correlated with blood TAP and CRP levels ( r = 0.64, 0.24, both P < 0.001). The area under the curve regarding the combined detection of TAP and CRP levels was 0.927 (95% CI: 0.873-0.967), with sensitivity and specificity of 91.0% and 93.6%, respectively. Conclusion:TAP and CRP levels in peripheral blood can reflect HPV infection and cervical lesion and are closely related to the type of HPV infection and the degree of cervical lesion. Combined detection of the two can improve the diagnostic efficiency of cervical cancer and deserves clinical promotion.

Results of carrier screening for Spinal muscular atrophy among 35 145 reproductive-aged individuals from Dongguan region / 中华医学遗传学杂志

OBJECTIVE@#To carry out carrier screening for Spinal muscular atrophy (SMA) in reproductive-aged individuals from Dongguan region and determine the carrier frequency of SMN1 gene mutations.@*METHODS@#Reproductive-aged individuals who underwent SMN1 genetic screening at the Dongguan Maternal and Child Health Care Hospital from March 2020 to August 2022 were selected as the study subjects. Deletions of exon 7 and 8 (E7/E8) of the SMN1 gene were detected by real-time fluorescence quantitative PCR (qPCR), and prenatal diagnosis was provided for carrier couples by multiple ligation-dependent probe amplification (MLPA).@*RESULTS@#Among the 35 145 subjects, 635 were found to be carriers of SMN1 E7 deletion (586 with heterozygous E7/E8 deletion, 2 with heterozygous E7 deletion and homozygous E8 deletion, and 47 with sole heterozygous E7 deletion). The carrier frequency was 1.81% (635/35 145), with 1.59% (29/1 821) in males and 1.82% (606/33 324) in females. There was no significant difference between the two genders (χ² = 0.497, P = 0.481). A 29-year-old woman was found to harbor homozygous deletion of SMN1 E7/E8, and was verified to have a SMN1∶SMN2 ratio of [0∶4], none of her three family members with a [0∶4] genotype had clinical symptoms. Eleven carrier couples had accepted prenatal diagnosis, and one fetus was found to have a [0∶4] genotype, and the pregnancy was terminated.@*CONCLUSION@#This study has determined the SMA carrier frequency in Dongguan region for the first time and provided prenatal diagnosis for carrier couples. The data can provide a reference for genetic counseling and prenatal diagnosis, which has important clinical implications for the prevention and control of birth defects associated with SMA.

Clinical efficacy of mild therapeutic hypothermia with different rewarming time on neonatal hypoxic-ischemic encephalopathy: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical efficacy of mild therapeutic hypothermia (MTH) with different rewarming time on neonatal hypoxic-ischemic encephalopathy (HIE).@*METHODS@#A prospective study was performed on 101 neonates with HIE who were born and received MTH in Zhongshan Hospital, Xiamen University, from January 2018 to January 2022. These neonates were randomly divided into two groups: MTH1 group (n=50; rewarming for 10 hours at a rate of 0.25°C/h) and MTH2 group (n=51; rewarming for 25 hours at a rate of 0.10°C/h). The clinical features and the clinical efficacy were compared between the two groups. A binary logistic regression analysis was used to identify the factors influencing the occurrence of normal sleep-wake cycle (SWC) on amplitude-integrated electroencephalogram (aEEG) at 25 hours of rewarming.@*RESULTS@#There were no significant differences between the MTH1 and MTH2 groups in gestational age, 5-minute Apgar score, and proportion of neonates with moderate/severe HIE (P>0.05). Compared with the MTH2 group, the MTH1 group tended to have a normal arterial blood pH value at the end of rewarming, a significantly shorter duration of oxygen dependence, a significantly higher proportion of neonates with normal SWC on aEEG at 10 and 25 hours of rewarming, and a significantly higher Neonatal Behavioral Neurological Assessment score on days 5, 12, and 28 after birth (P<0.05), while there was no significant difference in the incidence rate of rewarming-related seizures between the two groups (P>0.05). There were no significant differences between the two groups in the incidence rate of neurological disability at 6 months of age and the score of Bayley Scale of Infant Development at 3 and 6 months of age (P>0.05). The binary logistic regression analysis showed that prolonged rewarming time (25 hours) was not conducive to the occurrence of normal SWC (OR=3.423, 95%CI: 1.237-9.469, P=0.018).@*CONCLUSIONS@#Rewarming for 10 hours has a better short-term clinical efficacy than rewarming for 25 hours. Prolonging rewarming time has limited clinical benefits on neonates with moderate/severe HIE and is not conducive to the occurrence of normal SWC, and therefore, it is not recommended as a routine treatment method.

Clinicopathological Features of Primary Small Cell Neuroendocrine Carcinoma of the Bladder / 中国医学科学院学报

Objective To investigate the clinicopathological features,immunohistochemical features,diagnosis,and relationship with sporadic prostate cancer in primary small cell neuroendocrine carcinoma of the bladder. Methods We retrospectively analyzed the clinical characteristics of 12 patients with primary small cell neuroendocrine carcinoma of the bladder diagnosed at Beijing Chao-Yang Hospital affiliated to Capital Medical University from January 2013 to September 2022.The histological features of primary small cell neuroendocrine carcinoma of the bladder were re-evaluated by two pathologists according to the 2022 revision of the World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs.Electronic medical records were retrieved,and telephone follow-up was conducted from the time of histopathological diagnosis to the death or the end of the last follow-up until January 31,2023. Results The 12 patients include 7 patients in pT3 stage and 1 patient in pT4 stage.Eight patients were complicated with other types of tumors,such as high-grade urothelial carcinoma of the bladder and squamous cell carcinoma.Five patients had sporadic prostate cancer.Immunohistochemical staining showed that 12 (100.0%),10 (83.3%),and 8 (66.7%) patients were tested positive for CD56,Syn,and CgA,respectively.The Ki67 proliferation index ranged from 80% to 90%.Five patients with urothelial carcinoma were tested positive for CK20,GATA3,and CK7.P504S was positive in all the 5 patients with prostate cancer,while P63 and 34βE12 were negative.The follow-up of the 12 patients lasted for 3-60 months.Eight of these patients died during follow-up,with the median survival of 15.5 months.Four patients survived. Conclusions Primary small cell neuroendocrine carcinoma of the bladder is a rare urological tumor with high aggressiveness and poor prognosis.In male patients with bladder prostatectomy,all prostate tissue should be sampled.If prostate cancer is detected,the prostate-specific antigen level should be monitored.

A multimodal medical image contrastive learning algorithm with domain adaptive denormalization / 生物医学工程学杂志

Recently, deep learning has achieved impressive results in medical image tasks. However, this method usually requires large-scale annotated data, and medical images are expensive to annotate, so it is a challenge to learn efficiently from the limited annotated data. Currently, the two commonly used methods are transfer learning and self-supervised learning. However, these two methods have been little studied in multimodal medical images, so this study proposes a contrastive learning method for multimodal medical images. The method takes images of different modalities of the same patient as positive samples, which effectively increases the number of positive samples in the training process and helps the model to fully learn the similarities and differences of lesions on images of different modalities, thus improving the model's understanding of medical images and diagnostic accuracy. The commonly used data augmentation methods are not suitable for multimodal images, so this paper proposes a domain adaptive denormalization method to transform the source domain images with the help of statistical information of the target domain. In this study, the method is validated with two different multimodal medical image classification tasks: in the microvascular infiltration recognition task, the method achieves an accuracy of (74.79 ± 0.74)% and an F1 score of (78.37 ± 1.94)%, which are improved as compared with other conventional learning methods; for the brain tumor pathology grading task, the method also achieves significant improvements. The results show that the method achieves good results on multimodal medical images and can provide a reference solution for pre-training multimodal medical images.

Research progress of tradition Chinese medicine treatment mechanism of systemic lupus erythematosus based on biomarkers / 药学实践与服务

Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple organ involvement. There are still many limitations and individual differences in the treatment based on glucocorticoids and immunosuppressants. In recent years, more and more studies have shown that the combination of traditional Chinese medicine in the treatment of SLE has the advantages of good efficacy, low adverse reactions, and high safety. However, the exact regulatory mechanism and combined traditional Chinese medicine in the treatment of SLE are still unclear. This paper reviews the research on the mechanism of traditional Chinese medicine in the treatment of SLE from metabonomic, immune cells, lymphocyte factors and apoptosis, etc, provides ideas for exploring the mechanism of traditional Chinese medicine in the treatment of SLE with modern methods.

Analysis of the diagnostic value of ultrasound elastography combined with EZH2 and BRCA1 proteins in triple-negative breast cancer / 中华内分泌外科杂志

Objective:To investigate the diagnostic value of ultrasound elastography combined with enhancer of Zeste homolog 2 (EZH2) and breast cancer susceptibility gene 1 (BRCA1) proteins in triple-negative breast cancer.Methods:A total of 116 breast cancer patients selected for treatment in our hospital from 2019 to 2021 were analyzed, and ER and PR were analyzed according to the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). Patients who were all HER2 negative were classified as TNBC group, with a total of 21 cases, and patients who were positive for ER, PR, and HER2 were classified as non-TNBC, a total of 95 cases. All enrolled patients underwent ultrasonic elastography examination. The positive expression of EZH2 and BRCA1 was detected by immunohistochemistry. Chi-square test was used to analyze the diagnostic value of ultrasound elastography combined with EZH2 and BRCA1 proteins in TNBC.Results:In the TNBC group, the proportion of smooth edges (35.09) and lobulation of lesions (9.52) was higher than that in the non-TNBC group (12.63, 5.26), while the proportion of burrs (28.57) and fuzziness (23.81) was lower than that in the non-TNBC group (50.53, 31.58). The proportion of calcifications (52.38) in the TNBC group was lower than that in the non-TNBC group (85.26). The non-attenuation ratio of rear echo (80.95) was higher than that of non-TNBC group (52.63). The proportion of blood flow grade enrichment (57.14) was lower than that in the non-TNBC group (63.16) (all P<0.05). The positive expression rate of EZH2 in the TNBC group (85.71) was higher than that of non-TNBC (63.16) ( P<0.001), and the positive expression rate of BRCA1 in the TNBC group (19.05) was lower than that of non-TNBC (55.79) ( P<0.05). The posterior echo non-attenuation ratio (88.89) and rich blood supply ratio (88.89) of EZH2 positive patients in the TNBC group were higher than those with negative (33.33, 0) (all P<0.05), and the rear echo non-attenuation ratio (25.00) and rich blood supply ratio (25.00) of BRCA1 positive in the TNBC group were lower than those with negative (52.94, 88.24) (all P<0.05) ; According to the pathological results, the sensitivity, specificity and accuracy of posterior echo for the diagnosis of TNBC were 25.37%, 91.84% and 53.44%, respectively. The sensitivity, specificity and accuracy of EZH2 were 23.08%, 92.11% and 45.69%, respectively. The sensitivity, specificity and accuracy of BRCA1 were 28.81%, 92.98% and 60.34%, respectively. The combined sensitivity, specificity and accuracy of the three were 53.13%, 95.24% and 83.62%, respectively. The sensitivity, specificity and accuracy of blood flow fraction for the diagnosis of TNBC were 25.81%, 90.74% and 56.03%, respectively. The sensitivity, specificity and accuracy of blood flow fraction, EZH2 and BRCA1 were 59.26%, 94.38% and 86.21%, respectively. Conclusion:The joint classification of the posterior echoes and blood flow in ultrasonic elastography combined with EZH2 and BRCA1 has important significance in the diagnosis of TNBC.