Intelligent diagnostic model of keratoconus based on deep learning algorithm / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To establish an intelligent diagnostic model of keratoconus for small-diameter corneas by data mining and analysis of patients' clinical data.METHODS: Diagnostic study. A total of 830 patients(830 eyes)were collected, including 338 male(338 eyes)and 492 female(492 eyes), with an average age of 14-36(23.19±5.71)years. Among them, 731 patients(731 eyes)had undergone corneal refractive surgery at Chongqing Nanping Aier Eye Hospital from January 2020 to March 2022, and 99 patients had a diagnosed keratoconus from January 2015 to March 2022. Corneal diameter ≤11.1 mm was measured by Pentacam in all patients. Two cornea specialists classified patients' data into normal corneas, suspect keratoconus, and keratoconus groups based on the Belin/Ambrósio enhanced ectasia display(BAD)system in Pentacam. The data of 665 patients were randomly selected as the training set and the other 165 patients as the validation set by computer random sampling method. Seven parametric corneal features were extracted by convolutional neural networks(CNN), and the models were built by Residual Network(ResNet), Vision Transformer(ViT), and CNN+Transformer, respectively. The diagnostic accuracy of models was verified by cross-entropy loss and cross-validation method. In addition, sensitivity and specificity were evaluated using receiver operating characteristic curve.RESULTS: The accuracy of ResNet, ViT, and CNN+Transfermer for the diagnosis of normal cornea and suspect keratoconus was 85.57%, 86.11%, and 86.54% respectively, and the area under the receiver operating characteristic curve(AUC)was 0.823, 0.830 and 0.842 respectively. The accuracy of models for the diagnosis of suspect keratoconus and keratoconus was 97.22%, 95.83%, and 98.61%, respectively, and the AUC was 0.951, 0.939, and 0.988 respectively.CONCLUSION: For corneas ≤11.1 mm in diameter, the data model established by CNN+Transformer has a high accuracy rate for classifying keratoconus, which provides real and effective guidance for early screening.

Equity and efficiency of resource allocation for management and treatment of severe mental disorders in Shanghai in 2020 / 公共卫生与预防医学

Objective To analyze the equity and efficiency of resource allocation for management and treatment of severe mental disorders in Shanghai in 2020, and to provide a foundation for making relevant policies. Methods Data on resource allocation for the management and treatment of severe mental disorders in 17 district-level mental health institutions in 2020 were collected. The Gini coefficient was used to evaluate the equity of resource allocation by population and geographic area, and data envelopment analysis was carried out to analyze the equity of resource allocation. Results The Gini coefficients of special funds, psychiatric medical staff and actual open beds according to population were 0.24, 0.25 and 0.27, respectively. The Gini coefficients according to area were 0.54, 0.62 and 0.64, respectively. The average efficiency of resource allocation was 0.865. There were 5 institutions where DEA was effective, accounting for 29.41%. There were 12 institutions where DEA was non-effective, accounting for 70.59%. Conclusion The equity of resources allocation for the management and treatment of severe mental disorders according to population is good, but the equity of allocation based on geographic area is not high. The efficiency of resource allocation needs to be further improved. It is suggested that the resource allocation should be optimized to promote the fairness and efficiency of resource allocation for the management and treatment of severe mental disorders.

Influence of extracorporeal membrane oxygenation on in-hospital survival and prognosis of adult patients with fulminant myocarditis / 中华危重病急救医学

Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) on in-hospital survival and prognosis of adult patients with fulminant myocarditis.Methods:The registration materials of 21 patients with fulminant myocarditis supported by veno-arterial ECMO (VA-ECMO) from March 2019 to January 2022 in the Heart Center of the First Hospital of Lanzhou University were selected from the Chinese Society for Extracorporeal Life Support (CSECLS) Registry Database. The clinical baseline data, laboratory and echocardiographic data, VA-ECMO related parameters, complications and in-hospital outcome were recorded. The main end events of follow-up were death and readmission due to heart failure.Results:① The median age of 21 patients was (42.7±16.4) years, there were 12 males (57.1%) and 9 females (42.9%), and 16 patients (76.2%) survived in hospital and 5 patients (23.8%) died in hospital. ② Compared with the survival group, patients in the death group had a higher proportion of invasive ventilator support and continuous renal replacement therapy (CRRT) [3/16 (18.8%) vs. 4/5 (80.0%), 3/16 (18.8%) vs. 4/5 (80.0%)], and a lower survival after VA-ECMO score (SAVE) [score: -5.0 (-5.0, -3.0) vs. 1.0 (-6.0, 5.0)], the serum creatinine (SCr) level was higher during VA-ECMO support [μmol/L: 248.0 (144.0, 447.0) vs. 83.0 (71.7, 110.9)], the platelet count (PLT) level was lower [×10 9/L: 60.0 (31.5, 96.5) vs. 100.0 (71.0, 139.3)], and the ECMO initial support flow rate was higher (L/min: 3.2±0.7 vs. 2.6±0.4). All the differences were statistically significant (all P < 0.05). ③ The echocardiography indexes of the survival group were significantly improved at discharge compared with those at admission [left ventricular ejection fraction (LVEF, %): 54.0±6.7 vs. 30.0±7.2], left ventricular end-diastolic volume [(LVESV, mL): 55.7±27.5 vs. 85.9±28.7], cardiac index [(CI, L·min -1·m -2): 2.6±0.4 vs. 1.9±0.6], cardiac output [(CO, L/min): 4.5±0.7 vs. 3.2±0.9]. All the differences were statistically significant (all P < 0.05). ④ The median follow-up time of the 16 survivial patients was 9 (2, 14) months. During the follow-up period, 5 patients (31.3%) were readmitted to the hospital due to heart failure (1 case of cardiogenic death). The average ECMO support duration of the 5 patients who readmitted to the hospital due to heart failure was significantly shorter than that of the 11 patients without heart failure [hours: 82.0 (47.0, 99.0) vs. 116.0 (98.0, 156.0), Z = -2.381, P = 0.017]. Conclusions:On the basis of immunomodulatory and other treatments, early application of VA-ECMO in adult patients with fulminant myocarditis can significantly improve in-hospital survival rate and cardiac function. Heart failure after discharge may be related to short VA-ECMO support time during hospitalization.

Protective effects of various doses of Glycyrrhizin on hippocampal tissue of young rats with status epilepticus / 中华实用儿科临床杂志

Objective:To study the protective effects of various doses of Glycyrrhizin on hippocampus of young rats with status epilepticus (SE).Methods:Lithium chloride and pilocarpine were injected intraperitoneally into male Sprague-Dawley (SD) rats (with a postnatal age of 18-21 days), so as to induce SE in rats.The rats were divided into 5 groups according to the random number table method: control group, SE group, SE+ low dose Glycyrrhizin group, SE+ medium dose Glycyrrhizin group and SE+ high dose Glycyrrhizin group.Three different doses of Glycyrrhizin (20 mg/kg, 40 mg/kg and 60 mg/kg) were injected intraperitoneally into the rats.The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in serum of SE rats were determined by enzyme linked immunosorbent assay.Quantitative real-time PCR (qRT-PCR) was used to detect the mRNA expression levels of TNF- α, IL-1β and IL-6 in hippocampus of SE rats.The expression levels of Bax, Bcl-2 and Caspase-3 in hippocampus were detected by Western blot.The damage of neurons was measured by hematoxylin and eosin (HE) staining and Nissl staining.Neurons apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). The mitochondrial changes were observed under transmission electron microscopy.One-way ANOVA followed by Tukey post-hoc test was used for statistical analysis. Results:Compared to the control group, TNF-α[(369.69±58.07) ng/L vs. (75.46±14.64) ng/L], IL-1β[(242.27±25.23) ng/L vs. (45.29±5.90) ng/L] and IL-6[(288.15±24.60) ng/L vs. (46.59±8.80) ng/L] in the serum of SE rats were significantly up-regulated(all P<0.05). Compared to SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of TNF-α[(216.67±8.31) ng/L, (158.81±5.03) ng/L and (113.69±12.54) ng/L vs. (369.69±58.07) ng/L], IL-1β[(131.21±5.50) ng/L, (86.60±7.79) ng/L and (65.06±4.39) ng/L vs. (242.27±25.23) ng/L] and IL-6[(150.24±9.48) ng/L, (101.70±5.85) ng/L and (91.60±2.81) ng/L vs. (288.15±24.60) ng/L] released in serum after SE occurred (all P<0.05). The neuronal damage, loss, apoptosis and mitochondrial damage were found in the hippocampus of SE rats.Glycyrrhizin could ameliorate these symptoms.Compared to the control group, Bax levels(0.57±0.01 vs. 0.14±0.01)and Caspase-3 levels(0.54±0.00 vs. 0.11±0.01)in the hippocampus of SE rats were markedly increased, while Bcl-2 levels(0.27±0.01 vs. 0.57±0.02)were decreased(all P<0.05). Compared to the SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of Bax(0.51±0.02, 0.45±0.03 and 0.40±0.02 vs. 0.57±0.01)and Caspase-3(0.47±0.02, 0.42±0.02 and 0.37±0.01 vs. 0.54±0.00), and increase the levels of Bcl-2(0.41±0.02, 0.45±0.02 and 0.51±0.01 vs. 0.27±0.01)(all P<0.05). Conclusions:Glycyrrhizin can effectively protect the hippocampus of young rats with SE.

Protective effects of various doses of Glycyrrhizin on hippocampal tissue of young rats with status epilepticus / 中华实用儿科临床杂志

Objective:To study the protective effects of various doses of Glycyrrhizin on hippocampus of young rats with status epilepticus (SE).Methods:Lithium chloride and pilocarpine were injected intraperitoneally into male Sprague-Dawley (SD) rats (with a postnatal age of 18-21 days), so as to induce SE in rats.The rats were divided into 5 groups according to the random number table method: control group, SE group, SE+ low dose Glycyrrhizin group, SE+ medium dose Glycyrrhizin group and SE+ high dose Glycyrrhizin group.Three different doses of Glycyrrhizin (20 mg/kg, 40 mg/kg and 60 mg/kg) were injected intraperitoneally into the rats.The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in serum of SE rats were determined by enzyme linked immunosorbent assay.Quantitative real-time PCR (qRT-PCR) was used to detect the mRNA expression levels of TNF- α, IL-1β and IL-6 in hippocampus of SE rats.The expression levels of Bax, Bcl-2 and Caspase-3 in hippocampus were detected by Western blot.The damage of neurons was measured by hematoxylin and eosin (HE) staining and Nissl staining.Neurons apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). The mitochondrial changes were observed under transmission electron microscopy.One-way ANOVA followed by Tukey post-hoc test was used for statistical analysis. Results:Compared to the control group, TNF-α[(369.69±58.07) ng/L vs. (75.46±14.64) ng/L], IL-1β[(242.27±25.23) ng/L vs. (45.29±5.90) ng/L] and IL-6[(288.15±24.60) ng/L vs. (46.59±8.80) ng/L] in the serum of SE rats were significantly up-regulated(all P<0.05). Compared to SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of TNF-α[(216.67±8.31) ng/L, (158.81±5.03) ng/L and (113.69±12.54) ng/L vs. (369.69±58.07) ng/L], IL-1β[(131.21±5.50) ng/L, (86.60±7.79) ng/L and (65.06±4.39) ng/L vs. (242.27±25.23) ng/L] and IL-6[(150.24±9.48) ng/L, (101.70±5.85) ng/L and (91.60±2.81) ng/L vs. (288.15±24.60) ng/L] released in serum after SE occurred (all P<0.05). The neuronal damage, loss, apoptosis and mitochondrial damage were found in the hippocampus of SE rats.Glycyrrhizin could ameliorate these symptoms.Compared to the control group, Bax levels(0.57±0.01 vs. 0.14±0.01)and Caspase-3 levels(0.54±0.00 vs. 0.11±0.01)in the hippocampus of SE rats were markedly increased, while Bcl-2 levels(0.27±0.01 vs. 0.57±0.02)were decreased(all P<0.05). Compared to the SE group, low, medium and high doses Glycyrrhizin could effectively reduce the levels of Bax(0.51±0.02, 0.45±0.03 and 0.40±0.02 vs. 0.57±0.01)and Caspase-3(0.47±0.02, 0.42±0.02 and 0.37±0.01 vs. 0.54±0.00), and increase the levels of Bcl-2(0.41±0.02, 0.45±0.02 and 0.51±0.01 vs. 0.27±0.01)(all P<0.05). Conclusions:Glycyrrhizin can effectively protect the hippocampus of young rats with SE.

Effects of bisphenol A exposure at different circadian time on hepatic lipid metabolism in mice / 环境与职业医学

Background Lipid metabolism in liver shows circadian-dependent profiles. The hepatotoxicity of environmental chemicals is dependent on circadian time. Objective To observe the effects of bisphenol A (BPA) exposure at different zeitgeber time (ZT) on hepatic and blood lipid metabolism and decipher the underlying mechanisms related to circadian rhythm in mice. Methods Thirty-five female C57BL/6J mice were sacrificed every 4 h in a light-dark cycle (12 h/12 h). The liver tissues were collected to describe the circadian profiles of hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels within 24 h. Thirty female mice were divided into 6 groups by the timing (ZT3 represents the 3 h after light on, ZT15 represents the 3 h after light off) and dose (50 or 500 μg·kg−1·d−1) of BPA exposure to observe hepatotoxicity. Mice were gavaged with designed doses of BPA once per day for 4 weeks. Mice were maintained with ad libitum access to food and water and measured body weight weekly. After the experiment, mice were euthanatized and liver tissues were separated to determine the biochemical indicators of lipid metabolism and lipid metabolism- and circadian-related gene mRNA expressions. Results Hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels were rhythmic during a 24 h period in mice. At ZT3 and ZT15, BPA did not alter body weight, plasma glucose, plasma total cholesterol, plasma low density lipoprotein cholesterol, and plasma triglycerides (P>0.05). The plasma high density lipoprotein cholesterol decreased in the 50 μg·kg−1·d−1 BPA group at ZT3 by 14.56% compared with the control group (P<0.05). The liver triglycerides increased in the 50 μg·kg−1·d−1 BPA group at ZT15 by 115.20% compared with the control group (P<0.05). BPA decreased Srebp1c mRNA expression level when dosing at ZT3 and increased Chrebp, Srebp1c, and Acc1 mRNA expression levels when dosing at ZT15 compared with the control group (P<0.05). BPA increased Bmal1 mRNA expression level and decreased Rev-erbα mRNA expression level at ZT3 exposure and decreased Bmal1 and increased Rev-erbα mRNA expression level at ZT15 exposure (P<0.05). Conclusion BPA exposure at light or dark period has different effects on hepatic lipid metabolism in mice. Hepatic lipid deposit appears when BPA is dosed at dark period. Rev-erbα-Bmal1 regulation circuits and the subsequent upregulation of Srebp1c and Chrebp and the target gene Acc1 may be involved.

Research status of professional master degree students in provincial teaching hospital / 中华医学科研管理杂志

Objective:To understand the current research status of master of professional degree students in clinical medicine in provincial teaching hospitals with moderate scientific research level under the " dual-track" training system.Methods:Sojump online survey was conducted to investigate the cognition, current situation and self-evaluation of all clinical master degree students in three grades in a provincial teaching hospital, and the research status of professional degree and scientific degree students was compared and analyzed respectively.Results:The proportion of scientific degree students participating in scientific research projects was significantly higher than that of professional degree students. The proportion of professional degree students participating in scientific research projects was still not high even in the third year of graduate students. However, there was no difference between scientific degree and professional degree students in the publication of scientific research papers. The scientific degree of scientific research knowledge is significantly higher than that of professional degree students. Although scientific degree students receive more scientific research guidance from their supervisors, professional degree students communicate more with their supervisors, and the results show that professional degree students are significantly more satisfied with their supervisors, graduate policies and scientific research policies than scientific degree students. In addition, the results of graduate students found that the degree of research stress of both scientific and professional degrees exceeded 50%.Conclusions:Scientific degree is better than professional degree in research status because of professional characteristics and more research guidance from their supervisors. However, through the reform of professional degree training mode based on scientific research project management in recent years, professional degree students have been able to communicate more with their supervisors, and their satisfaction with their supervisors and colleges has significantly increased. In addition, sufficient attention should be paid to high scientific research pressure of medical graduate students.

Human acellular nerve allograft in repair of traumatic nerve defect of upper extremity: A preliminary observation / 中华显微外科杂志

Objective:To observe clinical outcomes of the repair of traumatic nerve defects in the proximal upper extremities by human acellular nerve allograft(hANG).Methods:Nerve defects in the upper extremities in 8 patients were repaired by hANG from March 2017 to January 2019. The patients were 6 males and 2 females with mean age of 35.4 (21-53) years old. The nerve defects were 2 radial nerve in distal upper arm, 4 median nerve in forearm, 1 interosseous dorsal nerve and 1 ulnar nerve in forearm. All injuries were acute nerve injury. Two patients had combined injury of upper arm muscle, 4 of forearm muscle and 1 of brachial artery defect. All wound were moderate to severe contaminated. The length of nerve defects was 30-60 (mean 45) mm. The surgical procedures were fixation of fracture, repair of the muscle and discovery of the broken ends of nerve and to repair with hANG. The postoperative follow-up period ranged 18 to 40 (mean 30.6) months to observe the local response of recovery. The efficacy was evaluated by the Upper Extremity Function Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association and Grading Standard of Muscle Strength.Results:No graft rejection was observed in all cases. Primarily healing was in 5 patients. Delayed healing in 2 patients and free skin grafting was performed. Local flap transfer was performed to repair the wound in 1 patient who developed a skin necrosis 10 days after surgery. Two patients with median nerve defects had nerve function restored well. The strength of finger grip and thumb opposition muscle restored to grade IV and the sensory function had restored S 3+. The interosseous dorsal nerve in 1 patient restored well. The strength of extensor digitorum tendon had restored to grade IV. Based on the evaluation criteria for the upper extremity issued by the Hand Surgery of the Chinese Medical Association, 3 patients was rated in excellent for function recovery, 1 in fair and 4 in poor. Conclusion:After throughout debridement, hANG can be applied in the repair of traumatic nerve defect in the proximal upper extremity in an emergency surgery and it can partially restore the nerve function.

LncRNA Gm13568 regulates the activation of A1 astrocytes and affects the EAE process in mice / 中华微生物学和免疫学杂志

Objective:To investigate the effects of long non-coding RNA (lncRNA) Gm13568 on the activation of A1 astrocytes and the progress of experimental autoimmune encephalomyelitis (EAE) in mice.Methods:A recombinant lentiviral vector (LV-Inhibit-Gm13568) carrying astrocyte-specific promoter of glial fibrillary acidic protein (GFAP) was established to inhibit the function of endogenous Gm13568. A control vector (LV-ctrl) was established as well. The recombinant vectors were packaged. C57BL/6 mice were injected with 1×10 7 transforming units of viral suspension via the tail vein and 7 d after the injection, myelin oligodendrocyte glycoprotein 35-55 (MOG 35-55) was used to establish the mouse model of EAE. Four groups, PBS group, EAE group, LV-ctrl+ EAE group and LV-Inhibit-Gm13568+ EAE group, were included in this study. Clinical signs of the mice were monitored daily in a double-blinded manner. The mice were sacrificed 23 d after the EAE model was established and the spinal cord tissues were collected. The expression of Serping 1, C3, Srgn and H2-T23 at mRNA level was detected by real-time PCR. Changes in the expression of IL-6, TNF-α, macrophage chemotactic protein-1 (MCP-1) and interferon-inducible protein-10 (IP-10) were measured. Western blot was used to investigate the expression of GFAP and Notch1 in spinal cord tissues and the phosphorylation of signal transduction and transcription activator 3 (STAT3). The expression of Notch1 intracellular domain (NICD) and GFAP in spinal cord tissues was detected by immunofluorescence. Furthermore, the infiltration of inflammatory cells and the demyelination of spinal cord were observed using HE and Luxol fast blue (LFB) staining methods. Results:Compared with PBS group, A1 astrocytes were activated and Notch1 expression was significantly up-regulated in EAE group and LV-ctrl+ EAE group. The clinical score of mice in LV-Inhibit-Gm13568+ EAE group was decreased from an average score of 3.5 to less than 1 on 23 d after antigen induction and the clinical symptoms were alleviated as compared with the mice in LV-ctrl+ EAE group. Meanwhile, the activation of A1 astrocytes was down-regulated, and the production of inflammatory cytokines and chemokines was also reduced. The expression of Notch1, GFAP and NICD at protein level and the phosphorylation of STAT3 were significantly reduced. Moreover, the infiltration of inflammatory cells and demyelination of spinal cord tissues were alleviated significantly.Conclusions:LncRNA Gm13568 might regulate the activation of A1 astrocytes via the Notch1/STAT3 pathway, thus affecting the production of inflammatory cytokines and chemokines and participating in the process of EAE.

A case of Coffin-Siris syndrome type 1 due to 6q25.3 deletion / 中华神经科杂志

Clinical data and genetic mutation characteristics of a patient with Coffin-Siris syndrome by 6q25.3 deletion were summarized. The child was a 7-year and 6-month old girl who had feeding difficulties, repeated infection, language and motor retardation, low intelligence, laryngeal cartilage dysplasia, thick eyebrows, sparse teeth, hairy back, hyperactivity and aggressive behavior, seizures and ataxia. There was no abnormality in chromosomal karyotype analysis by proband; genomic copy number variant sequencing (CNV-seq) indicated approximately 4.27 Mb heterozygous deletion in chromosome 6q25.3 region, with 17 genes including ARID1B gene, father maternal CNV-seq showing no abnormalities. Trio-whole-exome sequencing showed the proband missed all exons 1-20 of the ARID1B gene, with wild-type parents. The proband had severe clinical symptoms and haplodose insufficiency which was the genetic etiology.

Mechanism of Scutellariae Radix-Paeoniae Radix Rubra Combination of Different Proportions Against Hepatic Fibrosis in Rats / 中国实验方剂学杂志

ObjectiveTo observe the effects of Scutellariae Radix （SR）-Paeoniae Radix Rubra （PRR） combination of different proportions on the expression of the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear transcription factor κB （NF-κB） and phosphatidylinositol kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathways in liver tissues of rats with hepatic fibrosis and explore the mechanism against hepatic fibrosis. MethodSixty male SD rats of SPF grade were randomly divided into a normal group， a model group， a positive control （silymarin） group， and SR-PRR 1∶1， SR-PRR 1∶2， and SR-PRR 1∶4 groups， with 10 rats in each group. The hepatic fibrosis model was induced in rats except for those in the normal group by intraperitoneal injection of 40% tetrachloromethane （CCl4）-olive oil solution at 3 mL·kg-1， 5 mL·kg-1 for the first time， for 8 weeks， twice per week. After 4 weeks， rats were treated correspondingly at 10 mL·kg-1 by intragastric administration， and the body weight of rats in each group was weighed for 8 weeks. After administration， histopathological changes in the liver were observed. Serum alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， hyaluronic acid （HA）， laminin （LN）， albumin （ALB）， alkaline phosphatase （AKP）， and superoxide dismutase （SOD） activities， malondialdehyde （MDA）， and hydroxyproline （HYP） content in liver tissues were detected. The mRNA expression levels of TLR4， MyD88， NF-κB， PI3K， Akt， and mTOR in the liver of rats were detected by real-time fluorescence-based quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the model group， SR-PRR combination of different proportions could recover the body weight and improve the pathological injury of the liver. As revealed by enzyme linked immunosorbent assay （ELISA） results， compared with the normal group， the model group showed increased ALT， AST， HA， LN， AKP， MDA， and HYP levels to different degrees （P<0.05）. Compared with the model group， the groups with drug intervention showed decreased levels of ALT， AST， HA， LN， AKP， MDA， and HYP， potentiated SOD activity， and increased level of ALB （P<0.05）. As revealed by Real-time PCR results， compared with the normal group， the model group showed increased mRNA expression of TLR4， MyD88， NF-κB， PI3K， Akt， and mTOR （P<0.05）. Compared with the model group， the groups with drug intervention showed reduced mRNA expression of TLR4， MyD88， NF-κB， PI3K， Akt， and mTOR in the liver of rats （P<0.05）. ConclusionSR-PRR combination of different proportions can improve the histopathological injury in liver tissues caused by CCl4， with the optimal effect observed in the SR-PRR 1∶4 group. SR-PRR may inhibit the development of liver fibrosis by inhibiting the expression of TLR4/MyD88/NF-κB and PI3K/Akt/mTOR signaling pathways， thereby alleviating chemical-induced liver injury.

Retraction Note to: Radiofrequency ablation versus hepatic resection for breast cancer liver metastasis: a systematic review and meta-analysis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The authors have retracted this article (Xiao et al., 2018). After publication, they became aware that a number of studies included in the meta-analysis did not meet the eligibility criteria and that errors were made in classification and statistical analysis. The conclusions presented are therefore unreliable. All authors agree with this retraction.

Research progress on pesticide residues of Lonicera Japonica Flos / 中国中药杂志

Lonicera Japonica Flos is the dried bud or nascent flower of Lonicera japonica(Caprifoliaceae). The plant suffers from various diseases and pests in the growth period and thus pesticides are often used. As a result, the resultant pesticide residues in Lonicera Japonica Flos have aroused great concern. This review summarized the investigation, detection methods, content analysis, and risk assessment of pesticide residues in Lonicera Japonica Flos since 1996, and compared the maximum residue limits among different countries and regions. The results showed that the pesticide residues were detected in Lonicera Japonica Flos from different production areas, and only some exceeded the limits. The residual pesticides have changed from organochlorines to new types such as tebuconazole and nitenpyram. The detection method has upgraded from chromatography to chromatography-mass spectrometry. Most pesticide residues will not cause health risks, except carbofuran. Pesticide residues limit the development of Lonicera Japonica Flos industry in China. In practice, we should improve the drug registration of Lonicera Japonica Flos, promote ecological prevention and control technology, and formulate and promote pesticide residue limit standard of Lonicera Japonica Flos.

Research progress on pesticide residues of Panax notoginseng / 中国中药杂志

Panax notoginseng is a perennial Chinese medicinal plant, which has serious continuous cropping obstacles and is prone to a variety of diseases and insect pests during the growth process. At present, the prevention and control of pests and diseases is mainly carried out through chemical pesticides, and the consequent pesticide residues of P. notoginseng have attracted much attention. This study reviewed the types and detection methods of pesticide residues in P. notoginseng from 1981 to 2021, and compared the limits of pesticide residues in P. notoginseng in China and abroad to provide a reference for rational application of pesticides in P. notoginseng and quality control of medicinal materials, thereby promoting the sustainable development of the P. notoginseng industry in China. Currently, there are only 40 published papers on pesticide residues of P. notoginseng, which is indicative of a serious problem of insufficient research. At present, hundreds of pesticide residues in P. notoginseng can be detected simultaneously by using chromatography-tandem mass spectrometry. The pesticides detected have gradually changed from early prohibited ones, such as dichlorodiphenyl trichloroethane(DDT), benzene hexachloride(BHC), and parathion, to low toxic ones(e.g., dimethomorph, procymidone, propicona-zole, and difenoconazole). The dietary risk from pesticide residues in P. notoginseng is low, which would not cause harm to consu-mers. This study concluded that in the future, the development of the quality standard for pesticide residues of P. notoginseng should be actively carried out. To increase the pesticides used in actual production in the quality standard based on the existing ones and to guide farmers to use pesticides scientifically will be the focus of future work.

Research progress on pesticide residues of Panacis Quinquefolii Radix / 中国中药杂志

Panacis Quinquefolii Radix is the dry root of Panax quinquefolium, which is a perennial plant of Araliaceae. The plant has a long growth cycle and serious growth barrier problem, which leads to the use of pesticides. As a result, the pesticide residues in Panacis Quinquefolii Radix are arousing great concern. This paper reviews the research findings on the investigation, detection methods, content analysis and risk assessment of pesticide residues in Panacis Quinquefolii Radix since 1993, and compares the pesticide residue limit standards of different countries and regions. The pesticide residues in Panacis Quinquefolii Radix have been changing from organochlorines with high toxicity to triazines and triazoles with low toxicity. The pesticide residues are generally low, while the pollution of pentachloronitrobenzene and other pesticides still exist. The detection method has evolved from chromatography to chromatography-mass spectrometry. There are no reports of health risks caused by pesticide residues of Panacis Quinquefolii Radix. Pesticide residue is a major factor restricting the sound development of Panacis Quinquefolii Radix industry in China. Therefore, we suggest to improve the registration of pesticides applied to the plant, popularize mature ecological planting mode and supporting technology, and strengthen the research on the risk assessment and limit standard of pesticide residue in Panacis Quinquefolii Radix.

Research progress on pesticide residues of Panax ginseng / 中国中药杂志

Panax ginseng, a perennial herb, is prone to diseases and insect pests in the growth process, which are primarily prevented and treated by pesticides. However, due to the lack of standardization in the types, frequencies, and doses of pesticides, pesticide residues have become the main exogenous pollutants of P. ginseng. To explore the risk of pesticide residues in P. ginseng, this paper summarized and analyzed the common pesticide residues in P. ginseng, detection techniques, and pesticide residue limit stan-dards based on the published literature in recent years. The results revealed that the main pesticide residues in P. ginseng were organochlorine pesticides, such as tetrachloronitrobenzene, pentachloronitrobenzene, and hexachlorobenzene, and the detection techniques were dominated by gas chromatography(GC), liquid chromatography(LC), or those combined with mass spectrometry(MS). Because of the long half-life and difficulty in degradation, organochlorine pesticides have become the main factor affecting the export of P. ginseng. It is worth mentioning that P. ginseng has been classified as food in Japan, South Korea, the European Union, and other countries, and the standards of pesticide residues and limits are stricter than those in China. The quality and safety of P. ginseng are prerequisites for the efficacy of Chinese medicine and the development of traditional Chinese medicine. The formulation of scientific and effective standards for pesticide application and limits would promote the high-quality development of the P. ginseng industry.

Pesticide residues in Chinese medicinal materials and suggestions for safety / 中国中药杂志

The present study counted the frequency of detection technologies and monitoring frequency of pesticide species by frequency analysis based on the 28 258 pieces of data on pesticide content of Chinese medicinal materials in CNKI, calculated the detection rate and exceeding rate of different types of pesticides, and systematically analyzed the pesticide residue pollution of Chinese medicinal materials. The results showed that there were 40 types of pesticides with detection rates higher than 10%, where new pesticides such as organochlorines and nicotine accounted for 55%, and organic phosphorus, pyrethroids, and carbamates accounted for 17.5%, 15.0%, and 12.5%, respectively. Seventeen types of pesticides exceeded the standard to varying degrees, including 12 types(70.59%) with exceeding rates not higher than 5%, four types(23.53%) with exceeding rates in the range of 5%-10%, and one type(5.88%) with an exceeding rate higher than 10%. As revealed by the analysis results of the past five years, the pesticide residue pollution of Chinese medicinal materials showed a downward trend. Compared with the conditions at worst, organochlorines decreased by about 2/3 in detection rate and 47.23% in exceeding rate, carbamates by about 1/2 in detection rate and 10.78% in exceeding rate, organic phosphorus by 3/4 in detection rate and 7.22% in exceeding rate, pyrethroids by 1/2 in detection rate and 11.05% in exceeding rate, and other types by about 1/2 in detection rate but not exceeded the standard. In general, pesticide residues in Chinese medicinal materials and safety have been significantly improved. However, pesticide residues are still important factors affecting the quality and safety of Chinese medicinal materials. It is suggested to further improve the control standards of pesticide residues in Chinese medicinal materials, strengthen the monitoring of pesticides used in practical production, and promote the ecological planting mode to facilitate the high-quality development of the Chinese medicinal material industry.

MRI-based analysis of predictive factors for nucleus pulposus resorption in patients with lumbar disc herniation treated with three-dimensional balanced chiropractic technique / 中国辐射卫生

Objective To observe the effectiveness of the three-dimensional balanced chiropractic technique in the treatment of lumbar disc herniation (LDH) and analyze predictive factors for resorption of the herniated nucleus pulposus based on magnetic resonance imaging (MRI). Methods From June 2015 to June 2021, 95 patients with LDH treated with the three-dimensional balanced chiropractic techniquein our hospital were followed up for clinical and MRI data. They were divided into resorption group and non-resorption group based on the nucleus pulposus resorption rate. Multivariable binary logistic regression analysis was performed to determine the association of 12 factors (sex, age, course of disease, etc.)with nucleus pulposus resorption. Results Thirty-two cases (33.7%)were found at follow-up to have nucleus pulposus resorption (resorption rate≥30%). Resorption was most likely to occur in patients with a disease course of less than a year (P < 0.001), type 3 LDH accoding to the Michigan State University (MSU) classification (P = 0.014), leg numbness (P = 0.006), and a L4/5 or L5/S1 disc herniation (P < 0.001). Conclusion MRI can be used as an important tool to observe nucleus pulposus resorption in LDH. A disease course of less than a year, MSU type 3, leg numbness, a L4/5 or L5/S1 disc herniation are associated with a higher possibility of nucleus pulposus resorption, which can be used as indicators predicting the outcome of patients with LDH treated with the three-dimensional balanced chiropractic technique.

Establishment of random forest model and its predictive value for pathologic complete response in breast cancer patients undergoing neoadjuvant chemotherapy / 肿瘤研究与临床

Objective:To investigate the predictive value of established random forest model for pathologic complete response (pCR) in breast cancer patients undergoing neoadjuvant chemotherapy.Methods:The clinicopathologic data of 142 primary breast cancer patients undergoing breast-conserving surgery or modified radical mastectomy after neoadjuvant chemotherapy from Cangzhou Central Hospital between January 2010 and October 2021 were retrospectively analyzed. Histologically, breast and axillary lymph node without residual infiltrated tumors was treated as pCR. The patients were divided into pCR group (23 cases) and non-pCR group (119 cases) according to whether patients achieved pCR or not, and the differences of clinicopathologic data between the two groups were compared. The risk factors affecting pCR were identified by using logistic regression analysis, random forest model was established by using random forest function of R statistical software, and Gini index of random forest algorithmic was used to order the importance of variables. The receiver operating characteristic (ROC) curve was used to assess the value of random forest model in predicting the efficacy of neoadjuvant chemotherapy.Results:The overall pCR ratio after neoadjuvant chemotherapy was 16.20% (23/142). The proportion of tumor diameter ≤5 cm, negative axillary lymph node, negative human epidermal growth factor receptor 2 (HER2), Ki-67 positive index >20%, histological grade 2, and neoadjuvant chemotherapy regimens including targeted therapy in pCR group was higher than that in non-pCR group, and the difference was statistically significant (all P < 0.05). Univariate logistic regression analysis showed that tumor diameter, axillary lymph node, HER2, Ki-67, histological grade, and neoadjuvant chemotherapy regimens were related with pCR (all P < 0.05). Multivariate logistic regression analysis showed that tumor diameter >5 cm ( OR = 5.85, 95% CI 1.28-26.67, P = 0.022), positive axillary lymph node ( OR = 11.22, 95% CI 1.84-68.42, P = 0.009), positive HER2 ( OR = 7.35, 95% CI 1.45-37.26, P = 0.016), Ki-67 positive index ≤20% ( OR = 1.03, 95% CI 1.01-1.06, P = 0.017), histological grade 3 ( OR = 7.37, 95% CI 1.24-43.86, P = 0.028), and non-targeted therapy ( OR = 0.02, 95% CI 0.00-0.25, P = 0.003) were independent risk factors of pCR. Random forest algorithm showed that the importance order of risk factors of pCR was successively Ki-67 low expression, positive axillary lymph node, tumor diameter >5 cm, positive HER2, non-targeted therapy and histological grade 3. The area under the ROC curve of random forest model for predicting pCR was 0.84 (95% CI 0.74-0.93); the sensitivity was 87.0% and specificity was 72.3% when the optimal cut-off value was 0.88. Conclusions:Low expression of Ki-67, positive axillary lymph node, tumor diameter >5cm, positive HER2, non-targeted therapy and histological grade 3 are risk factors of pCR in breast cancer patients after neoadjuvant chemotheapy. Random forest model helps to predict pCR in breast cancer patients after neoadjuvant chemotheapy.

Impact of serum tenascin-C level on the long-term prognosis of patients with acute ST-segment elevation myocardial infarction / 中华检验医学杂志

Objective:To explore the serum tenascin-C levels in patients with acute ST-segment elevation myocardial infarction (STEMI) and its impact on the long-term prognosis.Methods:One hundred and thirteen STEMI patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Dalian Medical University and successfully underwent emergency PCI from June 2015 to June 2016 were included in this prospective study. The serum tenascin-C levels were measured during hospitalization, and the patients were divided into tenascin-C ≥ 120 μg/L group and tenascin-C<120 μg/L group according to the serum tenascin-C level. Major adverse cardiovascular events (MACE) were observed during the 5 years follow up in all patients. According to the incidence of MACE, the patients were divided into MACE group and non-MACE group, and the predictive factors of MACE were analyzed. Continuous variables were presented as the mean±standard deviation and compared with the Student′s t-test. Categorical variables were presented as percentages and compared with the Chi-square test or Fisher′s exact test. Receiver operating characteristic (ROC) curve was used to analyze the value of serum tenascin-C level in predicting MACE in STEMI patients. Kaplan Meier survival analysis was used to compare the incidence of MACE between two groups. Cox proportional hazards regression model was used to analyze the risk factors of MACE during the 5 years follow up.Results:The serum tenascin-C levels in the STEMI patients increased on the first day after the onset of disease (46.5±24.8 μg/L), peaked on the third day (97.5±41.2 μg/L), and then gradually decreased. All patients were followed up for 5 years. There were 37 cases of MACE, including 4 cases of cardiac death (3.5%), 14 cases of heart failure (12.4%), 14 cases of recurrent myocardial infarction or revascularization (12.4%), and 5 cases of stroke (4.4%). For prediction of MACE, the area under the curve of the serum TN-C level was 0.953 (95% CI 0.918-0.988, P<0.05), which was thus a valuable biomarker in predicting MACE for STEMI patients. The incidence of MACE in the group of tenascin-C≥120 μg/L group was higher than that in the group of tenascin-C<120 μg/L group (86.4% [19/22] vs 19.8% [18/91]), and Kaplan-Meier survival analysis showed that the difference was statistically significant ( P<0.05). Cox proportional hazards model analysis showed that serum tenascin-C level was an independent predictor of MACE for STEMI patients during the 5 years follow-up ( HR=1.007, 95% CI 1.001-1.012, P<0.05). In addition, other variables including high sensitivity C-reactive protein ( HR=1.028, 95% CI 1.007-1.049, P<0.05), and cardiac troponin Ⅰ ( HR=1.004, 95% CI 1.000-1.008, P<0.05) were also found to be the independent predictors of MACE. Conclusions:The serum tenascin-C levels in STEMI patients increased significantly during the acute disease phase. Detecting the serum tenascin-C levels is valuable for predicting MACE in STEMI patients, and serum tenascin-C is an independent predictor of MACE in STEMI patients during the long-term follow-up period after acute myocardial infarction.