Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus disease 2019 (version 2023) / 中华创伤杂志

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Mechanism of health behavior in relieving anxiety mood / 四川精神卫生

Taking the intervention of healthy behaviors in anxiety mood as the entry point， this paper aims to review the mechanism of healthy exercise behaviors， healthy eating behaviors， healthy leisure and entertainment behaviors in regulating anxiety mood based on recent national and international research findings， and to summary the alleviation of anxiety mood from the following three aspects： choice of exercise， diet control and participation in leisure and entertainment activities， thus providing a practical basis for the scale application of health behavior treatment for anxiety mood.

Analysis of variant of GLI3 gene in a child featuring autosomal dominant Pallister-Hall syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical and genetic characteristics of a child with Pallister-Hall syndrome (PHS).@*METHODS@#DNA was extracted from peripheral blood sample from the child and subjected to whole exome sequencing. Suspected variants were verified by Sanger sequencing of his family members.@*RESULTS@#Genetic testing revealed that the child has harbored a heterozygous c.3320_3330delGGTACGAGCAG (p.G1107Afs×18) variant of the GLI3 gene. Neither parent was found to carry the same variant.@*CONCLUSION@#The c.3320_3330delGGTACGAGCAG (p.G1107Afs×18) frameshift variant of the GLI3 gene probably underlay the pathogenesis of PHS in this child. Genetic testing should be considered for patients featuring hypothalamic hamartoma and central polydactyly.

The correlation between the timed up and go test and fall risks in elderly frail patients / 中华老年医学杂志

Objective:To evaluate the correlation between the timed up and go(TUG)test and fall risks in elderly frail patients.Methods:From July to September 2019, elderly frail patients who were treated at the cardiovascular department of our hospital were enrolled.Basic clinical data and fall-related information of patients were collected.Patients were divided into the fall group and the non-fall group.Results on the body mass index(BMI), TUG, 4-meter maximum walking speed(4 m MWS)and Barthel index were compared between the two groups.The correlation between TUG and each indicator was examined.Multivariate Logistic regression analysis was used to analyze the correlation between the TUG and falls in elderly patients.Results:A total of 96 eligible patients were enrolled, including 35 in the fall group and 61 in the non-fall group.The average TUG time was longer in the fall group than in the non-fall group(16.45±6.44 s vs.10.17±2.91 s, t=-6.556, P<0.001). The correlation analysis results showed that the TUG was correlated with falls and 4 m MWS( r=0.582 and 0.875, both P<0.001). Multivariate Logistic regression analysis showed that the TUG( OR=1.201, 95% CI: 1.111-1.470, P=0.004)and 4 m MWS( OR=1.146, 95% CI: 1.063-1.244, P=0.015)were risk factors for falls. Conclusions:The TUG is correlated with fall risks in elderly frail patients and should be recommended as a routine test in clinical practice.

Research progress in downstaging treatment of hepatocellular carcinoma before liver transplantation / 中华肝胆外科杂志

Liver transplantation is an effective curative treatment for hepatocellular carcinoma patients. However, most patients lost the change of surgery when diagnosed as hepatocellular carcinoma. Through local or systemic treatment, hepatocellular carcinoma can be treated in a downstaging manner to reduce tumor burden, so that patients who are beyond the transplantation criteria can still be up to the transplantation criteria after treatment, and finally receive liver transplantation. At present, pre-transplant downstaging treatment has been widely accepted. In this review, we summarized the indications, treatment options, treatment endpoints, and treatment outcomes of pre-transplant downstaging treatment.

A systematic review and meta-analysis of severe risk in patients with common chronic diseases and coronavirus disease 2019 / 中华传染病杂志

Objective:To systematically review the severe risk in common chronic diseases and coronavirus disease 2019 (COVID-19) cases.Methods:PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc, medRxiv, SSRN and ChinaXiv were searched for clinical and epidemiological studies that reported chronic diseases in patients with COVID-19. Only studies of severe COVID-19 in comparison with non-severe controls were included. The prevalence rates of chronic diseases including chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, malignant tumor, cardiovascular diseases, cerebrovascular disease, chronic kidney disease, and chronic liver disease were estimated. Pooled odds ratio ( OR) with 95% confidence interval ( CI) between patients with severe COVID-19 and non-severe groups were calculated. R 3.6.3 software was used for meta-analysis. Results:The search yielded 2 455 articles. A total of 19 eligible comparative studies with 4 792 patients were included in a quantitative analysis. Meta-analysis showed that there was a proportion of 55.0% (95% CI 40.0%-80.0%) male among patients with COVID-19, and the overall pooled prevalence of any chronic diseases in COVID-19 cases was 30.4% (95% CI 24.0%-37.0%). The most prevalent comorbidity was hypertension (16.9%(95% CI 14.0%-20.0%)), followed by diabetes mellitus (8.3%(95% CI 8.0%-9.0%)). The proportion of male patients with severe COVID-19 was higher than that of male patients with non-severe COVID-19 (64.4% vs 52.8%, OR=1.49, 95% CI 1.08-2.05, Z=4.63, P<0.01). The prevalence rates of COPD, cerebrovascular disease, diabetes mellitus, chronic kidney disease, hypertension, cardiovascular diseases and malignant tumor in severe COVID-19 patients were higher than those of non-severe patients ( OR=5.77, 95% CI 3.80-8.74; OR=4.47, 95% CI 2.71-7.38; OR=3.55, 95% CI 2.86-4.40; OR=3.05, 95% CI=1.76-5.28; OR=2.82, 95% CI=1.96-3.97; OR=2.39, 95% CI=1.77-3.23; OR=2.15, 95% CI 1.27-3.66, respectively, Z=8.37, 6.01, 11.60, 4.20, 5.46, 5.71, 3.12, all P<0.01). There was no significant difference in the prevalence of chronic liver disease between severe and non-severe patients ( OR=1.35, 95% CI 0.84-2.17, P=0.11). Conclusion:COVID-19 patients with chronic diseases have higher risk of developing severe disease, and the ORs from high to low are COPD, cerebrovascular disease, diabetes mellitus, chronic kidney disease, hypertension, cardiovascular diseases and malignant tumor.

Protective effect of diminazene on kidney injury of limb ischemiareperfusion model mice and its mechanism / 吉林大学学报(医学版)

Objective: To detect the levels of angioteinsin II (Ang II) and angioteinsin (1-7) [Ang (1-7)] and the expression levels of angiotensin II type-1 receptor (AT1R) and Mas receptor (MasR) proteins in kidney tissue of the limb ischemia-reperfusion (LIR) mice pre-treated with the angiotensin coverting enzyme 2 (ACE2) activator diminazene (DIZE), and to explore the protective effect of DIZE on the kidney injury of the LIR mice. Methods: Eighteen male ICR mice aged 8 weeks were divided into control group, LIR group and LIR+DIZE group. The mice in model group and LIR+DIZE group were subjected to 2 h of ischemia and 4 h of reperfusion to establish the LIR models. The mice in LIR + DIZE group were pre-treated with 10 mg · kg-1 · d-1 DIZE for 14 d by subcutaneous injection before LIR. The histological technique was used to observe the morphology of kidney tissue of the mice and the pathological injury was evaluated. Chemical colorimetry was performed to determine the levels of serum urea and serum creatinine (Scr) of the mice. Enzyme linked immunosorbent assay (ELISA) was used to determine the Ang II and Ang (1-7) levels in kidney tissue of the mice. Western blotting method was used to measure the expression levels of AT1R and MasR proteins in kidney tissue of the mice. Results: Compared with control group, the pathological changes such as inflammatory cell infiltration and epithelial cell degeneration were found in kidney tissue of the mice in LIR group, and the kindey injury score was obviously increased (P<0. 05); compared with LIR group, the kidney injury performance in the kidey tissue of the mice in LIR + DIZE group was alleviated and the kidney injury score was decreased significantly (P<0. 05). Compared with control group, the levels of serum urea and Scr of the mice in LIR group were significantly increased (P<0. 05); compared with LIR group, the levels of serum urea and Scr of the mice in LIR + DIZE group were significantly decreased (P<0. 05). Compared with control group, the Ang II, Ang (1-7) levels and the ratio of Ang II/Ang (1-7) of the mice in LIR group were significantly increased (P<0. 05); compared with LIR group, the Ang II level of the mice in LIR+DIZE group was markedly decreased (P<0. 05), the Ang (1-7) level was significantly increased (P<0. 05)), and the ratio of Ang II/Ang (1-7) was decreased (P<0.05). Compared with control group, the expression level of AT1R protein in kidney tissue of the mice in LIR group was significantly decreased (P<0.05), the expression of MasR protein was significantly increased (P<0. 05), and the ATlR/MasR ratio was decreased (P<0.05). Compared with LIR group, the AT1R and MasR protein expression levels in kidney tissue of the mice in LIR + DIZE group were significantly increased (P < 0.05), and the ATlR/MasR ratio was also increased (P < 0.05). Conclusion: The imbalance of Ang II/Ang (1-7) and AT1R/Mas expressions in kidney tissue of the mice may be involved in kidney injury after LIR of the mice. ACE2 activitor DIZE may play a protective role in the kidney by improving the imbalance of Ang II/Ang (1-7) and ATlR/MasR expressions.

Effect of auditory integration training on core symptoms in children with autism spectrum disorders whose auditory conduction dysfunction repaired / 中华行为医学与脑科学杂志

Objective:To explore the improvement of core symptoms in children with autism whose auditory pathway dysfunction were repaired after accepting auditory integration training(AIT).Methods:The ASD children with abnormal auditory evoked potentials were divided into AIT group (the ones whose BAEP return to normal after AIT training into test group), control group A (blank control group) and control group B (ABA training group). The ASD children were assessed by Portage Development Checklist, Child Autism Rating Scale (CARS) and Autism Therapy Assessment Scale (ATEC) at the time of admission, one month after admission, three months after admission.The curative effect with the change value of each factor fraction was evaluated.Results:At the time of enrollment, there were no significant differences among the scores of CARS((36.31±4.08), (36.33±3.76), (36.33±5.14)) as well as ATEC language ((19.08±6.43), (16.40±6.42), (18.48±5.96)), social ((15.63±7.13), (16.05±7.57), (16.19±7.19)), and perception ((16.78±5.39) (16.92±6.75), (17.12±6.73)) and self-care ((15.98±8.71), (17.93±8.22), (17.26±8.93), respectively)) in the AIT group, control group B and control group A. After one month and three months from enrollment, the scores of CARS were ((33.96±3.79), (35.09±4.38) and (34.30±3.98), respectively after one month; (32.95±3.15), (36.86±3.86) and (33.95±3.90), respectively) after three months in the AIT group, control group B and control group A. The repeated measurement analysis of variance showed that the main effect of time was significant ( F=22.308, P<0.01), the main effect of group was not significant ( F=2.647, P>0.05), and there was interaction between time and group ( F= 8.626, P<0.01). For the scores of ATEC language (one month: (16.18±7.10), (18.62±6.63), (13.40±5.44); three months: (14.13±6.13), (18.40±6.35), (10.75±5.17)), social(one month: (12.31±6.68), (17.76±6.82), (15.08±6.75); three months: (10.71±5.42), (16.31±6.30), (12.15±7.30)), perception (one month: (14.37±5.86), (17.43±7.22), (18.58±6.92); three months: (10.35±5.43), (16.44±7.05), (16.68±7.37)) in AIT group, control group B and control group A. The main effect of time was significant ( F=35.534, 40.729, 40.401, all P<0.01), the main effect of group was also significant ( F=7.600, 6.193, 7.675, all P<0.01), and there was interaction between time and group ( F=7.602, 3.355, 7.649, all P<0.05). Multiple comparisons showed that there were statistically significant differences between the AIT group and the control group B, the control group A and the control group B in the scores of ATEC language scale after intervention (I1-J1=-1.69, P1<0.05; I2-J2=-4.98, P2<0.01) between the AIT group and the control group A in the scores of ATEC social scale after intervention (I-J=-4.54, P<0.01) .There were significant differences between the AIT group and the control group A, the AIT group and the control group B in the scores of ATEC perception scale after intervention (I1-J1=-3.16, P1<0.05; I2-J2=-4.89, P2<0.01); for the scores of ATEC self-care ability subscale the main effect of time was significant ( F=22.876, P<0.01), the main effect of group was also significant ( F=3.427, P<0.05), and time and group had no interaction ( F=1.885, P>0.05). Multiple comparisons showed that the scores of ATEC self-care ability scale between the AIT group and the control group A were statistically significant (I-J=-4.46, P<0.05). Conclusion:The results of this study show that AIT training can improve the core symptoms of the ASD children whose BAEP returns to normal.

Association of JMJD3, MMP-2 and VEGF expressions with clinicopathological features of invasive ductal breast carcinoma / 南方医科大学学报

OBJECTIVE@#To examine the expressions of JMJD3, matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in invasive ductal breast carcinoma, their association with the clinicopathological features of the patients and the effect of JMJD3 overexpression on proliferation and MMP-2 and VEGF expressions in breast cancer cells.@*METHODS@#The protein and mRNA expressions of JMJD3, MMP-2, and VEGF in invasive ductal breast carcinoma and paired adjacent tissues were detected by immunohistochemistry and RT-PCR, respectively, and their correlation with the clinicopathological characteristics of the patients was analyzed. Kaplan-Meier survival analysis was used to evaluate the correlation of JMJD3, MMP-2 and VEGF expression levels with the survival of the patients. In breast cancer MDA-MB-231 cells transfected with a JMJD3-expression plasmid, the expression of Ki67 was examined immunohistochemically, the cell proliferation was assessed with CCK8 assay, and the mRNA expressions of MMP-2 and VEGF were detected with RT-PCR.@*RESULTS@#Breast cancer tissues had significantly lower JMJD3 expression and higher MMP-2 and VEGF expressions at both the mRNA and protein levels than the adjacent tissue (@*CONCLUSIONS@#The expressions of JMJD3, MMP-2 and VEGF in invasive ductal breast carcinoma are closely correlated to tumor proliferation, invasion, metastasis and prognosis and can be used for prognostic evaluation of breast cancer.

Study of peripheral blood T lymphocyte subsets CD45RA+ and CD45RO+ in children withHenoch-Schonlein purpura / 中国基层医药

Objective@#To observe the change and clinical significance of the peripheral blood T-lymphocytes CD45RA+ and CD45RO+ in children with Henoch-Schonlein purpura (HSP) under different clinical classification.@*Methods@#From October 2015 to July 2017, the clinical data of 80 children with HSP in the Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed.According to the clinical classification, they were divided into three groups: skin involvement group (35 cases), abdominal type group (36 cases), and renal type group (9 cases). Another 80 healthy children were selected as the control group.The changes and clinical significance of peripheral blood T-lymphocytes CD45RA+ , CD45RO+ and CD45RA+ /CD45RO+ ratio were analyzed.@*Results@#Among the 80 children, 40 cases were male and 40 cases were female, with age of (7.2±2.3)years old.The CD45RA+ and CD45RO+ rates in the HSP group were (13.19±7.09)%, (12.07±3.46)%, respectively, which were significantly lower than those in the control group [(23.26±6.01)%, (21.74±3.46)%], the differences were statistically significant (t=9.69, 16.42, all P<0.05). The CD45RA+ ratio, CD45RA+ count and CD45RA+ /CD45RO+ ratio of the kidney type group were (8.02±3.63)%, (2.19±0.33)/μL, (-0.28±0.19), respectively, which were significantly lower than those of the skin group [(15.74±7.71)%, (2.55±0.33)/μL, (0.27±0.12)], the differences were statistically significant(t=3.085, 2.709, 4.013, all P<0.05). The ratio of CD45RA+ /CD45RO+ in the abdominal group was significantly lower than that in the skin group[(-0.07±0.27)vs.(0.27±0.12), t=2.989, P<0.05].@*Conclusion@#Peripheral blood T lymphocyte subsets CD45RA+ and CD45RO+ may play a role in the generation and development of immune function changes in children with HSP, and the decrease of CD45RA+ T cells may be related to the risk of HSP nephritis.

The study of AAV9 expression in cochleae of mice at different ages / 中华耳鼻咽喉头颈外科杂志

Objective@#To determine the extent of transfection and expression of adeno-associated virus (AAV) serotype 9 (AAV9) in the cochleae of mice at different ages.@*Methods@#AAV9-green fluorescent protein (GFP) was inoculated into the cochlea of mice via the round window membrane (RWM) or through cochleostomy at different ages. Four groups were divided according to ages and injection sites: P1SM group, AAV9-GFP was delivered to the scala media by cochleostomy at postnatal day 1; P1RW group, AAV9-GFP was delivered to the scala tympani via RWM at postnatal day 1; P9RW group: AAV9-GFP was injected through RWM at postnatal day 9; and P30RW group, adult mice (P30) were injected through RWM. GFP expression in cochlear whole mount was analyzed and auditory brainstem response (ABR) tests were conducted one month after virus injection (for each animal, only left cochlea was injected and the right side was used as a control). GraphPad Prism 5 statistical software was used for data analysis.@*Results@#All of inner hair cells (IHCs) and most of outer hair cells (OHCs) were transfected via two approaches at P1 injection. There was no significant difference in ABR threshold between injected ears and untreated ears (P>0.05). All of the IHCs and parts of OHCs (69% in apical turn) were transfected via RWM at P9. The strongest GFP expression was observed near the apical turn. Cochlear inoculation via RWM at P30 led to transgene expression in only IHCs. The ABR threshold of injected ears in P9RW group and P30RW group was significantly higher than that of contralateral ears (P<0.01).@*Conclusions@#AAV9 can be highly expressed in the inner and outer hair cells of the cochlea and hearing sensitivity can be preserved if virus injections are performed in neonatal mice. After AAV9 is transfected into the inner ear of adult mice, it is only expressed in the inner hair cells, which leads to the increase of the ABR response threshold of mice. Transfection efficiency is significant higher in neonate mice than in P9 and adult mice.

Meta-analysis of effectiveness of laminectomy decompression compared with vertebral lamina decompression combined with lumbar fusion in DegreeⅠspondylolisthesis and spinal canal stenosis / 中国综合临床

Objective To analyze the effectiveness of laminectomy decompression compared with vertebral lamina decompression combined with lumbar fusion in Degree I spondylolisthesis and spinal canal stenosis. Methods PubMed, Science Direct Online, Springer, CNKI, Wan Fang and VIP were retrieved to collect relevant randomized controlled trials( RCT) . According to inclusion and exclusion criteria,two researchers screened literatures, extracted data and evaluated quality. RevMan5. 0 software was used for Meta analysis. A total of 11 RCT were included,with a total of 1684 patients. Meta analysis showed that compared with the simple laminectomy group,the VAS score of lumbar pain in the lumbar fusion group at 1 years after operation decreased ( MD and 95％CI:-1. 20(-1. 57--0. 83) ,P<0. 05) ,and the VAS score of the 1 year postoperative leg pain in the lumbar fusion group decreased(MD and 95％CI:-0. 88(-1. 32- -0. 44),P<0. 05),the excellent rate of lumbar fusion group at 2 years after operation was higher( OR and 95％CI:1. 65( 1. 13-2. 41) ,P<0. 05) . There was no significant difference in postoperative complications and lumbar spondylolisthesis at 1 years after operation. Conclusion In long term, compared with decompression alone, vertebral lamina decompression combined with lumbar fusion has more ideal effectiveness in the treatment.

Dual-source CT diagnosis of single atrium / 中国医学影像技术

Objective To investigate the value of ECG-gated dual-source computed tomography angiography (DSCTA) in the diagnosis of single atrium (SA).Methods DSCTA was performed in 29 patients with SA.The classification diagnosis was made,and the complicated deformities were observed.Results Among 29 patients,atrial situs solitus was found in 14 (14/29,48.28％),atrial situs inversus was found in 6 (6/29,20.69％) and atrial situs ambiguous was found in 9 (9/29,31.03％,including right atrial isomerism in 8 and left atrial isomerism in 1 patient).The patients complicated with 39 kinds,totally 228 deformities.The bronchi and lung structures were found in the same position as atrium in 23 patients (23/29,79.31％),including atrial situs solitus in 13,right atrial isomerism in 7 and atrial situs inversus in 3 patients.Conclusion DSCTA can accurately diagnose SA and associated abnormalities.The features of bronchus and lung structures are helpful to identifying left and right atrial appendage.

Discussion on traditional Chinese medicine treatment models of depression named "three phases, five internal organs and ten syndromes" / 国际中医中药杂志

Based on the inheritance, the research group summarized the transmissive pathogenesis of depression in three typical stages, formulating the stepward treatment units which included Chinese medicine, acupuncture and TCM characterized psychotherapy, and formed a sequential treatment plan that balanced the principle of strengthening healthy Qi to eliminate pathogens, active and passive treatment, physical therapy and psychotherapy. Based on the retrospective analyses, ten typical clinical syndromes have been formed, constituting the pattern differentiation of "Three Phases, Five internal organs and Ten syndromes" for depression, which sysmatically showed the TCM syndrome differentiation. This work promoted the experiences and methods of treating depression by Chinese medicine.

Protective mechanisms of hydrogen rich saline on renal ischemia-reperfusion injury / 重庆医学

Objective To explore the protective mechanisms of hydrogen-rich saline on renal ischemiareperfusion injury.Methods Mice were divided in to 3 groups:control (sham operation),ischemia-reperfusion (IR) and ischemia-reperfusion+ hydrogen-rich saline (HRS).Mice in IR+ HRS group were administrated HRS by intravenous injection 3days and 1min before operation and 4 times in the following 2hours after operation.Mice in control and IR group were administrated normal saline as the same volume and frequency with IR + HRS group.Mice were sacrificed 24 hours after operation,creatinine and urea nitrogen in serum were detected by biochemical analyzer,MDA and SOD level were detected by spectrophotometer,expression of Bcl-xl,Bcl2,Bak,Bax,Cleaved Caspase-3 proteins level were detected by western blot.Results Compared to IR group,creatinine,urea nitrogen,MDA level decreased significantly after HRS consumption.SOD enzyme activity increased significantly after HRS consumption.HRS treatment down-regulates expression of Bak,Bax and Cleaved Caspase-3 protein level,and up-regulates expression of Bcl2,and Bcl-xl protein level.Conclusion HRS eliminates ROS and elevates antioxidant activity in renal after IR,besides,HRS also regulate apoptosis signal pathway to protect IR injury in renal.

Value of Z score in evaluating coronary artery lesions in children with Kawasaki disease / 中国小儿急救医学

Objective To explore the clinical value of Z score in assessing coronary artery lesions (CAL) of children with Kawasaki disease. Methods The clinical records of 102 children with Kawasaki disease from January 2012 to December 2016 in Gansu Provincial Hospital were retrospectively analyzed. The internal diameter of left main coronary artery (LMCA) and right coronary artery ( RCA) was measured by echocardiography (ECHO),and the incidence of CAL was preliminarily judged. The Z scores of LMCA and RCA were calculated on the basis of the coronary artery diameter,the age of the children and the body surface area,and the incidence of CAL was judged again. Results A total of 22 cases(21. 6%) of CAL were found in 102 cases by ECHO examination,of which 18 cases(17. 6%) of LMCA lesions,and 22 cases(21. 6%) of RCA lesions. A total of 33 cases(32. 4%) of CAL were found by calculating the Z score of coronary artery, of which 29 cases(28. 4%) of LMCA lesions and 33 cases(32. 4%) of RCA lesions. There was significant difference between two methods for determining LMCA lesions (χ2=3. 35,P＜0. 05),and there was no sig-nificant difference between two methods for determining RCA lesions (χ2=3. 01,P＞0. 05). Z score of coro-nary artery was more accurate to detect the CAL in Kawasaki disease,especially LMCA lesions. A large coro-nary artery aneurysm was found in the patients with the largest Z score by selective coronary angiography. Conclusion The Z score can be more conductive to assess the CAL in children with Kawasaki disease,and the higher the Z score,the more serious the CAL is.

Clinical, endoscopic and pathological features of gastrointestinal and mesenteric reactive nodular fibrous pseudotumor / 中华消化内镜杂志

Objective To study the clinical, endoscopic and pathological features of gastrointestinal and mesenteric reactive nodular fibrous pseudotumor (RNFPT). Methods A retrospective analysis was conducted on data of 24 RNFPT patients in Nanjing Drum Tower Hospital admitted from October 2008 to June 2016. The clinical, endoscopic, pathological and immunohistochemical characteristics were analyzed. Results Among the 24 patients, 16 complained about discomfort in the upper abdomen and 10 had a history of surgery or trauma. Twenty-one had isolated masses and 3 had multiple masses, with diameter of 0. 5-4. 0 cm. Endoscopically, the tumors were mainly hard submucosal masses with broad base, and smooth surface with no mucosal bridge. Seventeen patients underwent endoscopic ultrasonography, which showed low echoes in lesions and nonuniform echoes partly. Among them, 13 lesions derived from muscularis, 4 others from submucosa. Microscopically, the tumors had clear boundary with no envelope, and most areas showed disorderly arranged spindle cells and extensively collagenous degenerated mesenchyma. The spindle cells had shuttle fibroblast-like morphology and elongated nucleus with no visible necrosis or mitosis. Inflammatory cells scattered between the tumor cells, and lymphoid follicles and calcium deposition could be seen in local areas. Immunohistochemically, SMA was focally positive in 7 cases and only 4 cases expressed CD117 scattered. Desmin, Dog-1, CD34, ALK-1 and S-100 were all negative, and Ki-67 proliferation index was lower than 1％. Conclusion RNFPT has diverse clinical manifestations, with a good prognosis and unlikely recurrences, and should be distinguished from spindle cell tumors.

Clinical value of X-ray plain film in the diagnosis of early lung cancer / 中国基层医药

Objective To evaluate the diagnostic value of X ray film in early lung cancer.Methods 100 patients with pulmonary nodules were selected as the subjects.X-ray examination was performed.The histopathological findings were the gold standard.The diagnostic efficacy of X-ray plain film in early lung cancer was analyzed.The diagnostic accuracy,radiation dose and characteristics of lesions were compared between X ray and CT.Results 47 cases of lung cancer were diagnosed by X-ray plain film,5 cases of benign lesions were diagnosed as malignant,and 9 cases of malignant lesions were diagnosed as benign.The diagnostic sensitivity,specificity,positive predictive rate,negative predictive rate and diagnostic coincidence rate were 83.9％,88.6％,90.4％,81.3％ and 86％,respectively.Comparison of X-ray and CT in the overall diagnosis of early lung cancer(86％ vs 93％),the difference was not statistically significant(x2 =2.647,P ＞ 0.05).But the effective radiation dose of X ray radiography was lower than CT scan [(0.16 ± 0.02)mGy/cm vs.(0.89 ± 0.03)mGy/cm],the difference was statistically significant(t =10.475,P ＜ 0.05).Comparison of X-ray and CT in the diagnosis of early lung cancer with minute lobe,burr,cavity and calcification,the difference was not statistically significant(P ＞ 0.05).But the X-ray film showed a significantly lower rate of grinding glass stove than CT(3.6％ vs.16.1％),the difference was statistically significant (x2 =4.940,P ＜ 0.05).Conclusion X ray film has high diagnostic accuracy in the diagnosis of early lung cancer,and with low price,low radiation dose,it is suitable for routine screening.

Relationship between tumor metastasis with T cell subsets and cytokines in patients with primary hepatocellular carcinoma / 重庆医学

Objective To investigate the correlation between tumor metastasis with T cell subsets and cytokines in the pa tients with primary hepatocellular carcinoma (HCC).Methods Ninety-seven cases of primary HCC were prospectively collected from January 2014 to January 2016 and assigned into the metastasis group (38 cases) and non-metastasis group(59 cases) according to whether suffering from metastasis.Surgical specimens were obtained from all pauents and flow cytometry was used to detect the CD4+,CD8+ T cell proportion in HCC tissue,paracancerous tissues and peripheral blood.Moreover,ELISA was adopted to detect the peripheral blood IL-6,IL-10,TNF-α and IFN-γ levels.Results Compared with the non-metastasis group,the CD4+ T cell proportion of HCC tissue in the metastasis group was significantly increased(P=0.02),while the CD8+ T cells were significantly decreased (P=0.015).There was no statistical difference in CD4+ T cells proportion in the paracancerous tissue between the two groups (P=0.328).However the CD8+ T cells proportion of paracancerous tissue in the metastasis group was significantly higher than that in the non-metastasis group (P=0.021).There was no statistically significant difference in the proportion of CD8+ T cells in peripheral blood of the two groups (P=0.362).The proportion of CD4+ T cells in peripheral blood of the metastatic group was significantly lower than that in non-metastasis group (P=0.032).When compared with non-metastasis group,the metastasis group got a decreased level of peripheral blood IL-6 (P =0.012);while the IL-10 level was significantly increased (P =0.006);the TNF-α level and IFN-γ level were significantly decreased(P=0.000,P=0.035).Conclusion The patients with primary HCC have obvious T cell subsets and cytokines imbalance.

Effect of postoperatively early stage-function-exercise on recovery of upper limb function of diseased side after breast cancer modified radical mastectomy / 重庆医学

Objective To investigate the effect of postoperatively early stage-function-exercise on the recovery of upper limb function of diseased side after breast cancer modified radical mastectomy.Methods One hundred patients with breast cancer admitted to our hospital from January 2013 to June 2016 were collected.All patients underwent modified radical mastectomy.The patients were divided into the observation group and control group after operation,50 cases in each group.The observation group was given the early stage-function-exercise,while the control group received the routine nursing care.The shoulder joint mobility,affected limb edema degree,self-rating anxiety scale (SAS)score,self-rating depression scale (SDS) score and 36-item short-form health survey (SF-36) score were observed in the both groups.Results When compared with the control group,the patients in the observation group got a significant increase in the shoulder joint activity such as antexion,abduction,internal rotation,external rotation,adduction and rear protraction at postoperative 3,6-months (P0.05).However,when compared with the control group,the patients in the observation group got a significant decrease of upper limb volume at postoperative 3 months[(1 543.38±414.93) mL vs.(1 635.58±401.58) mL,P=0.000)],a significantly decrease of SAS score[(37.87±6.90) points vs.(44.07±12.32) points,P=0.000)] and SDS score[(38.32±6.65) points vs.(45.02±11.07) points,P=0.000)] at postoperative 6 months,and a significant increase of SF-36 score at postoperative 6 months [(77.52±7.28) points vs.(70.28±7.55) points,P=0.000)].Conclusion Postoperatively early stage-function-exercise can help to improve the shoulder joint activity degree and quality of life,and reduce the limb edema degree after modified radical mastectomy in the patients with breast cancer.