Effects of CDA-G208A gene polymorphism on the efficacy of gemcitabine in the first-line treatment of lung squamous cell carcinoma / 中国临床药理学与治疗学

AIM: To investigate the effect of CDAG208A gene polymorphism on the efficacy and safety of gemcitabine in the first-line treatment of lung squamous cell carcinoma. METHODS: Sixty-five first-line treated patients with locally advanced or metastatic lung squamous cell carcinoma in The First Affiliated Hospital of Wannan Medical College hospital were screened. Group A included 31 patients tested with the GG (wild homozygous) CDAG208A gene, and group B included 34 patients without testing. All patients received gemcitabine plus platinum chemotherapy for at least 2 cycles. The efficacy and safety were evaluated following the RECIST 1.1 standard and the NCI-CTC 5.0 standard, respectively. The primary study endpoint was progression-free survival (PFS), overall survival (OS) and the secondary study endpoints included objective effective rate (ORR), disease control rate (DCR), adverse reactions, and influencing factors of PFS. RESULTS: The results showed that the DCR was 74.5% and 50% in group A and group B, respectively (P=0.045); mPFS was 6.1 months and 5.0 months in group A and group B, respectively (P=0.034); and the mOS was 13.3 months and 12.0 months in group A and group B, respectively, and there was no statistical difference (P=0.388). The number of cases of grade III-IV neutropenia in group A and group B was 2 and 10, respectively (P=0.017); grade III-IV neutropenia was an independent prognostic factor affecting patients with PFS (P=0.045); the group with unknown G208A gene status was more likely to develop grade III-IV neutrophils (P= 0.029). The AUC of CDA-G208A gene predicting neutropenia caused by gemcitabine chemotherapy was 0.756. CONCLUSION: Non-GG type of CDAG208A gene can reduce the metabolic rate of gemcitabine in the body and cause neutropenia after chemotherapy. In severe cases, it can indirectly reduce the clinical efficacy of gemcitabine. The detection of CDA-G208A gene status before treatment can predict the neutropenia caused by gemcitabine chemotherapy.

Distribution of CYP2C9∗3 and VKORC1-1639G>A gene polymorphism in Anhui Han population and their influence on the stable dose of warfarin / 中国临床药理学与治疗学

AIM: To study the distribution of CYP2C9∗3 and VKORC1-1639G>A gene polymorphism in Han population in Anhui province and their influence on the stable dose of warfarin. METHODS: The blood samples of 1 169 patients from 6 tertiary general hospitals in 5 areas of Anhui province from January 2020 to December 2021 were selected, the genotype of CYP2C9∗3 and VKORC1-1639G>A was detected by fluorescent staining in situ hybridization technique. RESULTS: The distribution of CYP2C9∗3 genotypes in 1 169 patients: the frequencies of AA, AC and CC genes were 90.16%, 9.24% and 0.60%, respectively; The distribution of VKORC1 genotype: the frequencies of AA, AG and GG genes were 84.26%, 14.71% and 1.03% respectively; There was no significant difference between the two genotypes in gender, age and regional distribution (P>0.05). The average daily warfarin dose of CYP2C9∗3 AA genotype in 755 patients with stable warfarin dose was (3.02±0.59) mg/d, which was significantly higher than patients with AC genotype and CC genotype; The average daily warfarin dose of patients with VKORC1-1639AA genotype was (2.72±0.40) mg/d, which was significantly lower than that of patients with AG genotype and GG genotype (P<0.05). And the difference was statistically significant (P<0.05); There are significant differences in gender, age and clinical diagnosis between patients with stable dose of warfarin and those without stable dose (P<0.05). CONCLUSION: CYP2C9 and VKORC1 genotypes are associated with the stable dose of warfarin. Clinical anticoagulation therapy guided by CYP2C9 and VKORC1 genotypes can provide guidance for individualized medication of warfarin.

Application of transoral robotic surgery in treatment of oropharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the therapeutic and prognostic outcomes of transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OSCC). Methods: A retrospective study of 99 OSCC patients treated with TORS in Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center between April 2017 and May 2021 was conducted. There were 84 males and 15 females, with an age range of 35-85 years. Patients' clinical characteristics, including clinical staging, HPV infection status, perioperative management and postoperative adjuvant treatment, were recorded. The overall survival (OS) and progression-free survival (PFS) were analyzed. The survival outcomes were analyzed with Kaplan-Meier method and Log-rank test. Results: The hospital stay of OSCC patients with TORS was (5.3±2.9) days and the average time of postoperative nasal feeding tube indwelling was (15.2±10.8) days. Among the 99 patients, 21 (21.2%) received tracheotomy and the average time of tracheotomy tube indwelling was (11.9±11.4) days. The two-year OS and PFS in patients with follow-up over two years were 94.0% and 87.7%, respectively and the three-year OS and PFS of patients with follow-up over three years were 94.0% and 78.9%, respectively. The two-year OS and PFS were respectively 97.4% and 88.9%, for patients with stages I-II and 86.8% and 88.9% for patients with stages III-IV. HPV-negative and HPV-positive patients had respectively two-year OS (100.0% vs. 91.5%) and PFS (88.9% vs. 87.2%). There was no significantly statistical difference in survival between patients with and without adjuvant radiotherapy after TORS (82.6% vs. 90.5%, HR=0.52, 95%CI: 0.12-2.23, P=0.400). Conclusions: TORS is more suitable for the treatment of patients with early (Ⅰ-Ⅱ) or HPV-positive oropharyngeal squamous cell carcinoma, and the recovery after TORS treatment is good.

Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery / 中华肿瘤杂志

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

The clinical value of oral robotic surgery in the treatment of oropharyngeal squamous cell carcinoma / 中华肿瘤杂志

Objective: To explore the therapeutic effects of transoral robotic surgery (TORS) and traditional surgical modes in oropharyngeal squamous cell carcinoma (OPSCC). Methods: The clinicopathological data of patients with oropharyngeal squamous cell carcinoma treated at Sun Yat-sen University Cancer Center from 2010 to 2018 were retrospectively analyzed. 135 cases were treated with traditional surgery (non-TORS group), while 52 cases were treated with TORS (TORS group). The prognosis of the two groups of patients were analyzed by Kaplan-Meier method and Log rank test, the influencing factors were analyzed by Cox regression model. Results: The 2-year overall survival (OS, 94.2%) and 2-year progression-free survival (PFS, 93.8%) of patients in the TORS group were better than those in the non-TORS group (71.4% and 71.4%, respectively, P<0.05). The 2-year OS (93.3%) and 2-year PFS (92.8%) of TORS group patients in T1-2 stage were better than those of non-TORS group (73.1% and 72.8%, respectively, P<0.05). The 2-year OS (95.8%) and 2-year PFS (95.2%) of patients with stage Ⅰ to Ⅱ in the TORS group were not significantly different from those in the non-TORS group (84.1% and 83.9%, respectively, P>0.05). The 2-year OS (92.9%) and 2-year PFS rate (92.7%) of patients with stage Ⅲ to Ⅳ in the TORS group were better than those in the non-TORS group (64.7% and 63.9%, respectively, P<0.05). The 2-year OS (94.4%) of HPV-positive patients in the TORS group was not significantly different from that in the non-TORS group (83.3%, P=0.222). The 2-year OS of HPV-negative patients in the TORS group (94.1%) was significantly different from that in the non-TORS group (43.7%, P<0.001). HPV status was an independent prognostic factor (P=0.008). Conclusions: TORS has a better prognosis in the treatment of oropharyngeal squamous cell carcinoma compared with the traditional treatment methods. The patients with T1-T2 can achieve better survival benefits after TORS treatment. The HPV-positive OPSCC patients has a better prognosis than that of HPV-negative OPSCC patients, and regardless of HPV status, OPSCC patients in the TORS group could obtain a better survival prognosis.

Distribution of gene polymorphism in folate metabolism pathway and its effect on serumhomocysteine concentration / 中国临床药理学与治疗学

AIM: To study the polymorphism distribution of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) genes and their influence on serum homocysteine (Hcy) concentration. METHODS: A total of 148 patients diagnosed with ischemic stroke from November 2020 to February 2021 in Yijishan Hospital of Wanan Medical College were selected for the study, and patients were typed for MTHFR 677C/T and MTRR 66A/G genes using fluorescent staining in situ hybridization technique. Serum Hcy concentrations were measured in 21 patients using a circulating enzyme assay. The distribution of MTHFR 677C/T and MTRR 66A/G gene polymorphisms were analyzed, and the differences in serum Hcy concentrations between patients with different genotypes were compared. RESULTS: The mutation rates of MTHFR 677C/T and MTRR 66A/G genes were 42.57% and 26.01%, respectively, and no significant differences in gene distribution frequencies were observed between men and women (P>0.05). The mean Hcy serum concentration was (16.04±4.34) μmol/L in 21 patients, including 8 patients (38.10%) with 0.05). CONCLUSION: MTHFR gene polymorphisms can affect serum Hcy concentrations. The MTHFR genotyping can be considered for individualized folic acid supplement. This conclusion should be further verified by expanding the clinical sample size.

Application of preoperative endoscopic carbon nanoparticles tracer labeling in patients undergoing laparoscopic radical gastric cancer surgery / 西安交通大学学报(医学版)

【Objective】 To explore the application value of preoperative gastroscopic carbon nanoparticles labeling in patients undergoing laparoscopic radical gastric cancer surgery. 【Methods】 We included cases of laparoscopic radical gastric cancer surgery at The First Affiliated Hospital of Xi’an Jiaotong University from January 2017 to December 2019. Some cases received submucosal injection of carbon nanoparticles under the gastroscope before surgery. The effects of carbon nanoparticles labeling on the number of lymph nodes detected， operation duration and surgical complications were compared and analyzed. 【Results】 A total of 397 patients undergoing laparoscopic radical gastric cancer surgery were enrolled. Among them， 78 cases underwent gastroscopic carbon nanoparticles tracer labeling before operation. No complications were observed. The total number of lymph nodes detected by pathology after surgery in the carbon nanoparticles group significantly increased ［（22.0（4.0） vs. 22.0（3.0）， P=0.033）］ while the operation time significantly reduced ［（185.0±37.48）min vs. （213.4±23.66）min， P<0.001］ compared with those in the control group. New gastric cancer lesions were revealed by gastroscopy in three cases （3.8%） of carbon nanoparticles labeling， and the original planned operation method was changed in two cases （2.6%）. 【Conclusion】 Preoperative endoscopic carbon nanoparticles tracer labeling can not only help shorten the time of laparoscopic radical surgery for gastric cancer and increase the number of total lymph nodes detected for more accurate TNM staging， but also provide an opportunity for the discovery of synchronous multiple gastric cancer.

Transoral robotic surgery for parapharyngeal space neoplasm: a report of 7 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the safety, efficacy and feasibility of transoral robotic surgery (TORS) for parapharyngeal space (PPS) neoplasms. Methods: We collected data from 7 patients with PPS neoplasm who received TORS in Sun Yat-sen University Cancer Center between May 2017 and November 2020, and patients' clinical and pathological characteristics were analysed. There were 2 men and 5 women with age ranged from 35 to 76 years. Among them, 2 patients underwent secondary surgery, 2 patients required combined transcervical approach to complete surgery, and 1 patient was suspected of ipsilateral cervical lymph node metastasis and scheduled for diagnostic TORS. The preoperative tumor size, operation time, intraoperative blood loss, postoperative bleeding, dyspnea, neurological impairment, feeding time and postoperative hospital stay were analyzed. SPSS 24.0 was used to analyze the data. Results: TORS was performed successfully with complete removal of tumors in all 7 cases. Among 6 patients with curative TORS, 5 patients received TORS with postoperative diagnoses of neurogenic tumors and 1 patient underwent TORS combined transcervical approach with postoperative disgnosis of recurrent pleomorphic adenoma; no intraoperative tumor rupture occurred; the intraoperative blood loss was 20-200 ml with a median of 40 ml; the operation time was 65.0-238.0 min with a median of 77.5 min; the oral feeding time was 3-6 days with a median of 3 days; and the postoperative hospital stay was 4.2±1.6 days. One patient presented with neck swelling 3 days after surgery, but this symptom relieved 3 days later after treatments with antibiotic, hemostasis and detumescence. One patient received diagnostic TORS, as intraoperative pathology indicating a recurrent pleomorphic adenoma, then the neoplasm got completely resected through transcervical-transparotid approach. None of 7 patients manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All patients were followed for 2 to 44 months, no local recurrence or distant metastasis was found. Conclusions: TORS is a safe, effective and feasible treatment for selected PPS neoplasms, with less cosmetic impact, less trauma and blood loss, few postoperative complications, enhanced postoperative recovery and short hospital stay.

Drug-resistant gene polymorphisms in Plasmodium falciparum isolated from Bioko Island, Equatorial Guinea in 2018 and 2019 / 中国血吸虫病防治杂志

Objective To investigate the genetic polymorphisms of Plasmodium falciparum multidrug resistance protein 1 (PfMDR1), chloroquine resistance transporter (PfCRT) and Kelch 13 (PfK13) genes in Bioko Island, Equatorial Guinea, so as to provide insights into the development of the malaria control strategy in local areas. Methods A total of 85 peripheral blood samples were collected from patients with Plasmodium falciparum infections in Bioko Island, Equatorial Guinea in 2018 and 2019, and genomic DNA was extracted. The PfMDR1, PfCRT and PfK13 genes were amplified using a nested PCR assay. The amplification products were sequenced, and the gene sequences were aligned. Results There were no mutations associated with artemisinin resistance in PfK13 gene in Bioko Island, Equatorial Guinea, while drug-resistant mutations were detected in PfMDR1 and PfCRT genes, and the proportions of PfMDR1_N86Y, PfMDR1_Y184F and PfCRT_K76T mutations were 35.29% (30/85), 72.94% (62/85) and 24.71% (21/85), respectively. Conclusion There are mutations in PfMDR1, PfCRT and PfK13 genes in P. falciparum isolates from Bioko Island, Equatorial Guinea.

Chronopharmacokinetics of melatonin in non-dipper spontaneous hypertension rats / 中国临床药理学与治疗学

AIM: To study the chronological pharmacokinetic differences of melatonin (MEL) in non-dipper spontaneously hypertensive rats (SHR). METHODS: The HPLC detection method of MEL was established, and the specificity, precision, recovery rate and stability of the method were examined. Twelve male SD rats were divided into two groups, and a single dose of MEL (20 mg/kg) was given intragastrically at either 08:00 or 20:00, respectively. Plasma samples were collected at 0, 5, 10, 15, 20, 30, 40, 60, 90, 120, 240, 360 min after drug administration, and the plasma MEL concentration was determined by fluorescence HPLC. RESULTS: The specificity, precision, recovery rate and stability of the MEL detection method established in this study were in line with the requirements of the biological analysis method guidelines, proving that the method was mature and reliable. After MEL was administered at 08:00, the T

Comparative analysis of inpatient medical services between secondary public and private general hospitals in Chengdu / 中华医院管理杂志

Objective:To evaluate and compare the inpatient medical services of secondary public and private general hospitals by using disease risk adjustment model, and to explore the application of disease risk adjustment model in medical service evaluation of different ownership hospitals.Methods:Based on 1 032 865 front pages of medical records in Chengdu in 2017 and 2018, a regression model with mortality, average length of stay, total hospitalization expenses, medical service fees, drug costs and surgical consumables costs as dependent variables and related influencing factors as independent variables was established by using disease management intelligent analytic and evaluation system. The risk adjusted case mix index(ACMI) was calculated. The mortality, average length of stay, hospitalization expenses and other indicators were predicted. The ratio of observed value to expected value(O/E value) of each index in public and private secondary general hospitals was obtained and compared.Results:The ACMI value of secondary public general hospital was 4.63, slightly higher than that of private hospitals(4.55). The technical difficulty and resource consumption of the public hospitals were slightly higher than that of the private hospitals.From the O/E value, the management of disease mortality, medical service fees and inpatient drug costs of secondary public hospitals was generally good, and the O/E values of hospitalization expenses of each secondary private general hospital were quite different, and there was a possibility that the costs were unreasonable. The O/E value of surgical consumables cost in secondary public general hospital was 1.54, and there was room for improvement in cost management.Conclusions:The disease risk adjustment model fully considers the characteristics of different types and severity of diseases in different institutions, which can not be simply compared. Based on individual cases, it realizes the comparability of different ownership hospitals, and provides a new means for the evaluation of medical service ability and quality.

The characteristics of Czech chemical defense medicine and its enlightenment and suggestions / 国际药学研究杂志

Based on the exchange and cooperation with international advanced chemical defense emergency rescue forces, combined with years of experience in chemical defense medicine research, and taking Czech National Institute for NBC Protection (SUJCHBO)as an example, we introduce in this paper the advantages and characteristics in the research filed of chemical defense medicine of SUJCHBO. Meanwhile, we discuss the training system, equipment system and scientific research platform construction combined with the enlightenment obtained from SUJCHBO, so as to provide reference for the research of chemical defense medicine and the construction of emergency rescue in China.

Effect of transfusing blood components containing Babesia microti on B. microti infection in BALB/c mice / 中国血吸虫病防治杂志

Objective To evaluate the effects of intravenous injection of different blood components containing Babesia microti on B. microti infection in mice. Methods Healthy mice were infected with B. microti, and then blood samples were collected from the mouse orbit to prepare whole blood, serum-free blood components and pure red blood cells containing B. microti. Twenty seven BALB/c mice were divided into three groups, including the whole blood group, the serum-free blood component group and the pure red blood cell group, of 9 mice in each group, and then, each group was divided into three subgroups, of 3 mice in each subgroup, which were injected with 100 μL of blood components containing B. microti at concentrations of 9.00, 0.90, 0.09 B. microti parasites/μL (900, 90, 9 B. microti parasites) via the tail vein, respectively. Blood samples were collected from the mouse tail tip every other day since one day post-injection to prepare thin blood smears. Following Giemsa staining of blood smears, B. microti infection was identified in red blood cells using microscopy. Results Following injection of 900 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group and the serum-free blood component group 3 days post-injection, and the density of B. microti parasites started to increase 15 days post-injection and peaked 21 days post-injection, with 2.21% and 1.76% rates of B. microti infection in red blood cells, respectively. Subsequently, the density of B. microti parasites declined, and the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was found in the peripheral blood in the pure red blood cell group. Following injection of 90 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group 3 days post-injection, and the density of B. microti parasites increased 15 days post-injection and peaked 21 days post-injection, with a 1.35% rate of B. microti infection in red blood cells, while the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was detected in the peripheral blood in the serum-free blood component group or the pure red blood cell group. Following injection of 9 B. microti parasites, no B. microti was detected in the peripheral blood in the whole blood group, the serum-free blood component group or the pure red blood cell group. Conclusion Blood components and dose of B. microti parasites may affect intravenous injection of B. microti injection in mice, and transfusion of blood components may case a risk of Babesia infection.

Effect of transfusing blood components containing Babesia microti on B. microti infection in BALB/c mice / 中国血吸虫病防治杂志

Objective To evaluate the effects of intravenous injection of different blood components containing Babesia microti on B. microti infection in mice. Methods Healthy mice were infected with B. microti, and then blood samples were collected from the mouse orbit to prepare whole blood, serum-free blood components and pure red blood cells containing B. microti. Twenty seven BALB/c mice were divided into three groups, including the whole blood group, the serum-free blood component group and the pure red blood cell group, of 9 mice in each group, and then, each group was divided into three subgroups, of 3 mice in each subgroup, which were injected with 100 μL of blood components containing B. microti at concentrations of 9.00, 0.90, 0.09 B. microti parasites/μL (900, 90, 9 B. microti parasites) via the tail vein, respectively. Blood samples were collected from the mouse tail tip every other day since one day post-injection to prepare thin blood smears. Following Giemsa staining of blood smears, B. microti infection was identified in red blood cells using microscopy. Results Following injection of 900 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group and the serum-free blood component group 3 days post-injection, and the density of B. microti parasites started to increase 15 days post-injection and peaked 21 days post-injection, with 2.21% and 1.76% rates of B. microti infection in red blood cells, respectively. Subsequently, the density of B. microti parasites declined, and the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was found in the peripheral blood in the pure red blood cell group. Following injection of 90 B. microti parasites, B. microti was identified in the peripheral blood in the whole blood group 3 days post-injection, and the density of B. microti parasites increased 15 days post-injection and peaked 21 days post-injection, with a 1.35% rate of B. microti infection in red blood cells, while the percentage of B. microti infection in red blood cells tended to be 0 31 days post-injection. During the study period, no B. microti was detected in the peripheral blood in the serum-free blood component group or the pure red blood cell group. Following injection of 9 B. microti parasites, no B. microti was detected in the peripheral blood in the whole blood group, the serum-free blood component group or the pure red blood cell group. Conclusion Blood components and dose of B. microti parasites may affect intravenous injection of B. microti injection in mice, and transfusion of blood components may case a risk of Babesia infection.

Diagnosis and treatment of Charcot's osteoarthropathy / 中国骨伤

Charcot foot is a rare disease in clinic, its pathogenesis includes neurotrauma theory, neurovascular theory, comprehensive theory, and inflammatory factor theory. The disease is characterized by progressive joint and bone destruction of foot and ankle joint. Conventional X-ray examination is not sensitive to the early diagnosis of disease, the manifestation of CT and MRI of disease is characteristic and could be used to make a comprehensive evaluation of bone and soft tissue lesions of disease. It is not difficult to make a diagnosis based on characteristic findings of CT and MRI and clinical manifestations such as swelling, pain and skin temperature rising of foot and ankle. Charcot foot has multiple classification methods including anatomy, imaging and clinical classification. Improved Eichenholtz staging classification is most commonly used currently which could make a more comprehensive assessment of disease and guide treatment better. According to the stage of disease, treatment could be carried out including non-weight bearing and brace protection, drugs therapy and surgical treatment, etc. Early diagnosis, brace protection, could protect joint and delaying progression of deformity. There is no clear long-term and generally accepted conclusion about the efficacy of drug therapy. For advanced patients, surgical treatment must be actively performed to preserve a stable and functional ankle joint and reduce amputation rate.

Clinical observation of selective posterior rhizotomy for improving spasticity and gross movement in patients with cerebral palsy / 中国骨伤

OBJECTIVE@#To explore the effect of selective lumbosacral posterior rhizotomy(SPR) on lower limb spasticity and gross motor function in patients with cerebral palsy.@*METHODS@#From January 2018 to October 2018, 47 patients with cerebral palsy were treated with rehabilitation alone and SPR combined with rehabilitation. According to whether SPR was performed, the patients were divided into group A and group B. Group A was treated with rehabilitation combined with SPR at lumbosacral level, and group B was treated with rehabilitation alone. There were 23 cases in group A, including 15 males and 8 females, with an average age of (7.30±3.25) years old; 24 cases in group B, 13 males and 11 females, with an average age of (7.00±3.09) years old. Forty-seven patients were assessed with modified Ashworth(MAS) and Gross Motor Function Scale(GMFM-88 items) before and after treatment. The changes of MAS and GMFM-88 scores before and after treatment were compared to evaluate the degree of spasm and the improvement of gross motor function in the two groups.@*RESULTS@#All 47 patients were followed up. At 6 months after treatment, the MAS classification of the two groups was significantly improved(<0.05), and the improvement of group A was more obvious than that of group B(<0.05). Six months after treatment, the D, E and total scores of GMFM-88 between two groups were significantly improved compared with those before operation(<0.05). The improvement of D and total scores in group A was more obvious than that in group B. There was no significant difference in the improvement of area E between two groups.@*CONCLUSIONS@#Selective posterior rhizotomy combined with rehabilitation can significantly improve the spastic state and gross motor function of lower limbs in children with cerebral palsy, and can effectively promote the reconstruction and recovery of motor function of lower limbs in children with cerebral palsy.

NANOG Alleviates the Damage of Human Hair Follicle Mesenchymal Stem Cells Caused by H2O2 through Activation of AKT Pathway / 生物医学与环境科学（英文）

OBJECTIVE@#To explore the protective effect of NANOG against hydrogen peroxide (H2O2) -induced cell damage in the human hair follicle mesenchymal stem cells (hHF-MSCs).@*METHODS@#NANOG was expressed from a lentiviral vector, pLVX-IRES-ZsGreen. NANOG hHF-MSCs and vector hHF-MSCs were treated with 400 μmol/L hydrogen peroxide (H2O2) for 2 h, the cell survival rate, cell morphology, ROS production, apoptosis and expression of AKT, ERK, and p21 were determined and compared.@*RESULTS@#Our results showed that NANOG could activate AKT and upregulate the expression of p-AKT, but not p-ERK. When treated with 400 μmol/L H2O2, NANOG hHF-MSCs showed higher cell survival rate, lower ROS production and apoptosis, higher expression of p-AKT, higher ratio of p-AKT/AKT.@*CONCLUSION@#Our results suggest that NANOG could protect hHF-MSCs against cell damage caused by H2O2 through activating AKT signaling pathway.

Risk adjustment and its application in refined hospital management and assessment / 中华医院管理杂志

Objective@#To study new ways and tools for assessing the inpatient disease management and improving refined management of the hospital.@*Methods@#By using homepages of medical records of the patients discharged from 21 tertiary general hospitals in a city in 2016, we completed the modeling and predicted value calculation within each DRGs with the Disease Management Intelligent Analytic & Evaluation System (DMIAES System).@*Results@#2 192 predication models were built, to compute the theoretic values of the mortality rate, length of stay, medical fee, medical service fee, and drug cost of each inpatient. Such values were compared with the observed results to gain the O/E index. If O/E is less than 1, it indicates that the inpatient′s disease management is good and better than expected. On the other hand, O/E index greater than 1 indicates poorer disease management than expected and rooms of further improvement. With the help of O/E index, we made multidimensional comparisons assessment and analysis of different hospitals, clinical disciplines, diseases and doctors.@*Conclusions@#The DMIAES System can take risk factors of inpatients′ outcomes into account, assessing the major indicators of inpatient outcomes by means of big data and modelling. This approach proves effective in enabling administrators and doctors to rapidly analyze problems for identifying solutions and enhancing management, thus having great potential in hospital management, supervision and assessment.

Influence of preoperative transarterial chemoembolization on patients' perioperative safety and short-term prognosis after liver transplantation / 中华普通外科杂志

Objective To explore the influence of preoperative transarterial chemoembolization on short-term prognosis in patients with hepatocellular carcinoma after liver transplantation Methods From Jan 2006 to Sep 2016 in Ruijin Hospital 21 patients received preoperative hepatic transarterial chemoembolization (TACE) before liver transplantation,the other 30 patients undergoing upfront liver transplantation served as control group.Results No statistical difference was found in the total operation time (401 ± 72) min vs.(377 ± 100) min,blood loss (2 785 ± 25 56) ml vs.(4 199 ± 3 748) ml and length of hospital stay (32-± 16) d vs.(28 ± 17) d between two groups,and the occurrence rate of vascular complications (14.3％ vs.0) or biliary complications (9.5％ vs.6.7％) also showed no difference (P ＞ 0.05).Although more patients were diagnosed with postoperative infection in the observation group (81％ vs.40％) (P ＜ 0.05),there was no statistically significant difference in complication grade and perioperative mortality between two groups (P ＞ 0.05).There's no remarkable difference in the liver function recovery level between two groups in terms of postoperative indexs of liver function such as TBL,ALT,AST,and there was also no statistical difference between two groups in 1-year,2-year and 3-year overall survival (P ＞ 0.05).The waiting time in the study group was significantly longer than that in the control group (P ＜ 0.05),and the incidence of postoperative immune dysfunction was lower than that of the control group (P ＜ 0.05).Conclusion Preoperative TACE does not affect liver function recovery and perioperative safety after liver transplantation.

Anti-depression effect of Yinao Jieyu Granules and its mechanism / 中成药

AIM To observe the effect of Yinao Jieyu Granules (Curcumae Radix,Schisandrae chinensis Fructus,Gardeniae Fructus,etc.) on rats depression induced by olfactory bulbectomy (OB).METHODS The model rats randomly divided into model group,Fluoxetine Hydrochloride Capsules group,Yinao Jieyu Granules groups (7.29,3.65 and 1.82 g crude drug/kg) went on with their corresponding intragastric administration once per day (the same volume of purified water for the model group) for 2 weeks.The weight,food intake,liquid consumption,open field test,killing test,light/dark transition test and step-down test were checked every week before and after the administration.The blood sample and brain tissue were procured within 2 hours after the final administration.The serum CRH,ACTH and CORT concentration and the content of hippocampal monoamine neurotransmitters 5-HT,DA and NE were tested by ELISA method.RESULTS Compared with the model group,rats of Yinao Jieyu Granules groups (7.29-3.65 g crude drug/kg) displayed a better sucrose consumption improvement (P ＜ 0.05);more content increase of hippocampal tissue 5-HT (P ＜ 0.05);longer duration time in the dark and on the platform before the error making (P ＜ 0.05);less horizontal and vertical movement,and more significant content decrease of the serum CRH (P ＜ 0.05).CONCLUSION Yinao Jieyu Granules can relieve the depression behaviors of OB animals,and the mechanism may associate with its efficacy on 5-HT and CRH modulation.