Clinical and pathological characteristics of immune-mediated liver injury caused by immune checkpoint inhibitors / 中华内科杂志

Objective: Cancer immunotherapy can lead to various side effects, termed immune-related adverse events (irAE). This study summarized and analyzed the clinical and pathological characteristics of immune-mediated liver injury caused by immune checkpoint inhibitors (ILICI). Methods: This is a retrospective case series study involving 11 patients diagnosed with ILICI at the Peking Union Medical College Hospital from November 2019 to November 2021. Patient demographic information and clinical data, including gender, age, ILICI onset, clinical and radiological manifestations, pathological features, treatment, and resumption of ICI were retrospectively collected and analyzed. Results: The patients were primarily males (9/11) with a median age of 65 (range: 32-73) years. ICI mainly resulted in either partial remission (4/11) or stable disease (3/11). ILICI occurred after a median of two cycles of anti-programmed cell death-1 (PD-1) therapy, with a median time from the initial and last anti-PD-1 therapy to ILICI onset of 57 days and 17 days, respectively. ILICI was mostly severe (3/11) or very severe (6/11). While the clinical and radiological manifestations were non-specific, the pathological features were active lobular hepatitis and portal inflammation, with prominent CD8+T lymphocyte infiltration. The basic treatment was hepatoprotective drugs (10/11). Glucocorticoids were used as the primary therapy (9/11) but were ineffective in 4 of 9 cases. Of these, 3 of 9 cases received combined treatment with mycophenolate mofetil (MMF), only one of whom achieved remission. By the end of the study, 2 of 11 cases had resumed ICI and neither had experienced an ILICI relapse. Conclusion: The ILICI patients in this study had a corresponding history of ICI treatment and pathological features. The main treatment included hepatoprotective drugs and glucocorticoids. Immunosuppressive drugs were added for some cases but had poor efficacy.

Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between serum 25(OH)D and anti-Müllerian hormone (AMH) among infertile females and their predictive impacts on in vitro fertilization and embryo transfer pregnancy outcome.@*METHODS@#Totally 756 infertile females treated with assisted reproductive technology were enrolled and divided into three groups according to their vitamin D levels (group A with serum 25(OH)D≤10 μg/L, group B with serum (10-20) μg/L, and group C with serum ≥20 μg/L). The serum AMH levels were detected. The differences among the groups were analyzed, as well as the correlation between vitamin D levels and serum AMH levels in various infertility types (fallopian tube/male factor, polycystic ovary syndrome (PCOS), ovulation disorders excluded PCOS, endometriosis, unexplained infertility, and others). Also, the predictive roles of vitamin D and AMH in pregnancy outcome in all the infertile females were discussed.@*RESULTS@#(1) 87.7% of the enrolled females were insufficient or deficient in vitamin D. (2) The serum AMH levels in the three groups with different vitamin D levels were 1.960 (1.155, 3.655) μg/L, 2.455 (1.370, 4.403) μg/L, 2.360 (1.430, 4.780) μg/L and there was no significant difference in serum AMH levels among the three groups (P>0.05). (3) Serum 25(OH)D and AMH levels presented seasonal variations (P < 0.05). (4) There was no prominent correlation between the serum AMH level and serum 25(OH)D level in females of various infertility types after adjusting potential confounding factors [age, body mass index (BMI), antral follicle count (AFC), vitamin D blood collection season, etc.] by multiple linear regression analysis (P>0.05). (5) After adjusting for confounding factors, such as age, BMI, number of transplanted embryos and AFC, the results of binary Logistics regression model showed that in all the infertile females, the serum AMH level was an independent predictor of biochemical pregnancy outcome (P < 0.05) while the serum 25(OH)D level might not act as a prediction factor alone (P>0.05). In the meanwhile, the serum 25(OH)D level and serum AMH level were synergistic predictors of biochemical or clinical pregnancy outcome (P < 0.05).@*CONCLUSION@#Based on the current diagnostic criteria, most infertile females had vitamin D insufficiency or deficiency, but there was not significant correlation between serum 25(OH)D and ovarian reserve. While vitamin D could not be used as an independent predictor of pregnancy outcome in infertile females, the serum AMH level could predict biochemical pregnancy outcome independently or jointly with vitamin D.

Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs).@*METHODS@#A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery.@*RESULTS@#In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred.@*CONCLUSION@#For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.

Progress on the researches of acupuncture preconditioning before surgery / 中国针灸

This paper reviews the researches on acupuncture preconditioning before surgery in recent years and explores its application value from three aspects, i.e. relieving preoperative anxiety, preventing from postoperative cognitive dysfunction, and preventing from postoperative gastrointestinal dysfunction. As a relatively safe non-drug treatment, acupuncture has the underlying advantages in participating into multidisciplinary coordination in the enhanced recovery after surgery (ERAS). By building up higher-quality medical evidences and revealing the effect mechanism of acupuncture from multi-dimenisonal aspects, it is expected that acupuncture technology can be coordinated with ERAS to optimize the clinical path in the perioperative period, and boost the development of the perioperative medicine ultimately.

Current situation of Investigator-Initiated Clinical Trial quality management: A scoping review / 中华医学科研管理杂志

Objective:To systematically identify and summarizes the weaknesses of the key aspects of Investigator-Initiated Clinical Trial (IIT) quality management in China, and quantitatively assess these weaknesses with a synthesis of relevant evidence, thereby providing references for the subsequent establishment of a complete IIT quality management system in China.Methods:According to the Scoping review report checklist (PRISMA-ScR statement), we conducted a systematic literature retrieval and screening, data extraction, and result synthesis of IIT quality management issues after defining the research questions.Results:73 eligible studies were eventually included. It was found that the most frequently explored issues were a lack of guidance and support from methodological and statistical experts at the project initiation stage (60.9%), a lack of research funding or improper funding management at the project implementation stage (49.3%), mismanagement of archival materials at the project completion stage (70.0%). Meta-analysis results showed that after evidence synthesis, the incidence of irregular informed consent signing, untraceable raw data, delayed study progress, and protocol violation were all above 40%, but there was heterogeneity in the results.Conclusion:Some outstanding issues in IIT quality management need to be addressed. Future studies should conduct more practical research to obtain quantitative data, undertake demonstrative application of management protocols, further carry out pioneering exploration and research in the field of IIT quality management, and propose effective solutions and strategies to improve IIT quality.

Establishment and validation of a nomograph model for prediction of bronchopulmonary dysplasia in very low birth weight infants born earlier than 32 weeks / 中华围产医学杂志

Objective:To investigate the risk factors of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants with gestational age ≤32 weeks within 28 days after birth and to establish and validate the nomogram model for BPD prediction.Methods:We retrospectively chose VLBW infants with gestational age ≤32 weeks who survived to postmenstrual age (PMA) 36 weeks and were admitted to the neonatal intensive care unit of Peking University Third Hospital from January 2016 to April 2020 as the training cohort. BPD was diagnosed in accordance with the 2018 criteria. The clinical data of these infants were collected, and the risk factors of BPD were analyzed by Chi-square test, Mann-Whitney U test, and multivariate logistic regression, and a nomogram model was established. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to assess the predictive performance. Decision curve analysis (DCA) was constructed for differentiation evaluation, and the calibration chart and Hosmer-Lemeshow goodness of fit test were used for the calibration evaluation. Bootstrap was used for internal validation. VLBW infants with gestational age ≤32 weeks survived to PMA 36 weeks and admitted to Hebei Chengde Maternal and Child Health Hospital from October 2017 to February 2022 were included as the validation cohort. ROC curve and calibration plot were conducted in the validation cohort for external validation. Results:Of the 467 premature infants included in the training cohort, 104 were in the BPD group; of the 101 patients in the external validation cohort, 16 were in the BPD group. Multivariate logistic regression analysis showed that low birth weight ( OR=0.03, 95% CI: 0.01-0.13), nosocomial pneumonia ( OR=2.40, 95% CI: 1.41-4.09), late-onset sepsis ( OR=2.18, 95% CI: 1.18-4.02), and prolonged duration of endotracheal intubation ( OR=1.61, 95% CI: 1.26-2.04) were risk factors for BPD in these groups of infants (all P<0.05). According to the multivariate logistic regression analysis results, a nomogram model for predicting BPD risk was established. The AUC of the training cohort was 0.827 (95% CI: 0.783-0.872), and the ideal cut-off value for predicted probability was 0.206, with a sensitivity of 0.788 (95% CI: 0.697-0.862) and specificity of 0.744 (95% CI: 0.696-0.788). The AUC of the validation cohort was 0.951 (95% CI:0.904-0.999). Taking the prediction probability of 0.206 as the high-risk threshold, the sensitivity and specificity corresponding to this value were 0.812 (95% CI: 0.537-0.950) and 0.882 (95% CI: 0.790-0.939). The Hosmer-Lemeshow goodness-of-fit test in the training and validation cohort showed a good fit ( P>0.05). DCA results showed a high net benefit of clinical intervention in very preterm infants when the threshold probability was 5%~80% for the training cohort. Conclusion:Low birth weight, nosocomial pneumonia, late-onset sepsis, and prolonged tracheal intubation duration are risk factors for BPD. The established nomogram model has a certain value in predicting the risk of BPD in VLBW less than 32 weeks.

Application of 3D slicer plus Sina software for performing hematoma puncture and drainage after local anesthesia in elderly patients with intracerebral hemorrhage / 中华老年医学杂志

Objective:To explore the effect of minimally invasive hematoma puncture and drainage in the treatment of elderly patients with cerebral hemorrhage by using 3D slicer and Sina software to conduct 3D reconstruction and preoperative localization of intracerebral hematoma.Methods:A total of 74 elderly patients with a first-onset intracerebral hematoma aged ≥75 years, having surgical indications and stable vital signs were grouped into 3D slicer plus Sina software localization group(as group A, n=40)or CT localization group(as group B, n=34). Based on the localization, hematoma puncture and drainage were performed after local anesthesia.Preoperative preparation time, hematoma location, puncture success rate, postoperative hematoma clearance rate, postoperative re-bleeding rate and GCS score were statistically analyzed.Glasgow coma scale(GCS)scores were used in predicting the mortality.Results:The preoperative preparation time was significantly shorter in group A than in group B[(5.5±3.4)min vs.(8.5±2.7)min, t=3.337, P=0.001]. The success rate of hematoma puncture and drainage(90.0% and 70.6%, χ2=4.51, P=0.034)and postoperative hematoma clearance rate[(87.5±3.4)% and(80.3±2.7)%, t=10.10, P=0.000]were higher in group A than in group B. There were no significant differences in operative time, the accuracy of hematoma localization, re-bleeding rate and GCS score between the two groups( P>0.05). Conclusions:3D slicer plus Sina software can precisely locate the intracerebral hematoma, and minimally invasive hematoma puncture and drainage of intracerebral hematoma under local anesthesia were safe and effective in the treatment of elderly patients with intracerebral hemorrhage.

Gestational weight gain in dichorionic twin pregnancies / 中华围产医学杂志

Objective:To investigate the optimal gestational weight gain (GWG) in dichorionic twin pregnancies.Methods:We conducted a retrospective analysis on 755 uncomplicated dichorionic twin pregnancies delivered at Peking University Third Hospital from August 2011 to December 2019. All participants were classified into three groups according to their pre-pregnancy body mass index (BMI), including underweight (BMI<18.5 kg/m 2, n=40), normal weight (BMI=18.5-24 kg/m 2, n=509), and overweight/obese (BMI≥24 kg/m 2, n=206) groups. Gestational BMI, rate of assisted reproduction, and the velocity of GWG were compared between the three groups using analysis of variance, Chi-square test and Kruskal-Wallis test. Regression model of GWG with the increase of gestational weeks was established using random effects model combined with restricted cubic spline to evaluate the percentiles of maternal weight gain during 4-39 gestational weeks. Results:The median of total GWG in the underweight, normal weight, and overweight/obese groups were noted for 17.0 (15.0-20.5) kg, 17.0 (14.0-21.0) kg, and 15.0 (12.0-20.0) kg, respectively, which decreased with the increase of pre-pregnancy BMI ( χ 2=11.974, P=0.002). The regression model fit well with the weight gain during different gestational weeks, which revealed that the weight gain was slow before 13 weeks of gestation, and kept at a steady speed thereafter, regardless of the pre-pregnancy BMI. The median and quartile ( P25- P75) of weight gain were 17.6 (15.2-20.3) kg, 17.3 (14.7-20.2) kg, and 15.7 (12.9-18.8) kg at 37 weeks in the underweight, normal weight, and overweight/obese groups, respectively. Conclusions:GWG of twin pregnancy changes slowly in the first trimester, and increases at a constant rate after the second trimester regardless of pre-pregnant BMI. Overweight/obese pregnancies have lower GWG.

Feasibility study of electronic nose for rapid screening of bacterial infection types in rat wounds / 中华创伤杂志

Objective:To detect the common pathogenic bacteria in rat wounds using electronic nose so as to explore the feasibility of electronic nose for rapid screening of pathogenic bacteria in clinic.Methods:The wound was cutted from the left and right side of the psoas muscle of 45 SD rats. The type of standard bacterial fluids applied to the wound was divided into Staphylococcus aureus group, Escherichia coli group, Pseudomonas aeruginosa group, Acinetobacter baumannii group and Klebsiella pneumoniae group according to the random number table, with 9 mice per group. Three days later, the wound pus was sent to culture. Five standard bacterial fluids were detected by electronic nose, and the overall recognition rate and individual recognition rate of standard bacterial fluids were calculated by neural network (BP). The wound pus in each group was detected by electronic nose to visually compare the overlap degree of the radar map of the wound pus with the standard bacterial fluid characteristic radar map. The detection rate of wound pus in each group by electronic nose was compared. The wound pus in each group was submitted for examination, and the clinical detection rate of wound pus in each group was compared. The consistency was compared between electronic nose test and clinical test.Results:The overall BP identification rate of five standard bacteria liquid was 93.2%. The BP single identification rate of the Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae reached over 99.0%, and was more than 88.0% for Pseudomonas aeruginosa and Acinetobacter baumannii. The radar pattern of wound pus was highly overlapped with the characteristics of radar pattern of standard bacterial fluid. The detection rate of wound pus by electronic nose was the highest (100.0%) in Pseudomonas aeruginosa group and Escherichia coli group, followed by 88.9% in Klebsiella pneumoniae group and 72.2% in Pseudomonas aeruginosa group and Acinetobacter baumannii group. Using electronic nose, the detection rate in Pseudomonas aeruginosa group and Acinetobacter baumannii group was significantly different from that in Staphylococcus aureus group and Escherichia coli group ( P<0.05). The clinical detection rate of wound pus was 100.0% in Staphylococcus aureus group, Escherichia coli group and Klebsiella pneumoniae group, 94.4% in Pseudomonas aeruginosa group and 66.7% in Acinetobacter baumannii group. The clinical detection rate in Acinetobacter baumannii group differed significantly compared to that in Staphylococcus aureus group, Escherichia coli group and Klebsiella pneumoniae group ( P<0.05), while there was no significant difference between Acinetobacter baumannii group and Pseudomonas aeruginosa group ( P>0.05). Comparison of detection rate of wound pus between electronic nose and clinic examination showed a Kappa coefficient of 0.475. Conclusions:The animal wound pus detected by electronic nose can obtain a feature map with high repeatability compared to the standard bacterial fluid. The electronic nose detection has a medium degree of consistency with clinical detection, providing an experimental basis for the feasibility of using electronic nose to rapidly screen types of pathogenic bacteria.

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing / 生物医学与环境科学（英文）

Objective@#Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before @*Method@#We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.@*Results@#The untreated PTB group had significantly lower clinical pregnancy (31.7% @*Conclusions@#Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.

Effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus / 中国当代儿科杂志

OBJECTIVES@#To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus.@*METHODS@#A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment (@*RESULTS@#Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups (@*CONCLUSIONS@#Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.

In vitro fertilization-embryo transfer in patients with unexplained recurrent pregnancy loss / 中华医学杂志(英文版)

BACKGROUND@#Empiric therapy for patients with unexplained recurrent pregnancy loss (URPL) is not precise. Some patients will ask for assisted reproductive technology due to secondary infertility or advanced maternal age. The clinical outcomes of URPL patients who have undergone in vitro fertilization-embryo transfer (IVF-ET) require elucidation. The IVF outcome and influencing factors of URPL patients need further study.@*METHODS@#A retrospective cohort study was designed, and 312 infertile patients with URPL who had been treated during January 2012 to December 2015 in the Reproduction Center of Peking University Third Hospital were included. By comparing clinical outcomes between these patients and those with tubal factor infertility (TFI), the factors affecting the clinical outcomes of URPL patients were analyzed.@*RESULTS@#The clinical pregnancy rate (35.18% vs. 34.52% in fresh ET cycles, P = 0.877; 34.48% vs. 40.27% in frozen-thawed ET cycles, P = 0.283) and live birth rate (LBR) in fresh ET cycles (27.67% vs. 26.59%, P = 0.785) were not significantly different between URPL group and TFI group. URPL group had lower LBR in frozen-thawed ET cycles than that of TFI group (23.56% vs. 33.56%, P = 0.047), but the cumulative LBRs (34.69% vs. 38.26%, P = 0.368) were not significantly different between the two groups. The increased endometrial thickness (EMT) on the human chorionic gonadotropin day (odds ratio [OR]: 0.848, 95% confidence interval [CI]: 0.748-0.962, P = 0.010) and the increased number of eggs retrieved (OR: 0.928, 95% CI: 0.887-0.970, P = 0.001) were protective factors for clinical pregnancy in stimulated cycles. The increased number of eggs retrieved (OR: 0.875, 95% CI: 0.846-0.906, P < 0.001), the increased two-pronucleus rate (OR: 0.151, 95% CI: 0.052-0.437, P < 0.001), and increased EMT (OR: 0.876, 95% CI: 0.770-0.997, P = 0.045) in ET day were protective factors for the cumulative live birth outcome.@*CONCLUSION@#After matching ages, no significant differences in clinical outcomes were found between the patients with URPL and the patients with TFI. A thicker endometrium and more retrieved oocytes increase the probability of pregnancy in fresh transfer cycles, but a better normal fertilization potential will increase the possibility of a live birth.

Domestic and international research progress of edible and medicinal Arecae Semen / 中国中药杂志

Arecae Semen, as the first place among "Four South Medicines" in China, has great dual-use value of medicine and food. The research of Arecae Semen was mainly focused on the active ingredients and efficacy value, and its potential safety hazards were also concerned. Until now, there is still a lack of clear boundaries between medicine and food, resulting in its safety cannot be guaranteed. Therefore, it is of great significance to establish clear boundaries of medicine and food use and health risk assessment. In this paper, the differences of pretreatment and application methods of Arecae Semen were analyzed, and the research progress of Arecae Semen in chemical composition identification and toxicology research and safety evaluation were reviewed emphatically. Finally, the differences of quality control and safety evaluation of Arecae Semen in pharmacopoeias or standards were analyzed at home and abroad. It was expected to provide reference value for quality control, safety evaluation and international standardization research of Arecae Semen.

Severe acute respiratory syndrome coronavirus 2 infection in renal transplant recipients: A case report / 北京大学学报(医学版)

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient's symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.

Application research of teach-back in mouth-opening training of patients with nasopharyngeal carcinoma / 中国实用护理杂志

Objective:To investigate the effect of teach-back on the compliance of mouth-opening training in patients with nasopharyngeal carcinoma after radiotherapy.Methods:Eighty patients with nasopharyngeal carcinoma in the First Affiliated Hospital of Gannan Medical University were selected. They were divided into intervention group and control group according to the random number table method. The intervention group used the teach-back method for health education, and the control group used conventional methods for health education. The knowledge mastery of mouth-opening training, the degree of compliance with mouth-opening training and the difficulty of mouth opening were compared between the two groups.Results:Within 1 week of the intervention group, the complete mastery rate, partial mastery rate, and unmastered rate was 77.5% (31/40), 17.5% (7/40), and 5.0% (2/40), respectively, within 2 weeks, that was 97.5% (39/40), 2.5% (1/40), 0. Within 1 week of the control group was 65.0% (26/40), 10.0% (4/40), 25.0% (10/40), respectively, within 2 weeks, that was 75.0% (30/40), 20.0% (8/40), and 5.0% (2/40). The knowledge mastery of mouth-opening training in the intervention group was higher than that in the control group within 1 week and 2 weeks, and the difference between the two groups was statistically significant ( χ2=6.590, 8.618, P<0.05). At the end of radiotherapy, the complete compliance rate, partial compliance rate, and non-compliance rate of the intervention group was 90.0% (36/40), 10.0% (4/40), 0, respectively. After 3 months of radiotherapy, the rate was 75.0% (30/40), 22.5% (9/40), 2.5% (1/40). At the end of 6 months of radiotherapy, the rate was 60.0% (24/40),30.0% (12/40) and 10.0% (4/40). At the end of the radiotherapy, the control group was 70.0% (28/40), 20.0% (8/40), and 10.0% (4/40), respectively. After 3 months of radiotherapy, the rate was 40.0% (16/40), 45.0% (18/40) and 15.0% (6/40). After 6 months of radiotherapy, the rate was 20.0% (4/40), 40.0% (16/40), and 40.0% (16/40). The compliance of the intervention group at the end of radiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy was higher than that of the control group, and the difference between the two groups was statistically significant ( χ2=5.986, 10.615, 15.771, P<0.05 or 0.01). In the intervention group, the incidence of Ⅰ degree, Ⅱ degree, Ⅲ degree and Ⅳ degree difficulty of mouth opening after 6 months of radiotherapy was 10.0% (4/40), 5.0% (2/40), 0, 0, respectively, and the control group was 15.0% (6/40), 15.0% (6/40), 2.5% (1/40), 2.5% (1/40), the incidence of difficulty of mouth opening of the intervention group was lower than that of the control group, and the difference between the two groups was statistically significant ( Z=15.737, P<0.01). Conclusions:Teach-back can effectively improve the mastery of patients′ mouth-opening training knowledge and the compliance of mouth-opening training, which is beneficial to reduce the incidence of mouth-opening difficulties in patients with nasopharyngeal carcinoma. It is worthy of clinical promotion.

Age and menopausal status are important factors influencing the serum human epididymis secretory protein 4 level: a prospective cross-sectional study in healthy Chinese people / 中华医学杂志(英文版)

BACKGROUND@#Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.@*METHODS@#A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%-95%) were determined for reference ranges in different populations.@*RESULTS@#There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and pre-menopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = -14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H = 408.18, P < 0.001) but not in the pre-menopausal subjects (Z = -0.43, P = 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.@*CONCLUSIONS@#Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.

CT-guided versus ultrasound-guided percutaneous lung puncture biopsy in the diagnosis of peripheral pulmonary masses: a Meta-analysis / 肿瘤研究与临床

Objective@#To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy.@*Methods@#Relevant domestic and foreign related databases such as PubMed, Web of Science, Cochrane Library, OVID, China Biology Medicine, VIP, Wanfang and CNKI databases were searched, the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected. After extracting the relevant data, a Meta-analysis was performed using RevMan 5.2 and Stata softwares.@*Results@#Ten studies met the inclusion criteria, with a total sample size of 1 158 cases, of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy. Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant [97.48% (619/635) vs. 96.56% (505/523), RR= 1.01, 95% CI 0.99-1.03, P= 0.360]; the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group, and the difference was statistically significant [92.44% (619/635) vs. 96.56% (505/523), RR= 0.97, 95% CI 0.94-0.99, P= 0.007]. The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [14.49% (92/635) vs. 9.56% (50/523), RR= 1.56, 95% CI 1.11-2.19, P= 0.010]; the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [11.50%(73/635) vs. 6.31% (33/523), RR= 1.77, 95% CI 1.17-2.68, P= 0.007]; the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant [2.99% (19/635) vs. 3.25% (17/523), RR= 1.08, 95% CI 0.59-1.98, P= 0.800].@*Conclusions@#Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value. However, for the intrapulmonary masses shown by ultrasound, the ultrasound-guided lung puncture biopsy has a shorter operation time, lower cost, and higher safety.

Application research of teach-back in mouth-opening training of patients with nasopharyngeal carcinoma / 中国实用护理杂志

Objective@#To investigate the effect of teach-back on the compliance of mouth-opening training in patients with nasopharyngeal carcinoma after radiotherapy.@*Methods@#Eighty patients with nasopharyngeal carcinoma in the First Affiliated Hospital of Gannan Medical University were selected. They were divided into intervention group and control group according to the random number table method. The intervention group used the teach-back method for health education, and the control group used conventional methods for health education. The knowledge mastery of mouth-opening training, the degree of compliance with mouth-opening training and the difficulty of mouth opening were compared between the two groups.@*Results@#Within 1 week of the intervention group, the complete mastery rate, partial mastery rate, and unmastered rate was 77.5% (31/40), 17.5% (7/40), and 5.0% (2/40), respectively, within 2 weeks, that was 97.5% (39/40), 2.5% (1/40), 0. Within 1 week of the control group was 65.0% (26/40), 10.0% (4/40), 25.0% (10/40), respectively, within 2 weeks, that was 75.0% (30/40), 20.0% (8/40), and 5.0% (2/40). The knowledge mastery of mouth-opening training in the intervention group was higher than that in the control group within 1 week and 2 weeks, and the difference between the two groups was statistically significant (χ2=6.590, 8.618, P<0.05). At the end of radiotherapy, the complete compliance rate, partial compliance rate, and non-compliance rate of the intervention group was 90.0% (36/40), 10.0% (4/40), 0, respectively. After 3 months of radiotherapy, the rate was 75.0% (30/40), 22.5% (9/40), 2.5% (1/40). At the end of 6 months of radiotherapy, the rate was 60.0% (24/40),30.0% (12/40) and 10.0% (4/40). At the end of the radiotherapy, the control group was 70.0% (28/40), 20.0% (8/40), and 10.0% (4/40), respectively. After 3 months of radiotherapy, the rate was 40.0% (16/40), 45.0% (18/40) and 15.0% (6/40). After 6 months of radiotherapy, the rate was 20.0% (4/40), 40.0% (16/40), and 40.0% (16/40). The compliance of the intervention group at the end of radiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy was higher than that of the control group, and the difference between the two groups was statistically significant (χ2=5.986, 10.615, 15.771, P<0.05 or 0.01). In the intervention group, the incidence of Ⅰ degree, Ⅱ degree, Ⅲ degree and Ⅳ degree difficulty of mouth opening after 6 months of radiotherapy was 10.0% (4/40), 5.0% (2/40), 0, 0, respectively, and the control group was 15.0% (6/40), 15.0% (6/40), 2.5% (1/40), 2.5% (1/40), the incidence of difficulty of mouth opening of the intervention group was lower than that of the control group, and the difference between the two groups was statistically significant (Z=15.737, P<0.01).@*Conclusions@#Teach-back can effectively improve the mastery of patients′ mouth-opening training knowledge and the compliance of mouth-opening training, which is beneficial to reduce the incidence of mouth-opening difficulties in patients with nasopharyngeal carcinoma. It is worthy of clinical promotion.

Risk assessment of exported risk of novel coronavirus pneumonia from Hubei Province / 中华预防医学杂志

To evaluate the exported risk of novel coronavirus pneumonia (NCP) from Hubei Province and the imported risk in various provinces across China. Data of reported NCP cases and Baidu Migration Indexin all provinces of the country as of February 14, 2020 were collected. The correlation analysis between cumulative number of reported cases and the migration index from Hubei was performed, and the imported risks from Hubei to different provinces across China were further evaluated. A total of 49 970 confirmed cases were reported nationwide, of which 37 884 were in Hubei Province. The average daily migration index from Hubei to other provinces was 312.09, Wuhan and other cities in Hubei were 117.95 and 194.16, respectively. The cumulative NCP cases of provinces was positively correlated with the migration index derived from Hubei province, also in Wuhan and other cities in Hubei, with correlation coefficients of 0.84, 0.84, and 0.81. In linear model, population migration from Hubei Province, Wuhan and other cities in Hubei account for 71.2%, 70.1%, and 66.3% of the variation, respectively. The period of high exported risk from Hubei occurred before January 27, of which the risks before January 23 mainly came from Wuhan, and then mainly from other cities in Hubei. Hunan Province, Henan Province and Guangdong Province ranked the top three in terms of cumulative imported risk (the cumulative risk indices were 58.61, 54.75 and 49.62 respectively). The epidemic in each province was mainly caused by the importation of Hubei Province. Taking measures such as restricting the migration of population in Hubei Province and strengthening quarantine measures for immigrants from Hubei Province may greatly reduce the risk of continued spread of the epidemic.

CT-guided versus ultrasound-guided percutaneous lung puncture biopsy in the diagnosis of peripheral pulmonary masses: a Meta-analysis / 肿瘤研究与临床

Objective:To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy.Methods:Relevant domestic and foreign related databases such as PubMed, Web of Science, Cochrane Library, OVID, China Biology Medicine, VIP, Wanfang and CNKI databases were searched, the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected. After extracting the relevant data, a Meta-analysis was performed using RevMan 5.2 and Stata softwares.Results:Ten studies met the inclusion criteria, with a total sample size of 1 158 cases, of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy. Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant [97.48% (619/635) vs. 96.56% (505/523), RR= 1.01, 95% CI 0.99-1.03, P= 0.360]; the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group, and the difference was statistically significant [92.44% (619/635) vs. 96.56% (505/523), RR= 0.97, 95% CI 0.94-0.99, P= 0.007]. The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [14.49% (92/635) vs. 9.56% (50/523), RR= 1.56, 95% CI 1.11-2.19, P= 0.010]; the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [11.50%(73/635) vs. 6.31% (33/523), RR= 1.77, 95% CI 1.17-2.68, P= 0.007]; the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant [2.99% (19/635) vs. 3.25% (17/523), RR= 1.08, 95% CI 0.59-1.98, P= 0.800]. Conclusions:Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value. However, for the intrapulmonary masses shown by ultrasound, the ultrasound-guided lung puncture biopsy has a shorter operation time, lower cost, and higher safety.