Reflections on "Health" from the Perspective of Immunology / 中国医学伦理学

The philosophical debate on "health" was examined based on three situations in immunology: the role of the immune system in cancer, maternal infant inheritance, and xenotransplantation. The concepts of "health" depicted by naturalism, dispositionalism inherited from naturalism, and constructivism are difficult to be well applied in the above three situations. Examining whether there is something "go wrong" in the organism on physiological and natural levels, and whether the occurrence of "wrong-goings" can bring "good" results, and then giving value judgments based on them, is a better approach to characterize "health". Conducting value judgments means arousing the imagination and expectation: there is a tension between the expectation that "health can be restored" through medical intervention and the inevitable uncertainty of actual medical knowledge. If expectation failed, patients’ well-being would be undermined. Therefore, in the clinical application and research of cutting-edge methods such as immunotherapy, it is still required to be cautious about statements such as "restoring health" that may bring excessive expectations to patients.

A neutrophil-biomimic platform for eradicating metastatic breast cancer stem-like cells by redox microenvironment modulation and hypoxia-triggered differentiation therapy

Metastasis accounts for 90% of breast cancer deaths, where the lethality could be attributed to the poor drug accumulation at the metastatic loci. The tolerance to chemotherapy induced by breast cancer stem cells (BCSCs) and their particular redox microenvironment further aggravate the therapeutic dilemma. To be specific, therapy-resistant BCSCs can differentiate into heterogeneous tumor cells constantly, and simultaneously dynamic maintenance of redox homeostasis promote tumor cells to retro-differentiate into stem-like state in response to cytotoxic chemotherapy. Herein, we develop a specifically-designed biomimic platform employing neutrophil membrane as shell to inherit a neutrophil-like tumor-targeting capability, and anchored chemotherapeutic and BCSCs-differentiating reagents with nitroimidazole (NI) to yield two hypoxia-responsive prodrugs, which could be encapsulated into a polymeric nitroimidazole core. The platform can actively target the lung metastasis sites of triple negative breast cancer (TNBC), and release the escorted drugs upon being triggered by the hypoxia microenvironment. During the responsiveness, the differentiating agent could promote transferring BCSCs into non-BCSCs, and simultaneously the nitroimidazole moieties conjugated on the polymer and prodrugs could modulate the tumor microenvironment by depleting nicotinamide adenine dinucleotide phosphate hydrogen (NADPH) and amplifying intracellular oxidative stress to prevent tumor cells retro-differentiation into BCSCs. In combination, the BCSCs differentiation and tumor microenvironment modulation synergistically could enhance the chemotherapeutic cytotoxicity, and remarkably suppress tumor growth and lung metastasis. Hopefully, this work can provide a new insight in to comprehensively treat TNBC and lung metastasis using a versatile platform.

Neuroprotective mechanism of autophagy in bradykinin postconditioning after cardiac arrest in rats / 中华危重病急救医学

Objective:To explore the protective effects of bradykinin postconditioning on cardiopulmonary resuscitation (CPR) rats, and to assess the underlying mechanisms.Methods:Forty-eight adult male Sprague-Dawley (SD) rats were randomly divided into four groups according to random number table: Sham operation group, cardiac arrest (CA) group, bradykinin treatment (BK) group, and AMP-activated protein kinase (AMPK) inhibitor Compound C+ bradykinin treatment (CP+BK) group, finally, 8 rats in each group were taken for follow-up experiment. CA was induced by asphyxia. Rats in the Sham group received arteriovenous catheterization, endotracheal intubation, and mechanical ventilation, without CA. Compound C (250 μg/kg) was intraperitoneally injected in CP+BK group 30 minutes before CA, and the same volume of dimethyl sulfoxide (DMSO) was given in the remaining groups. Bradykinin (150 μg/kg) was intraperitoneally injected in BK group and CP+BK group 48 hours after restoration of spontaneous circulation (ROSC), and same volume of saline was given in the remaining groups. The neural function of rats in each group was evaluated with neurological deficit score (NDS) 72 hours after ROSC. Microtubule-associated protein light chain 3 (LC3) and p62 expressions were detected by immunohistochemistry, autophagosomes were observed by transmission electron microscopy, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method (TUNEL) assay was used to assess apoptosis.Results:Compared with the Sham group, the NDS was decreased (60.75±5.80 vs. 80.00±0.00, P < 0.01), the expression levels of LC3 and p62 elevated [LC3 ( A value): 1.04±0.64 vs. 0.40±0.14, p62 ( A value): 2.75±0.57 vs. 0.36±0.12, both P < 0.05], the number of autophagosomes and apoptotic cells increased in the CA group [(39.00±8.00)% vs. (3.87±1.90)%, P < 0.05]. Compared with the CA group, the NDS (67.75±6.32 vs. 60.75±5.80, P < 0.05), the expression of LC3 ( A value: 1.60±0.34 vs. 1.04±0.64, P < 0.05), and the number of autophagosomes increased in the BK group, while the expression of p62 and the rate of apoptotic cells reduced [p62 ( A value): 1.51±0.32 vs. 2.75±0.57, apoptotic cells rate: (23.03±1.91)% vs. (39.00±8.00)%, both P < 0.05]. Compared with the BK group, the NDS (59.00±8.19 vs. 67.75±6.32, P < 0.05), the expression of LC3 ( A value: 0.62±0.41 vs. 1.60±0.34, P < 0.05) and the number of autophagosomes declined in the CP+BK group, while the expression of p62 and the rate of apoptotic cells elevated [p62 ( A value): 3.50±0.47 vs. 1.51±0.32, apoptotic cells rate: (44.53±10.15)% vs. (23.03±1.91)%, both P < 0.05]. Conclusion:Bradykinin postconditioning played a neuroprotective role in CPR rats by activating autophagy and reducing apoptosis.

Epidemiological and clinical features of dengue fever outbreak in Jiangxi Province in 2019 / 中华传染病杂志

Objective To investigate the epidemiological and clinical characteristics of 91 cases of dengue fever outbreak in Jiangxi Province in 2019,and to strengthen the management and prevention of dengue fever.Methods The clinical data,laboratory results and etiology tests of 91 patients with dengue fever from the Ninth Hospital of Nanchang,Zhangshu People's Hospital,Fengcheng People' s Hospital and Nanchang County People's Hospital from July 31,2019 to September 27,2019 were retrospectively collected.The t test was used for continuous variables and chi-square test was used for categorical variables.Results A total of 91 dengue fever patients were reviewed.The patients age ranged from 4 to 87 years old,and the majority were adult patients.Most patients were farmers and they all had mosquito-biting history.Local cases were the major source of this outbreak.The incubation time was(5.19±2.96)days.All patients had fever over 38℃.Thirty-eight(41.8％)patients developed rashes,mainly distributed on the limbs and trunk,and 15 patients(16.5％)developed myalgia and fatigue.The incidence of rashes in patients admitted in September was 15.9％(7/44),which was significantly lower than 68.1％(32/47)in July and August(x2 = 25.262,P ＜0.01).The incidence of headache in patients admitted in September was 27.3％(12/44),which was significantly lower than 78.7％(37/47)in July and August(x2=24.206,P ＜ 0.01).Among the 91 patients,64(70.3％)patients had white blood cell counts less than 4×109/L,14(15.4％)patients had platelet counts less than 50×109/L.The positive rate of dengue non-structural protein 1(NS1)antigen was 100.0％(37/37),the positive rates of dengue antibody IgM and IgG were 50.0％(11/22)and 13.6％(3/22),respectively.Among the 113 serum samples tested for dengue virus RNA,106 were identified with dengue virus type-1 and two were dengue virus type-2.In 22 patients who received tests within 7 days,the positive rate of NS1 antigen was 100.0％(22/22),the IgM and IgG positive rates were 50.0％(11/22)and 13.6％(3/22),respectively,and 19 patients were infected with dengue type-1.Among the IgM antibody positive cases,the onset days before sampling was(5.09±1.64)days,longer than that of IgM antibody negative cases((2.82± 1.83)days),with statistical significance(t = 3.063,P = O.007).The onset time before sampling in dengue virus RNA-positive group was(3.53±1.87)days,which was shorter than that of RN A-negative group((6.67± 0.58)days),and the difference was statistically significant(t = 2.839,P = 0.013).Conclusions The dengue fever outbreak cases in Jiangxi Province in 2019 have typical clinical manifestations of dengue fever.Using the NS1 antigen test,IgM and IgG antibody tests and real-time fluorescent quantitative polymerase chain reaction for dengue virus genotyping during early onset of the disease can assistant clinicians in clinical management,controlling infectious source and stopping disease transmission.

Epidemiological and clinical features of dengue fever outbreak in Jiangxi Province in 2019 / 中华传染病杂志

Objective@#To investigate the epidemiological and clinical characteristics of 91 cases of dengue fever outbreak in Jiangxi Province in 2019, and to strengthen the management and prevention of dengue fever.@*Methods@#The clinical data, laboratory results and etiology tests of 91 patients with dengue fever from the Ninth Hospital of Nanchang, Zhangshu People′s Hospital, Fengcheng People′s Hospital and Nanchang County People′s Hospital from July 31, 2019 to September 27, 2019 were retrospectively collected. The t test was used for continuous variables and chi-square test was used for categorical variables.@*Results@#A total of 91 dengue fever patients were reviewed. The patients age ranged from 4 to 87 years old, and the majority were adult patients. Most patients were farmers and they all had mosquito-biting history. Local cases were the major source of this outbreak. The incubation time was (5.19±2.96) days. All patients had fever over 38 ℃. Thirty-eight (41.8%) patients developed rashes, mainly distributed on the limbs and trunk, and 15 patients (16.5%) developed myalgia and fatigue. The incidence of rashes in patients admitted in September was 15.9% (7/44), which was significantly lower than 68.1% (32/47) in July and August (χ2=25.262, P<0.01). The incidence of headache in patients admitted in September was 27.3%(12/44), which was significantly lower than 78.7% (37/47) in July and August (χ2 =24.206, P<0.01). Among the 91 patients, 64 (70.3%) patients had white blood cell counts less than 4×109/L, 14(15.4%) patients had platelet counts less than 50×109/L. The positive rate of dengue non-structural protein 1 (NS1) antigen was 100.0%(37/37), the positive rates of dengue antibody IgM and IgG were 50.0%(11/22) and 13.6%(3/22), respectively. Among the 113 serum samples tested for dengue virus RNA, 106 were identified with dengue virus type-1 and two were dengue virus type-2. In 22 patients who received tests within 7 days, the positive rate of NS1 antigen was 100.0% (22/22), the IgM and IgG positive rates were 50.0%(11/22) and 13.6% (3/22), respectively, and 19 patients were infected with dengue type-1. Among the IgM antibody positive cases, the onset days before sampling was (5.09±1.64) days, longer than that of IgM antibody negative cases ((2.82±1.83) days), with statistical significance (t=3.063, P=0.007). The onset time before sampling in dengue virus RNA-positive group was (3.53±1.87) days, which was shorter than that of RNA-negative group ((6.67±0.58) days), and the difference was statistically significant (t=2.839, P=0.013).@*Conclusions@#The dengue fever outbreak cases in Jiangxi Province in 2019 have typical clinical manifestations of dengue fever. Using the NS1 antigen test, IgM and IgG antibody tests and real-time fluorescent quantitative polymerase chain reaction for dengue virus genotyping during early onset of the disease can assistant clinicians in clinical management, controlling infectious source and stopping disease transmission.

Diffusion tensor imaging of brain white matter in rats with ischemia reperfusion injury and its behavioral changes / 中华急诊医学杂志

Objective To investigate the changes of diffusion tensor imaging (DTI) in the cerebral white matter of rats with ischemia-reperfusion injury.Methods Adult SD rats were randomly divided into two groups,sham operation group and model group.The model of ischemia reperfusion injury was made by the Koizumi suture method to occlude the middle cerebral artery.Application of Zea-Longa score was carried out to determine the establishment of modeling,and the modified neurological severity score (mNSS) was used to evaluate the neurological deficit of rats.The Rotarod test instrument was used to observe the motor function of rats by using Rotarod fatigue balance signs,and the DTI sequence scanning observation of brain white matter nerve fiber damage was determined by using Brook 7.0T small animal magnetic resonance imaging system.Track Vis software was used to analyze the distribution of cerebral white matter nerve fibers,and the relative number of nerve fibers in the areas of ROI (region of interest,ROI),sensorimotor areas and striatum were calculated.Results The results showed varying degrees of neurological impairment in rats 2 h after cerebral ischemia reperfusion injury,and the Zea-Longa score and the mNSS score were gradually reduced at the 1 d,7 d and 14 d after ischemia reperfusion injury.The time of rats retaining on the rotating rod was shortened at the 7 d and 14 d after ischemia reperfusion injury.At the ischemic lateral,nerve fibers decreased significantly,and the number of sensory nerve fiber connections in the sensorimotor areas to striatum was reduced.Nissl staining showed that the cytoplasm of neurons in the sensorimotor cortex and striatum of the ischemic lateral were disappeared and the Nissl bodies were decreased.Conclusions The nerve fibers of sensory motor cortex connecting to striatum were damaged by ischemia reperfusion injury.

Evaluation of combined detection of FT3,FT4,TSH,T3 and T4 and its clinical significance / 国际检验医学杂志

Objective To explore the variation of serum levels of FT3,FT4,TSH,T3 and T4,the diagnose accordance rate of several indices in assessing thyroid function and its clinical significance.Methods Sixty patients with hyperthyrosis,ten patients with hypothyrosis(disease group)and 50 healthy people(healthy control group)were enrolled in the investigation.Chemiluminescent immunoassay(CLIA)was applied to measuring the contents of FT3,FT4,TSH,T3 and T4,and then the result correlation was compared and analyzed.Results There were statistical differences of serum levels of FT3,FT4,TSH,T3 and T4 between disease group and healthy control group(P＜0.05);while there wasn't significant difference of diagnose accordance rate for combined detection of FT3,FT4,TSH,T3 and T4 between disease group and healthy control group(P＞0.05).Conclusion Combined detection of FT3,FT4,TSH,T3 and T4 plays an important role in the early diagnosis,differential diagnosis and prognosis evaluation.It may guide the rational administration,as well as raise of healing rate and improvement rate.

Circulation assist in the radical operation of retro-peritoneal malignancy with the inferior vena cava thrombotic involvement / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the key role of various mode of circulation assist in the radical operation of retro-peritoneal malignancy with the inferior vena cava thrombotic involvement.</p><p><b>METHODS</b>>From the June 1999 to the March 2001, 6 patients with retro-peritoneal malignancy with thrombosis involving the inferior vena cava, were completely resected with various mode of circulation assist.</p><p><b>RESULTS</b>All the patients operated have good outcomes and follow-up (1 - 20 months) except one death 1 month after operation.</p><p><b>CONCLUSION</b>According to the various types of tumor thrombi, individualized and technically feasible circulation assist mode should be utilized to achieve the satisfactory outcomes.</p>

The figure-L unilateral transternal small incision for the treatment of anterior mediastinal tumor / 解放军医学杂志

Objective To explore the feasibility and advantage of the small figure-L unilateral transternal incision for the treatment of anteri or mediastinal tumor. Methods Twenty-four patients with anteri or mediastinal tumor were enrolled in the study. Under general anesthesia, after a 6 to 10 cm midline skin incision was made, a unilateral figure-L partial ste rnotomy on the side occupied by the tumor was made in the second or third interc ostals space, taking into account the tumor size and location. Tumors were resec ted with excellent exposure. Results All tumors were completely resected during the operation. In 8 cases, tumors encroached on the adjacent lu ng tissue, and lung tissue was partially resected. In 6 cases, tumors invaded th e pericardium, and the pericardium was partially removed. Mean operating time wa s 106 minutes (80~125 minutes). The mean time of hospital stay was 5 days after the operation, and there was no complication. All patients were alive with a mea n follow-up period of 14 months (3~24 months). Conclusion The figure-L unilateral mini-sternotomy is considered as an effective and useful mi nimally invasive approach for anterior mediastinal tumors.

Video-assisted thoracoscopic pulmonary resection under local anesthesia / 中国微创外科杂志

Objective To study the feasibility of video-assisted thoracoscopic (VAT) minor pulmonary resection under local anesthesia. Methods From February to December 2000,8 patients (6 cases of peripheral pulmonary nodules,2 cases of respiratory insufficiency and radiographic pulmonary infiltrate)were operated on through video-assisted thoracoscopy under local anesthesia. Results Except 1 case was converted to general anesthesia and performed minithoracotomy to resect pulmonary coin lesion due to pleural adhesion,other 7 patients underwent VAT-pulmonary wedge ressction under local anesthesia and definitive diagonosis.(3 with tuberculosis,1 with metastatic adenocarcinoma,1 with inflammatory pseudotumor and 2 with pulmonary fibrosis)were obtained.The duration of the procedures was from 40 to 200 min. Spontaneous breathing and hemodynamics were maintained well during the operation.There was neither severe postoperative complications nor mortality.The postoperative hospitalized days were 2～5 days with a mean of 3 days. The average medical fee for pulmonary wedge ressction using our procedure was 5400 RMB. Conclusions VAT-minor pulmonary resection can be performed safely under local anesthesia.

EXPERIENCE WITH ONE-STAGE BILATERAL VATS FOR SPONTANEOUS PNEUMOTHORAX / 中国内镜杂志

Objective:Evaluating the operative methods,complication,feasibiltity and safety of one-stage treatment by thoracoscopy for bilateral pneumothorax or pneumothorax combined with contralateral bullae.Methods:21 patients diagnosed as simultaneous bilateral pneumothorax or ipsilateral recurrent pneumothorax with contralateral bullaes received one-stage treatment by bilateral thoracoscopy.Results:all patients received VATS,postoperative complications include prolonged air leak over 4 days(2 cases), reexpansion pulmonary edema (1 case),and one patient required temporarily mechanical ventilation.There were no postoperative death.All patients recovered smoothly.Follow-up time ranges from 7 to 77 months (mean 32.7 months).Compared with the 127 thoracopcopic procedures of unilateral pneumothorax,there's no statistics difference in complications (χ2=1.7247,P＞0.05). Conclusions:one-stage VATS is a safe and effective procedure for bilateral spontaneous pneumothorax or pneumothorax combined with contralateral bullae.

EXPERIENCE WITH THE TREATMENT OF BILATERAL SYNCHRONOUS MULTIPLE PRIMARY LUNG CANCERS / 中国内镜杂志

Objective:Evaluate the role of video-assisted thoracic surgery (VATS) in the treatment of bilateral synchronous multiple primary lung cancers.Methods and Results:Two paitents diagnosised as bilateral synchronous multiple primary lung cancers received one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery,performing open lobectomy to remove the larger tumor,performing wedge resection using thoracoscopy to excise the smaller one.The surgery time is short.Patients all recover smoothly without complications.To date,these two patients all alive without any sign of recurrence or metastasis of tumor,median follow-up time is 5 months (2 months+8 months).Conclusions:It is feasible to carry out one-stage treatment combined conventional thoracotomy with video-assisted thoracic surgery on patients with bilateral synchronous multiple prima-ry lung cancers,when one of the tumors of bilateral synchronous multiple primary lung cancers is classificated as T1N0M0.