Application of different prognostic scores in liver transplantation decision-making for acute-on-chronic liver failure / 中华肝脏病杂志

Objective: To compare the impact of different prognostic scores in patients with acute-on-chronic liver failure (ACLF) in order to provide treatment guidance for liver transplantation. Methods: The information on inpatients with ACLF admitted at Beijing You'an Hospital Affiliated to Capital Medical University and the First Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to October 2022 was collected retrospectively. ACLF patients were divided into liver transplantation and non-liver transplantation groups, and the two groups prognostic conditions were followed-up. Propensity score matching was carried out between the two groups on the basis of liver disease (non-cirrhosis, compensated cirrhosis, and decompensated cirrhosis), the model for end-stage liver disease incorporating serum sodium (MELD-Na), and ACLF classification as matching factors. The prognostic condition of the two groups after matching was compared. The difference in 1-year survival rate between the two groups was analyzed under different ACLF grades and MELD-Na scores. The independent sample t-test or rank sum test was used for inter-group comparison, and the χ (2) test was used for the comparison of count data between groups. Results: In total, 865 ACLF inpatients were collected over the study period. Of these, 291 had liver transplantation and 574 did not. The overall survival rates at 28, 90, and 360 days were 78%, 66%, and 62%, respectively. There were 270 cases of matched ACLF post-liver transplantation and 270 cases without ACLF, in accordance with a ratio of 1:1. At 28, 90, and 360 days, patients with non-liver transplantation had significantly lower survival rates (68%, 53%, and 49%) than patients with liver transplantation (87%, 87%, and 78%, respectively; P < 0.001). Patients were classified into four groups according to the ACLF classification criteria. Kaplan-Meier survival analysis showed that the survival rates of liver transplantation and non-liver transplantation patients in ACLF grade 0 were 77.2% and 69.4%, respectively, with no statistically significant difference (P = 0.168). The survival rate with an ACLF 1-3 grade was significantly higher in liver transplantation patients than that of non-liver transplantation patients (P < 0.05). Patients with ACLF grades 1, 2, and 3 had higher 1-year survival rates compared to non-liver transplant patients by 50.6%, 43.6%, and 61.7%, respectively. Patients were divided into four groups according to the MELD-Na score. Among the patients with a MELD-Na score of < 25, the 1-year survival rates for liver transplantation and non-liver transplantation were 78.2% and 74.0%, respectively, and the difference was not statistically significant (P = 0.149). However, among patients with MELD-Na scores of 25-30, 30-35, and≥35, the survival rate was significantly higher in liver transplantation than that of non-liver transplantation, and the 1-year survival rate increased by 36.4%, 54.9%, and 62.5%, respectively (P < 0.001). Further analysis of the prognosis of patients with different ACLF grades and MELD-Na scores showed that ACLF grades 0 or 1 and MELD-Na score of < 30 had no statistically significant difference in the 1-year survival rate between liver transplantation and non-liver transplantation (P > 0.05), but in patients with MELD-Na score≥30, the 1-year survival rate of liver transplantation was higher than that of non-liver transplantation patients (P < 0.05). In the ACLF grade 0 and MELD-Na score of≥30 group, the 1-year survival rates of liver transplantation and non-liver transplantation patients were 77.8% and 25.0% respectively (P < 0.05); while in the ACLF grade 1 and MELD-Na score of≥30 group, the 1-year survival rates of liver transplantation and non-liver transplantation patients were 100% and 20.0%, respectively (P < 0.01). Among patients with ACLF grade 2, the 1-year survival rate with MELD-Na score of < 25 in patients with liver transplantation was 73.9% and 61.6%, respectively, and the difference was not statistically significant (P > 0.05); while in the liver transplantation patients group with MELD-Na score of ≥25, the 1-year survival rate was 79.5%, 80.8%, and 75%, respectively, which was significantly higher than that of non-liver transplantation patients (36.6%, 27.6%, 15.0%) (P < 0.001). Among patients with ACLF grade 3, regardless of the MELD-Na score, the 1-year survival rate was significantly higher in liver transplantation patients than that of non-liver transplantation patients (P < 0.01). Additionally, among patients with non-liver transplantation with an ACLF grade 0~1 and a MELD-Na score of < 30 at admission, 99.4% survived 1 year and still had an ACLF grade 0-1 at discharge, while 70% of deaths progressed to ACLF grade 2-3. Conclusion: Both the MELD-Na score and the EASL-CLIF C ACLF classification are capable of guiding liver transplantation; however, no single model possesses a consistent and precise prediction ability. Therefore, the combined application of the two models is necessary for comprehensive and dynamic evaluation, but the clinical application is relatively complex. A simplified prognostic model and a risk assessment model will be required in the future to improve patient prognosis as well as the effectiveness and efficiency of liver transplantation.

Advances in diagnosis and treatment of myocardial damage in childern DMD/BMD / 国际儿科学杂志

Duchenne/Becker muscular dystrophy(DMD/BMD)is a progressive, destructive neuromuscular disease.It is caused by mutations in the gene encoding dystrophy.The mutations come in various forms and the severity of the disease varies.The onset of the disease is insidious, and the initial manifestation is only abnormal serum enzymes.With the progression of the disease, the skeletal muscle and myocardial striated muscle cells are further destroyed, gait abnormalities and myocardial damage gradually appear, and eventually most children die of heart failure.At present, there is no effective radical cure.The existing treatment methods, including oral glucocorticoids and restoring functional dystrophin, are mostly limited to alleviate skeletal muscle symptoms, and are very limited to improve cardiac symptoms.This article reviews the progress in the diagnosis and treatment of myocardial damage in DMD/BMD, in order to provide reference for clinical research and gene therapy.

Clinicopathological characteristics of metastatic ovarian tumor from digestive system / 中国医师进修杂志

Objective:To investigate the clinicopathological features of metastatic ovarian tumors from digestive system.Methods:The clinicopathological and follow-up data of 21 patients with metastatic ovarian tumor from digestive system were collected from April 2006 to January 2020 in the Maternity Hospital of Dalian Women and Children′s Medical Group. The pathological slides were reviewed, immunostained by EnVision method, and the clinicopathological features were summarized.Results:Twenty-one cases, aging from 26 to 66 years (average 41.5 years), were treated with chief complaint of abdominal pain, menstrual disorder or pelvic mass. The incidence of bilateral ovarian tumor was 81.0% (17/21), with a diameter of 0.2 to 20.0 cm. Most of tumors were solid and cystic, nodular or lobulated. Microscopically, tumor cells diffusely infiltrated ovarian stroma, accompanied with stromal proliferation and luteinization obviously. Metastatic gastric cancers were mainly signet-ring cell carcinomas, with cytokeratin 7 (CK7) positive, tail homeobox transcription factor 2 (CDX2) and cytokeratin 20 (CK20) partially positive, paired-box gene 8 (PAX8) and special AT-rich sequence binding protein 2 (SATB2) negative; metastatic colorectal cancers were mainly characterized by atypical glands, forming single cells or cribriform structure; metastatic appendix tumors were mostly low-grade tumor cells similar to ovarian borderline tumors and abundant extracellular mucinous, accompanied by peritoneal pseudomyxoma. The CK7 and PAX8 were negative, while the CK20, CDX2 and SATB2 were positive in patients with metastatic ovarian tumor from colorectal cancer and appendix tumor. The average follow-up time was 36 months, 18 patients relapsed within 5 years, 15 patients died; 3 patients were lost to follow-up.Conclusions:The ovarian metastatic tumors from digestive system are mostly bilateral, mainly solid and cystic. Microscopically, they show diffuse interstitial infiltration of tumor cells. The diagnosis should be combined with medical history, clinical symptoms, gross and histological features of tumor and immunohistochemistry, which should be mainly differentiated from primary mucinous ovarian tumor. The overall prognosis is poor.

Preliminary practice in the postoperative cardiopulmonary exercise testing for children with congenital heart disease / 中华心血管病杂志

Objective: To investigate the postoperative cardiopulmonary fitness of children with congenital heart diseases (CHD). Methods: This is a retrospective study. A total of 136 children after cardiac correction undergoing cardiopulmonary exercise test (CPET) in Shanghai Children's Medical Center from March 1 to June 30, 2021 were selected. According to the surgical procedure, the children were divided into two groups: the biventricular correction group (BV group) (n=75) and single ventricular correction group (SV group) (n=61). The BV group was divided into two subgroups: simple congenital heart disease (S-CHD) group (n=35) and complex congenital heart disease (C-CHD) group (n=40). CPET parameters, including VO2 max, VO2/kg max, VO2/kg@AT, O2/HR max, HRR, PetCO2 max, CI, HRR at 1 min, VE/VCO2 slope, OUES/kg and EOV, were analyzed. CPET parameters of patients underwent different procedure were compared. In the subgroup analysis, CPET parameters of patients in S-CHD group and C-CHD group were compared. The parameters of the BV group were compared with the normal value. Linear correlation analysis was used to identify the correlation between the CPET parameters. Results: A total of 136 children with CHD after surgery were enrolled. The age was (9.4±3.1) (ranged 6.2-16.0) years, and there was 84 (61.8%) male. All the children completed CPET examination safely without experiencing serious circulation abnormalities. Compared with the SV group, the VO2/kg max ((32.6±6.9) ml·kg-1·min-1 vs. (23.5±5.9) ml·kg-1·min-1, P<0.001), O2/HR max ((7.24±2.93) ml/beat vs. (6.35±2.17)ml/beat, P=0.030), HRR at 1 min ((32.5±13.9) beat/min vs. (26.3±12.5) beat/min, P=0.036), OUES/kg (36.9±8.8 vs. 29.7±11.8, P=0.001) were significantly higher, VE/VCO2 slope (29.1±5.20 vs. 35.1±8.0, P<0.001) and incidence of EOV (32.0%(24/75) vs. 57.4%(31/61), P=0.027) were significantly lower in BV group. Compared with the simple CHD subgroup, VE/VCO2 slope and the incidence of EOV were higher, VO2/kg max, O2/HR max, HRR at 1 min and OUES/kg were lower in the complex CHD subgroup (all P<0.05). Cardiopulmonary function parameters of the BV group were lower than the normal value. Linear correlation analysis showed that VO2/kg@AT was strongly correlated with VO2/kg max (r=0.86, P<0.001), VO2/kg max was strongly correlated with OUES/kg (r=0.63, P<0.001), HRR was strongly correlated with CI (r=0.91, P<0.001), and VO2/kg max was strongly correlated with OUES/kg (r=0.63, P<0.001). VE/VCO2 slope was strongly correlated with PetCO2 max (r=1.00, P<0.001). Conclusions: The exercise cardiopulmonary function of children after single ventricular correction is weaker than that of biventricular correction, and the exercise tolerance of children after biventricular correction is lower than that of normal children. Among the children after biventricular correction, the exercise tolerance of children with complex CHD is lower than that of children with simple CHD. Postoperative CPET is of important realistic significance for CHD children.

Clinicopathological characteristics of primary ovarian mucinous adenocarcinoma / 中国医师进修杂志

Objective To investigate the clinicopathological characteristics of primary ovarian mucinous adenocarcinoma.Methods The clinical data of 28 patients with primary ovarian mucinous adenocarcinoma from April 2006 to December 2018 in Dalian Maternity Hospital Affiliated to Dalian Medical University were retrospectively analyzed.The pathological sections were reviewed,and the clinicopathological characteristics were analyzed by immunohistochemical staining.Results Among 28 patients,the average age of patients was 46.5 (22 to 64) years.Ten cases were found by health examination,15 cases showed lower abdominal discomfort,and 3 cases had irregular vaginal bleeding.Pelvic ultrasound examination showed heterogeneous internal echoes in adnexal region,and serum tumor marker levels did not significantly increase.The diameters of tumors were 8 to 32 cm,with an average of 16.5 cm.The unilateral ovarian tumor was in 26 cases,and bilateral ovarian tumor was in 2 cases.Most of tumors were solid-cystic with viscous liquid or jelly-like substance inside the cystic,accompanied with solid papillae or nodules.Microscopically,tumors were composed with gastrointestinal epithelium.Eighteen cases had borderline mucinous tumors with focal fusion infiltrating carcinoma;10 cases had fusion infiltrating carcinoma dominant,while there were 2 cases whose tumor exhibited focal invasive infiltration.Immunohistochemical result showed that the positive rates of cytokeratin (CK) 7,CK20 and tail-type homeobox gene (CDX) 2 were 100.0％ (28/28),71.4％ (20/28) and 53.6％ (15/28);the positive rates of paired box gene (PAX) 8 and special AT-rich sequence-binding protein (SATB) 2 were 14.3％ (4/28) and 10.7％ (3/28).According to the ovarian carcinoma stage standard of International Federation of Gynecology and Obstetrics (FIGO) 2014,Ⅰ stage was in 21 cases,Ⅱ stage in 4 cases,Ⅲ stage in 2 cases,and Ⅳ stage in 1 case.The patients were followed up for 3 to 120 months,with an average of 55 months.No recurrence or metastasis was in 17 cases (FIGO Ⅰ stage 16 cases,FIGO Ⅱ stage 1 case);recurrent within 2 years was in 5 cases (FIGO Ⅱ stage 2 cases,Ⅲ stage 2 cases,Ⅳ stage 1 case),of which 4 cases died within 5 years (FIGO Ⅱ stage 1 case,Ⅲ stage 2 cases,Ⅳ stage 1 case);lost to follow-up was in 6 cases (FIGO Ⅰ stage 5 cases,FIGO Ⅱ stage 1 case).Conclusions Primary ovarian mucinous adenocarcinoma is rare,and it has no specific clinical symptoms.It is mainly characterized by fusion infiltration.Immunohistochemical result shows that CK7 is always positive,the expressions of CK20 and CDX2 are different degree,and SATB2 and PAX-8 are mostly negative.Prognosis is closely related with FIGO stage,and the patients with FIGO Ⅰ stage have good prognoses,Ⅲ and Ⅳ stage have poor prognoses.It should be distinguished from ovarian metastatic mucinous tumor.

COVID-19 patient firstly visiting eye doctor due to tarsadenitis and subconjunctival hemorrhage: A case report / 中华实验眼科杂志

A 35-year-old female patient with a history of significant epidemiological exposure firstly visited eye doctor due to acute tarsadenitis in the right eye.Subsequently, she developed subconjunctival hemorrhage, fever and cough and received topical administration of antibiotics and systemic treatment of antiviral drug.Shortly thereafter, both his mother and father, who denied COVID-19 associated epidemiological history, appeared fever, fatigue and other symptoms and diagnosed as COVID-19.This female patient was diagnosed as COVID-19 by CT image of lung and COVID-19 RNA detection 17 days and 24 days after firstly visited eye doctor, respectively, and received specialized isolation treatment.The symptoms of COVID-19 are very varied, eye doctors should keep alert and pay attention to personal protection.

Association between recurrent corneal erosion syndrome and Demodexinfestation or meibomian gland dysfunction / 中华实验眼科杂志

Objective:To investigate the effect of Demodex palpebralis infestation and meibomian gland dysfunction(MGD) on the incidence of recurrent corneal erosion syndrome (RCES).Methods:A case-control study was performed.Thirty eyes of 30 RCES patients were enrolled from January to June 2018 in Hanyang Hospital of Wuhan Aier Eye Hospital, and served as the RCES group.Thirty-one eyes of 31 simple ametropia patients with matched age and gender were enrolled at the same time and served as the control group.Eyelash microscopic examination was performed for Demodex counting, slit-lamp examination was performed to observe the condition of meibomian gland.Keratograph 5M examination was performed to detect the morphological changes in the meibomian glands.This study was approved by the Ethics Committee of Wuhan Aier Eye Hospital.All subjects were aware of the method and purpose of this study.Results:The average meibomian glands score was 4(3, 4) in the RCES group, which was significantly higher than 2(1, 3) in the control group (Z=-4.55, P=0.00). The average meibomian gland secretion score was 15.5(11.0, 16.8) in the RCES group, which was significantly higher than 8.0(5.5, 10.0) in the control group (Z=-3.97, P=0.00). The average Demodex numbers was 8(4, 9) and 0(0, 2) in the RCES and control groups, respectively, with a significant difference between them (Z=-4.13, P<0.00). The average Demodex infection rate was 83.3% (25/30) and 38.7% (12/31) in the RCES and the control groups, respectively (χ 2=7.60, P<0.01). The recurrence frequency showed a positive correlation with the meibomian glands scores (r s=0.70, P<0.01), meibomian gland secretion scores (r s=0.47, P=0.04) and Demodex numbers (r s=0.73, P<0.01). Conclusions:The infection rate of Demodex palpebralis and the degree of MGD are obviously elevated in RCES patients, and are associated with the relapse frequency of RCES.

Long-term efficacy and adverse reactions of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma in non-endemic northwest China / 中华放射肿瘤学杂志

Objective@#To retrospectively analyze the characteristics of nasopharyngeal carcinoma, long-term efficacy, adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade.@*Methods@#Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed. All patients were treated with IMRT. The survival analysis was performed by Kaplan-Meier method. The multivariate analysis was conducted with Cox’s regression model.@*Results@#In non-endemic northwest China, a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma, and a majority of them were pathologically characterized as differentiated subtypes. The 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7%, 70.1%, 91.2%, 97.0% and 81.0%, respectively. Multivariate analysis showed that age, pathological type, nasopharyngeal tumor volume>23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P<0.05). Age, pathological type, neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P<0.05). N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P<0.05).@*Conclusions@#Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area. Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.

Clinicopathological characteristics of primary ovarian mucinous adenocarcinoma / 中国医师进修杂志

Objective@#To investigate the clinicopathological characteristics of primary ovarian mucinous adenocarcinoma.@*Methods@#The clinical data of 28 patients with primary ovarian mucinous adenocarcinoma from April 2006 to December 2018 in Dalian Maternity Hospital Affiliated to Dalian Medical University were retrospectively analyzed. The pathological sections were reviewed, and the clinicopathological characteristics were analyzed by immunohistochemical staining.@*Results@#Among 28 patients, the average age of patients was 46.5 (22 to 64) years. Ten cases were found by health examination, 15 cases showed lower abdominal discomfort, and 3 cases had irregular vaginal bleeding. Pelvic ultrasound examination showed heterogeneous internal echoes in adnexal region, and serum tumor marker levels did not significantly increase. The diameters of tumors were 8 to 32 cm, with an average of 16.5 cm. The unilateral ovarian tumor was in 26 cases, and bilateral ovarian tumor was in 2 cases. Most of tumors were solid-cystic with viscous liquid or jelly-like substance inside the cystic, accompanied with solid papillae or nodules. Microscopically, tumors were composed with gastrointestinal epithelium. Eighteen cases had borderline mucinous tumors with focal fusion infiltrating carcinoma; 10 cases had fusion infiltrating carcinoma dominant, while there were 2 cases whose tumor exhibited focal invasive infiltration. Immunohistochemical result showed that the positive rates of cytokeratin (CK) 7, CK20 and tail-type homeobox gene (CDX) 2 were 100.0% (28/28), 71.4% (20/28) and 53.6% (15/28); the positive rates of paired box gene (PAX) 8 and special AT-rich sequence-binding protein (SATB) 2 were 14.3%(4/28) and 10.7% (3/28). According to the ovarian carcinoma stage standard of International Federation of Gynecology and Obstetrics (FIGO) 2014, Ⅰ stage was in 21 cases, Ⅱstage in 4 cases, Ⅲ stage in 2 cases, and Ⅳ stage in 1 case. The patients were followed up for 3 to 120 months, with an average of 55 months. No recurrence or metastasis was in 17 cases (FIGO Ⅰ stage 16 cases, FIGO Ⅱ stage 1 case); recurrent within 2 years was in 5 cases (FIGO Ⅱ stage 2 cases, Ⅲ stage 2 cases, Ⅳ stage 1 case), of which 4 cases died within 5 years (FIGO Ⅱ stage 1 case, Ⅲ stage 2 cases, Ⅳ stage 1 case); lost to follow-up was in 6 cases (FIGO Ⅰ stage 5 cases, FIGO Ⅱ stage 1 case).@*Conclusions@#Primary ovarian mucinous adenocarcinoma is rare, and it has no specific clinical symptoms. It is mainly characterized by fusion infiltration. Immunohistochemical result shows that CK7 is always positive, the expressions of CK20 and CDX2 are different degree, and SATB2 and PAX-8 are mostly negative. Prognosis is closely related with FIGO stage, and the patients with FIGO Ⅰ stage have good prognoses, Ⅲ and Ⅳ stage have poor prognoses. It should be distinguished from ovarian metastatic mucinous tumor.

Comparison of GP and TP induction chemotherapy combined with concurrent radiochemotherapy for locally advanced nasopharyngeal carcinoma in the non-endemic of Northwest China: A prospective single center phase Ⅱ clinical study / 西安交通大学学报(医学版)

Objective: To explore the curative effect and adverse reactions of GP induction chemotherapy combined with chemoradiation contrast TP induction for local advanced nasopharyngeal carcinoma in the non-endemic of Northwest China, our center conducted the prospective, single-center, randomized controlled clinical research so as to clarify GP regimenvalue of induction chemotherapy in local advanced nasopharyngeal carcinoma treatment. Methods: We randomly assigned patients with newly diagnosed stage III-b patients to GP regimen of induction chemotherapy in combination with concurrent chemoradiotherapy and TP. Induction chemotherapy was given 2-3 cycles. Cisplatin regimen chemotherapy was given every 3 weeks and 1-3 cycles during radiotherapy. We compared the differences in tumor shrinkage and survival between the two groups and evaluated the toxicity and compliance of the two induction chemotherapy regimens. Results: A total of 72 patients were enrolled in this study, including 34 patients in GP group and 38 patients in TP group. The general clinical data of the two groups were balanced. Short-term efficacy evaluation showed no difference between the TP group and the GP group in terms of nasopharyngeal disease and ORR of cervical lymph nodes either after induction or concurrent chemoradiotherapy. The median follow-up time of the whole group was 74.8 months(0.8-108.9 months), and the 5-year DMFS of the GP group and the TP group was 83.9% and 76.5% (χ2=4.140, P=0.042), respectively. The difference was statistically significant. During the induction chemotherapy, the incidence of neutropenia, leukopenia and thrombocytopenia in the GP group was higher than that in the TP group (P<0.05). There was no difference between the two groups in other acute or late toxic or side effects. Results: In local advanced nasopharyngeal carcinoma in non-endemic regions of Northwest China, long-term efficacy of GP chemotherapy is better than that of TP chemotherapy. During the treatment, acute hematological toxicity of GP regimen group was heavier than that of TP group, but the compliance of subsequent chemoradiotherapy was not affected after symptomatic treatment. The late toxicity was equivalent to that of the two groups, and the treatment tolerance was acceptable.

Capecitabine maintenance in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective study / 中国肿瘤临床

Objective: The efficacy of sequential capecitabine maintenance chemotherapy after radical chemoradiotherapy for stage N2- 3 nasopharyngeal carcinoma in non- endemic areas of northwest China was retrospectively analyzed to clarify the value of capecitabine maintenance chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Methods: From Jannary 2014 to December 2016, patients with stage N2-3 nasopharyngeal carcinoma underwent 2 or 3 cycles of induction chemotherapy combined with concurrent chemoradiotherapy. The study group continued to receive capecitabine for 4 cycles of chemotherapy after radical chemoradiotherapy, whereas the control group was only observed. The survival differences between the two groups were compared, and the toxicity and compliance of the two regimens were evaluated. Result: A total of 179 patients were included in this study, among whom 84 were included in the maintain chemotherapy group and 95 in the control group. The median follow-up time was 44.4 (5.97-70.26) months. The 3-year distant metastasis-free survival rates and 3-year disease-free survival rates were 79.3% and 68.1% (chi-square=3.898, P=0.048) and 75.6% and 64.2% (chi-square=5.428, P=0.020) for the maintain chemotherapy and control groups, respectively. The differences were statistically significant. There was no difference between the two groups in acute and late toxicity (P> 0.05). The toxicity of capecitabine-specific drugs was below grade 2. Conclusions: For N2-3 stage nasopharyngeal carcinoma in non-endemic areas in northwest China, the 3- year distant metastasis- free survival and disease- free survival rates following sequential capecitabine maintenance therapy after radical radiotherapy and chemotherapy are improved. Treatment was well-tolerated, and compliance was good, with no obvious adverse reactions.

Reinforcement of Rhodobacter sphaeroides cofactor NADPH to increase the production of farnesol / 生物工程学报

Farnesol (FOH) is produced by dephosphorylation of farnesyl diphosphate (FPP) derived from two universal building blocks, dimethylallyl diphosphate (DMAPP) and isopentenyl diphosphate (IPP). In Rhodobacter sphaeroides these building blocks are generated by MEP pathway, however, many of the biosynthetic reactions and biotransformations in the MEP pathway are limited by low availability of NADPH. Improvement of the amount of intracellular NADPH may enhance the synthesis of FOH. In this study, we utilized the strategies of increasing the production of NADPH and decreasing the consumption of NADPH. The expression of glucose 6-phosphate isomerase (pgi) and glutamate dehydrogenase (gdhA) were inhibited by RNA interference, respectively, and overexpression of 6-glucose phosphate dehydrogenase (zwf) and 6-glucose phosphate dehydrogenase (gnd) in the pentose phosphate pathway were carried out. The results showed that the content of NADPH in the recombinant strains increased significantly, the highest FOH production of RSpgii in the RNA interfered strain was 3.91 mg/g, and the FOH production increased to 3.43 mg/g after zwf gene and gnd gene has been overexpressed. In order to obtain strains with higher FOH production, we used RSpgii as the starting strain, and zwf, gnd and co-overexpressed zwf + gnd gene were overexpressed in RSpgii, respectively. The highest FOH production of the strain RSzgpi reached to 4.48 mg/g which was 2.24 times that of the starting strain RS-GY2.

Effect of wearing overnight orthokeratology lens on the meibomian gland and detection rate of Demodex / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the effect of different time of wearing overnight orthokeratology lens(OOK lens)on the meibomian gland and detection rate of demodex.<p>METHODS:Case-control study. Totally 47(91 eyes)patients who wearing keratoscopy were enrolled from June 2019 to December 2019 in Hanyang Aier Eye Hospital. According to the wearing time, they were divided into short-term group(wearing time <2a)and long-term group(wearing time≥2a). Meanwhile, patients wearing frame glasses with gender, age and diopter matching with the two groups above were selected as the control group. All patients had non-invasive tear film rupture time(NI-BUT)examination, meibomial gland infrared photography, bulbar redness score(BRS), and eyelash sampling.<p>RESULTS: The three groups of NI-BUT were 12.68±4.59s, 12.37±4.97s, 10.45±6.04s,(<i>P</i>>0.05). BRS respectively were 0.99±0.41, 0.90±0.37, 0.84±0.35,(<i>P</i>>0.05). Meibomian gland score for all three groups: 1(0, 1)(<i>P</i>>0.05). In the three groups, the detection rate and quantity of demodex were 42%, 1(1, 2); 39%, 2(1, 2); 33%, 1(1, 2),(<i>P</i>>0.05). Among the patients with corneal staining, 5 were mite positive and 11 were mite negative(<i>P</i>>0.05). Meibomian gland score: 4 eyes were 0 grade, 12 eyes were 1 grade above(<i>P</i>>0.05). Short-term group 6 eyes, long-term group 10 eyes(<i>P</i>>0.05). <p>CONCLUSION:There was no significant effect on meibomian gland, the detection rate and quantity of demodex in patients wearing OOK lens. Whereas no significant relationship between meibomian gland score/ demodex detection rate and corneal staining.

Long-term efficacy and adverse reactions of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma in non-endemic northwest China / 中华放射肿瘤学杂志

Objective To retrospectively analyze the characteristics of nasopharyngeal carcinoma,long-term efficacy,adverse reactions of intensity-modulated radiotherapy (IMRT) in non-endemic northwest China and summarize the experience of IMRT in the treatment of nasopharyngeal carcinoma in the past decade.Methods Clinical data of 658 patients newly diagnosed with nasopharyngeal carcinoma without distant metastasis admitted to First affiliated hospital from January 2006 to December 2016 were retrospectively analyzed.All patients were treated with IMRT.The survival analysis was performed by Kaplan-Meier method.The multivariate analysis was conducted with Cox's regression model.Results In non-endemic northwest China,a large proportion of patients were newly diagnosed with locally advanced nasopharyngeal carcinoma,and a majority of them were pathologically characterized as differentiated subtypes.The 5-year overall survival (OS),disease-free survival (DFS),local recurrence-free survival (LRFS),regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates were 75.7％,70.1％,91.2％,97.0％ and 81.0％,respectively.Multivariate analysis showed that age,pathological type,nasopharyngeal tumor volume＞23 cm3 and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DFS (all P＜0.05).Age,pathological type,neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of OS (all P＜0.05).N stage and neck lymph node metastasis complicated with necrosis were the factors of poor prognosis of DMFS (both P＜0.05).Conclusions Similar clinical efficacy has been achieved in terms of IMRT for nasopharyngeal carcinoma in non-endemic northwest China compared with that in endemic area.Induction chemotherapy combined with concurrent radiochemotherapy can provide clinical benefits for patients with locally advanced nasopharyngeal carcinoma in non-endemic area.

A study on MRI dynamic functional connectivity based on independent component analysis in patients with neuropsychiatric systemic lupus erythematosus / 中华放射学杂志

Objective:To investigate the abnormal dynamic characteristics of brain functional connectivity in patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and its correlation with clinical indicators by using dynamic functional connectivity (dFC) analysis based on independent component analysis (ICA).Methods:The clinical and imaging data of female NPSLE patients diagnosed in the First Affiliated Hospital of Zhengzhou University from July 2018 to September 2019 were prospectively collected. The levels of complement C3, C4, CH50, glucocorticoid prednisone dosage, systemic lupus erythematosus disease activity index (SLEDAI) score and Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI) score were recorded. Age and sex matched healthy controls (HC) were enrolled at the same time. All subjects underwent resting state functional MRI (rs-fMRI). The spatial group independent component analysis was performed on MRI data using GIFT software, and 29 independent components (IC) were selected as internal connectivity network; five functional connectivity states and three dFC indexes (fraction time, mean dwell time, number of transitions) were obtained by using sliding time window technology. Two independent sample t test was used to calculate the difference of functional connectivity in different states. Mann-Whitney U test was used to calculate the difference of dFC indexes between groups. Spearman correlation analysis was used to calculate the correlation between dFC index and clinical data in NPSLE group. Results:A total of 45 NPSLE patients and 35 HC patients were enrolled. There was no significant difference in age and education level between the two groups ( t=-0.327, -0.460, P>0.05). Compared with HC group, NPSLE group had higher fraction time and longer mean dwell time ( Z=-2.496, -2.462, P<0.05); in state3 strong connection, compared with HC group, functional connectivity (FC) between posterior cerebellar lobe (IC39) and basal ganglia (IC10) was enhanced ( t=-5.201, P<0.05); FC was found decreased between posterior cerebellar lobe (IC39) and temporal lobe (IC5), temporal lobe (IC7), superior parietal lobe (IC65) ( t=4.212, 5.572, 4.415, P<0.05), as well as between paracentral lobular region (IC12) and posterior cingulate gyrus (IC15) ( t=3.893, P<0.05) in NPSLE group. The SDI score of NPSLE patients was negatively correlated with the fraction time and mean dwell time of state1 and state3 strong connection state ( P<0.05), and the SLEDAI score was negatively correlated with the fraction time and mean dwell time of state1 and state2 ( P<0.05). The SDI and SLEDAI scores were positively correlated with the fraction time and mean dwell time of state4 weak connection state, respectively ( P<0.05). The levels of serum complement C3, C4 and CH50 in NPSLE patients were positively correlated with the number of transitions ( r=0.428, 0.354, 0.385, P<0.05), and the dosage of prednisone was negatively correlated with the number of transitions ( r=-0.466, P<0.05). The validation analysis results showed the experimental results could be effectively repeated. Conclusion:The dFC analysis method based on ICA can effectively identify the alterations of brain functional connectivity on a shorter time scale, which may provide a new perspective for further exploration of the neuroimaging mechanism of cognitive impairment in NPSLE.

Ultrasound assessment of gastric insufflation in obese patients receiving transnasal humidified rapid-insufflation ventilatory exchange during general anesthesia induction / 南方医科大学学报

OBJECTIVE@#To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.@*METHODS@#Ninety obese patients (BMI 30-39.9 kg/m@*RESULTS@#The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (@*CONCLUSIONS@#Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.

Motif study of brain directed functional network in first-episode schizophrenia / 中国神经精神疾病杂志

Objective To investigate the difference of the motif patterns in brain directed functional network between first-episode schizophrenia patients and healthy controls, and to analysis the alterations of the underlying information flow patterns in patient networks. Methods The resting-state functional MRI data were collected from 44 first-episode schizophrenia patients and 39 healthy controls. The convergent cross mapping approach was employed to measure the causality connections between brain regions, and the directed functional networks were constructed. The calculations of the frequency and probability spectrum of all motif classes were performed at both whole brain and modular connected level. The between-group difference was then calculated. Results Compared with healthy controls, the frequency spectrum values of all motif classes in schizophrenia were significantly reduced (P＜0.05, FDR corrected), the Z scores of frequency spectrum of were decreased in chain-like motifs and increased in loop-like motifs. In the two groups, the probability values were higher at modular level than at whole brain level in two loop-like motifs (P＜0.05). Conclusion The present study revealed a loss in brain directed functional connections and abnormal alterations in the basic information flow patterns in first-episode schizophrenia brain.

Recent progress on obesity-induced myocardial remodeling and its possible mechanism of mitochondrial dyshomeostasis / 生理学报

Obesity is an important risk factor for cardiovascular diseases, which can lead to a variety of cardiovascular diseases including myocardial remodeling. Obesity may induce myocardial dysfunction by affecting hemodynamics, inducing autonomic imbalance, adipose tissue dysfunction, and mitochondrial dyshomeostasis. The key necessary biochemical functions for metabolic homeostasis are performed in mitochondria, and mitochondrial homeostasis is considered as one of the key determinants for cell viability. Mitochondrial homeostasis is regulated by dynamic regulation of mitochondrial fission and fusion, as well as mitochondrial cristae remodeling, biogenesis, autophagy, and oxidative stress. The mitochondrial fission-fusion and morphological changes of mitochondrial cristae maintain the integrity of the mitochondrial structure. The mitochondria maintain a "healthy" state by balancing biogenesis and autophagy, while reactive oxygen species can act as signaling molecules to regulate intracellular signaling. The excessive accumulation of lipids and lipid metabolism disorder in obesity leads to mitochondrial dyshomeostasis, which activate the apoptotic cascade and lead to myocardial remodeling. In this review, we provide an overview of the recent research progress on obesity-induced myocardial remodeling and its possible mechanism of mitochondrial dyshomeostasis.

Clinicopathological features of ovarian borderline seromucinous tumor / 中国医师进修杂志

Objective To investigate the clinicopathological features of ovarian borderline seromucinous tumor. Methods The clinical data of 22 ovarian borderline seromucinous tumor from April 2015 to March 2018 were retrospectively analyzed. The clinicopathological features were summarized by immunohistochemical staining with EnVision method. Results The age of patients was 23 to 66 years, with an average age of 39.2 years and a median age of 36 years. In the 22 patients, 14 patients were found by physical examination, 7 patients had abdominal discomfort or irregular vaginal bleeding, 4 patients had a history of dysmenorrheal, and 5 patients had cancer antigen 125 and/ or carcinoembryonic antigen elevation. Ultrasonography revealed mass in the adnexal region. The average diameter of these tumors was 7.2 cm. The tumors were cystic or cystic solid property and contained viscid or hemorrhagic fluid, with endogenous or exogenous papilla. Microscopically, these tumors showed complex papillary architecture and the larger papillae tended to have edematous stroma containing neutrophils. The epithelium lining the papillae was typically stratified and mostly composed of endocervical-type mucinous or serous epithelium, but endometrioid epithelium was not unusual. Eleven patients had endometriosis, and 2 cases occurred peritoneal or omental tumor implantation respectively. Immunohistochemistry showed that the estrogen receptor (ER), progesterone receptor (PR), paired box gene (PAX) 8 and cytokeratin (CK) 7 were positive in different degrees, and the CK20 and tail-type homeobox gene (CDX) 2 were negative in all patients. Twenty patients were International Federation of Gynecology and Obstetrics (FIGO)Ⅰstage without recurrence or metastasis in 3 to 36 months (average 13.6 months)′ follow-up. Conclusions Most patients with the ovarian borderline seromucinous tumor are young without specific clinical symptoms. Tumor is associated with endometriosis and maybe has characteristic histological changes. Attention should be paid to the differentiation from borderline serous and mucinous tumor before the final diagnosis. Most patients with ovarian borderline seromucinous tumor are FIGO Ⅰ stage and have the good prognosis. The clinical treatment is referred to the treatment of borderline endometrioid tumors.

Five cases of ovarian malignant tumor with thyroid component and literature review / 中国医师进修杂志

Objective To investigate the clinicopathological features of ovarian malignant tumor with thyroid components. Methods The clinical and pathological data of ovarian malignant tumor withthyroid component were collected from May 2006 to March 2018, including four cases of stroumal carcinoid and one case of metastatic thyroid follicular carcinoma, and the related literature was also reviewed. Results Ages of 5 cases ranged from 25 to 65 years old, and pelvic mass or abdominal discomfort was presented in physical examination. Tumors were unilateral, and mainly on the left side. The diameter of tumors was 5 to 13 cm with cyst or solid mainly. The strumal and carcinoid components were seen in strumal carcinoid. The insular and trabecular carcinoid were the common types of carcinoid. The synaptophysin (Syn) and chromogranin (CgA) were positive by immunohistochemistry. The patient with metastatic thyroid follicular carcinoma of ovary had a history of thyroid nodules for 13 years and the tumor grew rapidly in a short time. Under the microscope, dense thyroid follicles were arranged in papillary or diffuse distribution. Tumor cells were rich in eosinophilic cytoplasm and accompanied by follicular cell tumor-like hyperplasia. Conclusions Papillary tumor and strumal carcinoid are the most common primary malignant tumors of ovary with thyroid component, which both presented low malignancy and good prognosis. Ovarian metastasis from thyroid cancer is extremely rare and needs to be differentiated from primary ovarian thyroid cancer.