Genotyping Characteristics of Human Fecal Escherichia coli and Their Association with Multidrug Resistance in Miyun District, Beijing / 生物医学与环境科学（英文）

OBJECTIVE@#To explore the genotyping characteristics of human fecal Escherichia coli( E. coli) and the relationships between antibiotic resistance genes (ARGs) and multidrug resistance (MDR) of E. coli in Miyun District, Beijing, an area with high incidence of infectious diarrheal cases but no related data.@*METHODS@#Over a period of 3 years, 94 E. coli strains were isolated from fecal samples collected from Miyun District Hospital, a surveillance hospital of the National Pathogen Identification Network. The antibiotic susceptibility of the isolates was determined by the broth microdilution method. ARGs, multilocus sequence typing (MLST), and polymorphism trees were analyzed using whole-genome sequencing data (WGS).@*RESULTS@#This study revealed that 68.09% of the isolates had MDR, prevalent and distributed in different clades, with a relatively high rate and low pathogenicity. There was no difference in MDR between the diarrheal (49/70) and healthy groups (15/24).@*CONCLUSION@#We developed a random forest (RF) prediction model of TEM.1 + baeR + mphA + mphB + QnrS1 + AAC.3-IId to identify MDR status, highlighting its potential for early resistance identification. The causes of MDR are likely mobile units transmitting the ARGs. In the future, we will continue to strengthen the monitoring of ARGs and MDR, and increase the number of strains to further verify the accuracy of the MDR markers.

Prevalence of trigeminocervical convergence mechanisms in episodic and chronic migraine / Prevalência de mecanismos de convergência trigeminocervical na migrânea episódica e crônica

Abstract Background: Migraine pain location and trigeminocervical convergence have limited diagnostic value and have usually been assessed using non-standard verbal descriptors in a small number of centers. Objective: To use non-verbal descriptors of migraine pain location to determine the prevalence of trigeminocervical convergence mechanisms in patients with episodic and chronic migraine. In addition, we explored the factors associated with the presence of convergence. Methods: A multicenter study was carried out. The explicit pain location was explored by asking subjects to indicate, on an electronic form, three points on the anterolateral side and three points on the posterolateral side of the head and neck that represented the common locations of their migraine pain. We evaluated associations of the pain pattern with demographic and psychological features, comorbidities, lifestyle and other headache characteristics. Results: 97 episodic and 113 chronic migraine patients were included. Convergence was present in 116 migraineurs (55%) who indicated dominance of pain in the posterior cervical region. This site was more often involved in the chronic migraine group (21 vs. 33%; p=0.034). The number of migrainous/altered sensitivity symptoms (OR=1.39; 95%CI 1.14-1.71) was associated with convergence independently of the chronification status. In this symptom group, there were statistical associations between convergence and vomiting (p=0.045), tactile allodynia (p<0.001), nuchal rigidity (p<0.001) and movement allodynia (p=0.031). Conclusions: Trigeminocervical convergence is common in migraineurs and, in practice, it might be found frequently in chronic migraineurs. Some features commonly found in this group, such as altered sensitivity symptoms, are associated with this phenomenon.

RESUMO Antecedentes: A localização da dor da migrânea e a convergência trigeminocervical têm valor diagnóstico limitado geralmente sendo avaliadas por meio de descritores verbais não padronizados em um pequeno número de centros. Objetivo: Usar descritores não verbais da localização da dor migranosa para determinar a prevalência de mecanismos de convergência trigeminocervical em pacientes com migrânea episódica e crônica. Além disso, exploramos os fatores associados à presença de convergência. Métodos: Um estudo multicêntrico foi realizado. A localização explícita da dor foi explorada solicitando aos migranosos que indicassem, em um formulário eletrônico, três pontos no lado anterolateral e três pontos no lado posterolateral da cabeça e pescoço representando a localização comum de sua dor migranosa. Avaliamos a associação do padrão de dor com características demográficas e psicológicas, comorbidades, estilo de vida e outras características da cefaleia. Resultados: 97 pacientes com migrânea episódica e 113 com migrânea crônica foram incluídos. A convergência esteve presente em 116 migranosos (55%) que indicaram um predomínio da dor na região cervical posterior. Este local estava mais frequentemente envolvido no grupo migrânea crônica (21 vs. 33%; p=0,034). O número de sintomas de migrânea/sensibilidade alterada (OR=1,39; IC95% 1,14-1,71) foi associado à convergência independentemente do estado de cronificação. Nesse grupo de sintomas, houve associações entre convergência e vômito (p=0,045), alodinia tátil (p<0,001), rigidez de nuca (p<0,001) e alodinia ao movimento (p=0,0031). Conclusões: A convergência trigeminocervical é comum em pacientes com migrânea e, na prática, podemos encontrá-la com frequência em pacientes com migrânea crônica. Algumas características comumente encontradas nesse grupo, como sintomas de sensibilidade alterada, estão associadas a esse fenômeno.

Cathayanalactone G and other constituents from leaves and twigs of Callicarpa cathayana / 中草药·英文版

Objective: To study the chemical constituents from the leaves and twigs of Callicarpa cathayana. Methods: The chemical constituents were isolated and purified by column chromatography on silica gel, MCI gel CHP 20P/P120, Sephadex LH-20, and HPLC. The structures of the compounds were determined by HR-ESI-MS, 1D and 2D NMR data. Results: A total of 24 compounds were isolated from the 85% methanol extract of leaves and twigs of C. cathayana. They were identified as cathayanalactone G (1), a new diterpene, and 23 known compounds as patagonic acid (2), (-)-16-hydroxycledroda-3,13-dien-16,15-olide-18-oic acid (3), 15-methoxypatagonic acid (4), oleanolic acid (5), ursolic acid (6), siaresinolic acid (7), pomolic acid (8), α-amyrin (9), tormentic acid (10), lupeol (11), 5,7-dihydroxy-3,4′-dimethoxyflavone (12), 5,4′-dihydroxy-3,7,3′-dimethoxyfla-vone (13), 5-hydroxy-3,6,7,4′- tetramethoxyflavone (14), salvigenin (15), kaemferol (16), astragalin (17), pinoresinol 4-O-β-D-glucopyranoside (18), paulownin (19), β-sitosterol (20), β-sitosterol β-D-glucopyranoside (21), 5-hydroxy-coumarin (22), isocopoletin (23), and 4-hydroxycinnamic acid (24). Conclusion: Compound 1 is a new labdane diterpene. Compounds 10, 13, 16 and 17 are isolated from the genus Callicarpa for the first time. Compounds 7, 8, 9, 12, 14, 23 and 24 are reported from C. cathayana for the first time.

Two cases of acute chlorfenapyr poisoning and literature review / 中华劳动卫生职业病杂志

In recent years, chlorfenapyr poisoning has gradually increased in clinical practice, but the case fatality rate remains high. At present, the research on its poisoning mechanism and clinical characteristics is limited, and there is no effective treatment. In order to summarize the clinical characteristics of chlorfenapyr poisoning, in order to guide the clinical treatment, this article reported 2 cases of acute chlorfenayr poisoning and 21 cases of literature review, and summarized the clinical characteristics of chlorfenapyr poisoning.Most of the symptoms of gastrointestinal symptoms, profuse sweating, high fever, and changes in consciousness after chlorfenapyr poisoning, and delayed exacerbations are common, which can involve multiple organ systems such as the central nervous system, providing a basis for clinical diagnosis and treatment.

Analysis on Medication Regularity of Traditional Chinese Medicine in Treatment of Intermediate and Advanced Non-small Cell Lung Cancer Based on Data Mining / 中国实验方剂学杂志

ObjectiveTo explore medication regularity of traditional Chinese medicine （TCM） in the treatment of non-small cell lung cancer （NSCLC） and thereby to lay a theoretical basis for clinical medication and drug development. MethodArticles on clinical treatment of intermediate and advanced NSCLC with TCM in the past 40 years were retrieved from CNKI， which were taken the data source. Then the articles were screened to establish a formula database， followed by frequency statistics， association rule analysis， cluster analysis， factor analysis， and complex network construction. ResultA total of 307 eligible articles were screened out， involving 483 formulas. The common syndrome of intermediate and advanced NSCLC was the deficiency of both Qi and Yin， with the common syndrome elements of Qi deficiency， Yin deficiency， phlegm， blood stasis， pathogenic heat （fire）， toxin， and pathogenic dampness. The frequently used medicinals mainly had the functions of tonifying deficiency， clearing heat， resolving phlegm and relieving cough and dyspnea， promoting urination and draining dampness， and activating blood and resolving stasis. The high-frequency medicinals were Astragali Radix， Glycyrrhizae Radix et Rhizome， Ophiopogonis Radix， Fritillariae Thunbergii Bulbus， and Poria， which were mainly cold， bitter， sweet， and pungent， with tropism at lung， spleen， and stomach. The association rule analysis yielded 17 rules with strong association. Ten common factors were extracted from the factor analysis， and cluster analysis classified the medicinals into 5 groups. Complex network analysis suggested that the core formula was modified Liujunzi Tang and Yiqi Yangyin Jiedu prescription. ConclusionThe treatment principle for intermediate and advanced NSCLC is replenishing Qi and nourishing Yin， invigorating spleen and resolving phlegm， clearing heat and detoxifying， promoting blood circulation and removing blood stasis. The core combinations new prescription discovered by data mining are of important guiding significance， but they should be further verified in clinical practice and by experiments based on the theory of TCM.

Research Progress of Zebrafish Model in Toxicology and Its Application Prospects in Forensic Science / 法医学杂志

In recent years, zebrafish model has been widely concerned and recognized by scholars at home and abroad. As an animal model, zebrafish is of great research value because it is easy to feed, easy to operate, observe and analyze, and the model results can be highly combined with human body test data. Zebrafish model has been widely used in many fields, including basic medical science, clinical medicine, agricultural production, environmental toxicology and forensic science. This review introduces the biological characteristics of zebrafish, summarizes the research progress of zebrafish model in toxicology, and discusses the application prospect of zebrafish model in forensic science.

Clinical characteristics and pathogenic distribution of late-onset sepsis among premature infants with gestational age less than 34 weeks in Henan Province / 中华临床感染病杂志

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.

Preliminary clinical practice of Elekta Unity MR-linac / 中华放射肿瘤学杂志

Objective:To summarize the experience of ELEKTA Unity MR-linac in clinical application in our hospital and analyze the positioning accuracy, process time and other related issues.Methods:A total of 14 patients enrolled in the Unity MR-Linac study were reviewed. All treatment time (including positioning, scanning, replanning, and beam discharge) and setup errors in 3directions were statistically analyzed. 11 patients with conventional accelerators using the multifunctional immobilization system (MIS) were randomly selected to make statistical analysis of the setup errors, and the differences between the Unity group and the conventional accelerators using the MIS were compared using t-test. Results:In the Unity group, the setup errors in X, Y and Z directions were (-0.15±0.30) cm, (0.02±0.57) cm and (-0.10±0.28) cm, respectively. The average treatment time was 36.87minutes. The average positioning time was 5.40minutes. The mean scan time was 7.48minutes, the mean adaptive plan time was 7.46minutes, and the mean beam time was 9.48minutes. In the conventional accelerator group, the setup errors were (0.05±0.25) cm, (-0.01±0.25) cm and (-0.03±0.23) cm, respectively. The results of the setup errors of patients fixed with MIS showed that there were significant differences in the left and right directions ( P<0.001), while there were no significant differences in the Y and Z directions ( P=0.061 and 0.374) between two groups. Conclusions:Except in the X direction, there is no significant difference in setup errors between the Unity and conventional accelerator groups in the condition of laser-free system. Under smooth circumstances, the treatment time by using ATP (adapt to position) workflow will also be within the range of tolerance of the patients. Magnetic-guided radiotherapy has a promising application prospect, whereas the procedure needs to be optimized.

China experts' consensus on preventive and interceptive orthodontic treatments of malocclusions of children / 华西口腔医学杂志

Malocclusion is one of the three most common oral diseases reported by World Health Organization(WHO). In China, its incidence rate is rising. Malocclusion seriously affects the dental and maxillofacial function, facial appearance and growth development of nearly 260 million children in China, and what is more, it affects their physical and mental health development. Malocclusion occurrence is related to genetic and environmental factors. Early treatment of malocclusion can create a good dental and maxillofacial development environment, correct abnormal growth and control the adverse effects of abnormal genetic factors. It can effectively reduce the prevalence of children's malocclusion and enhance their physical and mental health. This is an urgent need from the economic perspective of our society, so it has great practical and social significance. Experts from the project group "standard diagnose and treatment protocols for early orthodontic intervention of malocclusions of children" which initiated by China National Health Institute of Hospital Administration wrote the "China Experts' Consensus on Preventive and Interceptive Orthodontic Treatments of Malocclusions of Children", which aims to guide and popularize the clinical practice, improve the clinical theory and practice level, and accelerate the disciplinary development of early treatment of children's malocclusion in China. The consensus elaborates the harmfulness of malocclusion and the necessity of early treatment, and brings up the principles and fundamental contents. Based on the law of dental and maxillofacial development, this paper puts forward the guiding suggestions of preventive and interceptive treatments in different stages of dental development ranging from fetus to early permanent dentition. It is a systematic project to promote and standardize the early treatment of malocclusion. Through scientific and comprehensive stratified clinical practice and professional training, the clinical system of early treatment of malocclusion in China will eventually be perfected, so as to comprehensively care for children's dental and maxillofacial health, and improve their oral and physical health in China.

Surveillance of schistosomiasis in Xiaogan City from 2016 to 2020 / 中国血吸虫病防治杂志

Objective To analyze the surveillance data of schistosomiasis in Xiaogan City, Hubei Province from 2016 to 2020, so as to provide the scientific evidence for understanding the epidemiological changes of schistosomiasis and evaluating the schistosomiasis control strategy. Methods A total of 16 surveillance sites were selected in the schistosomiasis endemic foci of Xiaogan City from 2016 to 2020, where Schistosoma japonicum infections in humans, livestock and Oncomelania snails and the schistosomiasis transmission risk were monitored. The schistosomiasis surveillance results were descriptively analyzed. Results During the period from 2016 to 2020, there was no schistosomiasis emergency epidemic in Xiaogan City. A total of 660 sero-positive individuals were identified in Xiaogan City during the 5-year period, and the seroprevalence of S. japonicum infections reduced from 2.08% in 2016 to 0.97% in 2020. Higher seroprevalence of S. japonicum infections was detected in men than in women, and in individuals at ages of over 60 years than in those at other age groups; however, no egg-positives were detected in humans or livestock. The mean density of living snails was 0.05 to 0.06 snails/0.1 m2 during the 5-year period, and the occurrence of frames with snails increased from 2.99% in 2016 to 3.92% in 2020; however, no S. japonicum infection was found in snails. Conclusions The endemic situation of schistosomiasis remarkably decreases in Xiaogan City during the period from 2016 through 2020. Further improvements of the sensitive and effective schistosomiasis surveillance system are required with an emphasis on the monitoring of the schistosomiasis transmission risk and management of floating populations.

Burden of Outpatient Visits Attributable to Ambient Temperature in Qingdao, China / 生物医学与环境科学（英文）

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.

SPDEF suppresses head and neck squamous cell carcinoma progression by transcriptionally activating NR4A1 / 国际口腔科学杂志·英文版

SAM pointed domain containing E26 transformation-specific transcription factor (SPDEF) plays dual roles in the initiation and development of human malignancies. However, the biological role of SPDEF in head and neck squamous cell carcinoma (HNSCC) remains unclear. In this study, the expression level of SPDEF and its correlation with the clinical parameters of patients with HNSCC were determined using TCGA-HNSC, GSE65858, and our own clinical cohorts. CCK8, colony formation, cell cycle analysis, and a xenograft tumor growth model were used to determine the molecular functions of SPDEF in HNSCC. ChIP-qPCR, dual luciferase reporter assay, and rescue experiments were conducted to explore the potential molecular mechanism of SPDEF in HNSCC. Compared with normal epithelial tissues, SPDEF was significantly downregulated in HNSCC tissues. Patients with HNSCC with low SPDEF mRNA levels exhibited poor clinical outcomes. Restoring SPDEF inhibited HNSCC cell viability and colony formation and induced G0/G1 cell cycle arrest, while silencing SPDEF promoted cell proliferation in vitro. The xenograft tumor growth model showed that tumors with SPDEF overexpression had slower growth rates, smaller volumes, and lower weights. SPDEF could directly bind to the promoter region of NR4A1 and promoted its transcription, inducing the suppression of AKT, MAPK, and NF-κB signaling pathways. Moreover, silencing NR4A1 blocked the suppressive effect of SPDEF in HNSCC cells. Here, we demonstrate that SPDEF acts as a tumor suppressor by transcriptionally activating NR4A1 in HNSCC. Our findings provide novel insights into the molecular mechanism of SPDEF in tumorigenesis and a novel potential therapeutic target for HNSCC.

The Role of Zyxin in Regulating Platelet Cytoskeleton Distribution / 中国实验血液学杂志

OBJECTIVE@#To investigate the regulatory effect of zyxin on the distribution of platelet cytoskeleton.@*METHODS@#Platelets were isolated from zyxin-knockout (Zyx@*RESULTS@#After zyxin gene was knockout, the expressions of cytoskeleton proteins β-actin, α-actinin, filamin A, and myosin Ⅱ A in resting and Jas-induced platelets were significantly increased. In the platelet spreading on fibrinogen surface, F-actin was increased in Zyx@*CONCLUSION@#Zyxin significantly regulates the distribution of platelet cytoskeleton, which plays an important role in maintaining platelet cytoskeleton homeostasis.

Effects of manual loading on calcitonin gene-related peptide and nerve growth factor in rats with chronic low back pain / 中国骨伤

OBJECTIVE@#To observe the analgesic effect of manipulation loading on chronic low back pain (CLBP) model rats and the expression of inflammatory factors in psoas major muscle tissue, and to explore the improvement of manipulation on local inflammatory microenvironment.@*METHODS@#Thirty two SPF male SD rats weighing 340-360g were randomly divided into blank group, sham operation group, chronic low back pain model group and treatment group, with 8 rats in each group. In the model group, L@*RESULTS@#There was no significant difference in PWT and PWL between the blank group and the sham operation group after modeling (@*CONCLUSION@#Local massage loading has analgesic effect on CLBP rats, at the same time, it can inhibit the content of CGRP and NGF in psoas muscle tissue of CLBP rats, and improve the local inflammatory microenvironment.

Study on anti-hyperlipidemia effect of Linderae Radix via regulating reverse cholesterol transport / 中国中药杂志

This article aims to investigate the ameliorative effect of Linderae Radix ethanol extract on hyperlipidemia rats induced by high-fat diet and to explore its possible mechanism from the perspective of reverse cholesterol transport(RCT). SD rats were divided into normal group, model group, atorvastatin group, Linderae Radix ethanol extract(LREE) of high, medium, low dose groups. Except for the normal group, the other groups were fed with a high-fat diet to establish hyperlipidemia rat models; the normal group and the model group were given pure water, while each administration group was given corresponding drugs by gavage once a day for five weeks. Serum total cholesterol(TC), triglyceride(TG), high density lipoprotein-cholesterol(HDL-c), low density lipoprotein-cholesterol(LDL-c), alanine aminotransferase(ALT), and aspartate aminotransferase(AST) levels were measured by automatic blood biochemistry analyzer; the contents of TC, TG, total bile acid(TBA) in liver and TC and TBA in feces of rats were detected by enzyme colorimetry. HE staining was used to observe the liver tissue lesions; immunohistochemistry was used to detect the expression of ATP-binding cassette G8(ABCG8) in small intestine; Western blot and immunohistochemistry were used to detect the expression of peroxisome proliferator-activated receptor gamma/aerfa(PPARγ/α), liver X receptor-α(LXRα), ATP-binding cassette A1(ABCA1) pathway protein and scavenger receptor class B type Ⅰ(SR-BⅠ) in liver. The results showed that LREE could effectively reduce serum and liver TC, TG levels, serum LDL-c levels and AST activity, and increase HDL-c levels, but did not significant improve ALT activity and liver index; HE staining results showed that LREE could reduce liver lipid deposition and inflammatory cell infiltration. In addition, LREE also increased the contents of fecal TC and TBA, and up-regulated the protein expressions of ABCG8 in small intestine and PPARγ/α, SR-BⅠ, LXRα, and ABCA1 in liver. LREE served as a positive role on hyperlipidemia model rats induced by high-fat diet, which might be related to the regulation of RCT, the promotion of the conversion of cholesterol to the liver and bile acids, and the intestinal excretion of cholesterol and bile acids. RCT regulation might be a potential mechanism of LREE against hyperlipidemia.

Investigation of sleep disturbance and related factors in patients with primary Sjögren's syndrome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of primary Sjögren' s syndrome (pSS) patients.@*METHODS@#One hundred and eighty-six pSS patients were included in the study, who were admitted to Peking University People' s Hospital and met the criteria of inclusion and exclusion. Sleep quality was assessed using the Pittsburgh sleep quality index(PSQI).Depression, anxiety were evaluated by patient health questionnaire (PHQ)-9, generalized anxiety disorder(GAD)-7, respectively. The demographic and clinical data were also recorded.Disease activity and damage were evaluated with the European League Against Rheumatism Sjögren's syndrome disease activity index (ESSDAI). According to the PSQI score>7, the pSS patients were divided into 152 cases of sleep disorder group and 34 cases of normal sleep group. Mann-Whitney U test, Chi-square test or Fisher' s exact test, independent samples t test, Spearman correlation analysis and Logistic regression were used for statistical analysis.@*RESULTS@#The prevalence of sleep disturbance (PSQI > 7) was 81.7% (152 / 186) in the pSS patients, and 52.7% (98/186) had moderate or severe sleep disorders (PSQI≥ 11). The mean PSQI score of sleep disordered group was (12.29±3.30), while the normal sleep group PSQI score was (5.50±1.20). The PSQI score, PHQ-9 score and GAD-7 score in the sleep-disordered group were significantly higher than those in the normal sleep group (P=0.000, 0.035, 0.031). The PSQI score in the sleep disordered group were significantly higher than those in the normal sleep group in seven aspects: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, hypnotic drug use and daytime dysfunction. All of them had statistical significance. According to the results of Spearman correlation analysis, PSQI had significantly positive correlation with course of disease, anxiety, depression score (r=0.151, 0.240, 0.421, P < 0.05), but negatively correlated with C3, C4 (r=-0.021, -0.235, P < 0.05). Logistic analysis identified the course of disease(OR=2.809, 95%CI: 1.21-6.52)and PHQ-9 score(OR=1.422, 95%CI: 1.04-1.94)as predictors of sleep disorders.@*CONCLUSION@#The incidence of sleep disorder in the pSS patients was higher, which was closely related to the course of disease, anxiety, depression and other factors. It is critical to assess and manage comprehensively the disease.

Comparison of the performance of two methods to determine set-up errors for DIBH patients with left sided breast cancer in radiotherapy / 中华放射肿瘤学杂志

Objective:To establish the basic procedures of the application of optical surface monitoring system (OSMS) in the deep inspiration breath hold (DIBH) radiotherapy for patients with left sided breast cancer and compare the performance of OSMS and cone-beam CT (CBCT) in the determination of the set-up errors of DIBH radiotherapy for patients with left sided breast cancer.Methods:Twenty patients with left sided breast cancer received DIBH radiotherapy. Through the registration of CBCT images with the planning CT images, and the registration of OSMS radiography images with the outer contour of the body surface, translational set-up errors and rotational errors were determined along the lateral-medial ( Rx), superior-inferior ( Ry) and anterior-posterior ( Rz) directions. Pearson correlation analysis was performed to evaluate the correlation of the set-up errors determined by two methods, and Bland- Altman plot analysis was used to assess the coincidence of these two methods. Results:Two methods were positively correlated. The Rz volume was 0.84, 0.74 and 0.84 in the x, y and z directions, and 0.65, 0.41 and 0.54 in the Rx, Ry and Rz directions, respectively (all P<0.01). The 95% CI of agreement were within preset 5 mm tolerance (-0.37-0.42cm, -0.39-0.41cm, -0.29-0.49cm ) in x, y and z directions for two methods. The 95% CI of agreement were within preset 3 ° tolerance -2.9°-1.4°, -2.6°-1.4°, -2.4°-2.5°in Rx, Ry and Rz directions for two methods. The system errors of 20 patients with left sided breast cancer receiving DIBH radiotherapy were <0.18cm and the random errors were <0.24cm. Conclusions:OSMS is equivalent to CBCT in the determination and stimulation of set-up errors for patients with left sided breast cancer receiving DIBH radiotherapy. The combination of CBCT and OSMS is a safe and reliable method.

Establishment of a prognostic Nomogram model for predicting the first 72-hour mortality in polytrauma patients / 中华危重病急救医学

Objective:To establish a prognostic Nomogram model for predicting the risk of early death in polytrauma patients.Methods:Data extracted from a polytrauma study on Dryad, an open access database, was selected for secondary analysis. Patients from 18 to 65 years old with polytrauma in the original data were included. All patients with missing variables, such as blood lactic acid (Lac), Glasgow coma score (GCS) and injury severity score (ISS) at admission, were excluded. The differences of gender, age, Lac, ISS and GCS scores between the patients who died within 72 hours and those who survived were analyzed. The risk factors for 72-hour death were analyzed by Logistic regression, and the Nomogram prediction model was established using R software. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model, and the Bootstrap method was used for internal verification by repeating sample for 1 000 times. Decision curve (DCA) was applied to analyze the clinical practical value of the model.Results:A total of 2 315 polytrauma patients were included. Logistic regression analysis showed that Lac, GCS score and age > 55 years old were the risk factors for early death in polytrauma patients [Lac: odds ratio ( OR) = 1.36, 95% confidence interval (95% CI) was 1.29-1.42, P < 0.001; GCS score: OR = 0.76, 95% CI was 0.73-0.79, P < 0.001; age > 55 years old: OR = 1.92, 95% CI was 1.37-2.66, P < 0.001]. The prediction model was established by using the above risk factors and displayed by Nomogram. ROC curve analysis showed that the area under the ROC curve (AUC) of Nomogram model to predict the risk of death within 72 hours was 0.858, and the predictive ability of Nomogram model was significantly higher than that of Lac (AUC = 0.743), GCS score (AUC = 0.774) and ISS score (AUC = 0.699), all P < 0.05. The model calibration chart showed that the predicting probability was consistent with the actual occurrence probability, and the DCA showed that Nomogram model presented excellent clinical value in predicting the 72-hour death risk for polytrauma patients. Conclusions:The prognostic Nomogram model presents significantly predictive value for the risk of death within 72 hours in polytrauma patients. Prognostic Nomogram model could offer individualized, visualized and graphical prediction pattern, and provide physicians with practical diagnostic tool for triage system and management of polytrauma according to precision medicine.

Comparable effects of Jiedu Granule, a compound Chinese herbal medicine, and sorafenib for advanced hepatocellular carcinoma: A prospective multicenter cohort study / 中西医结合学报

OBJECTIVE@#Sorafenib has been extensively used for the treatment of advanced hepatocellular carcinoma (HCC), and Chinese herbal medicine has also been used to manage advanced HCC. The present work evaluates the effectiveness and safety of Jiedu (JD) Granule, a compound of traditional Chinese herbal medicine, side-by-side with sorafenib for the treatment of advance HCC.@*METHODS@#Patients with advanced HCC receiving treatment with JD Granule or sorafenib were enrolled from December 2014 to March 2018. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and safety. Propensity score matching (PSM) analysis was used to control for possible selection bias from the study group allocation process.@*RESULTS@#Of the 325 patients included, 161 received JD Granule and 164 received sorafenib. No significant differences were found in OS or PFS among patients receiving JD Granule compared to sorafenib (P > 0.05). Median OS of the two study groups was 6.83 months (95% confidence interval [CI]: 5.83-9.47) in the group receiving JD Granule and 8 months (95% CI: 6.67-9.80) in the group receiving sorafenib, with half-, 1- and 2-year survival rates of 53.6%, 31.2% and 13.2% vs 60.1%, 35.5% and 14.2%, respectively. Even after PSM, the median survival time did not differ between the JD Granule group (9.03 months; 95% CI: 6.37-14.2) and the sorafenib group (7.93 months; 95% CI: 6.5-9.97), with comparable half-, 1- and 2-year survival rates. The most common adverse events (AEs) were diarrhea (13.7%) and fatigue (5.6%) in the JD Granule group, and hand-foot skin reaction (46.3%) and diarrhea (36.6%) in the sorafenib group. The JD Granule was more cost-effective than sorafenib treatment for advanced HCC.@*CONCLUSION@#Compared to sorafenib, JD Granule was more cost-effective and caused fewer AEs for the treatment of Chinese patients with advanced HCC.

Prognostic value of tertiary lymphoid structure and tumour infiltrating lymphocytes in oral squamous cell carcinoma / 国际口腔科学杂志·英文版

Tertiary lymphoid structures (TLS) are ectopic lymphoid structures in cancers that are largely associated with favourable prognosis. However, the prognostic value of TLSs in oral squamous cell carcinoma (OSCC) is largely unknown, and the association between tumour infiltrating lymphocytes (TILs) and TLSs has been rarely explored in OSCC. In this study, associated markers of TLS, including peripheral node address (PNAd) in high endothelial venules, CD20 in B cells and CD3 in T cells, were examined in 168 OSCC patients, and survival analysis was performed between TLS-positive and TLS-negative cohorts. We detected the presence of TILs by staining CD8+ cytotoxic T cells and CD57+ NK cells as well. TLSs appeared as highly organized structures in 45 (26.8%) cases. TLS-positive patients had a better 5-year overall survival (OS) rate (88.9% vs. 56.1%, P < 0.001) and relapse-free survival (RFS) rate (88.9% vs. 63.4%, P = 0.002). Moreover, the presence of TLS was an independent prognostic factor for both the 5-year OS rate (hazard ratio [HR] = 3.784; 95% confidence interval [CI], 1.498-9.562) and RFS rate (HR = 3.296; 95% CI, 1.279-8.490) in multivariate analysis. Furthermore, a higher density of CD8+ T cells and CD57+ NK cells was found in TLS-positive sections than in TLS-negative counterparts (P < 0.001), and their combination provided a higher predictive accuracy (AUC = 0.730; 95% CI, 0.654-0.805). In conclusion, our results suggest that TLS is an independent positive prognostic factor for OSCC patients. These findings provide a theoretical basis for the future diagnostic and therapeutic value of TLSs in OSCC treatment.