The diagnostic values of multicolor melting curve analysis on drug resistance to 5 anti-tuberculosis drugs / 中国热带医学

@#Abstract: Objective To explore and analyze the diagnostic value of multicolor melting curve analysis (MMCA) for the resistance of five anti-tuberculosis drugs, so as to clarify the clinical value of MMCA in detecting drug resistance of Mycobacterium tuberculosis. Methods From April 2021 to May 2022, 200 patients with positive Mycobacterium tuberculosis admitted to the Fourth People's Hospital of Qinghai Province were selected as research objects, and sputum specimens were taken from the patients. Traditional Mycobacterium tuberculosis drug sensitivity test (modified Löwenstein-Jensen medium method) and MMCA analysis were respectively given to detect the resistance of five anti-tuberculosis drugs, including isoniazid, ethambutol, streptomycin, rifampicin and isoniazid, respectively. Those samples with inconsistent results between the two diagnosis methods were subjected to gene sequencing verification, and the diagnosis efficiency of MMCA for the five anti-tuberculosis drugs was compared. Results Using Mycobacterium tuberculosis drug sensitivity as the gold standard for drug resistance diagnosis, the sensitivity of MMCA for detecting drug resistance of rifampicin, ethambutol, streptomycin, isoniazid and levofloxacin were 95.83% (46/48), 93.75% (15/16), 100.00% (15/15), 100.00% (20/20) and 70.00% (7/10), respectively, with statistical differences between groups (P<0.05). There were no statistically significant differences in the specificity, positive predictive value, negative predictive value and accuracy of MMCA for the five anti-tuberculosis drugs (P>0.05). For the 8 samples with inconsistent results between MMCA and modified Löwenstein-Jensen medium method, gene sequencing was performed and compared with the results of gene sequencing. After comparison with gene sequencing results, it was found that the coincidence rate of MMCA and gene sequencing results was 75.00% (6/8). Conclusions In the detection of drug-resistant mutations in TB patients, multi-color probe fusion curve analysis has high diagnostic efficacy for first-line anti-tuberculosis drugs, but is not sensitive to second-line anti-tuberculosis drug levofloxacin. Therefore, for the detection of first-line anti-tuberculosis drugs, MMCA has a good clinical application prospect.

Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development / 中华儿科杂志

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

A case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes mimicking migraine attacks with visual aura / 中国医师杂志

Objective:To study the case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) which mimic migraine attacks with visual aura, to analyze the clinical features, and to recognize the nature of headache.Methods:The clinical features, image data and video electroencephalogram (EEG) of a suspected patient with MELAS were analyzed. Genomic DNA of mitochondria was extracted from blood and the next generation sequencing was performed to explore the mutation of genes about MELAS.Results:The patient was adolescent-onset, and presented with migraine-like attacks with visual aura, epileptic seizures, stroke-like episodes and hyperlactemia. Brain images suggested basal ganglia calcification, reversible left occipital cortex infarction and abnormal lactic acid peaks in both occipital cortex. Video EEG suggested abnormal adolescent EEG. Mitochondrial DNA sequencing showed that MT-TL1 gene had m. 3243A>G pathogenic mutation.Conclusions:There are a variety of clinical manifestations in MELAS, and migraine-like attacks with visual aura as initial symptoms may be manifestations of occipital lobe epilepsy. Clinicians should avoid confusing the diagnosis of migraine with visual aura, occipital epilepsy and MELAS, in order to make rational clinical decisions.

Gut Microbiota Alteration Influences Colorectal Cancer Metastasis to the Liver by Remodeling the Liver Immune Microenvironment

Background/Aims@#This study aimed to explore the effect of gut microbiota-regulated Kupffer cells (KCs) on colorectal cancer (CRC) liver metastasis. @*Methods@#A series of in vivo and in vitro researches were showed to demonstrate the gut microbiota and its possible mechanism in CRC liver metastasis. @*Results@#Fewer liver metastases were identified in the ampicillin-streptomycin-colistin and colistin groups. Increased proportions of Parabacteroides goldsteinii, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides uniforms were observed in the colistin group. The significant expansion of KCs was identified in the ampicillin-streptomycin-colistin and colistin groups. B.vulgatus levels were positively correlated with KC levels. More liver metastases were observed in the vancomycin group. An increased abundance of Parabacteroides distasonis and Proteus mirabilis and an obvious reduction of KCs were noted in the vancomycin group. P. mirabilis levels were negatively related to KC levels. The number of liver metastatic nodules was increased in the P. mirabilis group and decreased in the B. vulgatus group. The number of KCs decreased in the P. mirabilis group and increased in the B. vulgatus group. In vitro, as P. mirabilis or B. vulgatus doses increased, there was an opposite effect on KC proliferation in dose- and time-dependent manners. P. mirabilis induced CT26 cell migration by controlling KC proliferation, whereas B. vulgatus prevented this migration. @*Conclusions@#An increased abundance of P. mirabilis and decreased amount of B. vulgatus play key roles in CRC liver metastasis, which might be related to KC reductions in the liver.

Surgical management and molecular diagnosis of persistent Müllerian duct syndrome in Chinese patients / 亚洲男科学杂志(英文版)

Persistent Müllerian duct syndrome (PMDS) is a rare clinically and genetically overlapping disorder caused by mutations in the anti-Müllerian hormone (AMH) gene or the anti-Müllerian hormone receptor type 2 (AMHR2) gene. Affected individuals present uterus and tubes in normally virilized males and are discovered unexpectedly during other surgeries. Since it is rare and complex, a definitive clinical diagnosis can be missed, and there are no guidelines regarding how to deal with the uterus. In the present study, exome sequencing and Sanger verification were performed for causal variants in 12 PMDS patients. Preoperative diagnoses were made by positive exome sequencing in 8 patients. Of them, 7 patients evoked on the basis of ultrasound indicating bilateral testes on the same side of the body. Twelve different AMH variants (2 frameshift/nonsense, 1 deletion, 8 missense, and 1 in-frame) in 9 patients and 6 different AMHR2 variants (5 missense and 1 splicing) in 3 patients were identified. Seven variants were classified as "pathogenic" or "likely pathogenic", and 4 of them were novel. All but two patients with AMH defects showed low serum AMH concentrations, but all patients with AMHR2 defects showed elevated AMH levels. During surgery, an abnormal vas deferens was observed in half of the patients. Eight patients underwent orchidopexy with uterine preservation. Of them, 2 patients presented complications including irreducible cryptorchidism, and 3 patients developed Müllerian remnant cysts. Three patients underwent subtotal hysterectomy. Of them, one patient had complication of injury to the vas deferens, and one had hemorrhage after operation. This is the first report of PMDS involving a large Chinese population. The present study not only expands the variation spectrum but also provides clinical experience about the management of the uterus.

Recent advance in research on sleep disorders associated with autoimmune encephalitis / 中华神经科杂志

Sleep disorders are common diseases of nervous system, while sleep disorders in autoimmune encephalitis have received little attention. Sleep involves in the complex function of nerve centers and brain networks. Some autoimmune encephalitis with specific antibodies has sleep disorders as the core symptoms, or sleep patterns change as disease evolution. Sleep disorders often occur in autoimmune encephalitis and usually persist beyond the acute stage of disease,which seriously affect the recovery and life quality of patients. The study of sleep disorders in autoimmune encephalitis is rarely recognized and studied. The characteristics and possible mechanisms of sleep disorders in autoimmune encephalitis were reviewed here to improve the recognition and attention of clinicians.

Clinical and electrophysiological study of familial cortical myoclonic tremor with epilepsy with fixation-off sensitivity / 中华神经科杂志

Objective:To discuss the clinical and electrophysiological characteristics of familial cortical myoclonic tremor with epilepsy (FCMTE) with fixation-off sensitivity (FOS).Methods:The clinical and electrophysiological characteristics of four patients diagnosed as FCMTE with FOS in the Electroencephalography (EEG) Monitoring Center of Xijing Hospital from May 2016 to December 2017 were studied and followed up.Results:The four patients were all female. The age was ranged from 29 to 67 years. The course was from six to 30 years, and the follow-up time was at least two years. The tremors and jerks occurred to the four patients frequently when the eyes were closed, which prevented their falling a sleep, and three of them had generalized tonic-clonic seizure occasionally. The FOS was monitored in the all four patients, and the photosensitivity occured to the three of them.Conclusions:The fixation-off sensitive trail during EEG monitoring is helpful to find the FCMTE with FOS. It is necessary to determine the potential clinical significance of FOS and photosensitivity coexisting in patients with FCMTE.

Clinical and electrophysiological study of neck myoclonus during sleep / 中华神经科杂志

Objective:To discuss the clinical and electrophysiological characteristics of neck myoclonus during sleep.Methods:The clinical and electrophysiological characteristics of 31 patients in the Electroencephalography Monitoring Center of Xijing Hospital from January 2020 to August 2020 were studied retrospectively. All the patients received video-polysomnography and video-electroencephalography.Results:There were 22 males (71%) and nine females (29%) in the 31 patients. The mean age of the patients at the time of inclusion in the study was 27.8 years. Neck myoclonus was most common in patients with narcolepsy ( n=8), followed by epilepsy ( n=4), obstructive sleep apnea syndrome ( n=4), anxiety and depression ( n=3), snoring ( n=3), etc. A total of 555 motor events were considered and analyzed, 89.5% (497/555) of which occurred during rapid eye movement (REM) sleep. The mean neck myoclonus index in REM sleep (5.8) was significantly higher than that in non-rapid eye movement sleep (0.2). Totally 48.3% (268/555) of neck myoclonus were accompanied by an arousal, 0.7% (4/555) by a full awakening, and 2.7% (15/555) by limb movements. Conclusions:Neck myoclonus is common during REM sleep, which can occur in patients with sleep disorders and epilepsy. Physiological or pathological significance of neck myoclonus has to be investigated in further studies.

Nutritional status of primary and middle school students in Yichun City， Jiangxi Province / 上海预防医学

Objective:To understand the basic nutrition situation of primary and secondary school students in the urban area of Yichun City， and to provide corresponding strategies and measures for the improvement of the nutrition of children and adolescents. Methods:A stratified sampling method was used to select the urban primary and secondary school students in 10 counties （cities， districts） in Yichun City from 2019 to 2020 for physical examinations to assess their nutritional status. Results:Among 8 921 primary and middle school students surveyed， 62（0.69%） were stunted in growth， 735（8.24%） were emaciated， 1 130（12.67%） were overweight， and 662（7.42%） were obese. The weight loss rate of primary school students was the highest （10.54%， 360/3 414）， followed by junior middle school students （7.07%， 214/3 026）， and senior high school students （6.49%， 161/2 481）. The difference was statistically significant （χ2=39.51， P<0.05）. The proportion of unbalanced nutritional status of boys was 35.66% （1 578/4 425）， which was higher than that of girls （22.49%， 1 011/4 496）， and the difference was statistically significant （χ2=187.91， P<0.01）. Conclusion:Both malnutrition and overweight/obesity exist in primary and middle school students in Yichun City. We should pay special attention to boys and lower grade students， and intervene different nutritional problems.

Clinical and electrophysiological features of patients with coexistence of epilepsy and narcolepsy / 中华神经科杂志

Objective:To describe the electroclinical features of the coexistence of epilepsy and narcolepsy.Methods:The electroencephalography database was searched using the terms “epilepsy” and “narcolepsy” over a four-year period from January 2016 to December 2019 in the Xijing Hospital. The clinical and electrophysiological characteristics of patients with coexistence of epilepsy and narcolepsy were studied.Results:Five patients with comorbidity for epilepsy and narcolepsy were found, of which three patients were female, two patients were male. The age at epilepsy onset and narcolepsy onset was 2-12 years and 8-17 years, respectively. There were two patients with juvenile myoclonic epilepsy, one with sleep-related hypermoter epilepsy, one with epilepsy with retardation of brain development, one with symptomatic epilepsy with cognitive decline. All the patients had narcolepsy with cataplexy, which followed the onset of epilepsy by three months to eight years. All the patients accepted 24 h video electroencephalography monitoring and multiple sleep latency test. Interictal epileptic discharges were found, mean sleep latency was<8 min, and two or more sleep onset rapid eye movement periods were recorded. Duloxetine hydrochloride can effectively improve the drowsiness and catalepsy symptoms of narcolepsy, and seizures did not worsen in patients using duloxetine hydrochloride.Conclusions:Both generalized and focal epilepsy can occur in narcolepsy with cataplexy. Duloxetine hydrochloride may be safe and effective in treating narcolepsy in patients with epilepsy.

Expression and significance of hypoxia inducible factor-1α and α-smooth-muscle actin in cervical cancer / 中国医师进修杂志

Objective To examine the expression levels of hypoxia inducible factor (HIF)-1α and α-smooth-muscle actin (SMA) in both cervical cancer tissues with concurrent chemoradiotherapy and non-cervical cancer tissues,and assess the clinical significance in cervical cancer.Methods The immune-histochemistry was used to detect HIF-1α and α-SMA in 68 cases of cervical cancer tissues and 56 cases of non-cervical cancer tissues (including normal cervical tissues,hysteromyoma and cervical intraepithelial neoplasias) from January 2013 to January 2014 in the First Affiliated Hospital of Hebei Northern University.Results The positive expression rates of HIF-1α and α-SMA in cervical cancer tissues and non-cervical cancer tissues were 58.8％ (40/68),39.3％ (22/56) and 54.4％ (37/68),35.7％ (20/56) respectively;the differences were significant statistically (P＜ 0.05).The expression of HIF-1α was positively correlated with the expression of α-SMA protein in cervical cancer tissues (r =0.376,P =0.001).The positive expression of HIF-1α was closely related to International Federation of Gynecology and Obstetrics (FIGO) stages (r =0.371,P =0.004),lymph node metastasis (r =0.243,P =0.039),abdominal aortic parathyroid lymph node metastasis (r =0.286,P =0.014) and serum squamous cell carcinoma antigen (SCC-Ag) (r =0.271,P =0.020),but it was not correlated with age and tumor size (P ＞ 0.05).The positive expression of α-SMA was associated with lymph node metastasis (r =0.363,P =0.001),abdominal aortic parathyroid lymph node metastasis (r =0.271,P =0.020) and SCC-Ag (r =0.272,P =0.020),but it was not correlated with age,FIGO stage and tumor size (P ＞ 0.05).The shortterm effect rates of concurrent chemoradiotherapy in cervical cancer tissues with positive and negative expression of HIF-1α and α-SMA were 27.5％ (11/40),21.6％ (8/37),and 64.3％ (18/28) and 48.4％ (15/31),and there were statistical differences (P ＜ 0.05).The medial follow-up time of 68 cases was 60 months,and the 5-year survival rate was 52.9％ (36/68).The 5-year survival rates of the patients with positive expression of HIF-1α and α-SMA were 42.5％ (17/40) and 40.5％ (15/31),the 5-year survival rates of the patients with negative expression of HIF-1α and α-SMA were 67.9％ (19/28) and 67.7％ (21/31),and the differences were statistically significant separately (x2 =4.091 and 4.573,P =0.043 and 0.032).Conclusions The elevation of HIF-1α and α-SMA may be used to predict the development and prognosis of cervical cancer with concurrent chemoradiotherapy.

Expression and significance of hypoxia inducible factor-1α and α-smooth-muscle actin in cervical cancer / 中国医师进修杂志

Objective@#To examine the expression levels of hypoxia inducible factor (HIF)-1α and α-smooth-muscle actin (SMA) in both cervical cancer tissues with concurrent chemoradiotherapy and non-cervical cancer tissues, and assess the clinical significance in cervical cancer.@*Methods@#The immune-histochemistry was used to detect HIF-1α and α-SMA in 68 cases of cervical cancer tissues and 56 cases of non-cervical cancer tissues (including normal cervical tissues, hysteromyoma and cervical intraepithelial neoplasias) from January 2013 to January 2014 in the First Affiliated Hospital of Hebei Northern University.@*Results@#The positive expression rates of HIF-1α and α-SMA in cervical cancer tissues and non-cervical cancer tissues were 58.8% (40/68), 39.3% (22/56) and 54.4% (37/68), 35.7% (20/56) respectively; the differences were significant statistically (P<0.05). The expression of HIF-1α was positively correlated with the expression of α-SMA protein in cervical cancer tissues (r = 0.376, P =0.001). The positive expression of HIF-1α was closely related to International Federation of Gynecology and Obstetrics (FIGO) stages (r = 0.371, P = 0.004), lymph node metastasis (r = 0.243, P = 0.039), abdominal aortic parathyroid lymph node metastasis (r = 0.286, P = 0.014) and serum squamous cell carcinoma antigen (SCC-Ag) (r = 0.271, P = 0.020), but it was not correlated with age and tumor size (P>0.05). The positive expression of α-SMA was associated with lymph node metastasis (r = 0.363, P = 0.001), abdominal aortic parathyroid lymph node metastasis (r = 0.271, P = 0.020) and SCC-Ag (r = 0.272, P = 0.020), but it was not correlated with age, FIGO stage and tumor size (P>0.05) . The short-term effect rates of concurrent chemoradiotherapy in cervical cancer tissues with positive and negative expression of HIF-1α and α-SMA were 27.5% (11/40), 21.6% (8/37), and 64.3% (18/28) and 48.4% (15/31), and there were statistical differences (P<0.05). The medial follow-up time of 68 cases was 60 months, and the 5-year survival rate was 52.9% (36/68). The 5-year survival rates of the patients with positive expression of HIF-1α and α-SMA were 42.5% (17/40) and 40.5% (15/31), the 5-year survival rates of the patients with negative expression of HIF-1α and α-SMA were 67.9% (19/28) and 67.7% (21/31), and the differences were statistically significant separately (χ2 = 4.091 and 4.573, P = 0.043 and 0.032).@*Conclusions@#The elevation of HIF-1α and α-SMA may be used to predict the development and prognosis of cervical cancer with concurrent chemoradiotherapy.

Automated breast ultrasound system for assessing tumor size and predicting T stage in breast cancer / 西安交通大学学报(医学版)

Objective: To compare the feasibility of automated breast volume scanner automated breast ultrasound system (ABUS) and the traditional ultrasound (US) in measuring breast cancer size so as to evaluate their value in predicting breast cancer T staging. Methods: We retrospectively recruited 60 women with breast cancer who had received US and ABUS. The maximal tumor diameter was measured as tumor size. Based on the actual postoperative tumor size in pathology, Bland-Altman analysis and intraclass correlation coefficient (ICC) were used to compare the values measured by US and ABUS. Then we made a preliminary study of the accuracy of US and ABUS in predicting breast cancer T staging. Results: The best absolute agreement was shown between US and ABUS in measuring tumor size. Moreover, ABUS showed better agreement with histology than US [average difference (-1.09±3.61)mm vs. (-1.57±4.99)mm] with a higher ICC (0.93 vs. 0.86), especially for tumors which were more than 2 cm. In addition, both US and ABUS could predict breast cancer T staging relatively accurately (82.1% vs. 87.5%). Conclusion: Both US and ABUS showed good agreement with pathology in measuring tumor size. ABUS even outperformed US in assessing tumor size for tumors beyond 2 cm. Therefore, ABUS can be considered as an alternative to US in T staging of breast cancer.

Whole Genome Analyses of Chinese Population and De Novo Assembly of A Northern Han Genome / 基因组蛋白质组与生物信息学报·英文版

To unravel the genetic mechanisms of disease and physiological traits, it requires comprehensive sequencing analysis of large sample size in Chinese populations. Here, we report the primary results of the Chinese Academy of Sciences Precision Medicine Initiative (CASPMI) project launched by the Chinese Academy of Sciences, including the de novo assembly of a northern Han reference genome (NH1.0) and whole genome analyses of 597 healthy people coming from most areas in China. Given the two existing reference genomes for Han Chinese (YH and HX1) were both from the south, we constructed NH1.0, a new reference genome from a northern individual, by combining the sequencing strategies of PacBio, 10× Genomics, and Bionano mapping. Using this integrated approach, we obtained an N50 scaffold size of 46.63 Mb for the NH1.0 genome and performed a comparative genome analysis of NH1.0 with YH and HX1. In order to generate a genomic variation map of Chinese populations, we performed the whole-genome sequencing of 597 participants and identified 24.85 million (M) single nucleotide variants (SNVs), 3.85 M small indels, and 106,382 structural variations. In the association analysis with collected phenotypes, we found that the T allele of rs1549293 in KAT8 significantly correlated with the waist circumference in northern Han males. Moreover, significant genetic diversity in MTHFR, TCN2, FADS1, and FADS2, which associate with circulating folate, vitamin B12, or lipid metabolism, was observed between northerners and southerners. Especially, for the homocysteine-increasing allele of rs1801133 (MTHFR 677T), we hypothesize that there exists a "comfort" zone for a high frequency of 677T between latitudes of 35-45 degree North. Taken together, our results provide a high-quality northern Han reference genome and novel population-specific data sets of genetic variants for use in the personalized and precision medicine.

Research progress in experimental animal models of breast cancer / 中国比较医学杂志

Breast cancer is the most common spontaneous malignancy in women, causing a serious threat to women's health. Experimental animal models have been important research tools in bringing insights into the related mechanisms of breast cancer, as well as in delivering improved therapies for the disease. To reveal the pathogenesis of various breast cancers and facilitate the development of new drugs,ideal animal models of breast cancer should share some common tumor molecular characteristics and biological behavior with that of human breast cancer. In this review,five types of experimental animal breast cancer models were included, which may provide a basis for research on diagnosis and treatment of human breast cancer.

Characteristic symptoms of exploding head syndrome:one case report and literature review / 中华神经科杂志

Exploding head syndrome(EHS)is a rare sensory parasomnia and rarely reported in China, leading to serious misdiagnosis, mistreatment, and unnecessary testing. A detailed collection of clinical symptoms and longterm polysomnography-electroencephalography monitoring is very important for diagnosis and differential diagnosis of EHS. We diagnosed a patient with EHS according to the International classification of sleep disorders, third edition diagnostic criteria. The electro-clinical feature of the patient and relevant references were analyzed in order to improve the understanding of EHS, meanwhile to prevent unnecessary testing and avoid misdiagnosis and mistreatment.

The impaction of thrombomodulin and D-Dimer on Peripherally inserted central catheter associated thrombosis in cancer patients / 中国医师进修杂志

Objective To investigate the chang and impaction of TM and D- Dimer on peripherally inserted central catheter (PICC) associated thrombosis in cancer patients. Methods The expression of TM and D-Dimer from 207 cancer patients with PICC was examined using nzyme-linked immunoassay. Paitents were divided into thrombosis group and control group according to Doppler Sonography. Results The thrombosis group had 33 cases and the control group had 174 cases in 207 malignant tumor patients with PICC. Compared with that in control group, the expression of TM (6.806 ± 1.805)μg/L and D-Dimer (0.786 ± 0.294) mg/L was significantly higher in thrombosis group and respectively statistically significant (P0.05). Conclusions The expression of TM, D-Dimer is elevated, which is expected to assess the early diagnosis and clinical value of PICC associated thrombosis in cancer.

Application of extracorporeal extended field radiotherapy in locally advanced cervical cancer / 中国综合临床

Objective To investigate the application value of extracorporeal extended field radiotherapy in locally advanced cervical cancer. Methods A total of one hundred and twenty patients with stage IIB?IVA cervical cancer in the First Affiliated Hospital of Hebei North University from June 2012 to June 2014 were randomly divided into two groups:the control group and the observation group,each with 60 cases. The routine concurrent chemoradiotherapy was adopted in the control group. The observation group was treated with extracorporeal extended field radiotherapy combined with concurrent chemotherapy. The patients have been followed up for three years. The total efficacy rate,toxicity reaction,local progression free survival time ( PFS) and survival rate of the two groups were compared. Results The total efficacy rate in the observation group was significantly higher than that of the control group ( 88. 3%( 53/60 ) vs. 73. 3%( 44/60 ) , χ2 = 4. 357, P=0. 037),while the incidences of toxicity reaction in the two groups were 18. 3%(11/60) and 16. 7%(10/60), the difference was not statistically significant (χ2=0. 058,P=0. 810) ,the percentages of I and II degree in the two groups were 3. 4%( 2/60 ) and 3. 4%( 2/60 ) , the difference between the two groups was not statistically significant (Z=0. 000,P=1. 000). The PFS value in the observation group was significantly longer than that of the control group ( 25. 6 months vs. 13. 8 months,χ2 = 25. 624, P= 0. 000 ) , and the survival rate in the observation group improved significantly ( 53. 3%( 32/60 ) vs. 33. 3%( 20/60 ) , the difference was statistically significant (χ2 = 4. 887, P= 0. 027 ) . Conclusion Extracorporeal extended field radiotherapy is safe and effective in the treatment of locally advanced cervical cancer.

Analysis of Present Situation on Medical Interns' Medical Ethics Education and Its Countermeasure / 中国医学伦理学

From the concept of medical ethics,combined with the relationship between medical ethics education and medical intern,this paper faced up to the present situation of medical ethics education of clinical medical interns,analyzed the reasons of problems mainly involved the values,subjective initiative of medical interns and the degree of recognition and direction of the hospital and teachers and put forward that it should take more measures to strengthen the medical ethics education of medical interns from three aspects of medical interns,hospital and teachers.

Comparison of the value of shear wave elastography and digital mammography in differential diagnosis of breast neoplasms / 西安交通大学学报(医学版)

Objective To compare the value of shear wave elastography (SWE)and mammography in differential diagnosis of benign and malignant breast neoplasms.Methods Totally 96 patients with breast tumor were randomly chosen and underwent SWE andmammography.The elastic maximum value (Emax)was obtained. Taking histological diagnosis as the golden standards,we compared the two techniques' sensitivity,specificity, accuracy,positive and negative predictive value in diagnosis of breast tumors.Results The sensitivity,specificity, accuracy,positive and negative predictive value of Emax were 91.3%,94.0%,92.7%,93.3% and 92.1%, respectively.The sensitivity and accuracy of E-max were significantly better than those of x-ray (both P <0.05 ). The area under the ROC curve of Emax was 0.983 (95% CI,0.963 to 0.998).Conclusion SWE outperforms mammography in differential diagnosis of benign and malignant breast tumors.