Long-term outcomes of definitive radiotherapy-based comprehensive treatment for inoperable stage I-III non-metastatic pancreatic cancer / 中华放射肿瘤学杂志

Objective:To analyze long-term outcomes of inoperable non-metastatic pancreatic cancer patients treated with definitive radiotherapy-based comprehensive treatment.Methods:Clinical data of 168 patients with medically unfit, refusal to surgery or inoperable non-metastatic pancreatic cancer treated with radiotherapy-based comprehensive treatment in PLA General Hospital between January 2016 and December 2020 were retrospectively analyzed. Survival outcomes,prognostic factors and patterns of treatment failure were analyzed in the radiotherapy ( n=95) and combined chemoradiotherapy ( n=73) groups. The survival analysis was conducted by Kaplan-Meier method. The survival curve was compared by log-rank test. Independent prognostic factors were identified by Cox proportional harzard model. Results:With a median follow-up of 20.2 months in the entire group, the median overall survival (OS) and median progression-free survival (PFS) were 18.0 and 12.3 months. The corresponding median OS and median PFS after receiving radiotherapy were 14.3 and 7.7 months. The 1-, 2-and 3-year OS rates were 72.1%, 36.6% and 21.5%, and the 1- and 2-year local control rates were 82.6% and 64.3%, respectively. The median OS for stage Ⅰ, stage Ⅱ and stage III were 27.1, 18.0 and 17.0 months, respectively. There was no significant difference in the median OS of patients with localized disease (stage Ⅰ-Ⅱ) between the radiotherapy and combined chemoradiotherapy groups (21.1 vs. 20.4 months, P=0.470). In patients with locally advanced disease (stage Ⅲ), combined chemoradiotherapy group showed better median OS compared with radiotherapy group (19.2 vs. 13.8 months, P=0.004). Clinical stage, CA19-9 before radiotherapy, comprehensive treatment and biological effective dose (BED 10) were identified as the independent prognostic factors for OS ( P=0.032, 0.011, 0.003 and 0.014). The cumulative 1- and 2-year actuarial rates of treatment failure, local-regional recurrence and distant metastasis were 48% and 74.4%, 15.0% and 27.4%, 23.6% and 33.1%, respectively. Liver metastasis (16.1%, 27/168) and local recurrence (11.9%, 20/168) were the primary patterns of treatment failure. Conclusions:Definitive radiotherapy-based comprehensive treatment effectively prolongs long-term survival in patients with inoperable non-metastatic pancreatic cancer. Definitive radiotherapy can be an alternative treatment option with curative intent for patients with localized pancreatic cancer who are medically unfit or refuse to undergo surgery. The combination of radiotherapy and chemotherapy remains an effective treatment choice for locally advanced unresectable pancreatic cancer.

Mechanosensitive Ion Channel TMEM63A Gangs Up with Local Macrophages to Modulate Chronic Post-amputation Pain / 神经科学通报·英文版

Post-amputation pain causes great suffering to amputees, but still no effective drugs are available due to its elusive mechanisms. Our previous clinical studies found that surgical removal or radiofrequency treatment of the neuroma at the axotomized nerve stump effectively relieves the phantom pain afflicting patients after amputation. This indicated an essential role of the residual nerve stump in the formation of chronic post-amputation pain (CPAP). However, the molecular mechanism by which the residual nerve stump or neuroma is involved and regulates CPAP is still a mystery. In this study, we found that nociceptors expressed the mechanosensitive ion channel TMEM63A and macrophages infiltrated into the dorsal root ganglion (DRG) neurons worked synergistically to promote CPAP. Histology and qRT-PCR showed that TMEM63A was mainly expressed in mechanical pain-producing non-peptidergic nociceptors in the DRG, and the expression of TMEM63A increased significantly both in the neuroma from amputated patients and the DRG in a mouse model of tibial nerve transfer (TNT). Behavioral tests showed that the mechanical, heat, and cold sensitivity were not affected in the Tmem63a-/- mice in the naïve state, suggesting the basal pain was not affected. In the inflammatory and post-amputation state, the mechanical allodynia but not the heat hyperalgesia or cold allodynia was significantly decreased in Tmem63a-/- mice. Further study showed that there was severe neuronal injury and macrophage infiltration in the DRG, tibial nerve, residual stump, and the neuroma-like structure of the TNT mouse model, Consistent with this, expression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β all increased dramatically in the DRG. Interestingly, the deletion of Tmem63a significantly reduced the macrophage infiltration in the DRG but not in the tibial nerve stump. Furthermore, the ablation of macrophages significantly reduced both the expression of Tmem63a and the mechanical allodynia in the TNT mouse model, indicating an interaction between nociceptors and macrophages, and that these two factors gang up together to regulate the formation of CPAP. This provides a new insight into the mechanisms underlying CPAP and potential drug targets its treatment.

Advances in Neuropathologic Research of Hypoglycemic Brain Damage Caused by Insulin Overdose / 法医学杂志

The number of death from insulin overdose, including accidental poisoning, suicide and homicide, is increasing these years. The forensic diagnosis of death from insulin overdose is a tough task. Glucose is the main energy source of the brain. Therefore, hypoglycemic brain damage is considered to be the main reason of death from insulin overdose. Recently, research of hypoglycemic brain damage caused by insulin overdose is gradually being paid attention in the field of forensic medicine. This paper summarizes the neuropathologic changes, pathophysiologic process and potential neural molecular markers of hypoglycemic brain damage caused by insulin overdose in terms of forensic neuropathology, providing reference for the research and practice in forensic medicine related fields.

Strategy of nursing care on the face skin injuries caused by wearing medical-grade protective equipment / 中华烧伤杂志

For effective resistance to virus attack and infection, reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. This paper summarizes the development causes, common locations, and prevention ways about the device related pressure injuries on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the nursing strategy for device related pressure injuries and other nursing strategy is proposed to take care efficiently the device related pressure injuries. Meantime, a corresponding nursing strategy is also suggested to deal with the correlative skin diseases during the application of medical-grade protective equipment. These paper aims to provide reference for the prevention of device related pressure injuries and the care of skin-related diseases for clinical working staff, especially to the respectable personnel in front line of fighting against Corona virus disease 2019.

Analysis of 4 Cases of Electrocution due to Direct Current Electronic Hunter / 法医学杂志

Objective To summarize the characteristics of cases of electrocution due to direct current （DC） electronic hunter, and to provide references for forensic identification. Methods Four cases of electrocution due to DC electronic hunter were collected. Statistical analysis was carried out from the perspective of the scene and electric marks distribution, damage characteristics and histopathological changes. Results All the 4 cases of electrocution were accidental events. There were multiple electric marks, most of which were located in the lower limbs with serious damage. Some strip type electric marks were visible. Conclusion The distribution, morphological characteristics and severity of the electric marks caused by DC electronic hunter are different from those of the ordinary low-voltage alternating current damage. It is alerting that there would be actions of destroying the scene and abandoning the corpse in such cases.

Advance of Forensic Research in Insulin Poisoning / 法医学杂志

Insulin as a common clinical hypoglycemic agent can effectively control serves to lower the concentration of blood glucose. However, insulin overdose can lead to death. In the whole fatal cases of insulin overdose, medical accident is the most common, followed by suicide. Though insulin homicide is extremely rare, it deserves great attention. Though there are some researches about insulin poisoning on forensic toxicology and pathology, it is still a difficult task in forensic practice. In this paper, the mechanism of death, pathological changes, detection methods and diagnose criteria of insulin overdose will be discussed in the view of forensic toxicology and pathology. We hope that this paper could enhance relative knowledges of insulin poisoning for medical examiners.

Advance of Forensic Research in Insulin Poisoning / 法医学杂志

Insulin as a com m on clinical hypoglycem ic agent can effectively control serves to low er the concentration of blood glucose. H ow ever, insulin overdose can lead to death. In the w hole fatal cases of insulin overdose, m edical accident is the m ost com m on, follow ed by suicide. T hough insulin hom icide is extrem ely rare, it deserves great attention. T hough there are som e researches about insulin poisoning on forensic toxicology and pathology, it is still a difficult task in forensic practice. In this paper, the m ech-anism of death, pathological changes, detection m ethods and diagnose criteria of insulin overdose w ill be discussed in the view of forensic toxicology and pathology. W e hope that this paper could enhance rela-tive know ledges of insulin poisoning for m edical exam iners.

Correlation analysis of chemokine CX3CL1 level and the prognosis of ST elevation myocardial infarction / 解放军医学杂志

Objective To investigate the correlation ofchemokine CX3CL1 and the major adverse cardiovascular events (MACCE) within 1 year in patients with ST elevation myocardial infarction (STEMI).Methods Five hundred patients with STEMI were continuously selected from the Department of Emergency,General Hospital of Shenyang Command,and 5ml venous blood was extracted at the time of admission.Plasma CX3CL1 levels were detected by ELISA.The median of CX3CL1 plasma concentration of all selected patients (2108.3pg/ml) was used to assign the patients to low expression group (＜2108.3pg/ml) and high expression group (≥ 2108.3pg/ml).The baseline information and the medical history of patients were recorded and followed up by telephone inquiry for 1 year.The endpoint events were defined as MACCE (including cardiac death,heart failure,nonfatal stroke and nonfatal myocardial infarction).Based on the MACCE in 1 year following up,patients were assigned into MACCE group and non-MACCE group.Multivariable Cox regression analysis was performed to analyze the correlation between CX3CL1 level and MACCE in STEMI patients.Results The plasma CX3CL1 level significantly increased in MACCE group compared with that in Non-MACCE group,the difference was statistically significant (P＜0.01).Kaplan-Meier and Cox regression analysis showed that the plasma concentration of CX3CL1 was independently associated with the occurrence of MACCE within 1 year (HR=1.124,95％CI:1.032-1.217,P=0.003).Conclusion Chemokine CX3CL1 concentration in plasma is positively correlated with the prognosis of patients with STEMI,and can be used in the prognosis assessment of STEMI patients.

Research advance of apolipoprotein J in brain injury / 中国法医学杂志

Apolipoprotein J plays an important role in neuroprotection and neurological restoration after brain injury. It shows spatiotemporal dynamic expression at varying times after brain injury. Thus, it will be of great importance in the clinical treatment of brain injury, as well as in post-injury intervals estimation in forensic pathology. In this paper, we will review relevant research advance of it in brain injury.

Subtype classification of Garden III femoral neck fractures in the elderly based on frontal Garden index and its clinical significance / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study postoperative Garden III femoral neck fractures in the elderly so as to explore the different degree of displacement of Garden III femoral neck fracture, and discuss the basis and clinical significance of the subtype classification.</p><p><b>METHODS</b>A total of 492 patients with complete clinical data out of the 1397 patients with femoral neck fractures treated by closed reduction and internal fixation with cannulated compression screws from September 2005 to September 2010 were included in the study. Each patient's frontal Garden Index was measured. On the basis of the frontal Garden Index, these cases were divided into three types:type A, which frontal Garden Index was more than or equal to 140°, included 53 males and 84 females with an average age of(65.3±7.2) years old ranging from 60 to 75 years old; type B, more than 120°and less than 140°, included 79 males and 172 females with an average age of (67.5±3.6) years old;and type C, less than or equal to 120°, included 38 males and 66 with an average age of(68.6±5.7) years old. Aspects were followed up including complications, consequences and hip joint function. The fracture healing and femoral head necrosis were compared among three types.</p><p><b>RESULTS</b>Operative incision of 492 cases was primary healing, and no infection and other complications occurred. All patients were followed up from 2 to 10 years with an average of 6.3 years, the healing of femoral neck fracture occurred in 432 cases, and the total union rate was 87.8%. Femoral head necrosis occurred in 83 cases, and the total necrosis rate of femoral head was 16.9%. The nonunion rate of type A was 6.6%, type B was 13.5%, and type C was 16.3%, there were significant differences among three types(²2AB=4.377,=0.036;²2AC=5.872,=0.015;²2BC=0.469, PBC=0.494). The necrosis rate of femoral head of group A was 8.8%, group B was 16.7%, and group C was 27.9%, there were significant differences among three groups(²2AB=4.704,=0.030;²2AC=15.317,=0.000;²2BC=5.715,=0.017).</p><p><b>CONCLUSIONS</b>It is different for the degree of displacement of Garden III femoral neck fracture in the elderly. Based on frontal Garden Index to differentiate degree of fracture displacement, Garden III femoral neck fracture would be divided into A, B and C subtypes. The prognosis of Garden III femoral neck fracture in the elderly is negatively related to its degree of displacement, which has clinical significance to make treatment plan for Garden III femoral neck fracture in the elderly.</p>

Progress in the research of diagnosis of amniotic lfuid embolism based on the methodologies in forensic medicine / 中国法医学杂志

Amniotic lfuid embolism refers to the accessible amniotic lfuid component of maternal circulation leading to a series of severe symptoms, such as pulmonary embolism, shock or even death. Up till now, AFE is a diagnosis of exclusion. The sensitivity and specificity of these methods were poor. With the increasing maternal mortality caused by AFE in forensic medicine, it is important to seeking for more precise diagnosis method. This review intends to provide methodological reference for forensic identification through the research progress of the diagnosis of AFE.

Embryo-fetus development toxicity of a novel PPAR-δ agonist in rat / 药学学报

The study aims to investigate the embryo-fetus development toxicity of the novel PPAR-δ agonist HS060098 on SD rats. The pregnant rats that were randomly divided into the solvent control group (1% hydroxypropyl methyl cellulose water solution) and HS060098 suspension groups (10, 30 and 100 mg x kg(-1) xd(-1)) were orally administered with HS060098 suspension or vehicle during the gestation of 6 -15 days (GD6-15). At termination (GD20), female rats were sacrificed. The pregnant females were evaluated by corpora lutea count, implantation sites, existence and death of embryos. Fetal sex, weight, externals, variations and malformations of viscus and skeleton were observed. The results show that there were no significant abnormality in maternal general conditions and fetal appearance as well as viscera, but in the 100 mg x kg(-1) x d(-1) group, the maternal weight gain decreased greatly (P < 0.01) and the skeletal ossification delayed remarkably (P < 0.01); in the 30 mg x kg(-1) xd(-1) group, the fatal and litter number of incompletely ossified sternebrae II was higher than those of the control group (P < 0.05); the skeletal malformations occurred in all dose groups, which indicate that the novel PPAR-δ agonist HS060098 had maternal toxicity and adversely effected fetal skeletal development under the experimental conditions.

Nursing of emotional disorder in patients with alcohol dependence / 中国实用护理杂志

Objective To analyze the nursing effect of emotional disorder in patients with alcohol dependence.Methods From January 2009 to February 2010,81 patients in our hospital with emotional disorder of alcohol dependence were randomly divided into the observation group (41 cases)and the control group (40 cases).The control group was given routine nursing care,and the observation group was given enhanced care for emotional disorders on the basis of routine nursing care,the clinical results of two groups were compared.Results In the observation group,the re-drinking rate and readmission rate were19.5 ％ and 7.3％,significantly lower than 40.0％ and 27.5％ of the control group,the time interval of re-drinking of the observation group was significantly longer than the control group,the anxiety and depression scores were significantly better than the control group.Conclusions To give enhanced care on the basis of routine nursing care for patients with emotional disorders because of alcohol dependence has better clinical effect,it contributes to the patients′ rehabilitation.