Efficacy and safety analysis of anlotinib in the treatment of distant metastatic radioactive iodine-refractory differentiated thyroid cancer / 中华核医学与分子影像杂志

Objective:To investigate the efficacy and safety of anlotinib in distant metastatic radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC).Methods:Retrospective analysis was performed on 17 patients with distant metastatic RAIR-DTC (6 males, 11 females, age: 57.0(45.5, 63.0) years) from Affiliated Hospital of Qingdao University between October 2018 and February 2023, including 13 patients receiving first-line treatment and 4 patients receiving second-line treatment with anlotinib. The changes of serum thyroglobulin (Tg) during the treatment of anlotinib, the changes of maximum diameter of the target lesion at the last follow-up compared with the diameter at baseline, the imaging efficacy, and treatment-related adverse events were analyzed. The serological and imaging effects of the first-line treatment group and the second-line treatment group were compared. The Fisher exact test was used to analyze the differences between groups.Results:The follow-up time of 17 patients was 17.3(9.5, 21.4) months, and the objective response rate (ORR) and disease control rate (DCR) were 7/17 and 16/17, respectively. There were no significant differences of ORR (6/13 vs 1/4; P=0.603) and DCR (13/13 vs 3/4; P=0.235) between the first-line and second-line treatment groups. The change rates of serum Tg at 3, 6 weeks and the last follow-up were -30.2%(-61.2%, -15.5%), -64.8%(-90.6%, -32.3%), and -85.8%(-96.1%, -50.7%), respectively. At the last follow-up, the change rate of maximum diameter of target lesions was -20.0%(-45.0%, -5.2%). The incidence of treatment-related adverse reactions was 14/17, and 2 patients (2/17) had grade 3 or above adverse reactions. Conclusion:Anlotinib shows superior efficacy with tolerable toxicity in the first-line treatment of distant metastatic RAIR-DTC, and hopefully plays an important role in second-line treatment for RAIR-DTC resistant to sorafenib.

Characteristics of obstructive sleep apnea in children with allergic rhinitis / 中国小儿急救医学

Objective:To analyze the characteristics of sleep disordered breathing (SDB) in children with allergic rhinitis (AR), and improve the diagnosis and treatment at AR combined with obstructive sleep apnea (OSA).Methods:The clinical data of 120 patients with AR and OSA (AR and OSA group) admitted to the respiratory department at Shenzhen Children′s Hospital from May 2019 to December 2020 were retrospectively analyzed.A total of 120 children diagnosed with OSA and excluded AR during the same period were selected as control group.The SDB day and night symptoms, sleep structure characteristics and sleep breathing events were compared between two groups.Results:The average course of disease in children with AR and OSA was significantly longer than that in control group ( P=0.030). The main manifestations of children in AR and OSA group were mouth breathing (100.0%), snoring (99.2%), nasal obstruction (88.5%), and restless sleep (68.0%). There was no significant difference in sleep structure between two groups ( P>0.05), but the sleep efficiency of AR and OSA group was significantly lower than that of control group ( P=0.028). The respiratory events apnea hypopnea index, obstructive apnea index, obstructive apnea hypopnea index, hypopnea index and oxygen desaturation index of each sleep period in AR and OSA group were significantly higher than those in control group ( P<0.05). Among the children in AR and OSA group, moderate and severe OSA were the main manifestations, and the difference between two groups was statistically significant ( P<0.001). Conclusion:The combination of AR delayed the course of OSA in children.The main characteristics of sleep disordered breathing in children with AR are mouth opening, restless sleep, snoring and nasal obstruction.The sleep efficiency is decreased.Obstructive hypopnea and apnea are the most common respiratory events, and oxygen deficiency often occurs in rapid eye movement phase.Children with AR are more likely to have moderate or severe obstructive sleep apnea.

The effect of olmesartan on the antigen presentation function of rat dendritic cells / 中华急诊医学杂志

Objective:To explore the effect of Olmesartan on the antigen presenting function of dendritic cells (DCs) in rats.Methods:Bone marrow-derived dendritic cells of female Lewis rats were obtained. Bone marrow-derived dendritic cells were cultured with Olmesartan (final concentration 10 μmol/L; OLM-DCs) or equal volume of DMSO (Con-DCs). Mean fluorescence intensity (MFI) of the surface costimulatory molecule CD80, CD86 and MHCⅡ on DCs and the levels of IL-10 and TGF-β of DCs were analyzed by flow cytometry. DCs and CD4 +T lymphocytes were cocultured. T lymphocytes proliferation was analyzed by flow cytometry. IFN-γ in the supernatants were determined by ELISA. Results:The expression of MHC Ⅱ on DCs was inhibited by Olmesartan. The level of intracellular IL-10 in DCs was up-regulated by Olmesartan. Compared with Con-DCs, T lymphocytes proliferation and the level of IFN-γ were inhibited by OLM-DCs.Conclusions:Olmesartan could induce tolerogenic DCs in vitro. These tolerogenic DCs could inhibit T lymphocytes proliferation and the production of Th1 cytokine.

Clinical study of Bushen-Jianpi-Huoxue Decoction combined with western medicine in the treatment of diabetes mellitus with osteoporosis / 国际中医中药杂志

Objective:To explore the clinical application of Bushen-Jianpi-Huoxue Decoction combined with western medicine in the treatment of diabetes mellitus with osteoporosis. Methods:A total of 180 patients with diabetes mellitus complicated with osteoporosis in Pudong Hospital from November 2017 to June 2019 who met the inclusion criteria were divided into two groups according to the random number table method, with 90 patients in each group. The control group was treated with conventional western medicine, the study group was treated with Bushen-Jianpi-Huoxue Decoction on the basis of the control group, and both groups were treated for 3 months. The TCM symptom scores were performed before and after treatment. Fasting blood glucose (FPG) and serum calcium levels were determined by a fully automated biochemical analyzer, HbAlc levels were determined by glycosylated hemoglobin analyzer, and TNF-α, monocyte chemoattractant protein-1 (MCP-1), and insulin-like growth factor-1 (IGF-1) and Chemerin levels were determined by a double-antibody sandwich ELISA. Bone mineral density (BMD) was measured by dual-energy X-ray apparatus and clinical efficacy was evaluated. Results:The total effective rate of the study group was 95.6% (86/90), and that of the control group was 76.7% (69/90), where the difference between the two groups was statistically significant ( χ2=13.425, P<0.01). After treatment, the main symptom, secondary symptom and total score of the study group were significantly lower than those in the control group ( t=20.851, 15.365, 27.339, respectively, all Ps<0.01). After treatment, FPG and HbAlc in the study group were significantly lower than those in the control group ( t=5.287, 10.304, P<0.01), BMD and serum calcium were significantly higher than those in the control group ( t=3.644, 3.964, P<0.01). After treatment, the levels of serum TNF-α (6.30 ± 2.05 pg/m vs. 10.43 ± 3.26 pg/m, t=10.174), MCP-1 (324.38 ± 20.05 pg/ml vs. 411.14 ± 27.67 pg/ml, t=24.087), Chemerin (57.74 ± 8.35 ng/ml vs. 63.34 ± 10.64 ng/ml, t=3.928) in the study group were significantly lower than those in the control group ( P<0.01); IGF-1 (167.79 ± 11.31 μg/L vs. 142.21 ± 9.34 μg/L, t=16.544) were significantly higher than that of the control group ( P<0.01). Conclusions:Bushen-Jianpi-Huoxue Decoction combined with conventional western medicine therapy can improve the blood glucose level and BMD of patients with diabetes mellitus complicated with osteoporosis, and improve the clinical effect.

Effects of Edaravone on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase signaling pathway in elderly patients with acute ischemic stroke / 中华老年医学杂志

Objective To investigate the effects of Edaravone on cognitive dysfunction and on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK)signaling pathway in elderly patients with acute ischemic stroke. Methods A total of 100 elderly patients with acute ischemic cerebral stroke admitted to our hospital from January 2011 to December 2015 were enrolled in this study.During the corresponding period ,100 healthy individuals receiving regular check-ups were selected as the control group. The effects of Edaravone on cognitive function in elderly patients with acute ischemic cerebral stroke were assessed.Serum proteins related to the MAPK/ERK signaling pathway were assayed. Results Elderly patients with acute ischemic stroke showed obvious cognitive dysfunction ,and scores on memory ,orientation ,attention ,calculation language and recall significantly decreased(P＜0.01)but returned to normal after Edaravone treatment (P＜0.01).Compared with the control group ,serum protein expression of rat sarcoma (Ras) ,rapidly accelerated fibrosarcoma(Raf) ,hypoxia inducible factor-1α(HIF-1α) ,connective tissue growth factor (CTGF),extracellular signal-regulated protein kinase(ERK1),ERK2 ,MAPK/ERK kinase(MEK), interleukin-1(IL-1) ,tumor necrosis factor-α(TNF-α) ,vascular endothelial growth factor (VEGF) , tissue inhibitor of metalloproteinase (TIMP) ,nerve growth factor (NGF)and its receptors was significantly downregulated(P＜0.01) ,while expression of leptin and its receptors was upregulated in elderly patients with acute ischemic cerebral stroke ( P ＜ 0.01 ). Expression levels of the above downregulated proteins clearly recovered after Edaravone treatment ( P ＜ 0.01 ). Conclusions Edaravone has favorable effects on cognition dysfunction in elderly patients with acute ischemic cerebral stroke ,which may be related to the regulation of the MAPK/ERK signaling pathway.

Changes in the Scleral Collagen and Elastic Modulus in Experimental High Myopia / 医用生物力学

Objective To investigate changes in the collagen expression and elastic modulus in scleral tissues of experimental high myopia, so as to further explain the mechanism of high myopia. Methods Twenty one-month-old New Zealand white rabbits were monocularly treated by eyelid suturation randomly to build an experimental high myopia eye model. Eyes without such operation were set as the normal control. After 60 days, the experimental high myopia eye models were successfully established by measuring the eye axis. The eyeballs were obtained to assess three regions of the sclera (anterior, equatorial, and posterior area). The three regions of the scleral tissues were separately divided into four groups. The first group was made into scleral strips for elastic modulus measurement using an Instron5544. The second group was hematoxylin-and-eosin stained for observation of the scleral structures. The third group was used for electron microscopy to observe the size distribution of collagen fibrils. The last group was homogenized, and the concentration of hydroxyproline was measured to determine the collagen content. Results The elastic modulus, collagen content, and diameters of the collagen fibrils of each scleral region increased with age. The posterior sclera of high myopia had looser collagen fibril arrangement, less hydroxyproline concentration, and lower elastic modulus than the normal eyes. However, there was no significant difference as for the anterior and equatorial sclera. Conclusions The remodeled posterior sclera of high myopia has a looser collagen fibril arrangement, less collagen, and lower elastic modulus, which easily causes expansion and deformation and thus lead to high myopia. The research findings provide the theoretical guidance for high myopia prevention by targeting the collagen during early development.

Comparison between posterior short-segment pedicle screw fixation combined with vertebroplasty or injured vertebral transpedicular fixation in treating osteoporotic thoracolumbar burst fracture / 中华创伤杂志

Objective To investigate the clinical efficacy of posterior short-segment pedicle screw fixation combined with vertebroplasty or injured vertebral transpedicular fixation in the treatment of osteoporotic thoracolumbar Magerl type A3 fractures.Methods A retrospective case control study was conducted on 39 patients with acute traumatic osteoporotic thoracolumbar burst fractures admitted from May 2007 to May 2016.There were 17 males and 22 females,aged 52-85 years (mean 61.3 years).All patients had single segment thoracolumbar fracture(T11-L2),with bone mineral density T value ＜-2.5 SD and the Frankel grade D or E.According to operation method,the patients were divided into Group A (n =22) which adopted short segment pedicle screw fixation combined with vertebroplasty and Group B (n =17) which adopted pedicle screw fixation combined with injured vertebra transpedicular fixation.The operation time and blood loss were compared between the two groups.VAS and Frankel grade were used to evaluate the patients' pain and the recovery of neurological function.The height recovery and Cobb angle of fracture vertebra were measured according to X-ray.Complications at follow ups were observed.Results All patients underwent the operations successfully with good healing.The mean follow-up time was 23.5 months (range,12-40 months).The operation time was (61.7 ± 6.7)minutes in Group A and (48.1 ± 7.5) minutes in Group B (P ＜ 0.05).The blood loss was (347.7 ± 44.9) ml in Group A and (288.3 ±41.6)ml in Group B (P ＜ 0.05).Postoperative VAS score and VAS at the final follow-up in both groups were significantly improved compared with those before operation (P ＜ 0.05),with no significant difference between the two groups.Four cases in Group A and two cases in Group B with Frankel grade D were classified as grade E.After operation,the recovery rate of injured vertebral Cobb angle and anterior height were significantly improved in both groups (P ＜ 0.05).The recovery rate of Cobb angle and anterior height at the last follow up was lower than that after surgery,but with no statistical difference (P ＞ 0.05),and no significant differences were found between the two groups either (P ＞ 0.05).The screws were removed from four patients in Group A and two patients in Group B.No complications or failure of internal fixation was found during follow-up.Conclusion Posterior shortsegment pedicle screw fixation combined with vertebroplasty or injured vertebra transpedicular fixation are both helpful to the height recovery of vertebral osteoporotic fractures and reduce kyphosis with similar efficacy,while the former has the advantages of shorter operation time and less bleeding.

Digital breast tomosynthesis for diagnosing non-calcified masses in dense breasts / 中国医学影像技术

Objective To analyze the clinical value of digital breast tomosynthesis (DBT) compared with digital mammography (DM) and ultrasound for diagnosing non-calcified masses in dense breasts.Methods Images taken with DBT,DM and ultrasound of 1144 patients with non-calcified masses in dense breasts were retrospectively analyzed using breast imaging reporting and data system (BI-RADS).Taking histopathologic results as golden standards,the detection rate and diagnostic accuracy,sensitivity,specificity,false negative and BI-RADS category were evaluated and compared statistically.Results The detection rate of DBT,DM and ultrasound for non-calcified massed in dense breasts was 86.62％ (991/1 144),77.80％ (890/1 144) and 99.65％ (1 140/1 144),respectively (P＜0.05),while the diagnostic accuracy was 83.92％ (960/1 144),75.00％ (858/1 144) and 94.67％ (1 083/1 144),respectively (P＜0.01).The sensitivity of DBT,DM and ultrasound was 89.39％ (312/349),79.93％ (231/289) and 92.70％ (432/466),the specificity was 81.51％ (648/795),73.33％ (627/855) and 96.02％ (651/678),while the false negative rate was 10.60％(37/349),20.07％ (58/289) and 7.30％ (34/466),respectively.No significant difference was found for benign lesions among three examination methods (P=0.75),while there was significant difference for malignant lesions among three examination methods (P＜0.01),and the differences of ultrasonography with DM and DBT,DBT and DM in the for BI-RADS category of malignant lesions were statistically significant (all P＜0.016 7).Conclusion For suspected masses in dense breasts,DBT shows significant advantage than DM,while DBT has the similar advantage compared with ultrasound for the detection and diagnosis of non-calcified masses in dense breasts.

Na+,K+-ATPase inhibitor induces cell cycle arrest in liver cancer HepG2 cells by regulating expression of DNA damage Mre11/Rad50/Nbs1 complex / 中国药理学通报

Aim To explore the relationship between Mre11/Rad50/Nbs1 ( MRN ) complex focus formation and DNA double-strand breaks( DSBs) caused by cinob-ufagin in human hepatocellular carcinoma HepG2 cells. Methods The Na+,K+-ATPaseα1 subunit expression level in liver cancer tissues was detected by immunohis-tochemistry. After HepG2 cells were treated with 5μmol·L-1 cinobufagin for 6, 12 and 24 h, the drug-in-duced DSBs were assessed by single cell gel electro-phroesis ( SCGE ) , the gene transcription and protein levels of Mrel1, Nbs1, Rad50 and p53 were evaluated by Real time-PCR and Western blot. The cell cycle in parallel was analyzed by flow cytometry. Results The Na+, K+-ATPase α1 subunit expression level in liver cancer tissues was significantly increased compared with the tissue adjacent to carcinoma ( P <0. 05 ) . The 5μmol · L-1 cinobufagin could induce the DSBs in a time-dependent manner (P <0. 05), and it could up-regulate the gene expression levels of Mre11, Nbs1, Rad50 and p53 in HepG2 cells ( P<0. 05 ) . The pro-portions of HepG2 cells in S phase were ( 21. 32 ± 4. 21) % in the control group, and (33. 25 ± 5. 72) %, (56. 72 ± 6. 29) % and (67. 32 ± 9. 42) % in HepG2 cells treated with 5 μmol · L-1 cinobufagin for 6, 12 and 24 h, respectively. The proportions of cells in S phase in cinobufagin groups were significantly increased compared with the control group ( P<0. 05 ) . Conclu-sion Cinobufagin could induce the cell cycle arrest in liver cancer HepG2 cells by activation of Mre11/Rad50/Nbs1 Complex.

Pharmaceutical Intervention and Care for Anaphylactoid Purpura Patient by Clinical Pharmacist / 中国药师

Objective:To improve the effectiveness and safety of drugs and the compliance of patients with anaphylactoid purpura through the participation of clinical pharmacists in the practice of pharmaceutical treatment .Methods:In the treatment of one patient with anaphylactoid purpura , clinical pharmacists took part in the whole process and provided the individualized regimen , adverse reac-tion monitoring , relative indices monitoring and drug education after the discharge .Results:Through the participation of clinical phar-macists in the medication development , the rational use of drugs was strengthened and the treatment process was monitored .As a re-sult, the infection of the patient obtained effective control .Conclusion:The participation of clinical pharmacist in the treatment of pa-tients with anaphylactoid purpura reflects the patient-oriented pharmacy service concept , which improves the efficiency and safety of treatment.

Arthroplasty versus joint preservation for displaced 3-and 4-part proximal humeral fractures:a meta-analysis / 中国组织工程研究

BACKGROUND:Currently, the treatment of proximal humeral fractures mainly contains joint preservation (conservative treatment, open reduction and internal fixation) and arthroplasty, but how to choose the treatment is stil controversial. OBJECTIVE:To evaluate and compare the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced 3-or 4-part humeral fractures in randomized control ed trials using meta-analysis. METHODS:Medline (January 1966 to December 2013), PubMed (January 1980 to December 2013), Embase (January 1990 to December 2013), Science (January 1990 to December 2013), Springer (January 1990 to December 2013), China National Knowledge Infrastructure (1994 to 2013), and Wanfang database (1982 to 2013) were searched for randomized control ed trials addressing joint preservation and arthroplasty for 3-or 4-part proximal humeral fractures. Articles meeting the inclusion criteria were included. The related data were extracted and loaded onto Comprehensive Meta-Analysis Software for meta-analysis. RESULTS AND CONCLUSION:Seven articles with 320 patients (165 patients undergoing joint preservation and 155 patients receiving arthroplasty) were accepted in this mete-analysis and al of them were high-quality English researches by modified Jadad Scale. Meta-analysis results displayed that the random-effects mean Constant score across al types was 55.9 (95%CI:50.7-61.1;P<0.001). Constant score was higher in the joint preservation group than in the arthroplasty group (P<0.01). The study displayed significant heterogeneity (I2 0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption. These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized control ed trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3-or 4-part proximal humeral fractures.=88%, Q statistic=107.6, Q=13;P<0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption. These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized controlled trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3- or 4-part proximal humeral fractures.

Comparative analysis of changes in provincial health expenditure since China health system re-form in 2009 / 中国卫生政策研究

Objective:To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi-nancing policy. Methods:20 provinces were chosen and vertical and horizontal Comparative approach was used to an-alyze the data. Results:Total health expenditure increased for all regions, of which the biggest rate was Anhui prov-ince, about 82. 97%, while the largest increasing for government health care expenditure was Ningxia province, a-bout 108 . 71%. In 2012 , the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu-sion:Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level;The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions: Under the premise of im-proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.

Effects of trichosanthin on apoptosis and cytoskeleton microtubule structure reconfiguration in lung cancer A549 cells / 中国肿瘤临床

Objective:This study aimed to explore the effects of trichosanthin on the proliferative inhibition and apoptosis induc-tion in human lung carcinoma A549 cells. Methods:A549 cells were treated with various concentrations of TCS. The inhibitory effects in proliferation were detected by the MTT method. The microfilament changes were observed by transmission electron microscopy. Apoptosis rate and cell cycle were determined by flow cytometry. Results:A549 cells treated with TCS presented apoptotic changes and decreased cell activity. When the concentration increased and time was prolonged, the inhibition rate increased correspondingly. Conclusion:Pharmacological doses of TCS inhibited the proliferation and differentiation in lung carcinoma A549 cells and affected the function in A549 cells by changes in the cytoskeleton.