Determination of Serum Unbound Bilirubin and Its Clinical Application Value in Neonates / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical appropriateness and application value of the peroxidase （POD） method for the detection of unbound bilirubin （UB） in neonatal serum. MethodsHydrogen peroxide （0.33 mol/L） and three different final concentrations （0.019， 0.038， 0.075 μg/mL） of horseradish peroxidase （HRP） were added to standard bilirubin solution （1， 2， 3 μmol/L） to obtain a standardized HRP primary rate constant Kp. Then 25 μL of neonatal serum was diluted by 41.6 fold， and measured with 2.4 and 4.8 μg/mL HRP at 37 ℃ under the dark， to determine the UB concentration. The accuracy， precision， and stability of the methodology were validated. The clinical characteristics of 33 jaundiced neonates were collected， including total serum bilirubin （TSB）， indirect bilirubin （IDB）， albumin （ALB）， bilirubin to albumin molar ratio （BAMR）， etc. The experimental data were analyzed by Graphpad Prism 8.0. ResultsA standardized Kp of （7.20±1.08） mL·μg-1·min-1 was determined at pH 7.4±0.2， 37 ℃ in the dark. The HRP activity and UB concentrations remained stable at -20 ℃ for 3 weeks and a week， respectively. The mean intra-day and inter-day coefficients of variation of the serum samples with different UB concentrations were less than 10%. In this study， the UB concentrations in 33 jaundiced neonates （gestational age ≥35 weeks） were measured by the POD method in the range of （0.32～1.20） μg/dL， which was positively correlated with TSB， IDB and BAMR. Of the five infants whose UB concentrations measured more than 1 μg/dL， three received intensive phototherapy （60%）. ConclusionsThe POD method combined with a standard equipment spectrophotometer to detect serum UB concentrations in neonates is easy to operate， rapid to detect， and low cost. This method has good accuracy and precision， which is convenient for clinical implementation. Moreover， the measurement of serum UB may assist us in better management of neonatal jaundice in clinical practice.

Clinical observation on wheat grain moxibustion for chronic superficial gastritis of spleen-stomach deficiency and cold / 中国针灸

OBJECTIVE@#To compare the clinical effect of wheat grain moxibustion and warming acupuncture on chronic superficial gastritis of spleen-stomach deficiency and cold.@*METHODS@#A total of 200 patients with chronic superficial gastritis of spleen-stomach deficiency and cold were randomly divided into a wheat grain moxibustion group (100 cases, 13 cases dropped off ) and a warming acupuncture group (100 cases, 16 cases dropped off ). The acupoints of Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), Liangqiu (ST 34) and Zusanli (ST 36) were selected in both groups. The patients in the wheat grain moxibustion group were treated with wheat grain moxibustion, and 5 cone were given on every acupoint each time. Moxibustion was performed after acupuncture in the warming acupuncture group, and 3 cone each acupoint. Both groups were treated every other day for 15 times. The scores of clinical symptoms and signs, scores of physical component summary (PCS) and mental component summary (MCS) of quality of life in the two groups were recorded before and after treatment and during follow-up 1 month after treatment, and the clinical effects of the two groups were evaluated after treatment and during follow-up.@*RESULTS@#After treatment and during follow-up, the scores of clinical symptoms and signs of the two groups were lower than before treatment (@*CONCLUSION@#The wheat grain moxibustion can effectively improve the clinical symptoms, signs and quality of life in patients with chronic superficial gastritis of spleen-stomach deficiency and cold, and its long-term effect is better than warming acupuncture.

Analysis of risk factors for diabetic retinopathy without proteinuria in type 2 diabetic patients / 医学研究生学报

Objective　To analyze risk factors for diabetic retinopathy without proteinuria in type 2 diabetic patients．　Methods　The clinical data of type 2 diabetic patients were retrospectively analyzed. These patients were divided into two groups based on the results of fundus examination. Basic clinical data were compared in simple diabetic retinopathy (DR, without albuminuria and DPN) group including 169 cases and non-diabetic retinopathy (NO-DR, without microvascular complications) group including 208 cases. Logistic regression analysis was used to analyze the risk factors of DR. Among DR, 60 patients were mild non-proliferation DR (NPDR), 82 patients were moderate NPDR, 20 patients were severe NPDR and 7 patients were proliferation DR (PDR). Severe NPDR and PDR were combined into severe DR group. The correlation between risk factors and DR staging were analyzed by Pearson correlation analysis.　Results　The results showed that duration of diabetes, HbA1c, systolic blood pressure, diastolic blood pressure, postprandial blood glucose, triglyceride, serum creatinine, cystatin C and ratio of statin were higher in DR group, but age at onset of diabetes, CKD-EPI formula estimated GFR, fasting c-peptide and postprandial c-peptide were lower in DR group than that in NDR group (P<0.05). Logistic regression analysis showed that young age at onset of diabetes (OR:0.914, P≤0.001), hypertriglyceridemia (OR:1.369, P<0.05), high systolic pressure (OR:1.041, P<0.01) and reduced GFR (OR:0.912, P≤0.001) were the risk factors of DR. Pearson correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=-0.513, P<0.001), TG (r=0.110，P<0.033) and SBP (r=0.231, P<0.001） were positive correlated to DR staging.　Conclusion　In addition to the traditional factors, simple diabetic retinopathy in type 2 diabetic patients was related to young age at onset of diabetes, high systolic pressure, hypertriglyceridemia and reduced eGFR. eGFR decline occurred before the proteinuria and associated with the development of DR was a predicted factor of DR.

Treatment of Skin Reaction Induced by Nivolumab Combined with Radiotherapy in Non-small Cell Lung Cancer: A Case Report / 中国医学科学杂志(英文版)

Skin reaction or dermatological toxicities induced by immunotherapy is common. It usually manifests skin rash or erythema and can be cured by skin lotion or steroid. Nivolumab, a human IgG4 programmed cell death protein 1 (PD-1) inhibitor, blocks T cells activation preventing signal and allows the immune system to clear cancer cells. Nivolumab was approved in the second-line therapy in squamous cell lung cancer by FDA, with less than 10% unusual skin reaction, like sensory neuropathy, peeling skin, erythema multiforme, vitiligo, and psoriasis. Radiotherapy could aggravate this skin reaction through inflammatory response and promotion of immunity. The combined treatment of anti-PD-1 and radiotherapy represented a new promising therapeutic approach in many studies, but the risk of side effects may be high. We reported a patient with advanced squamous cell lung cancer who suffered from serious skin immune-related adverse events when he was treated with nivolumab and radiotherapy. The immune overreaction of the treatment of anti-PD-1 treatment and radiotherapy might cause these serious skin adverse events. Our report warranted careful workup to reduce the risk of side effects by combinative therapy with anti-PD-1 and radiotherapy.

Serum 25-hydroxyvitamin D concentration is negatively related to carotid artery intima-media thickness in type 2 diabetic patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between 25-hydroxy vitamin D [25(OH)D] and carotid artery intimal medial thickness (IMT) in type 2 diabetic (T2DM) patients.</p><p><b>METHODS</b>Serum 25(OH)D and carotid IMT were measured in 300 T2DM patients. Patients were divided into four quartile groups according to the serum 25(OH)D levels (Q1: < 26.17 nmol/L, 74 cases; Q2: 26.17 - 32.75 nmol/L, 76 cases; Q3: 32.75 - 42.93 nmol/L, 78 cases; Q4 > 42.93 nmol/L, 72 cases).</p><p><b>RESULTS</b>Carotid IMT, carotid artery plaque prevalence, duration of diabetes, HbA1c, CRP and PTH were significantly higher in subjects with low 25(OH)D compared subjects with high 25(OH)D (P < 0.05). Carotid artery IMT in Q1 and Q2 groups were significantly higher than that in Q4 group (1.03 ± 0.21 vs. 0.90 ± 0.20, 1.01 ± 0.26 vs. 0.90 ± 0.20, P < 0.05), was similar among Q1 and Q2 and Q3 groups. Prevalence of carotid atherosclerotic plaque in Q1 group (50.0%) was also significantly higher than in Q3 (29.5%, P < 0.05) and Q4 (16.7%, P < 0.05). Similarly, 25(OH)D concentration was significantly lower in patients with carotid plaque compared patients without carotid plaque [(28.31 ± 4.91) nmol/L vs. (36.31 ± 4.31) nmol/L, P < 0.01]. Pearson correlation analysis showed that carotid IMT was positively correlated with age, smoking, BMI, HbA1c, CRP, LDL-C, PTH/25(OH)D ratio (P < 0.05), and was negatively correlated with 25 (OH) D (r = -0.51, P < 0.01). Multivariate regression analysis showed that 25(OH)D concentration was an independent predictor of carotid IMT in this cohort (β = -0.39, P < 0.01).</p><p><b>CONCLUSION</b>Serum 25(OH)D concentration is negatively correlated with carotid IMT and low 25 (OH) D level is a risk factor for preclinical atherosclerosis in T2DM patients.</p>

Aberrant gap junction and tumor / 国际肿瘤学杂志

Gap junctions are membrane structures made of intercellular channels that allow directly exchange of material and information between adjacent cells. It is the structural basis of gap junctional intercellular communication. Gap junction is aberrant frequently in variety of cancers, which relatives with tumor genesis and metastasis. New anti-cancer drugs targeting gap junctions will be a new direction for tumor treatment.

Eosinophils, Lymphocytes and Mast Cells in the Nasal Polyps and the Mechanism of Polyp Formation / 上海第二医科大学学报

Objective To investigate the infiltration of inflammatory cells and the pathogenesis of nasal polyps. Methods the nasal polyps were obtained from 42 patients undergoing nasal operations. The tissues from each patient were stained with HE and Toluidine Blue for eosiophils, lymphocyte, plasma cell and mast cell and observed under the light microscope. A mean number of the above cells were counted. All data were analyzed with the Ttest. Results Eosinophils were found predominantly in 12 polyps(28.57％). Lymphocyte infiltration was shown in the other 30 polyps (71.43％). Furthermore, many mast cells with only a few eosinophils were found in the lymphocyte infiltration polyps; the number of mast cells in these polyps were much more than those in eosinophil accumulation polyps with a very significant difference(P＜0.01). Conclusion The accumulation of eosinophils in the nasal polyps does not appear to be related to the presence of mast cells and allergy. The disorder of immunity may play an important role in the formation of nasal polyps.