Correlation Between Gene Polymorphism and Breast Cancer Incidence and Prognosis for Patients with Diabetes / 肿瘤防治研究

Objective To analyze the effects of fat mass and obesity-associated (FTO) gene, IL-6, and HSP-60 gene polymorphism on the incidence rate and prognosis of breast cancer (BCa) for patients with type 2 diabetes mellitus (T2DM). Results A total of 1551 patients with BCa were included in the experimental group and 1605 women of the same age who participated in physical examination were included in the control group. The clinical data of the 3156 participants were collected through the baseline data questionnaire, and the genotypes of FTO, IL-6, and HSP-60 single-nucleotide polymorphism (SNP) were determined through blood sample detection. The predictive value of the three SNPs for the incidence risk of BCa for T2DM patients was evaluated. The OS of 1168 patients with BCa was obtained through follow-up, and the effects of the three SNPs and T2DM on OS of BCa patients were evaluated. Results The three loci were FTO rs3751812, IL-6 rs1800796, and HSP-60 rs2605039. The BCa incidence rate for T2DM women with wild homozygous SNP genotype was significantly higher than that for non-T2DM women (FTO: χ2=3.530, P=0.013; IL-6: χ2=6.288, P=0.029; HSP-60: χ2=4.926, P=0.005). The three wild homozygous genotypes were independent risk factors that influenced the incidence rate of BCa (all P < 0.05). Patients with HSP-60 rs2605039 (GT+TT) genotype had better OS (P=0.031). Conclusion FTO, IL-6, and HSP-60 gene polymorphisms have certain value in BCa prediction for T2DM patients. Patients with BCa and HSP-60 rs2605039 GT+TT genotype have high OS.

Feasibility of core cervical muscle group exercises and massage in the improvement of cervical spine curvature changes during radiotherapy for head and neck neoplasms / 肿瘤研究与临床

Objective:To investigate the role of cervical core muscle group exercise and massage in the change of cervical spine curvature during radiotherapy for head and neck tumors and the effect on set-up errors.Methods:A total of 40 patients with head and neck tumours receiving radiotherapy in the First Affiliated Hospital of Air Force Military Medical University from March 2020 to July 2021 were prospectively selected, and all of them underwent different degrees of changes in cervical spine curvature during radiotherapy. The cervical core muscle exercise and manual massage were used to do treatment intervention on the change in the cervical spine curvature. Changes in cervical spine curvature at the time of the curvature change of the cervical spine and at 1 d, 3 d and 5 d after the intervention were observed by using cone beam CT, and then data were recorded in 3 dimensions. The set-up error when cervical spine curvature changed was compared with that after the muscle group exercise and manipulation, and Pearson was used to analyze the linear correlation of set-up errors in each direction.Results:There were 23 males and 17 females, with a median age of 41 years (26-62 years). The significant improvement of cervical curvature at 1 d, 3 d and 5 d after the intervention could be found in 2 cases (5.0%), 20 cases (50.0%) and 39 cases (97.5%). Using the cervical 4 vertebrae as the matching standard, the set-up errors at the time of change in cervical spine curvature and at 1 d, 3 d and 5 d after treatment were (1.3±0.9) mm, (1.2±0.8) mm, (1.3±0.7) mm and (1.3±0.7) mm in the left-right direction respectively; (2.0±0.7) mm, (1.7±0.8) mm, (1.8±0.7) mm and (1.9±0.8) mm in the head-foot direction respectively; (4.9±0.7) mm, (4.6±0.7) mm, (3.4±0.7) mm, (1.7±0.6) mm in the anterior-posterior direction respectively. The set-up error in the anterior-posterior directions at 3 d and 5 d after treatment intervention was lower than that at the time of change in cervical spine curvature and at 1 d after treatment intervention (all P < 0.01), and that at 5 d after treatment intervention was lower than that at 3 d after treatment intervention ( P < 0.01). There were no statistically significant differences between the left-right direction and head-foot direction at each time point (all P > 0.05). There was no correlation between left-right direction and head-foot direction ( r = 0.049, P = 0.540), between left-right direction and anterior-posterior direction ( r = 0.041, P = 0.607), and between head-foot direction and anterior-posterior direction ( r = 0.003, P = 0.931) in terms of set-up errors. Conclusions:Core cervical muscle group training and massage could improve the change in cervical spine curvature, increase the repeatability of the set-up, which provides a favourable guarantee for accurate treatment.

Variation of amniotic fluid γ-glutamyl transferase level at 19-23 +6 gestational weeks in normal pregnancies / 中华围产医学杂志

Objective:To detect the levels of γ-glutamyl transferase (GGT) in the amniotic fluid of normal pregnancies at 19-23 +6 gestational weeks and to analyze the changes in GGT level with gestational age. Methods:This study retrospectively collected the amniotic fluid supernatant from 383 singleton pregnant women (102, 103, 82, 68 and 28 cases at 19-19 +6, 20-20 +6, 21-21 +6, 22-22 +6, 23-23 +6 weeks of gestation, respectively) who underwent amniocentesis for prenatal diagnosis but had normal genetic diagnosis results in Cheeloo Hospital of Shandong University from January 2021 to September 2022. The levels of GGT in the amniotic fluid supernatant were tested and the statistical parameters including xˉ± s, min-max, median ( M), P1, P2.5, P5, P95, P97.5 and P99 values of GGT levels at each gestational week were calculated. GGT were non-normal data and converted into natural logarithms (lnGGT), and a least square linear regression equation was established to analyze the relationship between lnGGT and gestational week. Results:At 19-19 +6, 20-20 +6, 21-21 +6, 22-22 +6, and 23-23 +6 gestational weeks, the xˉ± s of amniotic fluid GGT were (385.8±235.7), (331.8±219.4), (253.7±197.9), (226.7±166.4), and (155.3±96.8) U/L, and the weekly declines were 14.0%, 23.5%, 10.6%, and 31.5%, respectively; the M values were 311.0, 288.0, 199.0, 160.5, and 105.5 U/L, and the weekly declines were 7.4%, 30.9%, 19.3%, and 34.3%, respectively; the P1- P99 were 67.1-1 404.5, 63.2-1 189.1, 36.0-849.8, 44.0-787.3, and 32.0-375.6 U/L, respectively. lnGGT was negatively correlated with gestational age ( R 2=0.148, P<0.001). Conclusions:In normal pregnancies at 19-23 +6 gestational weeks, GGT levels in amniotic fluid decrease with gestational age. Therefore, gestational age should be considered when establishing the reference value for amniotic fluid GGT in normal pregnancies.

Effects of adriamycin resistance cell-derived exosomes on the proliferation and migration of osteosarcoma cells through drug resistance transmission / 中华骨科杂志

Objective:To explore the relationship and underlying mechanism between exosomes derived from doxorubicin-resistant osteosarcoma cells and MDR1 and miRNAs. Methods:MG63 and U2OS cell lines were selected to construct doxorubicin-resistant strains, and the 50% inhibitory concentration (half maximal inhibitory concentration, IC 50) of drug-resistant and sensitive strains was detected by MTT, and fluorescence staining was performed at intervals of 15 min between 15 and 120 min to detect the change of fluorescence intensity. RT-PCR and Western Blot were used to detect the expression levels of MDR1 P-gp to verify the drug resistance of osteosarcoma cells. Exosomes were identified by particle size analysis and Western Bolt detection. The endocytosis of PKH26-labeled exosomes from doxorubicin-resistant cells was observed, and the proliferation level and migration of exosomes from doxorubicin-resistant cells co-cultured with osteosarcoma cells were detected by MTT assay and cell scratch assay. The differential expression levels of miRNAs in osteosarcoma-sensitive and drug-resistant cells were verified by sequencing and bioinformatics analysis and RT-PCR assay. Tumor growth, serum exosome identification and mRNA expression level of miR-21-5p in tumor-bearing nude mice between normal osteosarcoma cell group and drug-resistant group, drug-resistant+normal exosome group, drug-resistant+drug-resistant+drug-resistant exosome group were observed. MDR1 expression level in tumor tissue was detected by RT-PCR, Western Blot and immunohistochemistry. Results:The IC 50 of two adriamycin resistant strains were 2.21 vs. 11.81 μg/ml and 0.93 vs. 11.81 μg/ml, respectively, and the fluorescence intensity decreased faster than that of normal strains. The relative mRNA expression levels of MDR1 in two cell lines were normal 1.12±0.16, 1.02±0.11 and drug-resistant 2.15±0.10, 2.127±0.12, respectively. The relative protein expression of P-gp was normal 0.92±0.11, 0.73±0.10 and drug-resistant 0.46±0.03, 0.30±0.04, the differences were statistically significant ( P<0.05). Drug-resistant exosomes can enter osteosarcoma cells through endocytosis and concentrate in the cytoplasm when co-cultured with normal strains. Osteosarcoma cells were co-cultured with drug-resistant exosomes at 2, 4, 6, and 8 μg/ml adriamycin, respectively. Compared with normal group, the proliferation level in drug-resistant group was significantly increased. Compared with the normal cell group 35.95±3.92, 6.72±3.55 and the normal exosome group 51.22±5.55, 19.31±1.93, the drug-resistant cell group 54.20±9.32, 19.24±2.88 and drug-resistant exosome group 76.40±5.41, 30.26±4.87, all had significantly higher cell mobility, the difference was statistically significant ( P<0.05). Exosome sequencing and biogenic analysis of 10 highly upregated miRNAs to validate mRNA expression differences between normal and drug-resistant strains by RT-PCR, showing a significant increase in miR-21-5p expression level of drug-resistant strains (5.89±0.26 vs. 0.99±0.06; 1.05±0.07 vs. 8.80±0.93, P<0.05), the difference was statistically significant ( P<0.05). In MG63 and U2OS, the normal cell group and drug-resistant cell group, and the normal exosome group and drug-resistant exosome group were compared, the tumor volume and the terminal tumor weight of nude mice were increased to varying degrees. MRNA relative expression levels of miR-21-5p in serum exosomes of nude mice after drug intervention were 0.86±0.07 and 0.86±0.05 in normal cell group, respectively. The values were 1.13±0.12, 1.14±0.12 in drug-resistant cell group, 0.71±0.05, 0.75±0.03 in normal exosome group, and 0.90±0.07, 0.93±0.04 in drug-resistant exosome group. Compared with normal and drug-resistant strains, the expression levels of normal and drug-resistant exosome groups were increased, with statistical significance ( P<0.05). Conclusion:The exosomes of drug-resistant cells in osteosarcoma could enhance the proliferation level and migration ability of cells through intercellular transfer of MDR1 and miRNAs. The expression of MDR1 and miR-21-5p in drug-resistant cells and tumor-forming nude mouse serum and tumor tissues were up-regulated which suggested that it might be involved in regulating the drug resistance process of osteosarcoma.

The potential mechanism of Jiajian Xuezheng Decotion in infiltrative gastric cancer through on network pharmacology and proteomics / 国际中医中药杂志

Objective:To explore the potential mechanism of Jiajian Xuezheng Decotion in infiltrative gastric cancer by network pharmacology and proteomics.Methods:The Traditional Chinese Medicine Systems Pharmacology Database (TCMSP) database was used to find the compounds and their targets of Jiajianxuezhengtang, and the targets of invasive gastric cancer were determined by high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). The predicted target gene of Jiajian Xuezheng Decotion and the target protein data of infiltrative gastric cancer were analyzed by Venny to obtain the target gene. The target gene set was analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment by the David. The protein interaction network diagram (PPI) was obtained by the String method, displaying the prescription-drug-compound-gene network in Cytoscape software.Results:69 active ingredients and 215 drug targets were screened from Jiajian Xuezheng Decotion; 660 proteins were significantly up-expressed in infiltrative gastric cancer, and 10 drug targets and gene targets were the common targets. There were 10 protein nodes in the PPI network, of which 3 core nodes were CASP3, BCL2L1 and STAT1. The 11 KEGG pathways were significantly enriched such as include PI3K-Akt signaling pathway, p53 signaling pathway, proteoglycan in cancer, apoptosis, Jak-STAT signaling pathway and other pathways.Conclusions:Jiajian Xuezheng Decotion plays an anti-infiltrative gastric cancer effect possibly regulated apoptosis through PI3K-Akt signaling pathway, p53 signaling pathway and Jak-STAT signaling pathway. This study provides a theoretical basis for further research on the mechanism of Jiajian Xuezheng Decotion in the treatment of invasive gastric cancer.

Effect of Ganshuang granule combined with entecavir on portal vein thrombosis in patients with hepatitis B cirrhosis / 临床肝胆病杂志

Objective To investigate the effect of Ganshuang granule combined with entecavir on portal vein thrombosis (PVT) in patients with hepatitis B cirrhosis. Methods A total of 356 patients with hepatitis B cirrhosis who attended and were hospitalized in The Third People's Hospital of Kunming from January 1, 2018 to December 31, 2020 were enrolled and randomly divided into combination group with 191 patients and control group with 165 patients. The patients in the combination group received Ganshuang granule combined with entecavir, and those in the control group received entecavir alone. The course of treatment was at least 24 weeks. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to analyze the cumulative incidence rate of PVT in both groups, and the log-rank test was used for comparison between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for PVT in patients with hepatitis B cirrhosis. Results The 191 patients in the combination group were followed up for 296.25 person-years in total, with a mean follow-up time of 1.55±0.65 years, and there were 8 patients with PVT, with an incidence rate of 4.19% and an incidence density of 1.41 per ten-thousand person-years. The 165 patients in the control group were followed up for 253.25 person-years in total, with a mean follow-up time of 1.53±0.67 years, and there were 20 patients with PVT, with an incidence rate of 12.12% and an incidence density of 4.79 per ten-thousand person-years. There was a significant difference in the incidence rate of PVT between the two groups ( χ 2 =7.687, P =0.006). The cumulative incidence rate of PVT plotted by the Kaplan-Meier method showed that the combination group had a significantly lower cumulative incidence rate of PVT than the control group ( χ 2 =7.226, P =0.007), with a relative risk of 3.155 (95% confidence interval [ CI ]: 1.351-7.370). The univariate Cox analysis showed that hypertension, alanine aminotransferase, aspartate aminotransferase (AST), albumin (Alb), cholinesterase, estimated glomerular filtration rate, alpha-fetoprotein, D-dimer (D-D), Child-Pugh class, and Ganshuang granule combined with entecavir were influencing factors for PVT (all P < 0.05); the multivariate Cox analysis showed that AST (hazard ratio [ HR ]=1.002, 95% CI : 1.000-1.004, P =0.025), and D-D ( HR =1.907, 95% CI : 1.554-2.338, P < 0.001) were independent risk factors for PVT in patients with hepatitis B cirrhosis, while Alb ( HR =0.844, 95% CI : 0.755-0.944, P =0.003) and Ganshuang granule combined with entecavir ( HR =0.350, 95% CI : 0.144-0.851, P =0.021) were independent protective factors against PVT in patients with hepatitis B cirrhosis. Conclusion Ganshuang granule combined with entecavir can significantly reduce the incidence rate of PVT in patients with hepatitis B cirrhosis, thereby exerting a certain preventive effect against PVT.

Implementation study of Evidence-based Nursing Practice Guideline for Enteral Nutrition of Infants with Congenital Heart Disease application / 中国实用护理杂志

Objective:To evaluate the effectiveness of Evidence-based Nursing Practice Guideline for Enteral Nutrition of Infants with Congenital Heart Disease application on improving the nutritional status of infants with congenital heart disease (CHD) in the target population, and to explore the effective strategies of evidence implementation in the process of dissemination, implementation and integration into clinical practice. Methods:This was an implementation study. Promoting Action on Research Implementation in Health Services Integrated Framework (i-PARIHS) was used as a theoretical model. Infants with CHD who received cardiac surgery from the heart ICU of Children ′s Hospital of Fudan University from January 2019 to February 2020 were selected as the study subjects. January to June 2019 and September to February 2020 were the pre and post implementation phase respectively. For medical staff, communication strategy, implementation process strategy, integration strategy and capacity-building strategy were used to advance the implementation process. According to the implementation strategy of children, the 26 best practice recommendations in the guide were translated into operable nursing processes and enteral nutrition programs, which were implemented in four stages: admission to the hospital, pre operation, post operation cardiac care room, post operation ward recovery, and pre discharge. Implementation Results Variable Assessment Form was used to evaluate effectiveness of the implementation strategies; hospitalization weight and upper arm circumference, serum albumin and pre-albumin before discharge were used to evaluate effectiveness of the interventions. Results:Scores of eight aspects of Implementation Results Variable Assessment reached more than 75% of the total score. Pre-albumin of post-implementation was (166.53 ± 42.57) g/L, which was statistically significantly higher than (148.41 ± 30.66) g/L before discharge ( t=-3.21, P<0.01); the weight loss of pre-implementation was 0.00 (0.41) kg, while the weight change of post-implementation was -0.10 (0.40) kg, the difference was statistically significant ( Z=-2.90, P<0.01). Conclusions:The strategies of diffusing, implementing, integrating the CHD enteral nutrition protocol based on guide could improve the implementation results and the nutrition status of infants with CHD.

Psychological status and influential factors of postpartum depression in primiparae after cesarean section / 中国基层医药

Objective:To investigate the psychological status and the influential factors of postpartum depression in primiparae subjected to cesarean section and provide evidence for the prevention and treatment of postpartum depression in primiparae.Methods:A total of 288 primiparae underwent a psychological status survey in Hangzhou Seventh People's Hospital from January 2016 to January 2020 and were included in this study. We evaluated their psychological status using the Self-rating Depression Scale (SDS) and the Edinburgh Postnatal Depression Scale (EPDS). The factors that affect postpartum depression were analyzed.Results:The incidence of depression post-cesarean section was 25.00% in primiparae. The scores of SDS and EPDS were (61.23 ± 7.83) points and (12.47 ± 3.14) points in primiparae with a depressive status, which were significantly higher than those in primiparae without a depressive status [(41.39 ± 3.21) points, (8.39 ± 1.22) points, t1 = 15.30, P < 0.001; t2 = 15.87, P < 0.001). Univariate analysis results showed there was a significant difference in postpartum depressive psychological status in terms of maternal education level, family relationship, mother-in-law and daughter-in-law relationship, mental health education, depressive status during pregnancy, intrapartum psychological status, and spouse's education level (all P < 0.05). Logistic regression analysis results showed that postpartum depressive status in primiparae was related to family relationships, mother-in-law/daughter-in-law relationships, the depressive status during pregnancy, intrapartum psychological status, and spouse's education level are independent risk factors for postpartum depression in primipara after cesarean section ( P < 0.05). Conclusion:The incidence of postpartum depression is high in primiparae subjected to cesarean section. Family relationships and spouse's education level are the influential factors of depression. Family-oriented early psychological intervention should be strengthened to provide more counseling during pregnancy and promote maternal mental health.

Progress on the characteristics, prevention and treatment of neonatal central nervous system ureaplasma infection / 中国小儿急救医学

Ureaplasma is an opportunistic pathogen with a high population carrying rate.Maternal ureaplasma infection is related to adverse pregnancy outcomes such as premature birth etc.Ureaplasma infection in neonates can cause central nervous system inflammation and eventually lead to poor nervous system prognosis.Although the incidence of invasive central nervous system infection in newborns is low, due to the presence of immune escape in the body, atypical clinical manifestations after ureaplasma infection, and insensitivity to routine detection methods, the central ureaplasma infection in newborns is often unable to diagnose and treat properly in time, so it can easily lead to delayed treatment, which can lead to serious complications.This review aimed to explain the pathogenesis, clinical manifestations and complications of central nervous system inflammation caused by ureaplasma infection, and share diagnosis methods, as well as successful treatment experience in related cases, so as to provide the basis for early diagnosis and reasonable treatment, thereby reducing the occurrence of adverse neurological outcomes caused by ureaplasma infection.

Evidence summary of blood pressure management strategies in patients with ruptured intracranial aneurysm bleeding / 中国实用护理杂志

Objective:To estimate and summarize the evidence for the blood pressure in patients with ruptured intracranial aneurysm bleeding, to provide valuable reference for clinical care and improve the prognosis of patients.Methods:BMJ Best Practice, UpToDate, Chinese Guideline Website, Cochrane Library, PubMed, American Stroke Association, Chinese National Knowledge Infrastructure, Wanfang Database and VIP Database were utilized for screening out evidences of blood pressure management strategies for patients with ruptured intracranial aneurysm bleeding from database establishment to December 8, 2020. The source of evidences included guidelines, evidence summarization, information brochure of optimal clinical practice, recommended practice, systematic review and original research. Upon the assessment of the included literature, the evidences meeting the enrollment criterion would be identified and extracted.Results:There were 9 articles involved in this research and 20 evidences possessing clinical applicability were extracted. The evidences involved in clinical assessment, regulation tenets, intervention protocol, and nursing to prevent complications in patients with ruptured intracranial aneurysm bleeding.Conclusions:To summarize, we suggested strongly to evaluate the individual differences in age, underlying diseases and pharmacological tolerance, and to effectivelly control blood pressure in patients with ruptured intracranial aneurysm bleeding through scientific nursing methods, which could improve the nursing qualification.

Application of the in-basket test in head nurse competence evaluation / 中华医院管理杂志

Objective:To evaluate the competence of head nurses by using the in-basket test for establishing a hierarchical training system for these nurses.Methods:A set of in-basket test was independently designed to evaluate the head nurses of a tertiary hospital in September 2021.Fourteen competency indicators, including positive initiative, coordination and communication ability, and leadership, problem solving ability, motivation, empowerment, attention to quality and order, etc, were selected to analyze the answers of the in-basket test and score their competency level. The measures were described by Mean±SD and M(IQR), and the counts were described by rates and percentages. The rank sum test and multiple linear regression were used to analyze the influencing factors of competency scoring of head nurses. Results:A total of 133 head nurses were tested, with a total competency scoring of 30.0(5.5). The highest indicators were talent cultivation 3.0(2.0), positive initiative 3.0(1.0), coordination and communication ability 3.0(1.0), while those with lower scores were empowerment 1.0(1.0) and motivation 1.5(1.5). The rank sum test analysis showed that age, position, job position character and working seniority were the influencing factors of competency score( P<0.05). The multiple linear regression analysis showed that, working seniorities of 16-20 years( β=0.583, P=0.013), 21-25 years( β=0.732, P=0.008), 26-30 years( β=0.632, P=0.026) were the influencing factors of competency score of head nurses. Conclusions:The in-basket test is practical to evaluate the competence of head nurses as a basis for their targeted training in the future.

Development of a species-specific PCR assay for authentication of Agkistrodon acutus based on mitochondrial cytochrome b gene

BACKGROUND: Agkistrodon acutus, a traditional Chinese medicine, clinically used in the treatment of rheumatism, tumor, and cardiovascular and cerebrovascular diseases. Due to the unique medicinal value and the difficulty of artificial breeding of Agkistrodon acutus, the supply of Agkistrodon acutus on the market exceeds the demand, and a large number of its adulterants are found on the market. In this study, the cytb gene sequences of Agkistrodon acutus and 9 snakes were compared and analyzed, specific primers were designed, and specific PCR methods were established to detect Agkistrodon acutus medicinal samples on the market. RESULTS: This method was successfully applied to distinguish the snake from other adulterated species, and tested 18 Agkistrodon acutus samples randomly purchased from six cities. Twelve samples were counterfeit and six were genuine. The standard reference material of Agkistrodon acutus was cloned by molecular cloning and sequencing, and the gene sequence difference with other species was significant. It shows that the region could be used as the fingerprint region of the target species. CONCLUSIONS: The proposed method can be used as a species-specific marker and can be highly distinguished from other adulterated snake species, which is helpful to effectively avoid the problem of false sale of Agkistrodon acutus.

Analysis of clinical trials of dermatological drugs in China, 2020 / 中华皮肤科杂志

Objective:To deliver understanding of the latest research progress on clinical trials and approval of dermatological drugs in China in 2020.Methods:A registration and information disclosure platform for drug clinical studies and a query system for domestic and imported drugs in the National Medical Products Administration of China were searched for registered clinical trials and approved dermatological drugs, respectively. The number and stages of clinical trials, indications and classification of involved products, and listed dermatological drugs in 2020 were summarized and depicted.Results:There were 157 dermatological drug trials registered in China in 2020, accounting for 6.16% of all the 2 548 clinical drug trials, including 127 (80.9%) initiated by Chinese pharmaceutical enterprises and 25 (15.9%) international multicenter trials. Among the 127 drug trials initiated by Chinese pharmaceutical enterprises, bioequivalence trials were mostly common, accounting for 55.9% (71/127) . Compared with global pharmaceutical enterprises, domestic pharmaceutical companies initiated significantly decreased proportions of international multicenter trials (1.9% [3/157] vs. 14.0% [22/157], P < 0.001) , but significantly increased proportions of phaseⅠclinical trials and bioequivalence trials (24.4% [31/127] vs. 10.0% [3/30], 55.9% [71/127] vs. 0, respectively, both P < 0.001) . Totally, 90 kinds of dermatological drug were involved in all the trials, psoriasis, atopic dermatitis and melanoma were the most common indications, and innovative drugs accounted for 53.3% (48/90) ; the proportion of innovative drugs was significantly lower in domestic pharmaceutical companies than in global pharmaceutical companies (43.2% [32/74] vs. 16/16, P < 0.001) . In addition, 28 dermatological drugs developed by 22 pharmaceutical companies were approved in China in 2020, of which 21 drugs were developed by domestic pharmaceutical companies. Conclusion:Clinical drug trials carried out by domestic pharmaceutical companies mostly focus on generic drugs, and it is still necessary for domestic pharmaceutical companies to further improve the innovation ability.

Feasibility of transesophageal echocardiography-guided transthoracic micro-incisions for the treatment of aortic dissection / 中国基层医药

Objective:To investigate the feasibility of transesophageal echocardiography (TEE)-guided transthoracic micro-incisions for the treatment of aortic dissection.Methods:Ten patients with aortic dissection who received TEE before surgery between March 2017 and March 2019 in Zhejiang Provincial Hospital of Chinese Medicine, China were included in this study. They were divided into group A (involving the aorta, n = 5) and group B (aortic arch ulcer, n = 5). Diagnosis before and after surgery was analyzed in each group. Whether guide sheath tube and guide wire rapidly entered the interlayer during the surgery was assessed. In addition, the stability and position of the occluder device and its effect on local blood flow were assessed. Results:TEE findings revealed that occlusion treatment was effective and TEE-guided transthoracic micro-incisions successfully occluded the breaks of the aortic dissection. In group A, the occluded breaks of the aortic dissection disappeared, and thrombi formed in the false lumen. Blood flow velocity decreased from 230 cm/s to 120 cm/s. In group B, aortic wall was tightly bounded to the occluder device and the breaks disappeared. The velocity of the blood flow in the arch of the aorta was 120 cm/s. The occluder device was stable before and after occlusion. It had no effect on the velocity of local blood flow. At 40 days after surgery, the position of the occluder was not deviated.Conclusion:TEE before surgery for aortic dissection can effectively assess the injury degree and avoid missed diagnosis. TEE can guide the placement of the occluder device during the surgery. TEE can also help accurately assess the surgical outcomes.

One case of misdiagnosis of 22q11.2 deletion syndrome with ovarian mixed germ cell tumor / 中华内分泌代谢杂志

Idiopathic hypoparathyroidism is a rare endocrine disease. It is often manifested as neuropsychiatric symptoms, especially epileptic seizures. Thus, it is easy to be misdiagnosed as primary epilepsy. The following case report details the diagnosis of a 17-year-old girl who had been misdiagnosed as primary epilepsy for a long time. She was found hypoparathyroidism during the hospitalization for the operation of ovarian mixed germ cell tumor. After whole exome sequencing, she was ultimately diagnosed as 22q11.2 deletion syndrome. This case suggested that clinicians should be aware of the possibility of hypoparathyroidism in adolescent epilepsy, especially hereditary hypoparathyroidism. At the same time, the possible high risk of tumors should also be considered in hereditary hypoparathyroidism.

The effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement / 中国实用护理杂志

Objective:To explore the effect of micro-video education combined with active psychological management on the rehabilitation effect of hip replacement.Methods:From January to December 2018, 100 patients with total hip arthroplasty were divided into control group and observation group, 50 cases in each group. The control group was given routine nursing, and the observation group was given micro video education combined with positive psychological management. The depression, pain, joint function and complications were evaluated.Results:After the intervention, the Self-rating Depression Scale (SDS) score of patients in the observation group was (34.72±6.83) points, which was significantly lower than (40.58±7.59) points of the control group. The difference was statistically significant ( tvalue was 4.058, P<0.05); pain control education in the observation group and satisfaction scores for pain control or reduction methods were (43.01±5.72) and (63.77±8.62) points respectively, which were better than the control group's (33.96±4.58) and (55.15±9.27) points. The difference was statistically significant ( tvalues were 8.733, 4.815, P<0.05); the excellent and good rate of hip joint function in the observation group was 90.00% (45/50), which was higher than 64.00% (32/50) in the control group. The difference was statistically significant ( χ 2value was 4.336, P<0.05); the complication rate in the observation group was 2.00% (1/50), which was significantly lower than the control group's 18.00% (9/50). The difference was statistically significant ( χ 2value was 7.111, P<0.05); The scores of each item of quality of life in the observation group were higher than those in the control group, and the differences were statistically significant ( tvalues were- 9.859 to- 3.154, P<0.01). Conclusion:Micro video education combined with positive psychological management can improve the depression of patients after hip arthroplasty, reduce the degree of joint pain, promote the function of hip joint and reduce complications.

Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation / 中华医学杂志(英文版)

BACKGROUND@#The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.@*METHODS@#In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.@*RESULTS@#Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.@*CONCLUSIONS@#Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.@*TRAIL REGISTRATION@#Clinicaltrials.gov; NCT02878811.

Analysis of risk factors for measles complicated with pneumonia in children / 中华传染病杂志

Objective:To investigate the demographic, epidemiological and clinical characteristics of measles in children, and to explore the risk factors for measles complicated with pneumonia in children.Methods:Children with measles aged≤18 years who were hospitalized in Jinan Infectious Disease Hospital from January 1, 2014 to December 31, 2018 were included. The demographic, epidemiological, clinical and laboratory data of inpatients were collected. The features of patients with pneumonia were analyzed. The risk factors of pneumonia were analyzed by chi-square test and multivariate logistic regression.Results:A total of 1 730 patients were recruited, including 423 patients (24.5%) in 2014, 437 patients (25.3%) in 2015, 856 patients (49.5%) in 2016, 10 patients (0.6%) in 2017 and four patients (0.2%) in 2018. The male to female ratio was 2∶1. The age ranged from four days to 18 years, and 1 572 patients (90.9%) were under three years old. There were 1 381 patients (79.8%) living in rural areas and 83 patients (4.8%) born with low birth weight. Two hundred and twenty-nine patients (13.2%) had a history of respiratory diseases within half a year before measles onset, and 1 489 patients (86.1%) had not been vaccinated before. According to the presence of pneumonia, 1 730 children with measles were divided into pneumonia group ( n=1 295) and non-pneumonia group ( n=435). There were more patients with bucking in pneumonia group than those in non-pneumonia group (56.8%(735/1 295) vs. 40.9%(178/435), χ2=32.770, P<0.01). Zero point seven percent (12/1 730) of children were critically ill, and 0.5%(8/1 730) of children died, all of whom were in pneumonia group. The white blood cell count, the percentage of white blood cell count>10×10 9/L, neutrophilic granulocyte count, the percentage of neutrophilic granulocyte count>7×10 9/L, C reactive protein level, the percentage of C reactive protein level>8.2 mg/L, procalcitonin level, the percentage of procalcitonin>0.5 ng/L, the percentage of hemoglobin level<110 g/L, and the percentage of albumin<35 g/L in pneumonia group were all significantly higher than those in non-pneumonia group ( t=7.153, χ2=47.239, t=8.297, χ2=41.176, Z=-6.769, χ2=40.131, Z=-4.119, χ2=19.284, χ2=7.465, χ2=18.356, respectively, all P<0.01). Multivariate logistic regression analysis showed that male (odds ratio ( OR)=1.316), living in rural areas ( OR=1.521), age<three years old ( OR=2.044), birth weight <2.5 kg ( OR=2.014), respiratory diseases ( OR=1.905), without measles vaccination ( OR=1.591), bucking ( OR=1.550), neutrophilic granulocyte count >7×10 9/L ( OR=3.666), and C reactive protein level >8.2 mg/L ( OR=1.871), procalcitonin>0.5 ng/L ( OR=1.711) were independent risk factors for pneumonia in children with measles. Conclusions:Measles vaccination in children should be farther strengthened. Male, children living in rural areas, low birth weight, history of respiratory diseases before measles and without measles vaccination are prone to be complicated with pneumonia, and special medical attention should be given.

Single-center data analysis of organ donation and utilization after citizen's death / 器官移植

Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.

Diagnosis and treatment of spontaneous rupture of renal pelvis caused by pelviureteric junction obstruction in infants / 中华泌尿外科杂志

Objective@#To analyze the clinical features of spontaneous rupture of the renal pelvis (SRRP) in infants caused by UPJO.@*Methods@#A retrospective analysis of 7 cases of SRRP in infants caused by UPJO in our hospital from October 2013 to October 2018 was performed. All the patients included 5 males and 2 females. The average age was(12.0±6.1) months(ranging 2 days-25 months). 3 cases suffered renal rupture in left side and 4 cases suffered renal rupture in right side. 2 cases had grade Ⅲ hydronephrosis and 5 cases had grade Ⅳ hydronephrosis. Other symptoms included fever in 4 cases, digestive symptoms in 3 cases, oliguria in 2. 7 cases were revealed RBC(+ + + )with urinary occult blood positive in urine test. 6 cases were found the white blood cells in urine was more than 8/μl. 3 cases had the elevated blood C-reactive protein.3 cases suffered with renal function insufficiency, which the creatinine was more than 110 μmol/L. The 2 cases of urinary extravasation was found in the posterior abdominal cavity and 2 in posterior abdominal cavity and abdominal cavity by CT enhanced scan. 4 cases performed open pyeloplasty, nephrostomy and perirenal drainage.2 cases performed pyeloplasty, nephrostomy, abdominal and perirenal drainage. 1 case performed perirenal drainage and retrograde indwelling Double-J stents.@*Results@#All operation performed successfully. The median operation time was 84 min (ranging 45-90 min). The estimate blood loss was 15 ml (ranging 10-35 ml)without any transfusion. The median time of postoperative perirenal drainage tube was 3 d (ranging 2-5 d), The median time of the abdominal drainage tube was 5 d (ranging 3-7 d), the median time of nephrostomy was 12 d (ranging 10-14 d). The median hospital stay was 14 d (ranging 10-21 d). The median follow-up was 18 months (ranging 3-36 months). One performed the second stage pyeloplasty after double-J stents removed, and the renal function gradually recovered.@*Conclusions@#The SRRP in infants caused by UPJO is rare and easily misdiagnosed. The degree of hydronephrosis and inflammation may be important factors affecting the spontaneous rupture of pediatric renal pelvis. When it occurs, it requires active intervention by the operation, while treating the stenosis of the UPJ and draining the extravasation of urine.