A new classification of left apicoposterior segmental bronchus and its clinical significance / 中国胸心血管外科临床杂志

@#Objective    To analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods     We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results     Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion     This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.

Staged Treatment of Endometriosis Combined with Infertility Using the Method of Warming Yang and Removing Turbidity / 中医杂志

It is believed that the key pathogenesis of endometriosis combined with infertility is spleen and kidney yang deficiency and binding of dampness and stasis， for which the method of warming yang and removing turbidity is advocated， and self-made Wenyang Huazhuo Formula （温阳化浊方） is recommended with flexibility by stages in accordance with the rules of the changes of yin and yang in the menstrual cycle and the storing and drainage of uterus. Specifically， during the menstruation， it is suggested to warm channels and invigorate blood， drain dampness and remove dampness； during the late menstruation， the method of warming yang and replenishing yin， regulating and supplementing the chong mai （冲脉） and ren mai （任脉）； for inter-menstruation period， it is advised to warm yang and replenish qi， rectify qi and harmonize blood； in terms of premenstrual period， the method of warming and supplementing spleen and kidney， warming uterus and assisting in fertility can be used. Accordingly， Formulas at the menstruation stage， follicular stage， ovulation stage， and luteal stage to warm yang and remove turbidity are recommended in their modifications， respectively.

Role of ceRNA network in inflammatory cells of rheumatoid arthritis / 中南大学学报(医学版)

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease caused by inflammatory cells. Various inflammatory cells involved in RA include fibroblast-like synoviocytes, macrophages, CD4+T-lymphocytes, B lymphocytes, osteoclasts and chondrocytes. The close interaction between various inflammatory cells leads to imbalance of immune response and disorder of the expression of mRNA in inflammatory cells. It helps to drive production of pro-inflammatory cytokines and stimulate specific antigen-specific T- and B-lymphocytes to produce autoantibodies which is an important pathogenic factor for RA. Competing endogenous RNA (ceRNA) can regulate the expression of mRNA by competitively binding to miRNA. The related ceRNA network is a new regulatory mechanism for RNA interaction. It has been found to be involved in the regulation of abnormal biological processes such as proliferation, apoptosis, invasion and release of inflammatory factors of RA inflammatory cells. Understanding the ceRNA network in 6 kinds of RA common inflammatory cells provides a new idea for further elucidating the pathogenesis of RA, and provides a theoretical basis for the discovery of new biomarkers and effective therapeutic targets.

The mechanism of modified Gan Cao Fu Zi Decoction in the treatment of rheumatoid arthritis based on network pharmacology and experimental validation / 药学学报

We used network pharmacology to predict the mechanism in the treatment of rheumatoid arthritis (RA) via modified Gan Cao Fu Zi Decoction (GCFZ), and validated the results of the analysis and explored the pharmacodynamic effects of GCFZ through animal experiments. Firstly, TCMID, SymMap, HERB, STITCH and GEO databases were utilized to obtain the target genes of GCFZ for the treatment of RA, which yielded a total of 1 250 differentially expressed genes for RA, 534 genes for GCFZ targets and 83 intersecting genes. Then functional enrichment analysis of the intersecting genes was performed through GO and KEGG databases, and the results revealed that GCFZ and its active ingredients mainly functioned through cytokine pathways, where chemokine signaling pathway and tumor necrosis factor (TNF) signaling pathway were enriched with a high number of genes. Cytoscape 3.8.0 software was used to construct the drug-target-disease network and screen key proteins, which included TNF, C-X-C chemokine ligand 8 (CXCL8), C-X-C chemokine ligand 10 (CXCL10), C-C chemokine ligand 5 (CCL5), C-X-C chemokine ligand 2 (CXCL2) and C-X-C chemokine receptor type 4 (CXCR4). The molecular docking technology was used to confirm the binding ability of the main active ingredients of GCFZ to the core proteins. Additionally, the therapeutic effects of GCFZ in low (4 g·kg-1), medium (8 g·kg-1) and high (16 g·kg-1) dose groups were investigated by constructing the collagen-induced arthritis (CIA) rat model. X-ray imaging approach, HE staining and Safranin O-Fast Green staining showed that GCFZ treatment significantly improved bone destruction, synovial hyperplasia and cartilage damage in CIA rats, while immunofluorescence results showed that GCFZ treatment could regulate the expression of TNF, CXCL8 and CCL5. In summary, our results indicate that GCFZ contains a variety of small molecule pharmacodynamic substances, which can exert therapeutic effects via multiple targets and pathways, and obviously reduce the symptoms of arthritis in CIA rats. This animal experiment of our research was approved by the Experimental Animal Management and Ethics Committee of Bengbu Medical College.

Time series analysis and prediction model of percentage of influenza-like illness （ILI） cases in Shanghai / 上海预防医学

ObjectiveTo predict the incidence trend of influenza-like illness proportion （ILI%） in Shanghai using the seasonal autoregressive integrated moving average model （SARIMA）， and to provide an important reference for timely prevention and control measures. MethodsTime series analysis was performed on ILI% surveillance data of Shanghai Municipal Center for Disease Control and Prevention from the 15th week of 2015 to the 52nd week of 2019， and a prediction model was established. Seasonal autoregressive integrated moving average （SARIMA） model was established using data from the foregoing 212 weeks， and prediction effect of the model was evaluated using data from the latter 36 weeks. ResultsFrom the 15th week of 2015 to the 52nd week of 2019， the average ILI% in Shanghai was 1.494%， showing an obvious epidemic peak. SARIMA（1，0，0） （2，0，0） 52 was finally modeled. The residual of the model was white noise sequence， and the true values were all within the 95% confidence interval of the predicted values. ConclusionSARIMA（1，0，0） （2，0，0） 52 can be used for the medium term prediction of ILI% in Shanghai， and can play an early warning role for the epidemic and outbreak of influenza in Shanghai.

Study on the Relationship between Five-state Personality and Cattell's 16 Personality Factors Based on Structural Equation Model / 中医杂志

ObjectiveTo explore the relationship between five-state personality and Cattell's 16 personality factors. MethodsA total of 913 students recruited from Beijing University of Chinese Medicine from November 2020 to January 2021 were assessed by using the Five-state Personality Test Form and the 16 Personality Factors Questionnaire （16PF）. The five-state personality scores were compared with national norms and gender differences were examined. Additionally， a structural equation model was established and the model fit was assessed using comparative fit index （CFI）， Tucker-Lewis index （TLI）， and root mean square error of approximation （RMSEA）. The five-state personality （Taiyang， Shaoyang， Yin-yang balance， Shaoyin and Taiyin） was used as individual outcome variables while the 16PF factors was employed as predictor variables. Based on standardized parameter estimation results， we explored the relationships between the five-state personality and 16PF. ResultsA total of 913 students were recruited， and 756 valid samples were obtained after excluding unqualified questionnaires. Among these， the scores of Taiyang， Shaoyang and Taiyin in the 756 school students were significantly lower than the national norms， while the scores of Yin-yang balance was significantly higher （P＜0.05 or P＜0.01）. The scores of Taiyang， Shaoyang， Yin-yang balance and Shaoyin were significantly higher than in males compared to females （P＜0.05 or P＜0.01）. Regarding the relationship between the dimensions of five-state personality and 16PF， the model demonstrated a good fit with CFI and TLI values of 0.993 and 0.980， respectively， and an RMSEA value of 0.027. The 16PF factors， including dominance， social boldness， vigilance， rule-consciousness， tension， and emotional stability， positively predicted the Taiyang personality traits， while privateness and apprehension negatively predicted the Taiyang personality traits （P＜0.05 or P＜0.01）. For Shaoyang personality traits， factors such as liveliness， social boldness， dominance， and tension positively predicted them， while rule-consciousness， apprehension， and privateness negatively predicted Shaoyang perso-nality traits （P＜0.05 or P＜0.01）. In the case of Yin-yang balance personality traits， perfectionism， rule-consciousness， emotional stability， and self-reliance positively predicted them， while apprehension negatively predicted Yin-yang balance personality traits （P＜0.05 or P＜0.01）. Regarding Shaoyin personality traits， perfectionism， emotional stability， self-reliance， rule-consciousness， and vigilance positively predicted them， while dominance， social boldness， and liveliness negatively predicted Shaoyin personality traits （P＜0.01）. Apprehension， tension， vigilance， and self-reliance positively predicted Taiyin personality traits， while social boldness， rule-consciousness， and intelligence negatively predicted Taiyin personality traits （P＜0.05 or P＜0.01）. ConclusionThere is a significant correlation between five-state personality test and 16PF with 16PF factors capable of predicting five-state personality factors. The five-state personality demonstrates scientific validity and effectiveness.

Application of three dimensional bio-printing materials for tissue engineering tracheal grafting / 中华器官移植杂志

Currently three dimensional bio-printing technology has become one of the hot topics for tissue engineering tracheal grafting.Different biomaterials have their own performance advantages in the preparation and regeneration of tracheal scaffolds.It is particularly imperative to seek natural or polymeric materials with excellent profiles of printability, structural stability and biocompatibility to enable neo-cartilage formation, neo-epithelialization and neo-vascularization of tissue engineering trachea grafting.This review summarized the shortcomings and challenges of classifying and applying materials for three dimensional bio-printing tissue engineering trachea, aiming to provide new rationales for researches and applications of tissue engineering tracheal grafting.

Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023) / 中华创伤杂志

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Effects of butylphthalide combined with alteplase on acute ischemic stroke / 中国基层医药

Objective:To analyze the effects of butylphthalide combined with alteplase on acute ischemic stroke.Methods:A total of 176 patients with acute ischemic stroke who received treatment at The Second People's Hospital of Liaocheng from November 2020 to October 2021 were prospectively included in this study. They were divided into control and combined treatment groups ( n = 88/group) according to hospital registraction number. The control group was given intravenous thrombolysis with alteplase. The combined treatment group was intravenously administered alteplase for 6 hours followed by butylphthalide sodium chloride injection. The two groups were treated for 2 consecutive weeks. The National Institutes of Health Stroke Scale score, clinical efficacy, interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein levels as well as the incidence of adverse drug reactions were compared between the two groups. Results:After thrombolysis, the National Institutes of Health Stroke Scale score, interleukin-6, tumor necrosis factor-α, and high-sensitivity C-reactive protein levels in the combined treatment group were (4.23 ± 1.75) points, (6.42 ± 2.05) ng/L, (13.42 ± 3.59) ng/L, and (3.17 ± 0.94) mg/L, respectively, which were significantly lower than (7.28 ± 1.93) points, (9.58 ± 2.79) ng/L, (22.28 ± 3.73) ng/L, and (5.23 ± 1.25) mg/L, respectively in the control group ( t = 10.98, 20.29, 16.06, 12.36, all P < 0.001). The total response rate in the combined treatment group was significantly higher than that in the control group [94.32% (83/88) vs. 80.68% (71/88), χ2 = 7.48, P < 0.05]. There was no significant difference in the incidence of adverse drug reactions between the combined treatment and control groups [6.82% (6/88) vs. 11.36% (10/88), χ2 = 0.01, P > 0.05]. Conclusion:Butylphthalide combined with alteplase for the early treatment of acute ischemic stroke can increase therapeutic efficacy, improve neurological function, and reduce inflammatory responses. The combined therapy has a positive clinical value in the early treatment of acute ischemic stroke.

Value of cytotoxic T lymphocyte and natural killer cell levels in prognosis evaluation of patients with ST-elevation myocardial infarction / 中国基层医药

Objective:To analyze the value of cytotoxic T lymphocyte and natural killer cell levels in prognosis evaluation of patients with ST-elevation myocardial infarction (STEMI).Methods:A total of 158 patients with STEMI who underwent percutaneous coronary intervention in The Second People's Hospital of Liaocheng from September 2020 to August 2021 were included in this study. The ratio of cytotoxic T lymphocytes to natural killer cells was measured immediately after admission and 48 hours after surgery. These patients were followed up for 1 month after treatment. They were divided into the adverse cardiovascular event group (occurrence group) and no adverse cardiovascular event group (non-occurrence group) according to the occurrence of cardiovascular adverse events. The influential factors of the prognosis of STEMI and the correlation between the influential factors and STEMI were analyzed.Results:Among 158 patients with STEMI, 27 patients had adverse cardiovascular events, accounting for 17.09%. There were significant differences in systolic blood pressure, left ventricular ejection fraction, and low-density lipoprotein levels between the occurrence and non-occurrence groups ( t = 2.82, 4.27, 2.32, all P < 0.05). At 48 hours after surgery, the levels of cytotoxic T lymphocytes [(22.75 ± 8.39)%, (29.23 ± 4.61)%] and natural killer cells [(13.73 ± 4.64)%, (20.64 ± 4.52)%] in the peripheral blood in the occurrence and non-occurrence groups were significantly decreased compared with before surgery [ t = -5.05, -83.68, -142.71, -7 084.80, all P < 0.001]. Before and 48 hours after surgery, the levels of cytotoxic T lymphocytes [(27.47 ± 3.35)%, (22.75 ± 8.39)%] and natural killer cells [(21.42 ± 4.36)%, (13.73 ± 4.64)%] in the peripheral blood in the occurrence group were significantly lower than those in the non-occurrence group ( t = 7.68, 13.10, 4.16, 5.76, all P < 0.001). Univariate analysis showed that preoperative cytotoxic T lymphocytes < 27.47%, preoperative natural killer cells < 21.42%, left ventricular ejection fraction, and low-density lipoprotein may be the risk factors that affect the prognosis of patients with STEMI ( P < 0.000, 0.012, 0.019, 0.033). Cox regression analysis showed that preoperative cytotoxic T lymphocytes < 27.47% and preoperative natural killer cells < 21.42% were independent risk factors affecting the prognosis of patients with STEMI (both P < 0.001). Conclusion:Reduced levels of baseline cytotoxic T lymphocytes and natural killer cells in patients with STEMI suggest an increased risk of poor prognosis.

Research progress on kidney injury-related complications after heart transplantation / 器官移植

In recent years, significant progress has been achieved in heart transplantation, perioperative management and application of immunosuppressants. Nevertheless, complications after heart transplantation are still main risk factors affecting the survival of recipients. Among them, acute kidney injury is a common complication during the early stage following heart transplantation. It may lead to secondary chronic kidney diseases after heart transplantation and progress into end-stage renal diseases, severely affecting the quality of life and long-term survival of recipients. Therefore, it is of significance to identify the risk factors of kidney injury after heart transplantation and deliver prompt interventions to improve clinical prognosis of heart transplant recipients. In this article, research progress on the incidence, risk factors, prevention and treatment strategies of kidney injury-related complications after heart transplantation was reviewed, aiming to provide reference for the prevention, diagnosis and treatment of kidney injury-related complications after heart transplantation and enhance clinical prognosis of recipients undergoing heart transplantation.

Comparison of techniques between concave distraction or convex resection in the treatment of congenital cervicothoracic scoliosis / 中华骨科杂志

Objective:To compare the technique between concave distraction and convex resection in the treatment of congenital cervicothoracic scoliosis and evaluate its curative effect.Methods:Data of congenital cervicothoracic scoliosis patients from January 2010 to January 2020 were collected, among which 5 were males and 3 were females. The patients' age was 12.5±4.5 years old (range 6-20 years old). One case had C 7 wedged vertebra, 4 cases had T 1 hemivertebra and unbalanced vertebra, 2 cases had T 2 hemivertebra and 1 case had fused facet joint and wedged lamina in T 1. All patients had different degrees of vertebra fusion. Convex resection technique (one stage anterior and posterior combined hemivertebrae resection and annular osteotomy) was used to treat 4 cases before 2015; Concave distraction technique (A combination of anterior and posterior release, intervertebral space and facet space distraction, cage placed and fusion) was used to treat 4 cases after 2015 and 2 of them had 2 segments distraction. Perioperative neurological, vascular and wound related complications were recorded. The main parameters were structure Cobb angle, cephalic and caudal compensatory Cobb angle, mandibular incline, neck tilt, shoulder balance and head shift were measured pre-operation, post-operation and at the last follow-up. Results:All patients' surgeries were completed successfully. In convex resection group, the duration of surgery was 201±100 min (range 113-300 min) per vertebra, the estimated blood loss was 294±153 ml (range 100-450 ml) per vertebra, the hospital stay was 14±3 d (range 11-18 d) and follow up time was 51±11 months (range 36-60 months). In concave distraction group, the duration of surgery was 117±14 min (range 101-129 min) per vertebra, the estimated blood loss was 119±36 ml (range 85-167 ml) per vertebra, hospital stay was 17±3 d (range 14-20 d) and follow up time was 28±21 months (range 12-60 months). Convex resection group had longer operation time and more blood loss per vertebra than concave distraction group. In convex resection group, structural Cobb angle was 45.1°±21.0° pre-operation and 22.7°±15.3° post-operation, which was corrected significantly ( Z=6.53, P=0.038). The correction rate was 54.8%±30.9%. Cephalic compensatory Cobb angle was 22.1°±8.2° pre-operation and 8.2°±5.8° post-operation, which was corrected significantly ( F=6.01, P=0.049). The correction rate was 66.8%±15.1%. Mandible incline was 7.8°±3.1° pre-operation and 3.5°±1.5° post-operation, which was corrected significantly ( F=8.02, P=0.018). The correction rate was 51.0%±29.7%. In concave distraction group, structural Cobb angle was 32.2°±27.2° pre-operation and 16.3°±16.7° post-operation, which was corrected significantly ( F=7.43, P=0.024) . The correction rate was 59.0%±24.7%. Caudal compensatory Cobb angle was 18.9°(17.2°, 32.1°) pre-operation and 9.5°±10.3° post-operation, which was corrected significantly ( Z=6.00, P=0.049). The correction rate was 64.0%±24.1%. Clavicle angle was 3.9°±2.3° pre-operation and 0.3°±0.4° post-operation, which was corrected significantly ( F=1.75, P=0.040). The correction rate was 97.0% (48.5%, 99.8%). There was no significant difference in the correction rate of all radiographic parameters between the two groups. At the last follow-up, the patients' appearance of head, neck and shoulder were improved compared with those before surgery. In convex resection group, 2 patients showed nerve root stimulation symptoms postoperatively on convex side. One patient developed C 5 nerve root palsy which weakened deltoid muscle and the other patients presented with reduced triceps muscle strength. In concave distraction group, one patient developed C 5 nerve root palsy on convex side. All these symptoms recovered by conservative treatment 3 months after operation. Conclusion:It is safe and effective to treat congenital cervicothoracic scoliosis with convex resection technique and concave distraction technique. The concave distraction technique has the advantages of more safety, less operating time, less blood loss and easier to perform and has a wider application prospect.

Effects of esophageal squamous cell carcinoma-related long non-coding RNA ESCCAL-1 on polarization of macrophages / 肿瘤研究与临床

Objective:To explore the effect of esophageal squamous cell carcinoma-related long non-coding RNA (lncRNA) ESCCAL-1 on the polarization of THP-1 cells-derived macrophages.Methods:The esophageal cancer cell line KYSE450 was divided into 5 groups: KYSE450 group (normal KYSE450 cells), shRNA-ESCCAL-1 group (infected with knockout ESCCAL-1 lentivirus), shRNA-NC group (infected with interference control lentivirus), OE-ESCCAL-1 group (infected with overexpressing ESCCAL-1 lentivirus) and OE-NC group (infected with overexpressed control lentivirus). The expression of ESCCAL-1 was detected by real-time quantitative polymerase chain reaction (qRT-PCR). After co-culture of cells in each group with THP-1 cells-derived macrophages, flow cytometry was used to detect the expressions of THP-1 cells-derived macrophages M1 polarization markers HLA-DR, iNOS, CD86 and M2 polarization markers Arg-1, CD163, CD206, and inflammatory cytokines.Results:After THP-1 cells were stimulated with 100 ng/ml phorbol ester for 48 hours, the cells grew adherently, and the expression levels of CD11b and CD36 increased, indicating that THP-1 cells were successfully differentiated into macrophages. After THP-1 cells-derived macrophages were co-cultured with esophageal cancer KYSE450 cell line treated differently for 24 hours, there were no significant differences in the expressions of M1 polarization markers HLA-DR, iNOS and CD86 between shRNA-ESCCAL-1 group and shRNA-NC group or between OE-ESCCAL-1 group and OE-NC group (all P > 0.05). Compared with shRNA-NC group, the expressions of M2 polarization markers Arg-1, CD163 and CD206 in shRNA-ESCCAL-1 group decreased [8.54±0.29 vs. 11.83±0.69, 12.0±0.3 vs. 24.5±0.8, 2.05±0.23 vs. 14.54±1.10], and the differences were statistically significant ( t values were 7.636, 27.38 and 19.31, all P < 0.01); compared with the OE-NC group, the expressions of M2 polarization marker Arg-1, CD163 and CD206 in OE-ESCCAL-1 group increased [32.60±1.14 vs. 14.20±0.20, 43.7±1.5 vs. 25.1±1.2, 35.8±0.7 vs. 13.6±0.6], and the differences were statistically significant ( t values were -27.58, -17.24 and -43.98, all P < 0.01). Compared with shRNA-NC group, the expression level of interferon-γ in shRNA-ESCCAL-1 group decreased [(6.3±1.5) pg/ml vs. (20.0±2.6) pg/ml, t = 7.75, P = 0.001]; compared with OE-NC group, the expression level of interleukin-1RA in OE-ESCCAL-1 group increased [(3 167±306) pg/ml vs. (467±176) pg/ml, t = -13.27, P < 0.01]. Conclusions:Esophageal squamous cell carcinoma-related lncRNA ESCCAL-1 can promote the M2 polarization of macrophages.

Time comparison of artificial airway establishment in operating room and on slope using endotracheal intubation and laryngeal mask / 北京大学学报(医学版)

OBJECTIVE@#To compare the completion time of endotracheal intubation and laryngeal mask implantation in operating room and on slope of ski resort, and to discuss the optimal method of estab-lishing artificial airway on slope of ski resort.@*METHODS@#The simulator was placed with the head under the feet on slope of ski resort. The artificial airway was established by tracheal intubation assisted by video laryngoscope (endotracheal intubation group) and laryngeal mask placement (laryngeal mask group) respectively by an anesthesiologist who wore full set of ski suits, helmets, goggles, gloves and ski boots. Each method was repeated 5 times, and the operation time of artificial airway establishment was recorded. While the simulated human was placed flat on the operating table in an operating room of a hospital, and the artificial airway was established by the same anesthesiologist using the same methods. Time was recorded and repeated for 5 times. The completion time of endotracheal intubation and laryngeal mask placement in the operating room and on the ski slope were compared.@*RESULTS@#The operating time of tracheal intubation in the operating room was longer than that of laryngeal mask placement [(79.8±10.4) s vs. (53.4±2.7) s, P=0.005], and the operating time of endotracheal intubation on the ski slope was longer than that of laryngeal mask placement [(209.2±32.7) s vs. (72.2±3.1) s, P=0.001]. The time of endotracheal intubation group on the slope of the ski resort was longer than that in the opera-ting room(t=-7.851, P=0.001). The time of laryngeal mask group on the slope was longer than that in the operating room (t=-19.391, P < 0.001).@*CONCLUSION@#On ski slope, both of tracheal intubation assisted by video laryngoscope and laryngeal mask placement can quickly complete the establishment of artificial airway, but the time required is longer than that in the operating room. The time of laryngeal mask placement to establish artificial airway is shorter than that of tracheal intubation assisted video laryngoscope, which may have a certain advantage in ski rescue.

Establishment of a genomic model for predicting the likelihood of poor early graft function after liver transplantation / 中华器官移植杂志

Objective:To explore the poor early liver graft function(PEGF)-related biomarkers and establish a genomic model for PEGF prediction specific to liver transplantation(LT)with allografts of donation after brain death(DBD).Methods:By data-mining a public GSE23649 dataset from the database of Gene Expression Omnibus(GEO), key PEGF-related genes in DBD liver biopsies after 2h reperfusion were identified by differential expression analysis.And LASSO-penalized Logistic regression model was utilized for selecting an optimal gene set.Receiver operating characteristic curves with its area under the curve(AUC)and a nomogram were generated for evaluating and visualizing its predictive capability for PEGF.Gene set enrichment analysis(GSEA) was performed for exploring the biological pathways underlying PEGF.Results:Six key PEGF-related genes in DBD-LT were initially identified, including 4 up-regulated genes(HBB, PFDN5, RPS3A & RPS5)and 2 down-regulated genes(RPL22 & FAM62B). A six-mRNA-based risk-scoring model was further established with an excellent predictive capability(AUC=1.000, P=0.0008). Four PEGF-related biological pathways in DBD livers, such as "VEGF" and "natural killer cell-mediated cytotoxicity" , were identified by GSEA(all P<0.05). Conclusions:The genomic model may effectively predict the likelihood of PEGF immediately after DBD-LT or even prior to transplantation in the context of normothermic machine perfusion.

The application of distraction on the concave side in the treatment of congenital cervical scoliosis / 中华骨科杂志

Objective:To explore the safety, feasibility, and short-term outcome ofdistraction on the concave side in the treatment of patients with congenital cervical scoliosis.Methods:Between August 2015 and December 2019, 11 patients with congenital cervical scoliosis underwent distraction technique on concave side, among which 5 were males and 6 were females. Age was 9.9±3.1 years old (range 6-16 years old). The primary cervical spine deformity was hemi-vertebra with different degrees of vertebra fusion. 7 cases were in C 3, 3 cases were in C 4 and 1 case was in C 5. Anterior-posterior combined approach was used. Firstly, discectomy and soft tissue release on concave side were made through anterior approach, then distraction on concave side and fusion with internal fixation were made through posterior approach and at last fixation and fusion in anterior approach were made. In this study we measured structure Cobb angle, compensatory Cobb angle, mandibular incline, shoulder balance and the angle difference of trapezius muscle preoperation and post operation. Perioperative neurological,vascular and wound related complicationswere recorded. Results:All patients' surgeries were completed successfully. Eight patients received single site distraction and 3 patients received distraction in two sites. The duration of surgery was 466±141 min (range 150-659 min), the estimated blood losswas 387±191 ml (range 100-660 ml) and follow up time was 12.2±9.5 months (range 3-24 months). Structural Cobb angle was 28.9°±13.1° pre-operation and 7.4°(3.0°, 27.7°) post-operation at 3 months, which was corrected significantly ( Z=-2.934, P=0.003). The correction rate was 58.1±26.1% (range 18.8%-97.6%). Structural Cobb angle was 13.2°±12.3°at 1 year post operation and had no significant difference compared with 3 months post operation ( t=1.960, P=0.107). Compensatory Cobb angle was 18.3°±6.1° pre-operation and 9.4°±7.3° post-operation at 3 months, which was corrected significantly ( t= 5.071, P<0.001) and the correction rate was 51.3%±28.3% (range 2.4%-94.7%). Compensatory Cobb angle was 8.9°±7.7° at 1 year follow up and was corrected significantly ( t=5.253, P=0.003) compared to 3 months after surgery and the correction rate was 61.4%±26.9%. Two patients developed C 5 nerve root dysfunction and 1 patient developed numbness on the index and middle fingers after surgery. All of them occurred on the concave side and recovered by conservative treatment. Conclusion:The application of distraction on the concave side in the treatment of congenitalcervical scoliosis is with good feasibility and clinical safety. Short-term follow-up showed excellent resultswith a promising future.

Correlation of peripheral blood lymphocyte-to-monocyte ratio after induction chemotherapy with treatment efficacy and prognosis in acute myeloid leukemia / 白血病·淋巴瘤

Objective:To explore the value of peripheral blood lymphocyte-to-monocyte ratio (LMR) after induction chemotherapy in patients with acute myeloid leukemia (AML) for the judgment of curative effect and prognosis.Methods:The clinical data of 63 newly-treated AML patients (except for acute promyelocytic leukemia) in Heze Municipal Hospital of Shandong Province from January 2015 to January 2020 were retrospectively analyzed. No blasts were seen on the blood films of all patients at one week after induction chemotherapy. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value of LMR at one week after the completion of all induction chemotherapy for predicting complete remission (CR) of patients, and based on this value, the patients were divided into the low LMR group (LMR <the best cut-off value) and the high LMR group (LMR ≥ the best cut-off value). The differences in clinical characteristics, laboratory test indicators, treatment efficacy, recurrence and survival between the two groups of patients were compared.Results:Sixty-three patients were enrolled in the study. The median LMR of 63 patients was 3.64 (0.13-88.01) at one week after the completion of all induction chemotherapy. Fifty-one patients (81.0%) achieved CR after one course of induction chemotherapy, 54 patients (85.7%) achieved CR after two courses, and there were finally 56 patients (88.9%) with CR. The ROC curve determined that the best cut-off value of LMR was 1.515, and there were 20 cases and 43 cases in the low LMR group and the high LMR group, respectively. There were no significant differences in age, gender, hemoglobin, bone marrow blast cell ratio, white blood cell count, platelet count, and lactate dehydrogenase levels between the two groups (all P > 0.05). The CR rates after 1 course of treatment in the low LMR group and the high LMR group were 65.0% (13/20) and 88.4% (38/43), respectively, and the difference was statistically significant ( χ2=4.836, P=0.028). In the low LMR group, 3 of the 13 patients who achieved CR within 1 course of treatment relapsed; in the high LMR group, 2 of the 38 patients who achieved CR within 1 course of treatment relapsed. The 3-year RFS rates of the low LMR group and the high LMR group were 64% and 80%, respectively, and the difference was not statistically significant ( χ2=2.897, P=0.089); the 3-year OS rates were 84% and 80%, respectively, and the difference was not statistically significant ( χ2=0.136, P=0.712). Conclusion:For newly-treated AML patients with no nucleated cells in blood smear microscopy at one week after the completion of induction chemotherapy, LMR may be used to evaluate the treatment efficacy and recurrence.

Regorafenib regulates the proliferation and apoptosis of human hepatocellular carcinoma SMMC-7721 cells through miR-122 / 中国肿瘤生物治疗杂志

@#[摘 要] 目的：探究瑞戈非尼（regorafenib，Rego）对人肝癌SMMC-7721细胞增殖、凋亡的影响及其可能的机制。方法：将SMMC-7721细胞分为对照组及Rego组，分别用0、10 μmol/L Rego处理48 h后，流式细胞术检测各组细胞凋亡率，qPCR检测细胞中miR-122的表达。采用脂质体转染的方法将合成的hsa-miR-122-5p模拟物转染SMMC-7721细胞构建miR-122过表达的overExp-miR-122细胞，并将细胞分为对照组、Rego组、overExp-NC组、overExp-NC+Rego组、overExp-miR-122组及overExp-miR-122+Rego组，采用MTT法检测细胞活性，流式细胞术检测细胞凋亡率、WB法检测细胞中Bcl2、cleaved caspase-3、RAS、RAF1、p-ERK1蛋白表达水平。结果：与对照组相比，Rego处理后细胞凋亡率显著升高（P<0.05），且miR-122表达量显著上升（P<0.01）；与overExp-NC组比较，overExp-miR-122组细胞增殖抑制率、凋亡率和cleaved caspase-3表达均显著升高（均P<0.01），RAS蛋白表达显著下降（P<0.05），Bcl2、RAF、p-ERK1蛋白表达均显著下降（均P<0.01）；与overExp-miR-122组相比，overExp-miR-122+Rego组细胞中各检测指标变化进一步显著增加（P<0.01）。结论：Rego可抑制SMMC-7721细胞增殖、促进凋亡，其作用可能与调控miR-122、凋亡相关因子的表达和抑制RAS/RAF/ERK信号通路有关。

Application of colonoscopy and cognition of colonoscopists in China: a national survey / 中华消化内镜杂志

Objective:To investigate the current application of colonoscopy at hospitals in China.Methods:From November 2019 to January 2020, an online questionnaire survey was conducted among gastroenterologists and colonoscopists in hospitals of different levels. The contents of questionnaire survey included basic information of colonoscopy at the respondent′s hospital, protocols and patient education of bowel preparation, implementation of colonoscopy quality control, and colonoscopists′ understanding of polypectomy techniques and post-polypectomy follow-up.Results:A total of 236 valid questionnaires were collected, involving 187 hospitals, and 143 (76.5%) had an annual operation capacity of more than 5 000 cases. In terms of bowel preparation, split-dosed polyethylene glycol electrolyte powder (PEG) was the most commonly used (60.4%, 113/187) and the most common volume of PEG was 3 L (67.4%, 126/187). Verbal (90.9%, 170/187) and written (79.7%, 149/187) instructions were given more often than other methods for patient education of bowel preparation. Antifoaming agent was routinely used in 124 (66.3%) hospitals. In terms of quality control, only 11.5% (20/174) hospitals implemented all four measures. In terms of polypectomy techniques, 98.1% (203/207) colonoscopists chose hot snare polypectomy or endoscopic mucosal resection for lesions of diameter>1 cm, while options varied for lesions of diameter<1 cm. The interval of follow-up after polypectomy recommended by colonoscopists was shorter than that by guidelines.Conclusion:Several problems are found in the survey in the application of colonoscopy in China, i. e., patient education of bowel preparation is not diversified; quality control of colonoscopy still needs to be strengthened; polypectomy techniques and follow-up after polypectomy need to be further standardized.

Association between time in range and cancer mortality among patients with type 2 diabetes: a prospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Little was known about the association among time in range (TIR), time above range (TAR), time below range (TBR), and cancer mortality among patients with type 2 diabetes. We aimed to investigate the association among TIR, TAR, TBR, and the risk of cancer mortality among patients with type 2 diabetes.@*METHODS@#A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period. Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.@*RESULTS@#During a mean follow-up of 7.10 years, we confirmed 237 death events related to cancer. The multivariable-adjusted hazard ratio (HR) for cancer mortality was 1.32 (95% confidence interval [CI]: 1.01-1.75) in patients with TIR ≤70% compared with those with TIR >70%. When TIR was considered as a continuous variable, the multivariable-adjusted HR for cancer mortality associated with each 10% decrease in TIR was 1.07 (95% CI: 1.02-1.14). In the site-specific analysis, a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found (HR: 1.24; 95% CI: 1.09-1.41). However, no relationship between hemoglobin A1c and cancer mortality was observed (HR: 1.04; 95% CI: 0.97-1.10).@*CONCLUSIONS@#The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes. New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes.