A Rare Case of Lung Adenocarcinoma with EGFR L833V/H835L Co-mutation and Literature Review / 中国肺癌杂志

Epidermal growth factor receptor (EGFR) mutations are the most common driver genes in the development of non-small cell lung cancer (NSCLC), of which mutations in exons 18-21 are frequent, especially the loss of exon 19 and exon 21 L858R mutation are the most frequent. Other rare gene mutations are rare. Simultaneous occurrence of two or more rare EGFR mutations are extremely rare in lung cancer, and the incidence of EGFR L833V/H835L rare gene compound mutations is very low, and there is little clinical data and evidence of relevant treatment methods. Some EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are effective in treating lung cancer patients with rare gene mutations. In this article, we reported a case of NSCLC patient with a rare gene compound mutation EGFR L833V/H835L, who responded to Afatinib in combination with Anilotinib treatment well after 5 months of treatment, and computed tomography (CT) showed shrinkage of lung lesions. Meanwhile, we also compiled previously reported NSCLC patients with EGFR L833V/H835L rare gene compound mutation and summarized the characteristics of this group of patients and the effect of applying different kinds of EGFR-TKIs treatment.
.

Impact of statin use on major adverse cardiovascular events in patients with normal stress myocardial perfusion imaging and elevated coronary artery calcium score

INTRODUCTION@#Normal stress myocardial perfusion imaging (MPI) carries a favourable prognosis. Conversely, elevated coronary artery calcium (CAC) is associated with increased major adverse cardiovascular events (MACE). There is limited information on the prognosis and management of patients with elevated CAC and normal MPI. We aimed to assess the outcomes of patients with elevated CAC and normal MPI in relation to post-MPI statin use.@*METHODS@#A retrospective review of normal MPI with CAC score >300 was performed between 1 March 2016 and 31 January 2017 in a Singapore tertiary hospital. Patients with known atherosclerotic cardiovascular disease or left ventricular ejection fraction <50% on MPI were excluded. Patient demographics, prescriptions and MACE (cardiac death, nonfatal myocardial infarction and/or ischaemic stroke) at 24 months after MPI were traced using electronic records. Binary logistic regression was used to evaluate for independent predictors of MACE.@*RESULTS@#We included 311 patients (median age 71 years, 56.3% male), of whom 65.0% were on moderate to high-intensity statins (MHIS) after MPI. MACE was significantly lower in the post-MPI MHIS group (3.5% vs. 9.2%, P = 0.035). On univariate binary logistic regression, post-MPI MHIS use was the only significant predictor for MACE (odds ratio [OR] 0.355 [95% confidence interval (CI) 0.131-0.962], P = 0.042), even after multivariate adjustment (adjusted OR 0.363, 95% confidence interval 0.134-0.984, P = 0.046).@*CONCLUSION@#Post-MPI MHIS use is associated with lower MACE and is an independent negative predictor for 24-month MACE among patients with normal MPI and CAC >300.

New steroidal saponins from aerial parts of Paris polyphylla var. chinensis / 中国中药杂志

The shortage of Paridis Rhizoma promotes comprehensive utilization and development research of waste aerial parts of the original plant. The chemical compositions of the aerial parts of Paris polyphylla var. chinensis were clarified based on the ultrahigh performance liquid chromatography tandem quadrupoles time of flight mass spectrometry(UPLC-QTOF-MS/MS) in the previous investigation, and a series of flavonoids and steroidal saponins were isolated. The present study continued the isolation and structure identification of the new potential compounds discovered based on UPLC-QTOF-MS/MS. By using silica gel, ODS, flash rapid preparation, and other column chromatography techniques, combined with prepared high performance liquid chromatography, five compounds were isolated from the 75% ethanol extract of the aerial parts of P. polyphylla var. chinensis, and their structures were identified by spectral data combined with chemical transformations, respectively, as(23S,25R)-23,27-dihydroxy-diosgenin-3-O-α-L-rhamnopyranosyl-(1→2)-[β-D-glucopyranosyl-(1→3)]-β-D-glucopyranoside(1),(25R)-26-O-β-D-glucopyranosyl-furost-5-en-3β,22α,26-triol-3-O-α-L-rhamnopyranosyl-(1→2)-[β-D-glucopyranosyl-(1→4)-α-L-rhamnopyranosyl-(1→4)]-β-D-glucopyranoside(2),(25R)-27-O-β-D-glucopyranosyl-5-en-3β,27-dihydroxyspirost-3-O-α-L-rhamnopyranosyl-(1→2)-[β-D-glucopyranosyl-(1→4)-α-L-rhamnopyranosyl-(1→4)]-β-D-glucopyranoside(3),(25R)-27-O-β-D-glucopyranosyl-5-en-3β,27-dihydroxyspirost-3-O-α-L-rhamnopyranosyl-(1→2)-[β-D-glucopyranosyl-(1→3)]-β-D-glucopyranoside(4), and aculeatiside A(5). Among them, compounds 1-4 were new ones, and compound 5 was isolated from P. polyphylla var. chinensis for the first time.

Relationship between preoperative inflammatory indexes and prognosis of patients with rectal cancer and establishment of prognostic nomogram prediction model / 中华肿瘤杂志

Objective: To compare the prognostic evaluation value of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in rectal cancer patients. Nomogram survival prediction model based on inflammatory markers was constructed. Methods: The clinical and survival data of 585 patients with rectal cancer who underwent radical resection in the First Affiliated Hospital of Xi'an Jiao tong University from January 2013 to December 2016 were retrospectively analyzed. The optimal cut-off values of NLR, PLR, LMR, and SII were determined by the receiver operating characteristic (ROC) curve. The relationship between different NLR, PLR, LMR and SII levels and the clinic pathological characteristics of the rectal cancer patients were compared. Cox proportional risk model was used for univariate and multivariate regression analysis. Nomogram prediction models of overall survival (OS) and disease-free survival (DFS) of patients with rectal cancer were established by the R Language software. The internal validation and accuracy of the nomograms were determined by the calculation of concordance index (C-index). Calibration curve was used to evaluate nomograms' efficiency. Results: The optimal cut-off values of preoperative NLR, PLR, LMR and SII of OS for rectal cancer patients were 2.44, 134.88, 4.70 and 354.18, respectively. There was statistically significant difference in tumor differentiation degree between the low NLR group and the high NLR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative carcinoembryonic antigen (CEA) level between the low PLR group and the high PLR group (P<0.05). There was statistically significant difference in tumor differentiation degree between the low LMR group and the high LMR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative CEA level between the low SII group and the high SII group (P<0.05). The multivariate Cox regression analysis showed that the age (HR=2.221, 95%CI: 1.526-3.231), TNM stage (Ⅲ grade: HR=4.425, 95%CI: 1.848-10.596), grade of differentiation (HR=1.630, 95%CI: 1.074-2.474), SII level (HR=2.949, 95%CI: 1.799-4.835), and postoperative chemoradiotherapy (HR=2.123, 95%CI: 1.506-2.992) were independent risk factors for the OS of patients with rectal cancer. The age (HR=2.107, 95%CI: 1.535-2.893), TNM stage (Ⅲ grade, HR=2.850, 95%CI: 1.430-5.680), grade of differentiation (HR=1.681, 95%CI: 1.150-2.457), SII level (HR=2.309, 95%CI: 1.546-3.447), and postoperative chemoradiotherapy (HR=1.837, 95%CI: 1.369-2.464) were independent risk factors of the DFS of patients with rectal cancer. According to the OS and DFS nomograms predict models of rectal cancer patients established by multivariate COX regression analysis, the C-index were 0.786 and 0.746, respectively. The calibration curve of the nomograms showed high consistence of predict and actual curves. Conclusions: Preoperative NLR, PLR, LMR and SII levels are all correlated with the prognosis of rectal cancer patients, and the SII level is an independent prognostic risk factor for patients with rectal cancer. Preoperative SII level can complement with the age, TNM stage, differentiation degree and postoperative adjuvant chemoradiotherapy to accurately predict the prognosis of rectal cancer patients, which can provide reference and help for clinical decision.

"Can more be done to save my daughter?" - Primary palliative care for patients with unexpected, rapid cancer progression

@#This is a case study of a 58-year-old lady with metastatic nasopharyngeal carcinoma (NPC) who suffered a left neck of femur fracture. Unfortunately, there was an unexpected and rapid cancer progression, requiring her goals of care to transit from rehabilitation after her fracture to palliation. The case brings to light the need for family physicians to be poised to manage cancer patients at the end of life in the community, and work together with other stakeholders to deliver compassionate and supportive care.

Separation and structural elucidation of C25 epimers of furostanol saponin from aerial parts of Paris polyphylla var. chinensis / 中国中药杂志

Paris polyphylla var. chinensis(PPC) is used as one of the origin plants of Paridis Rhizoma described in the Chinese Pharmacopoeia(2020 edition). Its resources shortage makes the planting scale gradually expand, and plenty of aerial parts are abandoned because of not being effectively used. On the basis of previous research, this study separated steroidal saponins to further clarify the chemical composition of the aerial parts of PPC. As a result, three pairs of 25R or 25S epimers of furostanol saponins were obtained by various column chromatography techniques. Their structures were identified as neosolanigroside Y6(1), solanigroside Y6(2), neoprotogracillin(3), protogracillin(4), neoprotodioscin(5) and protodioscin(6) by spectral data combining with chemical transformation. Compound 1 is a new compound, and compounds 2, 3 and 5 are isolated from Paris plants for the first time. Compounds 4 and 6 are isolated from this plant for the first time. Previously, only several spirostanol glycosides with 25S configuration were isolated from Paris plants. Guided by mass spectrometry, the present study isolated the furostanol saponins with 25S configuration from this genus for the first time, which further enriches the chemical information of Paris genus and provides a reference for the isolation of similar compounds.

Correlation between vascular cognitive dysfunction and ankle-brachial index in the elderly / 中国医师杂志

Objective:To investigate the clinical value of ankle-brachial index (ABI) in evaluating vascular cognitive dysfunction (VCI) in the elderly.Methods:According to the mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA), 200 elderly inpatients from May 2016 to February 2018 in our hospital were selected. MoCA scale was used to evaluate the cognitive function of the patients. The patients were divided into cognitive dysfunction group ( n=110) and cognitive normal group ( n=90). The clinical data of the two groups were analyzed and compared. The correlation between ABI and MMSE, MOCA and clinical indicators was observed. The receiver operating characteristic (ROC) curve of ABI value to the predictive value of VCI in the elderly was drawn. Results:⑴ There was no significant difference between the two groups in terms of gender, the first fasting blood glucose value in hospital and the situation of diabetes, hypertension and hyperlipidemia ( P>0.05); there was significant difference in age, low-density lipoprotein cholesterol (LDL-C) level, history of small cerebral vessels and ABI between the two groups ( P<0.05). ⑵ Logistic regression analysis showed that ABI was the related factor of VCI in the elderly ( P<0.01). ⑶ Pearson correlation analysis showed that MMSE score was positively correlated with ABI ( r=0.887, P<0.01), MOCA score was positively correlated with ABI ( r=0.843, P<0.01). ⑷ The area under ROC curve of ABI prediction value for VCI in the elderly was (0.965±0.01) [95% CI (0.945, 0.985), P<0.01]. When ABI ≤0.9, the sensitivity and specificity were 88.2%, 91.1% respectively; the accuracy and the yordan index were 89.5% and 0.793. Conclusions:⑴ ABI is an influencing factor of VCI in the elderly and is positively correlated with the severity of cognitive impairment in patients. ⑵ ABI has a high predictive value for VCI of the elderly, and ABI≤0.9 can be used as an early warning factor for VCI of the elderly.

Effect of Voice Training on Vocal Function for Patients with Early Vocal Fold Polyps / 中国康复理论与实践

Objective:To investigate the clinical effect of voice training on the vocal function of patients with early vocal fold polyps. Methods:From May, 2016 to May, 2018, 80 patients with unilateral wide-based vocal fold polyps were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups underwent voice hygiene education, and the experimental group accepted voice training, 40 minutes a week for twelve weeks in addition. They were evaluated with fiber laryngoscope, voice handicap index (VHI) and the computer phonatory detection before and after training. Results:Five in the control group and seven in the experimental group were dropped out. After training, the cure rate and the improvement rate of vocal fold polyps were significantly higher in the experimental group than in the control group (χ2 = 24.608, P < 0.001). The scores of VHI significantly improved in the experimental group (t/Z > 11.701, P < 0.05), and were better than those in the control group (t/Z > 7.027, P < 0.001). The scores of jitter, shimmer, and maximum phonation time improved (|t/Z| >5.012, P < 0.001) after training in the experimental group, and were better than those in the control group (t/Z > 4.596, P < 0.001). Conclusion:Voice training could improve the vocal function of patients with early vocal fold polyps, reduce hoarseness, and improve the voice quality.

Thoughts on the development of emergency and first aid system in rural China / 中华医院管理杂志

In recent years, the contradiction between the construction of backward first aid system and the demand for emergency services in rural areas in China is increasingly serious. In order to further improve the quality and efficiency of first aid, the state has vigorously promoted the construction of the " Five Centers" , namely chest pain centers, stroke centers, trauma centers, critical maternal treatment centers, and critically ill children and neonatal treatment centers in rural areas, in an effort to develop an efficient rural emergency service network. The authors collected relevant policy documents and summarized practices of the " Five Centers" construction. On such basis, they referred to experiences of overseas emergency systems and medical rescue centers, and made focused analysis for on the functionality and mechanism of the " Five Centers" in building an innovative first-aid system, in terms of internal and external environment, institutional function positioning, resource integration, and operation mechanism. In view of the integration among " Five Centers" , pre-hospital emergency and in-hospital first aid in rural areas, information construction, personnel first aid capacity building and interest allocation, policy recommendations are proposed.

Comparative analysis of the clinical symptoms and laboratory examination indexes between patients with HIV/AIDS infection complicated with tuberculosis and those with HIV/AIDS alone / 公共卫生与预防医学

Objective To explore the differences in clinical symptoms and laboratory examination indexes between patients with HIV/AIDS infection complicated with tuberculosis (TB) and those with HIV/AIDS alone, so as to provide a reference for early identification and diagnosis of HIV/AIDS infection with TB. Methods A total of 206 patients with HIV/AIDS infection and TB who were admitted to Suining Central Hospital from January 2015 to April 2019 were selected as the study group. 86 patients with pure HIV/AIDS were selected as the disease control group. Data of clinical diagnosis and treatment as well as follow-up of the patients were retrospectively analyzed. The clinical symptoms, laboratory examination indexes and clinical treatment outcomes were compared between the two groups. Results The incidence rates of fever, emaciation, electrolyte imbalance, hypoproteinemia, cough and chest pain in the study group were significantly higher than those in the disease control group (P0.05). The positive rates of sputum smear acid fast stain, sputum mycobacterium tuberculosis culture and PPD test in the study group were significantly higher than those in the disease control group, while the CD3+ count, CD4+ count and CD4+/CD8+ were obviously lower than the disease control group (P0.05). The ROC curve suggested that the areas under the curve of CD3+, CD4+, CD4+/ CD8+ and the three combined indicators to evaluate HIV/AIDS infection combined with TB were 0.799, 0.841, 0.913, and 0.935, respectively. The hospitalization time in the study group was significantly longer than that in the disease control group. The proportion of discharged patients (improved) in the study group was significantly lower than that in the disease control group, while the proportion of discharged patients (not improved) was significantly higher than that in the disease control group (P<0.05). Conclusion Although the clinical symptoms of patients with HIV/AIDS infection combined with TB are similar to those of patients with HIV/AIDS alone, the main symptoms of the former are fever, emaciation and electrolyte imbalance. The detection of laboratory immune function indexes is of positive significance for improvement of the diagnostic sensitivity and accuracy of HIV/AIDS infection with TB.

Effect and influencing factors of Nd:YAG laser dacryocystoplasty combined with lacrimal stent implantation in the treatment of lacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyse the curative effect and influencing factors of Nd:YAG laser lacrimal duct angioplasty combined with lacrimal duct stent implantation on the treatment of lacrimal duct obstruction. <p>METHODS: Totally 150 eyes of 150 patients with lacrimal duct obstruction admitted to our hospital from June 2017 to June 2019 were selected and treated with Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent placement. Follow-up 6mo after extubation, the patients were divided into effective group(135 cases, 135 eyes)and ineffective group(15 cases, 15 eyes)according to the clinical efficacy. General information, complications, causes of lacrimal duct blockage, postoperative lacrimal duct flushing frequency and clinical data such as the condition of bony lacrimal duct, analysis of related factors affecting the therapeutic effect.<p>RESULTS: Follow-up 6mo after extubation, the effective rate and recurrence rate were 90.0%(135 eyes)and 1.3%(2 eyes)respectively. The course of the disease in the effective group was significantly shorter than that of the ineffective group, and the incidence of complications was significantly lower than in the ineffective group, the length of osseous lacrimal duct obstruction was significantly shorter than that of the ineffective group, the minimum diameter of the obstruction was significantly longer than that of the ineffective group, there was a significant difference in the frequency of tract flushing(all <i>P</i><0.05). Logistic regression analysis showed that the course of disease(<i>OR</i>=4.600; 95%<i>CI</i>: 3.448-6.136), complications(<i>OR=</i>2.524; 95% <i>CI</i>: 1.481-4.302),the length of osseous lacrimal duct obstruction(<i>OR</i>=3.785; 95% <i>CI</i>: 1.844-7.770)and the minimum diameter of the obstruction(<i>OR</i>=2.330; 95% <i>CI </i>1.464-3.708), as well as flushing frequency(<i>OR</i>=4.773; 95% <i>CI</i>: 2.227-10.231)were related factors affecting the therapeutic effect of Nd:YAG laser lacrimal duct plasty combined with lacrimal duct stent implantation.<p>CONCLUSION: Nd:YAG laser lacrimal duct angioplasty combined with lacrimal duct stent implantation is effective in the treatment of lacrimal duct obstruction, with the lower incidence of complications and recurrence rate. The course of disease, complications, postoperative lacrimal passage irrigation frequency and the condition of bone lacrimal passage are all influencing factors, among which the effective rate can be improved by properly increasing the number of lacrimal duct expansion irrigation.

Relationships Between Expression level of MicroRNA-146a, STAT1 Protein and Clinical Characteristics in Children with Acute Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the relationships between expression levels of serum microRNA-146a, STAT1 protein and clinical characteristics in children with acute lymphoblastic leukemia (ALL).@*METHODS@#A total of 102 children diagnosed as ALL in our hospital from June 2014 to June 2016 were enrolled, and were compared by into groups according to clinical characteristics including sex, age, lymphocyte type, disease risk, chemotherapy stage and gene mutation. Fifty healthy children were chosen as control group. The relative expression of microRNA-146a and STAT1 gene was detected by real-time RT-PCR and the relative level of STAT1 protein was detected by Western blot. The difference of microRNA-146a and STAT1 protein levels between clinical factors and laboratory indexs were compared. Followed-up for 3 years, The difference of overall survival (OS) rates between ALL children with different microRNA-146a and STAT1 protein were compared.@*RESULTS@#The levels of microRNA-146a, STAT1 mRNA and protein in ALL children were significantly higher than those in control group (P＜0.05), but there were no significantly differences in sex, age and lymphocyte type grouping in ALL children (P＞0.05). There were significantly differences in different disease risk, chemotherapy stage and gene mutation groups in ALL children (P＜0.05). Followed-up for 3 years, the OS rate of ALL children with high microRNA-146a and STAT1 protein levels were better than those with low microRNA-146a and STAT1 protein levels (P＜0.05).@*CONCLUSION@#The up-regulation of microRNA-146a and STAT1 protein may be involved in occurrence and development of ALL, which closely relates to clinical characteristics in ALL children, such as disease risk, chemotherapy stage and gene mutation.

Correlation between endothelial microparticles and subacute 1,2-dichloroethane toxic encephalopathy / 中国职业医学

OBJECTIVE: To explore the correlation between endothelial microparticles(EMPs) and subacute 1,2-dichloroethane(1,2-DCE) toxic encephalopathy. METHODS: A total of 24 patients with subacute 1,2-DCE toxic encephalopathy were selected as the case group, and 24 healthy individuals were selected as the control group using a convenient sampling method. Blood plasma was collected from the fasting venous blood of patients in these two groups, and the level of EMPs in the plasma was detected by flow cytometry. RESULTS: The levels of plasma EMPs of patients in the control group and the case group were(692.0±174.4) ×10~3/L and(839.8±155.8) ×10~3/L respectively. The levels of plasma EMPs in patients with mild, moderate and severe case subgroups were(691.6±101.9) ×10~3/L,(900.6±46.6) ×10~3/L and(1 026.8±69.8)×10~3/L respectively. The EMPs level of patients in the case group was higher than that of the control group(P<0.01). The level of EMPs in the moderate and severe case subgroups was higher than that of the control group and mild case subgroup(P<0.01). CONCLUSION: Endothelial injury was found in patients with subacute 1,2-DCE toxic encephalopathy and endothelial injury is related to the severity of poisoning.

Impact of childhood sexual abuse on risky sexual behaviors among men who have sex with men in Guangzhou / 中华疾病控制杂志

Objective To explore the experience of childhood sexual abuse (CSA) among men who have sex with men (MSM) in Guangzhou, and to evaluate its impact on risky sexual behaviors in adulthood. Methods A non-probability sampling method was used to recruit MSM aged 18 years and over in Guangzhou. Sociodemographic characteristics, experience of CSA and risky sexual behaviors during the past 6 months were collected using an electronic questionnaire. 2 tests were used to compare the prevalence of CSA and risky sexual behaviors during the past 6 months among different sociodemographic characteristics. Logistic regressions were performed to assess the impact of CSA on risky sexual behaviors. Results Overall, 976 MSM were included with an average age of (28.35±6.83) years old. Nearly one-third (26.95%, 263/976) of MSM experienced CSA. Participants having multiple sexual partners (MSP) and unprotected anal intercourse (UAI) during the past 6 months accounted for 61.68% (602/976) and 47.95% (468/976), respectively. After adjusting age, ethnicity, household registration, local residence time, marital status, education, employment status, monthly income and sexual orientation, the results of multivariate Logistic regression showed that MSM who experienced CSA were likely to have MSP during the past 6 months (aOR=1.62; 95%CI: 1.19-2.22) than those did not experience CSA. But the association between UAI and CSA was not statistically significant. Conclusions The prevalence of CSA among MSM in Guangzhou is high. CSA can substantially increase the risk of risky sexual behaviors in adulthood. Intervention to reduce the risk of sexual risk behaviors may need to be tailored for MSM who experienced CSA.

Association between sexual sensation seeking and sexual risk behaviors among men who have sex with men in Guangzhou / 中华疾病控制杂志

Objective To evaluate the association between sexual sensation seeking (SSS) and sexual risk behaviors among men who have sex with men (MSM) in Guangzhou. Methods MSM aged 18 and over were recruited in Zhitong Charity from June 2017 to April 2018. Data on socio-demographic characteristics, sexual behaviors and SSS were collected using an electronic questionnaire. Logistic regression analyses were performed to evaluate the association between SSS and sexual risk behaviors. Results A total of 500 MSM were included in the current study. The mean age of the participants was (27.77±5.96) years old. The multiple logistic regression analyses showed that MSM with high SSS scores were more likely to engage in multiple sexual partners (OR=2.05, 95% CI: 1.40-2.30,P<0.001), one-night stand (OR=2.11, 95% CI: 1.44-3.09,P<0.001), and unprotected anal intercourse (OR=1.70, 95% CI: 1.16-2.50,P=0.007) than those with low SSS scores. Conclusions High SSS is associated with an increased risk of sexual risk behavior among MSM in Guangzhou. The behavior intervention strategy should be tailored for MSM with high SSS to improve the effectiveness to reduce sexual risk behaviors.

Observation of the efficacy of biological patch in hybrid technique for incisional herniorrhaphy: 5-year follow-up results from a single center / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the safety and efficacy of biological patch (Biodesign Surgisis mesh, SIS) in hybrid technique for incisional herniorrhaphy.</p><p><b>METHODS</b>Clinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm.</p><p><b>RESULTS</b>There were four male and tenfemale patients with average age of (67.7±11.6) years and average body mass index(BMI) of (25.5±1.7) kg/m². As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months (median, 8 months). Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra-umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was (202.5±72.9) minutes. The average length and width of hernia ring were (10.9±4.3) cm and (9.3±3.9) cm, respectively. Clean operation was performed in 11 cases, potential contaminative operation in 2 cases and contaminative operation in 1 case. The amount of operative bleeding was (15.0±4.8) ml. The NRS pain scores within 24 hours after the operation, at POD3 and at POD7 were 5.1±0.9, 4.2±0.7 and 3.7±0.9, respectively. The time to flatus after operation was (2.5±0.9) days and the time to liquid diet was (3.8±1.2) days. No patient died during the perioperative period. The average hospitalization time was (21.5±12.0) days. Postoperative complications occurred in 8 cases, including 4 cases of fever, 8 cases of incision complications, 4 cases of abdominal infection, 4 cases of intestinal obstruction, 5 cases of effusion under patch, 2 cases of pneumonia, and 1 case of acute myocardial infarction. According to the Clavien-Dindo classification, 3 cases were grade zero, 3 cases were grade I(, 6 cases were grade II(, 1 case was grade III(, and 1 case was grade IIII(. Thirteen patients received follow-up and the average follow-up time was (33.2±12.3) (18.2-61.0) months. One patient died of cerebral infarction 38 months after operation. The chronic abdominal pain or discomfort was found in 4 cases. The recurrent incisional hernia developed in 5 cases and the average time of recurrence was (11.0±8.3) months.</p><p><b>CONCLUSIONS</b>Biological patch can be used safely and effectively in hybrid technique for incisional herniorrhaphy. However, the morbidity of postoperative complication and the risk of recurrence are high. Terefore, the long-term outcome is still subject to observation.</p>

Clinical effects of loading doses of rosuvastatin in treatment of acute cerebral infarction and influence on cere-bral hemodynamics / 局解手术学杂志

Objective To observe the effects of loading doses of rosuvastatin in treatment of acute cerebral infarction and influence on cerebral hemodynamics.Methods One hundred and twenty-six patients of acute cerebral infarction who were admitted into hospital from January 2014 to June 2016 were selected and randomly divided into the observation group(63 cases,loading doses of rosuvastatin,40 mg per day at the first time,and then 20 mg per day)and the control group(63 cases,routine doses of rosuvastatin,10 mg per day),and one course lasted for 3 months.The NIHSS scores and Barthel index before treatment,1 month and 3 months after treatment were compared,as well as the clinical effects and cerebral hemodynamics changes 3 months after treatment.Results The NIHSS scores of the observation group at 1 month and 3 months after treatment were respectively lower than those of control group with statistical significance(P<0.05),and scores of the Barthel index of the observation group were higher than those of the control group with statistical significance(P<0.05).The total effective rate in the observation group was 88.89%,which was higher than that of the control group(77.78%),but the difference was not statistically significant(P>0.05).After the treatment,bilateral pulsation index(PI)of the observation group were lower than those of the control group (P<0.05).Systolic blood flow velocity(Vs)and mean blood flow velocity(Vm)were higher than those in the control group(P<0.05). The difference of adverse reaction between 2 groups was not statistically significant(P>0.05).Conclusion Loading doses of rosuvastatin can achieve better curative efficacy in treatment of patients with acute cerebral infarction and better improvement of cerebral hemodynamics.

Efficacy analysis of porcine small intestine submucosa-derived mesh and polypropylene mesh applied in anterior abdominal wall incisional hernia repair / 中华消化外科杂志

Objective To investigate the clinical efficacy of porcine small intestine submucosa-derived (SIS) mesh and polypropylene (PP) mesh applied in anterior abdominal wall incisional hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 59 patients who underwent anterior abdominal wall incisional hernia repair in the First Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2017 were collected.Of 59 patients,22 undergoing anterior abdominal wall incisional hernia repair with SIS mesh and 37 undergoing anterior abdominal wall incisional hernia repair with PP mesh were respectively allocated into the SIS group and PP group.Surgeons selected surgical procedures according to hernia ring situations of patients.Observation indicators:(l) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect long-term complications of patients including foreign body sensation or pain in abdominal wall and hernia recurrence up to May 2018.Measurement data with normal distribution were represented as (x)±s,and comparison between groups was done using t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was done using Mann-Whitney U test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery situations:patients of the SIS group and PP group underwent successfully anterior abdominal wall incisional hernia repair.There were 2,3,3,14 and 5,26,1,5 patients undergoing open Onlay repair,open Sublay repair,laparoscopic intraperitoneal onlay mesh repair,laparoscopic combined with open mesh repair in the SIS group and PP group respectively.The volume of intraoperative blood loss,cases of postoperative incisional seroma and surgical site infection were (23± 11)mL,7,5 in the SIS group and (30± 13)mL,3,1 in the PP group respectively,with statistically significant differences between groups (t=-2.238,P＜0.05).(2) Follow-up:patients of the SIS group and PP group were respectively followed up for 29.3 months (6.0-66.0 months) and 31.0 months (7.0-76.0 months),with no statistically significant difference between groups (Z =-1.388,P＞0.05).During the follow-up,foreign body sensation or pain in abdominal wall and hernia recurrence were detected in 6,6 patients in the SIS group and 4,2 patients in the PP group respectively,with a statistically significant difference in hernia recurrence between groups (P＜0.05) and with no statistically significant difference in foreign body sensation or pain in abdominal wall between groups (P＞0.05).Conclusion Compared with polypropylene mesh,anterior abdominal wall incisional hernia repair using SIS mesh has higher incidence rate of postoperative incisional seroma,surgical site infection and hernia recurrence,but fewer volume of intraoperative blood loss.

Open scientific research social networks based on the expansion of literature management software function / 中华医学图书情报杂志

Scientific researchers can access,manage,read,analyze and cite literature with the help of literature management software which is developing from a single individual management tool to the networked, intelligent, sharable and collaborative open scientific research social networks with the rapid development of Internet and social network. The characteristics of scientific research social networks were thus analyzed with the trends and sustain-ability of literature management software to the expanded open scientific research social networks discussed from the basic functions of literature management software in combination with literature investigation.

The effect of WT1 expression on the prognosis of allogeneic hematopoietic stem cell transplantation in acute leukemia / 中华血液学杂志

Objective: To study the effect of WT1 expression on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia (AL) and its significance as molecular marker to dynamically monitor minimal residual disease (MRD) . Methods: Retrospectively analyzed those AL patients who underwent allo-HSCT in the First Hospital Affiliated to Zhejiang University School of Medicine during Jan 2016 to Dec 2017, a total number of 314 cases, 163 males and 151 females, median age was 30 (9-64) years old. Comparing the difference of WT1 expression at diagnosed, pre-HSCT and after HSCT. Using the receiver operating characteristic (ROC) curve to determine the WT1 threshold at different time so as to predict relapse. The threshold of WT1 expression before transplantation was 1.010%, within 3 months after HSCT was 0.079% and 6 months after HSCT was 0.375%. According to these thresholds, WT1 positive patients were divided into low expression groups and high expression groups. Analyzed the relationship between overall survival (OS) , disease-free survival (DFS) , cumulative incidence of relapse (CIR) and WT1 expression. Results: The OS and DFS of high expression group pre-HSCT were lower than low expression group [69.2% (9/13) vs 89.1% (57/64) , χ(2)=4.086, P=0.043; 53.8% (7/13) vs 87.5% (56/64) , χ(2)=9.766, P=0.002], CIR was higher than low expression group [30.8% (4/13) vs 7.8% (5/64) , P=0.017]. There was no significant difference of OS and DFS between high expression and low expression group of 3 months after HSCT (P=0.558, P=0.269) . The OS and DFS of high expression group of 6 months after transplantation were both lower than low expression group (P=0.049, P=0.035) . Multivariate analysis showed that WT1>0.375% when 6 months after transplantation was the only independent prognostic factor for shorter DFS (P=0.022) . There was no statistically significant difference in CIR between the high-expression group and the low-expression group 3 months after transplantation and 6 months after transplantation (P=0.114, P=0.306) . Conclusion: High expression of WT1 before and after HSCT was an adverse prognosis factor. It is of clinical practical value to use WT1 as a transplant recommendation index for patients with acute leukemia and as a marker to monitor MRD dynamically.