Value of number of negative lymph nodes in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model / 中华消化外科杂志

Objective:To investigate the value of number of negative lymph nodes (NLNs) in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 924 patients with esophageal cancer after neoadjuvant therapy uploaded to the Surveillance, Epidemiology, and End Results Database of the National Cancer Institute from 2004 to 2015 were collected. There were 1 624 males and 300 females, aged 63 (range, 23?85)years. All 1 924 patients were randomly divided into the training dataset of 1 348 cases and the validation dataset of 576 cases with a ratio of 7:3 based on random number method in the R software (3.6.2 version). The training dataset was used to constructed the nomogram predic-tion model, and the validation dataset was used to validate the performance of the nomogrram prediction model. The optimal cutoff values of number of NLNs and number of examined lymph nodes (ELNs) were 8, 14 and 10, 14, respectively, determined by the X-tile software (3.6.1 version), and then data of NLNs and ELNs were converted into classification variables. Observation indicators: (1) clinicopathological characteristics of patients in the training dataset and the validation dataset; (2) survival of patients in the training dataset and the validation dataset; (3) prognostic factors analysis of patients in the training dataset; (4) survival of patients in subgroup of the training dataset; (5) prognostic factors analysis in subgroup of the training dataset; (6) construction of nomogram prediction model and calibration curve. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Based on the results of multivariate analysis, the nomogram prediction model was constructed. The prediction efficacy of nomogram prediction model was evaluated using the area under curve (AUC) of the receiver operating characteristic curve and the Harrell′s c index. Errors of the nomogram prediction model in predicting survival of patients for the training dataset and the validation dataset were evaluated using the calibration curve. Results:(1) Clinicopathological characteristics of patients in the training dataset and the validation dataset. There was no significant difference in clinicopatholo-gical characteristics between the 1 348 patients of the training dataset and the 576 patients of the validation dataset ( P>0.05). (2) Survival of patients in the training dataset and the validation dataset. All 1 924 patients were followed up for 50(range, 3?140)months, with 3-year and 5-year cumulative survival rate as 59.4% and 49.5%, respectively. The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the training dataset was 46.7%, 62.0% and 66.0%, respectively, and the 5-year cumulative survival rate was 38.1%, 52.1% and 59.7%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=33.70, P<0.05). The 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 in the validation dataset was 51.1%, 54.9% and 71.2%, respectively, and the 5-year cumulative survival rate was 39.3%, 42.5% and 55.7%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=14.49, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the training dataset was 53.9%, 60.0% and 62.7%, respectively, and the 5-year cumulative survival rate was 44.7%, 49.1% and 56.9%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=9.88, P<0.05). The 3-year cumulative survival rate of patients with number of ELNs as <10, 10?14 and >14 in the validation dataset was 56.2%, 47.9% and 69.3%, respectively, and the 5-year cumula-tive survival rate was 44.9%, 38.4% and 51.9%, respectively. There was a significant difference in the survival of these patients in the validation dataset ( χ2=9.30, P<0.05). (3) Prognostic factors analysis of patients in the training dataset. Results of multivariate analysis showed that gender, neoadjuvant pathological (yp) T staging, ypN staging (stage N1, stage N2, stage N3) and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=0.65, 1.44, 1.96, 2.41, 4.12, 0.69, 0.56, 95% confidence interval as 0.49?0.87, 1.17?1.78, 1.59?2.42, 1.84?3.14, 2.89?5.88, 0.56?0.86, 0.45?0.70, P<0.05). (4) Survival of patients in subgroup of the training dataset. Of the patients with NLNs in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 61.1%, 71.6% and 76.8%, respectively, and the 5-year cumulative survival rate was 50.7%, 59.9% and 70.1%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=12.66, P<0.05). Of the patients with positive lymph nodes in the training dataset, the 3-year cumulative survival rate of patients with number of NLNs as <8, 8?14 and >14 was 26.1%, 42.9% and 44.7%, respectively, and the 5-year cumulative survival rate was 20.0%, 36.5% and 39.3%, respectively. There was a significant difference in the survival of these patients in the training dataset ( χ2=20.39, P<0.05). (5) Prognostic factors analysis in subgroup of the training dataset. Results of multivariate analysis in patients with NLNs in the training dataset showed that gender, ypT staging and number of NLNs (>14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadju-vant therapy ( hazard ratio=0.67, 1.44, 0.56, 95% confidence interval as 0.47?0.96, 1.09?1.90, 0.41?0.77, P<0.05). Results of multi-variate analysis in patients with positive lymph nodes in the training dataset showed that race as others, histological grade as G2, ypN staging as stage N3 and number of NLNs (8?14, >14) were independent influencing factors for the prognosis of patients with esophageal cancer after neoadjuvant therapy ( hazard ratio=2.73, 0.70, 2.08, 0.63, 0.59, 95% confidence interval as 1.43?5.21, 0.54?0.91, 1.44?3.02, 0.46?0.87, 0.44?0.78, P<0.05). (6) Construction of nomogram prediction model and calibration curve. Based on the multivariate analysis of prognosis in patients of the training dataset ,the nomogram prediction model for the prognosis of patients with esophageal cancer after neoadju-vant treatment was constructed based on the indicators of gender, ypT staging, ypN staging and number of NLNs. The AUC of nomogram prediction model in predicting the 3-, 5-year cumulative survival rate of patients in the training dataset and the validation dataset was 0.70, 0. 70 and 0.71, 0.71, respectively. The Harrell′s c index of nomogram prediction model of patients in the training dataset and the validation dataset was 0.66 and 0.63, respectively. Results of calibration curve showed that the predicted value of the nomogram prediction model of patients in the training dataset and the validation dataset was in good agreement with the actual observed value. Conclusion:The number of NLNs is an independent influencing factor for the prognosis of esophageal cancer patients after neoadjuvant therapy, and the nomogram prediction model based on number of NLNs can predict the prognosis of esophageal cancer patients after neoadjuvant therapy.

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Application of multiplex PCR capillary electrophoresis and analysis of distribution characteristics of HPV infection subtypes / 中华预防医学杂志

Objective: To analyze the characteristics of human papillomavirus (HPV) infection and the distribution of HPV subtypes in Shijiazhuang, Hebei Province, and to explore the application evaluation of multiple PCR capillary electrophoresis fragment analysis for HPV typing test. Methods: A population-based cross-sectional study was conducted among 434 women (age range 17 to 74 years old, 260 patients and 174 physical examinations) included from May to August 2022 in Hebei General Hospital. HPV typing was detected by multiple PCR-capillary electrophoresis fragment analysis. Using the multiple fluorescence quantitative PCR kit as a reference, Chi-square test was used to analyze the diagnostic effect of multiple PCR-capillary electrophoresis fragment analysis, and the consistency was analyzed by Kappa value. Results: The total HPV infection rate was 45.85%(199/434), including 35.48% (154/434) of high-risk HPV (HR-HPV), 3.92% (17/434) of low-risk HPV (LR-HPV), 6.45% (28/434) of HR-HPV and LR-HPV mixed infection, 27.88% (121/434) of single type HPV and 17.97% (78/434) of multi type HPV. HPV52 (9.68%, 42/434), HPV16 (6.91%, 30/434), and HPV58 (6.91%, 30/434) are common HPV subtypes. The positive rate of physical examination was 45.40% (79/174), which was slightly lower than that of patients 46.15% (120/260), there was no significant difference (χ2=0.024,P>0.05). The highest infection rate in the 17-30 age group was 54.76% (46/84), and there was no statistical difference among the age groups(χ2=4.123,P>0.05). The sensitivity and specificity of multiplex PCR capillary electrophoresis fragment analysis were 92.96% and 94.04%, respectively, and Kappa value was 0.870, with the multiplex fluorescent quantitative PCR as the reference. Conclusion: HPV infection may appear younger, and the positive rate of HR-HPV infection is the highest, with HPV52, 16, 58 as the main infection subtypes. The detection results of multiplex PCR capillary electrophoresis fragment analysis method are highly consistent with those of multiplex fluorescent quantitative PCR method, which is suitable for HPV DNA typing.

Correlation analysis between uranium exposure and renal injury / 中华放射医学与防护杂志

Objective:To analyze the relationship between plasma uranium concentration and renal injury.Methods:A case-control study was conducted in Hunan province, involving 102 renal injury cases and 102 matched controls. The association between plasma uranium concentration and renal injury was analyzed using conditional logistic regression models, and the dose-response relationship was analyzed through restricted cubic spline regression. The linear regression model and Spearman correlation were used to analyze the association between plasma uranium concentration and renal injury indicators.Results:The median of plasma uranium concentration was 8.94 ng/L in all subjects and 10.19 ng/L in the case group. The plasma uranium may be a risk factor for renal injury, with a dose-response relationship between the both representing nonlinear association ( χ2=5.15, P<0.05). The risk of renal injury was 4.21 times higher in the group exposed to highest uranium concentration than that in the group exposed to lowest uranium concentration. Plasma uranium concentration was closely related to glomerular filtration rate, serum creatinine and β 2-microglobulin ( r=0.211, -0.142, 0.195, P<0.05). Conclusions:The plasma uranium concentration is significantly associated with the renal injury, which may provide epidemiology evidence for the prevention of renal injury.

Alphacalcidol Supplementation Improves AcetylcholineMediated Relaxation in Aorta of Diabetic Rats on Vitamin D-Deficient Diet

@#Introduction: Vitamin D deficiency has been implicated as one of the factors involved in endothelial dysfunction associated with diabetes. This study aimed to evaluate the effects of active vitamin D (alphacalcidol) supplementation on aortic endothelial function in diabetic rats receiving vitamin D-deficient diet. Methods: Streptozotocin-induced diabetic rats were fed with standard diet (D) or vitamin D-deficient diet (DD and DDS) for 10 weeks. Group DDS was then supplemented with 0.2 μg/kg alphacalcidol at the last four weeks of the study duration. Non-diabetic rats were fed with standard diet (N) or vitamin-D deficient diet (ND). At the end of the experiment, the rats were sacrificed, and their aortic rings were harvested for endothelial functional study. Results: Acetylcholine-induced relaxation in aorta of diabetic rats (D and DD) were significantly lower compared to non-diabetic rats (N). In the presence of endothelial nitric oxide synthase blocker (L-NAME), maximal relaxation induced by acetylcholine in aorta of D and DD groups were significantly higher compared to N, ND and DDS groups, indicating involvement of non-nitric oxide (NO) relaxation pathways in diabetes. Four weeks supplementation with alphacalcidol in DDS group significantly improved acetylcholine-induced relaxation and reduced the reliance on non-NO relaxation pathways. Conclusion: The present study suggests that impairment of acetylcholine-induced relaxation in aorta of diabetes and diabetes with vitamin D-deficient diet was largely due to a decrease in NO related pathways, and this was compensated by non-NO pathways. Supplementation with alphacalcidol alleviated endothelial impairment in aorta of diabetic rats with vitamin D-deficient diet.

Progress of comprehensive surgical treatment for esophageal cancer / 中华消化外科杂志

Esophageal cancer is one of the common malignant tumors in the worldwide and has regional characteristics in China. At present, the treatment of esophageal cancer is still a comprehensive diagnosis and treatment mode based on surgery. With the application of minimally invasive technique in surgery of esophageal cancer, the concept of surgical diagnosis and treatment for esophageal cancer is constantly updating. The application of robotic surgical system in esophageal surgery promotes the surgical quality of lymph node dissection and improves the technique of intraluminal anastomosis under total endoscopy. For locally advanced esophageal cancer, a diagnosis and treatment mode based on neoadjuvant therapy has been gradually accepted by most of doctors around China. Combined with the latest researches at home and abroad, the authors investigate the development of surgical techniques, the renewal of surgical concept and the changes on diagnosis and treatment, summarize the new advances in comprehensive surgical treatment for esophageal cancer, in order to provide the theoretical guidance for the standardized treatment of esophageal cancer.

Relationship between physical exercise and smoking behavior of adolescents aged 16-18 / 中国学校卫生

Objective@#To explore the relationship between physical exercise and smoking behavior in adolescents aged 16-18,and to provide reference for promoting tobacco control among teenagers.@*Methods@#A total of 1 057 adolescents who took part in the 2018 China Family Panel Studies (CFPS 2018) were investigated for smoking and physical exercise. The Chi square test, Mann Whitney U test, Pearson correlation analysis and Logistic regression analysis were performed to explore the relationship between adolescent physical exercise and smoking behavior.@*Results@#There were 104 (9.8%) smokers among the adolescents. The age at starting smoking was (14.21±2.68) years old and the age of quitting smoking was (14.41±2.72) years old. Age ( χ 2=7.23), gender ( χ 2=83.01), school status ( χ 2=107.12), physical exercise ( Z =-2.20), subjective well being ( Z =-2.20) and life satisfaction ( Z =-2.93) were associated with adolescent smoking( P <0.05). Physical exercise was negatively correlated with adolescent smoking ( OR =0.92, P =0.03). After controlling demographic and psychosocial and cognitive variables, the negative correlation was not statistically significant ( OR =0.93, P =0.08). Further analysis showed that physical exercise was negatively correlated with boys smoking ( OR=0.91, P =0.04), but it was not statistically correlated with girls smoking ( OR=1.12, P =0.20).@*Conclusion@#Physical exercise is associated with lower rate of smoking among adolescents aged 16-18, but no similar association is found in girls.The findings warrants further longitudinal study.

Research progress and challenges of neoadjuvant therapy for esophageal squamous cell carcinoma / 中华胃肠外科杂志

Surgery is the main treatment for resectable esophageal squamous cell carcinoma. However, for patients with locally advanced lesions, surgery-based comprehensive treatment is the best treatment strategy. According to the results of some randomized controlled clinical studies and meta-analysis, preoperative neoadjuvant therapy is recommended to improve the survival rate of patients. Neoadjuvant therapy includes neoadjuvant chemotherapy, chemoradiotherapy, targeted therapy and immunotherapy. Great progress has been made in neoadjuvant therapy, but there are still many clinical problems that need to be solved urgently, including the efficacy and safety of neoadjuvant therapy, the choice of neoadjuvant regimen and treatment cycle, the best combination and advantages of multimodal treatment, and the selection of responders to treatment, etc. This article provides a systematic review of the latest developments and existing controversies in neoadjuvant therapy for esophageal squamous cell carcinoma.

A family report of myoclonus-dystonia caused by epsilon-sarcoglycan gene mutation / 中华神经科杂志

Objective:To analyze the clinical phenotype and gene mutation characteristics in a family of myoclonus-dystonia caused by epsilon-sarcoglycan (SGCE) gene mutation in order to improve the understanding of the disease.Methods:The clinical data of a family with myoclonus-dystonia from the Shaanxi Provincial People′s Hospital in August 2019 were collected. The proband was confirmed by generation sequencing techniques to detect possible pathogenic mutations and the Sanger test was used in the family members, and the mutation characteristics of SGCE gene were analyzed and the clinical features were summarized.Results:The proband, a 46-year-old man, presented with spasmodic torticollis accompanied with involuntary movements of the extremities (especially on the left). A gene mutation of c.1011delA at the chr7:94229984 was identified by genetic testing in the SGCE gene, which is an unreported frameshift mutation at home and abroad. Sanger sequencing revealed the same mutation site in the proband′s eldest sister, second elder brother and his grandnephew, who pessented similar symptoms as the proband including myoclonus and dystonia. The proband′s younger niece and grandniece were a mutation carrier without obvious symptoms.Conclusions:SGCE myoclonus-dystonia is a rare autosomal dominant inherited disorder characterized by the presentation of both myoclonic jerks and dystonia, which shows clinical heterogeneity and maternal imprinting. Genetic testing confirmed the diagnosis of SGCE myoclonus-dystonia and the pathogenic mutation c.1011delA in the SGCE gene.

Endoscopy assisted sub-pectoral fascial breast augmentation and reconstruction: preliminary clinical results / 中华医学美学美容杂志

Objective:To investigate the preliminary effects of sub-pectoral fascial breast augmentation and reconstruction.Methods:Six patients (10 breasts) of mammary dysplasia, mastatrophy, prophylactic mastectomy, unilateral breast defect with contralateral mastatrophy were included in the study from Oct. 2019 to July 2021. The mean patient age was 29 years (range, 20 to 35 years). All the textured and smooth cohesive gel implants were inserted under pectoralis major fascia by endoscopic-assisted, incisions were including axillary, around areola and inferior mammary fold approaches. The prophylactic mastectomy cases were performed nipple sparing mastectomy and sub-pectoral fascial breast restoration with implants. The fat and fascia tissue were well reserved to give a satisfying coverage of the appropriate implant. Negative pressure drainage and moulding dressing were used after the surgery.Results:Ten breast augmentation and restoration with a mean implant size of 200 cc (range, 180-300 cc). Less immediate postoperative pain and bleeding were reported. Patients were followed up for an average of 10 months (range, 6 to 21 months). There were no cases of major malpositions, double-bubble and bottom out symptoms. The overall outcome was with better symmetry and satisfaction with time passed by, and no secondary surgical procedures needed.Conclusions:Primary and satisfactory results have been obtained in subfascial breast augmentation and restoration for indications. With the endoscopic-assisted accurate pectoral fascial dissection, and well reserved soft tissue coverage, this technique could avoid the pectoralis major muscle ablation and keep the advantages of sub-glandular plane.

Identification and characterization of a novel elastase inhibitor from Hirudinaria manillensis / 中国天然药物

A large number of protease inhibitors have been found from leeches, which are essential in various physiological and biological processes. In the curret study, a novel elastase inhibitor was purified and characterized from the leech of Hirudinaria manillensis, which was named HMEI-A. Primary structure analysis showed that HMEI-A belonged to a new family of proteins. HMEI-A exerted inhibitory effects on elastase and showed potent abilities to inhibit elastase with an inhibition constant (K

Molecular Detection of Tick-borne Pathogens in Ticks Collected from Hainan Island, China / 生物医学与环境科学（英文）

Pathogens like bacteria and protozoa, which affect human and animal health worldwide, can be transmitted by vectors like ticks. To investigate the epidemiology and genetic diversity of bacteria and protozoans carried by ticks in Chengmai county of Hainan province, China, 285 adult hard ticks belonging to two species [

Frequency Characteristics of AEPs in Normal Young Adults and Comparison of Their Response Threshold and Pure Tone Audiometry Threshold / 法医学杂志

Objective The tests of three types of auditory evoked potentials （AEPs） were performed on normal young adults, to understand the frequency characteristics of different testing methods and the relationship between response threshold and pure tone audiometry threshold of different methods, and to discuss the forensic value of 3 types of AEPs to evaluate hearing function. Methods Twenty normal young adults were selected, their standard pure tone audiometry threshold, short-term pure tone audiometry threshold and the response threshold of 3 types of AEPs （tone burst-auditory brainstem response, 40 Hz auditory event-related potential and slow vertex response） at 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz were recorded. The relationship between the response threshold and standard pure tone audiometry threshold, short-term pure tone audiometry threshold of 3 types of AEPs at different frequencies as well as the differences between different types of AEPs were analyzed. Results The short-term pure tone audiometry threshold was higher than the standard pure tone audiometry threshold at each frequency. The response threshold and standard pure tone audiometry threshold of the 3 types of AEPs all had a certain correlation, and the response threshold of the 3 types of AEPs was higher than short-term pure tone audiometry threshold and standard pure tone audiometry threshold at each frequency. The differences in the differences between the response threshold and standard pure tone audiometry threshold of the 3 types of AEPs at different frequencies had statistical significance. Linear regression mathematical models were established to infer the standard pure tone audiometry threshold （hearing level） from response threshold （sound pressure level） of 3 types of AEPs of normal young adults. Conclusion When using response threshold of different types of AEPs to estimate pure tone audiometry threshold, conversion and correction are needed. Combined use of different types of AEPs could improve the accuracy of hearing function evaluation.

Characteristics and risk factors of lymph node metastasis in 56 synchronous multiple primary esophageal squamous cell carcinoma / 中国肿瘤临床

Objective: To investigate characteristics and risk factors of lymph node metastasis in synchronous multiple primary esophageal squamous cell carcinoma. Methods: Data of 56 patients with synchronous multiple primary esophageal squamous cell carcinoma who underwent surgery in Tianjin Medical University Cancer Institute & Hospital, during a period from January 2011 to December 2018, were collected. The lymph node metastasis rate at different sites was retrospectively analyzed. The depth of tumor infiltration, tumor length at different sites and other factors were analyzed to assess their influences on lymph node metastasis. Results: Of the total 56 patients with synchronous multiple primary esophageal squamous cell carcinoma, 34 suffered from lymph node metastasis, and the total nodal metastasis rate was 60.7%. And the lymph node metastasis rates in cervical, upper mediastinum, lower mediastinum and abdomen were 16.7%, 34.7%, 32.7% and 38.2%, respectively. The lymph node metastasis patterns varied based on different cancer sites. But lymph node metastasis was always observed in the areas of upper mediastinum, lower mediastinum and along with the abdomen. The results from univariate analysis showed that the lymph node metastasis was associated with length of the tumor and depth of infiltration at each tumor site (P<0.05). The results from multivariate analysis showed that the depth of tumor infiltration at the primary tumor site and harvested lymph node numbers were the independent prognostic factors for the nodal metastasis. Conclusions: McKeown resection with systematic lymph node dissection is the best option for treating synchronous multiple primary esophageal squamous cell carcinoma.

Clinical study of modified continuous single straight needle suture in the treatment of early traumatic ciliary body detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical effect of modified continuous single straight needle suture in the treatment of early traumatic ciliary body detachment.<p>METHODS: Totally 25 patients with cyclodialysis associated with macular edema were retrospectively analyzed during 2017-2018. The range of cycloidalysis was determined by ultrasound biomicroscopy(UBM)and the level of macular edema was observed by optical coherence tomography(OCT)before surgery. In the closed state of the eyeball, the modified continuous single-straight needle suture method was used for suture repair, and mydriasis and corticosteroid drugs were applied to control inflammation. Visual acuity and intraocular pressure were observed after operation. Ciliary body reduction was observed by UBM, OCT was used to observe the recovery of macular edema.<p>RESULTS: Three months after the operation, all the ciliary body detachment of 25 patients were restored, the intraocular pressure returned to normal, the vision was improved, and the macular edema disappeared.<p>CONCLUSION:It is a minimally invasive, safe and effective operation method to suture ciliary body detachment with single straight needle under the closed state of vitreous body cavity and anterior chamber.

Clinical Efficacy of Jianpi Qingchang Decoction in Treating Patients with Spleen Deficiency Damp-heat Hormone-dependent Ulcerative Colitis / 中国实验方剂学杂志

Objective::To observe the effect of Jianpi Qingchang decoction on hormone withdrawal in patients with hormone-dependent spleen deficiency damp-heat ulcerative colitis. Method::The 60 patients with hormone-dependent ulcerative colitis with spleen deficiency and damp-heat were selected and collected from the outpatient department and the inpatient department of Longhua Hospital, Shanghai University of Traditional Chinese Medicine(TCM) between April 1, 2012 and January 31, 2014.All of patients in two groups were treated with standard hormone reduction method. The control group was given orally Bupi Yichang pills, 6 g/time, 3 times/day, and the experimental group was given orally Jianpi Qingchang recipe, 300 mL water decoction, 1 dose/d, 2 times/d. All of the patients received continuous treatment for 3 months. After treatment, disease activity index, mucosal healing evaluation, curative effect changes of TCM syndromes and changes of inflammatory factors in the two groups were observed. Result::Compared with before treatment, the two groups of Mayo scores after treatment were significantly reduced (P<0.01), and the experimental group was reduced more significantly than the control group (P<0.01). After treatment, 66.67%of patients in experimental group were in remission, and 13.33%of patients in control group were in remission, with statistically significant differences between two groups (P<0.01). After treatment, the healing rate of the control group was 46.67%, while that of the experimental group was 70.0%, with statistically significant differences (P<0.01). After treatment, the effective rate of TCM syndromes in control group was 80.0%, while that in experimental group was 96.67%, with statistically significant differences (P<0.01). Compared with control group before treatment, the levels of IL-1 in both groups were decreased (P<0.05), while the levels of IL-6 and IL-10 were increased (P<0.05). Compared with control group after treatment, the changes in experimental group were significantly better than those in control group (P<0.05). Conclusion::Jianpi Qingchang decoction can reduce the index of disease activity in patients with hormone-dependent ulcerative colitis due to spleen deficiency and dampness-heat, promote mucosal healing and improve the curative effect of TCM symptoms, and thus is worthy of clinical promotion.

Effect of early continuous blood purification on the prognosis of children with septic shock: a prospective randomized controlled clinical trial / 中国当代儿科杂志

OBJECTIVE@#To study the effect of early continuous blood purification (CBP) on the prognosis of children with septic shock.@*METHODS@#A prospective analysis was performed for the children with septic shock who did not reach the 6-hour initial recovery target and/or had a fluid overload of >10%. According to the treatment time of CBP, they were divided into an early group with 30 children and a conventional group with 28 children. The two groups were compared in terms of the start time of CBP and 28-day mortality rate, as well as the related indexes in the children who were cured.@*RESULTS@#The early group had a significantly earlier start time of CBP than the conventional group (P0.05). The children who were cured in the early group had significantly shorter correction time of lactic acid, urine volume, and fluid overload than those in the conventional group (P10%, early CBP treatment can quickly control the disease, shorten the course of disease, and accelerate immune reconstruction.

Clinical Efficacy of Jianpi Qingchang Decoction in Treating Patients with Spleen Deficiency Damp-heat Hormone-dependent Ulcerative Colitis / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of Jianpi Qingchang decoction in the treatment of spleen deficiency and damp-heat hormone-dependent ulcerative colitis and explore its possible target. Method:A total of 60 patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis were selected and collected from the outpatient department and the inpatient department of Longhua Hospital affiliated to Shanghai University of Chinese Medicine on April 31, 2012.Two groups were given the basic therapy of prednisone, and control group received orally bolus for spleen and spleen and intestines, 6 g/time, 3 times/d. The treatment continued for three months. The experimental group was given orally Jianpi Qingchang decoction, 1 dose per day, and 300 mL water decoction, 150 mL each time, 2 times/d, and took at different temperatures in the morning and evening. The treatment continued for three months. After treatment, changes in intestinal symptom score, traditional Chinese medicine (TCM) syndrome score and endoscopic score of two groups were observed. Result:Compared with before treatment, the symptom scores of diarrhea, mucous purulent in control group were significantly reduced after treatment (PPPPPPPPPConclusion:Jianpi Qingchang decoction can effectively improve mucous purulent stool and diarrhea symptoms in patients with spleen deficiency and damp-heat hormone-dependent ulcerative colitis, and reduce TCM syndrome score and endoscopic score, and thus is worthy of clinical reference and promotion.

Simultaneous Determination of Four Alkaloid Components in Xiangbin Decoction by UPLC-QqQ-MS/MS / 中国实验方剂学杂志

Objective: To establish a quantitative method for the simultaneous determination of arecaine,arecoline,norisoboldine and boldine in Xiangbin decoction by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-QqQ-MS/MS), and compare the variation of their contents between single and mixed decoctions. Method: The separation was carried on a Waters ACQUITY UPLC BEH Shield RP18(2.1 mm×150 mm,1.7 μm)column, with 0.1%formic acid solution-acetonitrile as mobile phase for gradient elution. The flow rate was 0.2 mL·min-1, and the column temperature was 30℃. The quantitative MRM transitions of the four components were m/z 142.10/44.11 for arecaine,m/z 156.20/44.07 for arecoline,m/z 314.29/265.12 for norisoboldine and m/z 328.13/265.10 for boldine. The determination was performed in multiple reaction monitoring (MRM) mode by mass spectrometry with electrospray ionization (ESI) source under positive mode. Result: The linear ranges of arecaine,arecoline,norisoboldine and boldine were 0.479 0-57.48,0.976 0-78.08,0.812 0-64.96, 0.091 2-18.24 μg·L-1,respectively. The average recoveries of the above compounds ranged from 93.73%to 104.34%, with RSD (n=6) of less than 5%. The contents of arecoline,arecoline,norbibeldine and boltinine in Xiangbin decoction were (90.07±1.26),(445.27±12.39),(742.35±38.39),(38.50±3.33) μg·g-1,which were significantly lower than the contents in Linderae Radix and Arecae Semen. Conclusion: The method is rapid,sensitive,accurate and reproducible,and suitable for the simultaneous determination of multiple components in Xiangbin decoction,so as to provide a basis for the quality control of Xiangbin decoction. The compatibility of Xiangbin decoction has a significant effect on the dissolution contents of arecaine,arecoline,norisoboldine and boldine.

Screening and grading of fundus images of diabetic retinopathy based on visual attention / 中华实验眼科杂志

Objective To construct an intelligent analysis system based on visual attention for diabetic retinopathy ( DR) assistant diagnosis and to realize the automatic screening and grading of fundus images of DR. Methods Total of 35126 DR fundus images were downloaded from the Diabetic Retinopathy Detection competition in the Data Modeling and Data Analysis Competition Platform (Kaggle),and 1200 fundus images were downloaded from the Messidor website. Firstly,according to the characteristics of DR fundus images,a series of preprocessing was carried out for retina images. Then,on the basis of VGG16 network,visual attention SENet module was introduced to improve the saliency of lesion features,and a deep convolution neural network SEVGG with complex network structure was generated. The network basically inherited some structural parameters of VGG16,and the parameters of SENet module were adjusted according to the basic network and training data set. Finally, the SEVGG network model was used to screen the DR fundus image,and the fundus image was divided into different levels according to the degree of lesions of DR in different periods. Configure the training platform and environment and perform algorithm performance verification experiments. Results The method proposed in this study was tested on different open standard datasets,and finally achieved high accuracy in image-based classification. The accuracy of 5 classification in Kaggle dataset was 83％,the sensitivity of lesion detection was 99. 86％ and the specificity was 99. 63％. The accuracy rate of the 4 classification in the Messidor data set was up to 88％,the sensitivity of the lesion detection was 98. 17％,and the specificity was 96. 39％. The introduction of visual attention was more significant for the focus of the lesion,which helped the accurate detection of DR. Conclusions This method effectively avoids some shortcomings of traditional artificial feature extraction and fundus image classification,and is more accurate for lesion recognition. It is not only superior to the previous method,but also shows better robustness and generalization.