Characteristics of serum bile acids among healthy children in Zhejiang province / 中华儿科杂志

Objective: To characterize the serum bile acid profiles of healthy children in Zhejiang Province. Methods: A cross-sectional study was conducted on 245 healthy children who underwent imaging and laboratory biochemical tests during routine physical examinations at the Children's Hospital of Zhejiang University School of Medicine from January 2020 to July 2022. Overnight fasting venous blood samples were collected, and the concentrations of 18 individual bile acids in the serum were accurately quantitated using tandem mass spectrometry. The concentration difference of bile acid were compared between different genders and to explore the correlation between age and bile acid levels. Used the Mann-Whitney U test for intergroup comparison and Spearman test to correlation analysis. Results: A total of 245 health children with a age of 10 (8, 12) years including 125 boys and 120 girls. There were no significant differences in levels of total bile acids, primary and secondary bile acids, free and conjugated bile acids between the two gender groups (all P>0.05). The serum concentrations of ursodeoxycholic acid and glycoursodeoxycholic acid in girls were significantly higher than those in boys (199.0 (66.9, 276.5) vs. 154.7 (49.3, 205.0) nmol/L, 274.0 (64.8, 308.0) vs. 181.0 (43.8, 209.3) nmol/L, Z=2.06, 2.71, both P<0.05). The serum taurolithocholic acid in both boys and girls were positively correlated with age (r=0.31, 0.32, both P<0.05). The serum chenodeoxycholic acid and glycochenodeoxycholic acid in the boys group were positively correlated with age (r=0.20, 0.23, both P<0.05), whereas the serum tauroursodeoxycholic acid in the girls group was negatively correlated with age (r=-0.27, P<0.05), and the serum cholic acid was positively correlated with age (r=0.34, P<0.05). Conclusions: The total bile acid levels are relatively stable in healthy children in Zhejiang province. However, individual bile acids showed gender differences and were correlated with age.

Association between body mass index and physical fitness index among secondary school students in Jiangxi Province / 中国学校卫生

Objective@#To measure the body mass index (BMI) of secondary school students and analyze its association with the physical fitness index, so as to improve the physical health of middle school students.@*Methods@#Using a randomized cluster stratified sampling method, 3 813 secondary school students from six cities (Ganzhou, Ji an, Fuzhou, Nanchang, Shangrao and Jiujiang) in Jiangxi Province, China, were selected in September 2022. Questionnaire survey was administered to obtain basic information and to assess the nutritional status and physical fitness tests were conducted among secondary school students. The study was stratified by gender and age, and the Kruskal Wallis H test was used to compare the differences in the mean values of grip strength, sit-ups, standing long jump performance and strength quality among secondary school students with different BMI levels, while the correlation between BMI and strength quality index was inferred by using curve regression analysis.@*Results@#There was statistical significance in the strength quality index of middle school students with different BMI level ( H=56.79, 8.84, P <0.05). Except 13 years old group, the difference of physical fitness by BMI grade strength quality index of boys in other age groups was statistically significant ( H =22.21, 16.23, 17.98, 18.21, 8.08), while the difference of physical fitness by BMI of girls at 14 years old was statistically significant ( H =9.11)( P <0.05). The curve fitting using regression showed that the physical fitness index and BMI of middle school students (boys and girls) show an inverted U-shaped curve. The physical fitness index was higher in the middle region of BMI ( Z-score) and lower in the two end regions, while showing a decreasing trend from the middle to the two ends.@*Conclusion@#An association is found between BMI and physical fitness among secondary school students in Jiangxi Province, and wasting and overweight/obesity are negatively correlated with physical fitness. Greater attention should be paid to the nutritional status of secondary school students to ensure the normal development of physical fitness.

Analysis of serum CA125 and related influencing factors in silicosis patients with pulmonary heart disease / 中华劳动卫生职业病杂志

Objective: To analyze the serum carbohydrate antigen 125 (CA125) level and its influencing factors in male silicosis patients with pulmonary heart disease. Methods: In October 2021, data of 38 male patients with simple silicosis (silicosis group), 28 cases of silicosis with pulmonary heart disease (pulmonary heart disease group), and 27 healthy controls (control group) in the same age group were collected in inpatient and outpatient of Nanjing Occupational Disease Prevention and Control Hospital from January 2017 to December 2020. The serum CA125 levels of the three groups were compared, and the correlation between disease-related indexes and serum CA125 in silicosis patients with pulmonary heart disease was analyzed, as well as the influencing factors of pulmonary heart disease and serum CA125 levels in silicosis patients. Results: The serum CA125 level[ (19.95±7.52) IU/ml] in pulmonary heart disease group was higher than that in silicosis group[ (12.98±6.35) IU/ml] and control group[ (9.17±5.32) IU/ml] (P<0.05). There was no significant difference in serum CA125 level between the silicosis group and the control group (P>0.05). Serum CA125 levels were positively correlated with blood uric acid and fasting blood glucose in silicosis patients with pulmonary heart disease (r=0.39, 0.46, P<0.05). Serum CA125 level was a risk factor for silicosis patients with pulmonary heart disease (OR=1.13, 95%CI: 1.02-1.24, P<0.05). Dust exposure time, lactate dehydrogenase and smoking history were positively correlated with serum CA125 level in silicosis patients (P<0.05) . Conclusion: The serum CA125 level of male silicosis patients with pulmonary heart disease is significantly increased, and the level of CA125 is correlated with the level of fasting blood glucose and blood uric acid.

Holocarboxylase synthetase deficiency induced by HLCS gene mutations: a rare disease study / 中国当代儿科杂志

A boy, aged 16 months, attended the hospital due to head and facial erythema for 15 months and vulva erythema for 10 months with aggravation for 5 days. The boy developed perioral and periocular erythema in the neonatal period and had erythema and papules with desquamation and erosion in the neck, armpit, and trigone of vulva in infancy. Blood gas analysis showed metabolic acidosis; the analysis of amino acid and acylcarnitine profiles for inherited metabolic diseases and the analysis of organic acid in urine suggested multiple carboxylase deficiency; genetic testing showed a homozygous mutation of c.1522C>T(p.R508W) in the HLCS gene. Finally the boy was diagnosed with holocarboxylase synthetase deficiency and achieved a good clinical outcome after oral biotin treatment. This article analyzes the clinical data of a child with holocarboxylase synthetase deficiency and summarizes the etiology, diagnosis, and treatment of this child, so as to provide ideas for clinicians to diagnose this rare disease.

Comparison of the therapeutic effects of high-intensity focused ultrasound cycloplasty and cyclocryotherapy on refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the therapeutic effects of high-intensity focused ultrasound cycloplasty(UCP)and cyclocryotherapy on refractory glaucoma.<p>METHODS:This retrospective study included 45 patients(81 eyes)with refractory glaucoma admitted to the hospital between January 2017 and December 2020. According to the treatment method, patients enrolled were divided into cyclocryotherapy group(22 patients, 40 eyes)and high-intensity UCP group(23 patients, 41 eyes). Changes in intraocular pressure at 1d, 1wk, 1 and 3mo after operation were compared between the two groups. The Numerical Rating Scale(NRS)was used to evaluate eyeball pain. Surgical results and complications in the two groups were compared. <p>RESULTS:The total effective rate of operation in the high-intensity UCP group was significantly higher than that in the control group(<i>P</i><0.05). Generalized estimation equation analysis showed that there were statistically significant differences in intraocular pressure and eyeball pain between the two groups before and after operation(all <i>P</i><0.05). There were statistically significant differences in intraocular pressure and eyeball pain between the two groups at different time points after operation(all <i>P</i><0.05). The incidence rates of complications such as conjunctival hyperemia, corneal edema, anterior chamber inflammatory exudation, reactive intraocular hypertension and hyphema in the high-intensity UCP group were significantly lower than those in the cyclocryotherapy group(<i>P</i><0.05).<p>CONCLUSION: High-intensity UCP is effective in the treatment of refractory glaucoma, with obvious advantages in reducing intraocular pressure, eyeball pain and complications as compared with cyclocryotherapy.

Significance of serum miRNA-126 and miRNA-449a expression levels in the therapeutic efficacy and prognostic evaluation of pemetrexed combined with cisplatin for treatment of non-small cell lung cancer / 肿瘤研究与临床

Objective:To investigate the effects of serum miRNA-126 (miR-126) and miRNA-449a (miR-449a) expression levels on the efficacy and prognostic evaluation of pemetrexed combined with cisplatin in treatment of non-small cell lung cancer (NSCLC).Methods:The data of 100 NSCLC patients admitted to Wuhan Hankou Hospital from January 2016 to January 2017 were retrospectively analyzed. Before treatment, the relative expression levels of miR-126 and miR-449a in serum of both groups were detected by using real-time fluorescence quantitative polymerase chain reaction. A total of 100 healthy volunteers during the same period were treated as the control group. The efficacy was evaluated after 2 courses of treatment, and the correlation of miR-126 and miR-449a relative expression levels with clinicopathological characteristics, efficacy and prognosis of patients was analyzed.Results:The relative expression levels of serum miR-126 and miR-449a in NSCLC patients were lower than those in the control group (1.23±0.34 vs. 2.22±0.57, 0.95±0.21 vs. 2.13±0.43), and the differences were statistically significant ( F = 14.92, 24.66; all P < 0.01). There were significant differences in the relative expression levels of serum miR-126 and miR-449a in NSCLC patients with different therapeutic effects ( F = 80.65, 22.43, all P < 0.01). Spearman correlation analysis showed that the relative expression levels of serum miR-126 and miR-449a were correlated with the therapeutic effect ( ρ = 0.782, 0.618, all P < 0.01). The relative expression levels of serum miR-126 and miR-449a in NSCLC patients with different gender and age had no statistically significant difference (all P > 0.05). The relative expression levels of serum miR-126 and miR-449a in NSCLC patients with different TNM staging, pathological type, tumor diameter, degree of differentiation showed significant differences (all P < 0.05). Univariate Cox regression analysis showed TNM staging, tumor diameter, degree of differentiation, relative expression levels of serum miR-126 and miR-449a were correlated with the survival of NSCLC patients (all P < 0.05). Multivariate Cox regression analysis revealed TNM staging, tumor diameter, degree of differentiation and the relative expression levels of miR-126 and miR-449a were independent factors affecting the survival of NSCLC patients after surgery. The overall survival of patients with the high expressions of miR-126 and miR-449a was better than that of patients with the low expressions (all P < 0.05). Conclusions:The relative expression levels of serum miR-126 and miR-449a can be used as a potential serologic indicator to analyze the prognosis of NSCLC patients treated with pemetrexed combined with cisplatin.

Clinical and imaging features of basal ganglia germinoma in children and adolescents / 中国医师杂志

Objective:To investigate the clinical and imaging features of basal ganglia germinoma in children and adolescents, so as to improve the accuracy of early diagnosis.Methods:The clinical symptoms and imaging findings of 10 cases of basal ganglia germinoma diagnosed by surgical examination or diagnostic radiotherapy in Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University from January 2010 to December 2019 were analyzed retrospectively.Results:There were 9 males and 1 female, aged from 5 to 15 years, with an average age of 9.7 years.There were 10 cases of limb weakness or mild hemiplegia, 1 case of headache and vomiting, and 1 case of extrapyramidal tract sign. There were 9 cases of computed tomography (CT) examination, 5 cases of high density, 4 cases of mixed density, and 3 cases of intrafocal calcification. 10 cases of routine magnetic resonance imaging (MRI) examination, MR T1-weighted imaging (T1WI): 5 cases of low signal, 3 cases of slightly low signal, 1 case of equal low signal, 1 case of equal slightly low signal; MR T2-weighted imaging (T2WI): 3 cases of high signal, 5 cases of slightly high signal, 2 cases of high and low mixed signal; T2 fluid attenuated inversion recovery (T2FLAIR): 1 case of low signal, 2 cases of slightly high signal, 1 case of iso-high signal, 5 cases of high signal, 1 case of high and low mixed signal; Diffusion weighted imaging (DWI): 2 cases of low signal, 1 case of equal signal, 1 case of equal slightly high signal, 4 cases of slightly high signal, 2 cases of high signal; 1 case of functional imaging susceptibility-weighted imaging (SWI): 1 case of low signal; 10 cases of MRI enhancement: 2 cases of no enhancement, 5 cases of mild enhancement, 3 cases of moderate/obvious enhancement, and the enhancement methods can be seen in spot, patch, mass and ring enhancement; Functional imaging magnetic resonance angiography (MRA) in 2 cases: 1 case had slender middle cerebral artery, fewer branch arteries than the opposite side, and 1 case showed no obvious abnormality; 2 cases of positron emission (PET)-CT: the metabolism of methionine (MET) on the affected side was significantly increased in 2 cases.Conclusions:Germinoma in the basal ganglia of children and adolescents are more common in men, with weakness or mild hemiplegia as the main symptom. The imaging findings have certain characteristics. Imaging findings combined with relevant clinical data can improve the accuracy of early diagnosis of germinoma in the basal ganglia.

Application exploration of basic and applied teaching method in musculoskeletal ultrasound continuing medical education / 中华医学教育探索杂志

Objective:Based on the research results of the national continuing medical education project "musculoskeletal ultrasound and new technology quality class" held by the Department of Ultrasound Diagnosis of Peking University Third Hospital, to explore and analyze the effect of basic and applied teaching method based on musculoskeletal ultrasound.Methods:Totally 109 participants attending the classes held on April 14-18, 2019 and on September 9-13, 2019 were selected as study objects, and the training effects of quality private classes were evaluated by questionnaires, operational tests and theoretical tests. SPSS 21.0 was used for t test. Results:The results showed that more than 80% of students were satisfied with the teaching content, teaching plan and teaching materials. Through the class training, the greatest gains of the students were that the operation ability [67 cases (30.7%)] and the theoretical level [53 cases (24.3%)] had been significantly improved. All 109 students passed the operation test. There were no statistical differences in the average scores of theoretical tests among the students with different professional titles, academic qualifications and whether they were from primary hospitals (75-80 points, P>0.05) . Conclusion:The musculoskeletal ultrasound quality private class can improve the students' operating ability and theoretical level in the musculoskeletal system. The class model can guarantee the teaching quality and provide a new direction for continuing medical education.

The application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath in diagnosis of nonresolving pneumonias / 中国医师进修杂志

Objective:To explore the application of transbronchial lung cryobiopsy guided by endobronchial ultrasound sheath (EBUS-GS-TBCB) in diagnosis of nonresolving pneumonias.Methods:Sixty patients with nonresolving pneumonias from March 2019 to July 2020 in Dalian Municipal Central Hospital were selected. The patients were divided into EBUS-GS-TBCB group (31 cases) and transbronchial forcep lung biopsy guided by endobronchial ultrasound sheath(EBUS-GS-TBLB) group (29 cases) by random digits table method.Results:The diagnostic rate of nonresolving pneumonias in EBUS-GS-TBCB group was significantly higher than that in EBUS-GS-TBLB group: 87.10% (27/31) vs. 65.52% (19/29), and there was statistical difference ( χ2 = 3.90, P = 0.048). There were no statistical difference in sensitivity, specificity, accuracy, positive predictive value and negative predictive value between 2 groups ( P>0.05). There were no statistical difference inthe shortest distance from lesions to pleura, incidence of pneumothorax and incidence of bleeding between EBUS-GS-TBCB group and EBUS-GS-TBLB group: (27.42 ± 2.88) mm vs. (27.01 ± 2.37) mm, 6.45%(2/31) vs. 3.45%(1/29) and 22.58%(7/31) vs. 13.79% (4/29), P>0.05. Among the causes of nonresolving pneumonias, infectious factors accounted for 21.67% (13/60), non infectious factors accounted for 66.67% (40/60), and uncertain causes accounted for 11.67% (7/60). Conclusions:The diagnostic rate of EBUS-GS-TBCB in nonresolving pneumonias is significantly higher than EBUS-GS-TBLB, and the complications such as bleeding and pneumothorax do not increase significantly.

Application value of Da Vinci robotic transanal minimally invasive surgery for local resection of rectal neoplasms / 中华消化外科杂志

Objective:To investigate the application value of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for local resection of rectal neoplasms.Methods:The retros-pective and descriptive study was conducted. The clinicopathological data of 7 rectal neoplasms patients undergoing R-TAMIS in Daping Hospital of Army Medical University from June 2017 to March 2021 were collected. There were 3 males and 4 females, aged (60±7)years. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) postoperative histopatholo-gical examinations; (4) follow-up. Follow-up was conducted using telephone interview or outpatient examination to detect readmission of patients within postoperative 30 days, tumor recurrence and metastasis and survival of patients. Follow-up was performed at postoperative 1, 3, 6 months and once every 6 months thereafter up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All the 7 patients underwent R-TAMIS successfully without conversion to laparotomy or laparoscopic surgery. Of the 7 patients, 2 cases underwent full-thickness rectal resection and 5 cases underwent submucosal dissection of tumor. The rectal wounds were not sutured in 2 cases because of large lesions, and the rectal wounds were sutured with synthetic sutures in 5 cases after resection of lesions. Transanal drainage tube was placed in 2 cases and not in 5 cases. The volume of intra-operative blood loss of the 7 patients was 15(range, 2?50)mL. The total operation time of the 7 patients was (91.4±18.4)minutes, including (19.1±2.3)minutes for transanal platform placement and Da Vinci robotic surgical system installation, and (72.3±16.6)minutes for operation. There was no intraoperative complication such as urethral injury. (2) Postoperative recovery. All the 7 patients started water drinking and out-of-bed activities at postoperative day 1 and liquid food intake at postoperative day 2. The time to postoperative first flatus of the 7 patients was 1(range, 1?3)days. The two cases with transanal drainage underwent removing of transanal drainage at postoperative day 2. There was no postoperative complication and the duration of postoperative hospital stay of the 7 patients was 3(range, 3?9)days. (3) Postoperative histopathological examinations. Of the 7 patients, 3 cases had villous adenoma, 2 cases had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor invasion into submucosa (stage SM1), 1 case had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor localized in the inner mucosa (stage Tis) and 1 case had moderately differentiated adeno-carcinoma with tumor invasion into superficial muscle layer (stage T2). All the 7 patients had negative surgical margins with none of tumor cell remained in the base. (4) Follow-up. All the 7 patients were followed up for 18(range, 1?42)months. One of the 7 patients showed rectal adenocarcinoma with tumor invasion into superficial muscle layer by the postoperative histopathological examina-tion and was recommended for remedial radical surgery. The patient refused further surgery and underwent 3 courses of oral capecitabine chemotherapy. The other 6 patients did not receive postoperative chemotherapy. None of 7 patients underwent readmission within postoperative 30 days, and no patient had tumor local recurrence, distant metastasis or death during the follow-up.Conclusion:R-TAMIS for local resection of rectal neoplasms is safe and feasible for patients with rectal adenoma and early rectal cancer, with reliable short-term efficacy and short-term oncological efficacy.

PXR activation impairs hepatic glucose metabolism partly via inhibiting the HNF4α-GLUT2 pathway

Drug-induced hyperglycemia/diabetes is a global issue. Some drugs induce hyperglycemia by activating the pregnane X receptor (PXR), but the mechanism is unclear. Here, we report that PXR activation induces hyperglycemia by impairing hepatic glucose metabolism due to inhibition of the hepatocyte nuclear factor 4-alpha (HNF4α)‒glucose transporter 2 (GLUT2) pathway. The PXR agonists atorvastatin and rifampicin significantly downregulated GLUT2 and HNF4α expression, and impaired glucose uptake and utilization in HepG2 cells. Overexpression of PXR downregulated GLUT2 and HNF4α expression, while silencing PXR upregulated HNF4α and GLUT2 expression. Silencing HNF4α decreased GLUT2 expression, while overexpressing HNF4α increased GLUT2 expression and glucose uptake. Silencing PXR or overexpressing HNF4α reversed the atorvastatin-induced decrease in GLUT2 expression and glucose uptake. In human primary hepatocytes, atorvastatin downregulated GLUT2 and HNF4α mRNA expression, which could be attenuated by silencing PXR. Silencing HNF4α downregulated GLUT2 mRNA expression. These findings were reproduced with mouse primary hepatocytes. Hnf4α plasmid increased Slc2a2 promoter activity. Hnf4α silencing or pregnenolone-16α-carbonitrile (PCN) suppressed the Slc2a2 promoter activity by decreasing HNF4α recruitment to the Slc2a2 promoter. Liver-specific Hnf4α deletion and PCN impaired glucose tolerance and hepatic glucose uptake, and decreased the expression of hepatic HNF4α and GLUT2. In conclusion, PXR activation impaired hepatic glucose metabolism partly by inhibiting the HNF4α‒GLUT2 pathway. These results highlight the molecular mechanisms by which PXR activators induce hyperglycemia/diabetes.

β-Elemene induces apoptosis and autophagy in colorectal cancer cells through regulating the ROS/AMPK/mTOR pathway / 中国天然药物

β-Elemene is an effective anti-cancer ingredient extracted from the genus Curcuma (Zingiberaceae familiy). In the present study, we demonstrated that β-elemene inhibited the proliferation of colorectal cancer cells and induced cell cycle arrest in the G2/M phase. In addition, β-elemene induced nuclear chromatin condensation and cell membrane phosphatidylserine eversion, decreased cell mitochondrial membrane potential, and promoted the cleavage of caspase-3, caspase-9 and PARP proteins, indicating apoptosis in colorectal cancer cells. At the same time, β-elemene induced autophagy response, and the treated cells showed autophagic vesicle bilayer membrane structure, which was accompanied by up-regulation of the expression of LC3B and SQSTM1. Furthermore, β-elemene increased ROS levels in colorectal cancer cells, promoted phosphorylation of AMPK protein, and inhibited mTOR protein phosphorylation. In the experiments in vivo, β-elemene inhibited the tumor size and induced apoptosis and autophagy in nude mice. In summary, β-elemene inhibited the occurrence and development of colon cancer xenografts in nude mice, and significantly induced apoptosis and autophagy in colorectal cancer cells in vitro. These effects were associated with regulation of the ROS/AMPK/mTOR signaling. We offered a molecular basis for the development of β-elemene as a promising anti-tumor drug candidate for colorectal cancer.

A qualitative study on clinical nursing managers′management experience of diagnosis-related groups-prepaid payment system / 中国实用护理杂志

Objective:To explore the management experience of clinical nursing managers and to provide reference for the implementation of the reform of DRGs-PPS.Methods:15 clinical nursing managers were surveyed in an in-depth semi-structured interview by phenomenological research methods, and the data were analyzed by Colaizzi 7 analysis method.Results:Four themes were extracted: the positive effect of the reform, the value reflection of nursing work, the promotion and obstacles of nursing management during DRGS implementation.Conclusions:Clinical nursing managers, there are positive experience as well as negative experience for the implementation of the reform of DRGs-PPS, so we need to constantly improve the staff′s cognition, to maximize the value of nursing, draw support from policy guidance and third-party building platforms, optimizes the allocation of human resources, strengthen the management of consumables, promote nursing quality and cost effective integration and effective supervision, and promote healthy development of the DRGs-PPS.

Correlation Study on Expression of PD-1 and PD-L1 in Non-small Cell Lung Cancer and Epidermal Growth Factor Receptor Mutations / 中国肺癌杂志

BACKGROUND@#The treatment mode of lung cancer is epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) as a first-line treatment for patients with EGFR mutant in non-small cell lung cancer (NSCLC). At the same time programmed death receptor 1 (PD-1) and its programmed death receptor ligand 1 (PD-L1) inhibitors therapy as the representative immune checkpoint inhibitors (ICIs) has a significant effect in the treatment of lung cancer. The aim of this study was to investigate the correlation between the expression of PD-1 and PD-L1 in NSCLC and clinicopathologic feature, EGFR gene mutation.@*METHODS@#The protein expression of PD-1 and PD-L1 was detected by immunohistochemistry from 127 patients with NSCLC and EGFR gene mutation was detected by quantitative polymerase chain reaction (qPCR) to analyze its relation with clinicopathologic feature. Also, the correlation between protein expression of PD-1 and PD-L1 and EGFR mutation.@*RESULTS@#The PD-1 positive expression in NSCLC tumor cells and tumor infiltrating immune cells is 53.5% (68/127), PD-L1 is 57.5% (73/127). The PD-1 and PD-L1 expression significantly higher in well-differentiated and moderately-differentiated carcinoma than poorly differentiated carcinoma, I+II than III+IV in clinical staging (P<0.05). The EGFR mutation rate was 46.5% (59/127), correlate with female, without smoking history, adenocarcinoma and well-differentiated and moderately-differentiated patients respectively higher than male, smoking history, squamous carcinoma and poorly differentiated patients (P<0.05). The protein expression of PD-L1 and PD-1 had the consistency in NSCLC patients (kappa=0.107,5, P=0.487). There was a negative correlation between the EGFR mutation and PD-1 and PD-L1 expression (Φ=-0.209, Φ=-0.221, P<0.05). Follow-up of NSCLC patients, the median total survival in under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, with PD-L1 expression patients respectively higher than over the age of 65, squamous carcinoma, poorly differentiated, without PD-L1 expression patients (P<0.05). The median survival of hypo expression patients of PD-L1 significantly higher than hyper expression patient (P=0.04).@*CONCLUSIONS@#According to the Chinese Expert Consensus on Standards of PD-L1 immunohistochemistry testing for NSCLC, we tested the PD-L1 expression in NSCLC and then the dominant population of anti-PD-1/PD-L1 treatment was screened out. Patients with EGFR mutation were also detected and EGFR mutation was negatively correlated with the expression of PD-1 and PD-L1 as well. On the basis of PD-L1 expression and EGFR mutation status, it may benefit NSCLC patients from individualized treatment. Meanwhile, patients who were under the age of 65, adenocarcinoma, well-differentiated and moderately-differentiated, hypo expression of PD-L1 have a relatively good prognosis, to provide reference for the prognosis evaluation of NSCLC.

Recurrent vulvar rashes in a girl aged 22 months for more than half a year / 中国当代儿科杂志

A girl, aged 22 months, attended the hospital due to recurrent vulvar rashes for more than half a year. Skin biopsy showed Langerhans cell histiocytosis, and evaluation of systemic conditions showed no systemic involvement. Therefore, the girl was diagnosed with Langerhans cell histiocytosis (skin type). In conclusion, for rashes on the vulva alone, if there are no specific clinical manifestations, the possibility of Langerhans cell histiocytosis should be considered after molluscum contagiosum, sexually transmitted diseases, and Fordyce disease are excluded.

Design and application of / 中国针灸

On the base of the principle of penetrating moxibustion and in combination with free adjustment devices such as movable U-shaped moxa stick holder and movable clamp, a new type of moxibustion box exerted on the head is designed, with precise positioning and sufficient heat intensity.

Clinical effect and mechanism of moxibustion combined with western medication for rheumatoid arthritis of liver-kidney deficiency / 中国针灸

OBJECTIVE@#To observe the clinical effect of moxibustion combined with western medication for rheumatoid arthritis (RA) of liver-kidney deficiency, and explore the mechanism of moxibustion for RA.@*METHODS@#A total of 60 patients with RA of liver-kidney deficiency were randomly divided into an observation group and a control group, 30 cases in each group. In the control group，leflunomide tablets were taken orally, once a day. On the base of the treatment as the control group, moxibustion was applied at Sanyinjiao (SP 6), Shenshu (BL 23), Zusanli (ST 36) and @*RESULTS@#After treatment, the TCM syndrome scores, HAQ scores and DAS-28 scores were decreased in the two groups (@*CONCLUSION@#Moxibustion combined with western medication can effectively relieve clinical symptoms, improve quality of life in RA patients, the curative effect is better than simple western medication. And its mechanism may be related to the regulation of serum level of Ca

Influence of different grafts on vision, corneal astigmatism and tear film function in patients with pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the influence of limbal conjunctival autograft and amniotic membrane transplantation on vision, corneal astigmatism(CAD)and tear film function in patients undergo pterygium surgery.<p>METHODS: Totally 96 patients(96 eyes)who had undergone pterygium surgery in the Department of Ophthalmology at Pengzhou People's Hospital were enrolled in this retrospective study between August 2018 and March 2020. According to random number table method, the patients were divided into observation group(48 patients with 48 eyes treated with pterygium excision combined with limbal conjunctival autograft)and control group(48 patients with 48 eyes treated with pterygium excision combined with amniotic membrane transplantation). General surgical indicators, uncorrected visual acuity(UCVA), tear film function \〖break-up time(BUT), SⅠt\〗, CAD, ocular surface disease index(OSDI), recurrence rate and incidence of complications were compared between the two groups.<p>RESULTS: The surgical time of observation group was longer than that of the control group, and the corneal epithelial healing time was shorter than that of the control group(<i>P</i><0.001). There was no significant difference in hospital stay or conjunctival hyperemia and edema remission time between the two groups(<i>P</i> >0.05). The UCVA of the two groups increased at 1, 3 and 6mo after surgery(<i>P</i><0.05), without statistically significant difference between groups(<i>P</i> >0.05). Compared with pre-operation, the BUT and SⅠt of both groups also increased, while CAD and OSDI scores decreased at 1, 3 and 6mo after surgery(<i>P</i><0.05). Besides, the BUT and SⅠt of observation group at 1mo after surgery were shorter/lower than control group, which were longer/higher than control group at 3 and 6mo after surgery(<i>P</i><0.05). However, there was no significant difference in CAD between the two groups(<i>P</i> >0.05). OSDI scores of the observation group were lower than those of the control group at 1, 3 and 6mo after surgery(<i>P</i><0.05). The recurrence rate of observation group within 6mo after surgery was lower than that of control group(<i>P</i><0.05), but the difference in incidence of complications was not significant(<i>P</i>>0.05).<p>CONCLUSION: Compared with amniotic membrane transplantation, limbal conjunctival autograft combined with pterygium excision applied in treatment of patients with pterygium can significantly shorten the corneal epithelial healing time, and reduce the influence on tear film function and recurrence rate, without affecting vision and corneal astigmatism. It is also safe and reliable.

Clinical efficacy of gabapentin or topiramate combined with venlafaxine in the treatment of chronic migraine with anxiety disorder / 中国医师进修杂志

Objective:To investigate the clinical efficacy and safety of gabapentin or topiramate combined with venlafaxine in the treatment of chronic migraine patients with generalized anxiety disorder.Methods:From June 2018 to February 2020, 127 patients with chronic migraine complicated with generalized anxiety disorder in the Second Affiliated Hospital of Guangxi Medical University were selected. The patients were divided into gabapentin combined with venlafaxine group (observation group, 64 cases) and topiramate combined with venlafaxine group (control group, 63 cases) according to the random number table method, and all patients were treated for 6 months. The headache attack days per month, headache visual analogue scale (VAS), migraine specific quality of life questionnaire V2.1 (MSQ V2.1), headache impact measurement-6 (HIT-6) score, Pittsburgh sleep quality index (PSQI) score were recorded before treatment and 3 and 6 months after treatment.Results:In observation group, 57 cases completed 3 months of treatment, and 53 cases completed 6 months of treatment. In the control group, 56 cases completed 3 months of treatment, and 50 cases completed 6 months of treatment. The headache attack days per month, headache VAS, HIT-6 and PSQI 3 and 6 months after treatment in 2 groups were significantly lower than those before treatment, observation group: (16.31 ± 5.02) and (15.69 ± 6.31) d vs. (22.62 ± 3.27) d, (3.67 ± 1.60) and (1.91±1.05) scores vs. (5.09 ± 1.43) scores, (49.34 ± 11.01) and (47.34 ± 9.05) scores vs. (60.25 ± 11.61) scores, (10.09 ± 2.81) and (9.68 ± 2.74) scores vs. (13.50 ± 2.81) scores; control group: (14.58 ± 7.37) and (9.92 ± 5.07) d vs. (23.05 ± 5.24) d, (4.74 ± 1.15) and (3.16 ± 1.60) scores vs. (5.90 ± 2.06) scores, (42.77 ± 8.02) and (40.09 ± 9.72) scores vs. (59.37 ± 9.08) scores, (9.66 ± 2.71) and (8.62 ± 2.07) scores vs. (14.61 ± 2.79) scores, and there were statistical differences ( P<0.05). The headache VAS 3 and 6 months after treatment in observation group was significantly lower than that in control group, and there was statistical difference ( P<0.05). The functional limitations, function loss, emotional function scores and total score of MSQ V2.1 3 and 6 months after treatment in 2 groups were significantly lower than those before treatment, observation group: (17.62 ± 9.81) and (16.01 ± 5.73) scores vs. (36.96 ± 9.55) scores, (12.17 ± 5.60) and (11.09 ± 3.27) scores vs. (17.06 ± 6.08) scores, (8.42 ± 2.17) and (8.94 ± 1.90) scores vs. (11.40 ± 4.09) scores, (33.24 ± 9.61) and (28.62 ± 5.04) scores vs. (62.75 ± 14.02) scores; control group: (17.08 ± 8.73) and (16.79 ± 5.19) scores vs. (36.82 ± 9.68) scores, (9.04 ± 4.48) and (8.90 ± 3.46) scores vs. (17.26 ±6.01) scores, (6.92 ± 2.61) and (5.15 ± 1.74) scores vs. (11.30 ± 5.47) scores, (31.65 ± 9.17) and (30.66 ± 6.04) scores vs. (62.91 ± 11.18) scores, and there were statistical differences ( P<0.05). There was no significant difference in the effective rate and the incidence of adverse drug reactions 3 and 6 months after treatment between 2 groups ( P>0.05). Conclusions:Gabapentin or topiramate combined with venlafaxine can reduce the degree of headache in chronic migraine patients with generalized anxiety disorder, reduce the number of headache days per month, improve sleep and improve the quality of life. However, the adverse reactions of gabapentin still need to be paid more attention.

Current situation and influence factors of suicidal self-injurious behavior in teenagers in Guangdong / 上海预防医学

Objective:To investigate the current situation of suicidal self-injurious behavior in teenagers and analyze its influencing factors. Methods:From January to November 2020， a stratified sampling method was used to investigate 707 teenagers in Guangdong. The “questionnaire of health-related behaviors of Chinese teenagers” compiled by the Chinese Center for Disease Control and Prevention was used anonymously to investigate the current situation of suicidal self-injurious behavior of the teenagers. The chi-square test was used for univariate analysis， and logistic regression was used for multivariate analysis. Results:The incidence rate of suicidal self-injurious behavior was 14.57% （103/707）. It was 13.31% （45/338） in males， 15.72% （58/369） in females， 13.83% （48/347） in junior high school students and 15.28% （55/360） in senior high school students. There was no statistical significance in the incidence of suicidal self-injurious behavior of teenagers between different genders， different learning stages， smoking or not， asexual behavior or not， gambling or not， and fighting or not （all P>0.05）. The incidence of suicidal self-injurious behaviors in teenagers from single parent family， drunkenness， runaway， loneliness， under great study pressure， lovelorn， and mobile phone addiction was significantly higher （χ2=13.809， 10.852， 14.279， 11.451， 12.893， 22.905， 19.473， respectively. All P<0.001）. Logistic regression analysis showed that the following were main risk factors affecting the incidence of suicidal self-injurious behavior in teenagers： single parent family （OR=3.826， 95%CI： 1.402-7.501）， drunkenness （OR=3.903， 95%CI： 1.512-7.368）， runaway （OR=3.447， 95%CI： 1.669-7.715）， loneliness （OR=3.613， 95%CI： 1.504-7.697）， great study pressure （OR=3.712， 95%CI： 1.387-7.604）， lovelorn（OR=4.125， 95%CI： 1.516-8.117） and mobile phone addiction（OR=4.027， 95%CI： 1.499-7.984 （all P<0.001）. Conclusion:The incidence of suicidal self-injurious behavior in teenagers is not low in Guangdong， and targeted measures should be developed to screen and intervene based on the influencing factors.