Radiotherapy strategy for advanced esophageal cancer / 中华放射肿瘤学杂志

Advanced esophageal cancer accounts for a large proportion of all esophageal cancer cases, and the treatment modality recommended by the current guidelines is systemic treatment. Radiotherapy is an important treatment option for malignant tumors, which is widely applied in clinical practice. Retrospective analysis and small-sample prospective studies have shown that combination of radiotherapy with chemotherapy, targeted therapy, and immunotherapy has the advantages of improving disease control rate, symptom remission rate and prolonging survival of advanced esophageal cancer patients. Therefore, it is an important clinical topic issue to make better use of the advantages of radiotherapy for esophageal cancer, such as rapid relief of symptoms, durable efficacy, and stimulation of immune neoantigens, etc. To optimize the treatment strategy of advanced esophageal cancer, the radiotherapy strategy for esophageal cancer with oligometastases or multiple metastases, and the screening method for the eligible population for radiotherapy were reviewed, aiming to provide reference for improving the status of radiotherapy in comprehensive treatment of advanced esophageal cancer.

Change and clinical significance of T helper 9 cells in previously untreated patients with chronic hepatitis C / 临床肝胆病杂志

ObjectiveTo investigate the changes of T helper 9 (Th9) cells, interleukin-9 (IL-9), and related transcription factors in previously untreated patients with chronic hepatitis C, as well as their association with clinical indices. MethodsA total of 29 previously untreated patients with chronic hepatitis C who attended Hainan Provincial People’s Hospital from December 2018 to July 2019 were enrolled, and 15 healthy individuals were enrolled as healthy controls. The patients with chronic hepatitis C received sofosbuvir/velpatasvir antiviral therapy for 12 weeks, and then plasma and peripheral mononuclear cells (PBMCs) were isolated. Flow cytometry was used to measure the percentage of CD3+CD4+IL-9+ Th9 cells in PBMCs; ELISA was used to measure the plasma level of IL-9; quantitative real-time PCR was used to measure the relative mRNA expression of IL-9 and the transcription factors PU.1 and Foxo1 in PBMCs. The t-test or the paired t-test was used for comparison between two groups, and a Pearson correlation analysis was used to investigate correlation. ResultsCompared with the healthy controls, the previously untreated chronic hepatitis C patients had significantly lower percentage of peripheral Th9 cells (0.92%±0.14% vs 1.14%±0.21%, t=4.31, P＜0.001) and plasma IL-9 level (248.2±66.97 pg/ml vs 309.02±88.48 pg/ml, t=2.63, P=0.012). The previously untreated chronic hepatitis C patients had significantly lower relative mRNA expression of IL-9 and PU.1 than the healthy controls (t=20.67 and 23.21, both P＜0.001), while there was no significant difference in the relative mRNA expression of Foxo1 between the previously untreated chronic hepatitis C patients and the healthy controls (P＞0.05). In the previously untreated chronic hepatitis C patients, the percentage of peripheral Th9 cells, IL-9 level, and mRNA expression of IL-9 and PU.1 were negatively correlated with HCV RNA (r=-0.46, -0.38, -0.52, and -0.41, all P＜0.05), but they were not correlated with the level of alanine aminotransferase (all P＞0.05). Sofosbuvir/velpatasvir antiviral therapy achieved virologic response in 29 chronic hepatitis C patients, and the percentage of peripheral Th9 cells and the mRNA expression of PU.1 after antiviral therapy were significantly higher than those at baseline (t=2.20 and 6.52, both P＜0.05), while there were no significant changes in the plasma level of IL-9 and the relative mRNA expression of IL-9 from baseline to after treatment (both P＞0.05). ConclusionChronic hepatitis C virus infection may suppress the activation of Th9 cells, suggesting that Th9 cells might be involved in the chronicity of hepatitis C virus infection.

Anterior choroidal artery territory infarction: infarct size and its related factors / 国际脑血管病杂志

Objective:To investigate the infarct size and its related factors in patients with anterior choroidal artery (AchA) territory infarction.Methods:From April 2016 to April 2018, consecutive patients with acute AchA territory infarction hospitalized in the Department of Neurology, the Affiliated Shuyang Hospital of Xuzhou Medical University were enrolled retrospectively. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of the disease at baseline, and the Diffusion-Weighted Imaging (DWI) was used to determine the side, location, size, and morphology of the infarct lesions. The patients were divided into small infarction group (<20 mm) and large infarction group (≥20 mm). Multivariate logistic regression analysis was used to determine the independent risk factors for infarct size. Results:A total of 100 consecutive patients with acute AchA territory infarction were enrolled, including 86 (86.0%) in small infarction group, 14 (14.0%) in large infarction group. Based on the NIHSS score, there were 89 patients with mild stroke, 9 with moderate stroke, and 2 with severe stroke. According to DWI, 69 patients (69.0%) had long cord-like infarcts and 31 (31.0%) had other shapes of infarcts. The baseline NIHSS score (7.0 [2.0-10.5] vs. 3.0 [2.0-4.0]; Z=2.353, P=0.019) and the proportion of patients with severe stroke (14.3% vs. 0%; P=0.018), the infarcts in posterior part of periventricular area (85.7% vs. 57.0%; χ2=4.180, P=0.041) and medial globus pallidus (21.4% vs. 4.7%; χ2=5.206, P=0.023), and cord-like infarction (92.9% vs. 65.1%; χ2=4.332, P=0.037) in patients of the large infarction group were significantly higher than those of the small infarction group; leukocyte count (7.7±1.7×10 9/L vs. 6.6±1.8×10 9/L; t=2.214, P=0.036) and platelet count (234.5±39.5×10 9/L vs. 198.0±49.4×10 9/L; t=2.618, P=0.010) were significantly higher than those of the small infarction group; the proportion of patients with sensory impairment was significantly higher than that of the small infarction group (50.0% vs. 24.4%; χ2=3.908, P=0.048). Multivariate logistic regression analysis showed that platelet count (odds ratio 1.018, 95% confidence interval 1.000-1.621; P=0.044) and stroke severity (odds ratio 18.245, 95% confidence interval 1.534-217.052; P=0.022) were significantly and positively correlated with the infarct size. Conclusion:The related factors of the infarct size in patients with AchA territory infarction included sensory impairment, baseline NIHSS score, stroke severity, morphology and location of infarct lesions, and leukocyte and platelet counts, of which platelet count and stroke severity were independently positively correlated with the infarct size.

Predictive value of fetal umbilical artery Doppler in preterm birth in patients with Systemic Lupus Erythe-matosus / 实用医学杂志

Objective To examine the predictive value of fetal umbilical artery Doppler in preterm birth in pregnant women with systemic lupus erythematosus(SLE).Methods The clinical data from 160 live births of SLE patients were analyzed retrospectively.Results The mean age of SLE patients at pregnancy was(29.7 ± 3.7) years(20 ~ 37 years). Totally,56 patients(32.5%)were preterm births and 76(47.5%)were full-term births without any other adverse pregnancy outcomes. The rate of preterm birth before 34 weeks was 26.9% and that was 73.1% for those preterm deliveries after 34 weeks. Iatrogenic preterm birth was the most common cause of preterm birth(32 cases),followed by spontaneous preterm birth(12 cases)and preterm premature rupture of membranes (10 cases).The pulsatility index(PI),resistance index(RI)as well as S/D value of SLE patients with pre-term delivery was higher than those of patients with full-term delivery(P<0.05).The area below the ROC curve for PI, RI and S/D was 0.6(95% CI 0.5~0.7),0.7(95% CI 0.6~0.8)and 0.6(95% CI 0.5~0.7),respectively.PI with cut-off value of 1.0 indicated the highest risk of preterm birth,with sensitivities of 34.6% and 84.2.The optimal cut-off value for RI and S/D was 0.7 and 2.8 respectivly,at which sensitivity and specificity had the best combination. Conclusions Pregnancies in lupus still have an increased risk of preterm birth. Umbilical artery Doppler was a useful monitoring tool for preterm birth in lupus pregnancies.

Prognostic effect of intrauterine pregnancy induced by different methods of cervical ripening / 中国基层医药

Objective@#To investigate the effect of different cervical ripening methods on induction of labor in term pregnancy.@*Methods@#160 cases of labor induction of full-term pregnancy primipara were selected as the research subjecs.According to the different methods of cervical ripening, they were divided into two groups.The observation group (n=80) underwent dinoprostone suppositories induced labor, the control group (n=80) received intravenous infusion of small dose of oxytocin.The cervical Bishop score, cervical ripening effect, induction of labor, mode of delivery, neonatal outcome were observed in the two groups.@*Results@#Before treatment, the Bishop scores of the two groups had no statistically significant difference (t=0.436, P>0.05). After treatment for 24h, the Bishop score of the observation group was (8.3±2.6)points, which was higher than (5.9±2.0)points of the control group (t=6.544, P<0.05). In the observation group, the total effective rate of cervical ripening was 95.0%, which was higher than 66.2% of the control group (Z=-5.716, P<0.05). The duration of labor in the observation group was (12.6±4.5)h, which was significantly shorter than (21.7±7.8)h in the control group (t=9.039, P<0.05). The total labor, postpartum hemorrhage volume had no statistically significant differences between the two groups (t=2.298, 1.102, all P>0.05). In the observation group, 66cases (82.5%) were vaginal delivery, 14cases(17.5%) were cesarean section, those were 49cases(61.2%) and 31cases(38.8%) in the control group.The delivery mode of the observation group was significantly better than that of the control group(χ2=8.935, P<0.05). There were no statistically significant difference between the two groups in neonatal birth weight and postnatal 1min and 5min Apgar scores (all P>0.05).@*Conclusion@#Parturient with dinoprostone suppositories full-term pregnancy abortion can improve the cervical Bishop score and cervical ripening effect, improve the quality of delivery, it is better than oxytocin, and worthy of clinical application.

A pilot study on indunction and differentiation of human fibroblasts to iPS cells and iPS-RPE cells mediated by retrovirus infection / 中华实验眼科杂志

Background Retinal pigment epithelium (RPE) cell transplantation is the primary means of human trial for the treatment of retinal degeneration.Induced pluripotent stem cells (iPSCs) will become an important source for cell transplantation.In addition,iPS-RPE cells may provide a personalized treatment platform for the patient's own cells treatment.Objective This study was to evaluate the feasibility of human fibroblasts differentiate toward iPSCs from retinitis pigmentosa (RP) patients and toward iPSC-RPE cells from non-RP individual by retroviral transfection of Oct4,Sox2,c-Myc and KLF4 genes.Methods Human thigh skin tissues were obtained from a RP patient with hotspot mutation of SNRNP200 p.S1087L and individual without SNRNP200 p.S1087L mutation,respectively,with the size 2 c m×3 cm.Human dermal fibroblasts were isolated and cultured by trypsin digestion and explant method.The fibroblasts were transfected by a series of retrovirus and cultured by human embyonic cellconditioned medium to generate and induce iPSCs,and then the iPSCs were identified by morphology,alkaline phosphatase (AP) staining and immunofluorescence assay of specific markers of pluripotent stem cells.iPSCs suspension were injected into SCID mouse to observe the tumorigenesis.The iPSCs from non-RP subject were induced to differentiate toward iPS-RPE cells by embryonic body (EB) inducing method,and iPS-RPE cells were identified by detecting the expression of RPE65,zonula occludens protein 1 (ZO-1) and lecithin retinol acyltransferase (LRAT).Results Cultured human dermal fibroblasts showed fusiform or polygon shape and intercellular close arrangement,and Vimentin was positively expressed in the cells.Small cell colonies were harvested 5-7 days after infected by retroviruses,and the morphology changed from spindle into round mass.The hESC-like iPSCs clonies appeared 20 days after cultivation,and the positive expressions of hESC-specific surface antigens including SSEA3,SSEA4,TRA-1-60,TRA-1-81 and Nanog were found in the cells 25-30 days after cultivation,and the positive staining of AP was obtained 12 weeks after cultivation.A teratoma was formed at the injection site of iPSCs suspension in SCID mouse.Immunofluorescence technique showed that RPE cell-specific proteins including RPE65,ZO-1 and LRAT proteins were positively expressed in iPS-RPE cells at 30 days after differentiation.Conclusions Mutation SNRNP200 p.S1087L of RP patient-specific iPSCs can be induced from human dermal fibroblast by retrovirus infection method.The function and morphology of the iPSCs were similar to hESCs.Human iPSCs cell line generated from the dermal fibroblasts of non-RP individuals can differentiate into iPS-RPE cells.

Evaluation of the liver damage in patients with Budd-Chiari syndrome by shear wave elastography / 中华医学超声杂志（电子版）

ObjectiveTo investigate the value of shear wave elastography (SWE) in the evaluation of liver damage in patients with Budd-Chiari syndrome (BCS).MethodsSixteen patients with BCS which were all conifrmed by interventional therapy or inferior vena cava angiography were enrolled in the study. And iffty healthy volunteers who were conifrmed with no liver disease history, no surgical history and no metabolic disease such as diabetes were included in this study. All the subjects underwent conventional ultrasound and no obvious abnormality was detected. All the BCS patients and the volunteers underwent SWE. The elastic graph and the quantitative elastic value, including the average value, the maximum value and the minimum value, were acquired and compared between BCS patients and the volunteers.ResultsThe elastic graphs for the healthy volunteers were uniform light blue while the elastic graphs for BCS patients were hybrid images of blue, green and yellow. The average value, the maximum value and the minimum value of BCS patients were (18.1±9.4) kPa, (20.6±10.5) kPa and (15.5±8.5) kPa, which were statistically higher than those of healthy volunteers [(6.2±1.0) kPa, (7.5±1.2) kPa and (4.8±1.1) kPa,t=7.69, 8.94 and 7.83, allP<0.01].ConclusionsSWE can reflect the liver damage of patients with BCS before the change of the two-dimensional ultrasound. It can play an important role in the accurate selection of treatment and the accurate evaluation of treatment effect and the prognosis.

Analysis on the Importance of Basic Medical Insurance System to the Implementation of Essential Drug System / 中国药房

OBJECTIVE: To provide reference for the implementation of Essential Drug System. METHODS: According to the contents of Essential Drug System and Basic Medical Insurance System in the New Medical Reform, the relationship between Essential Drug System and Basic Medical Insurance was analyzed. RESULTS: Essential Drug System and Basic Medical Insurance System were important aspects of New Medical Reform in China, which complemented each other. Basic Medical Insurance System improved the implementation of Essential Drug System, while Essential Drug System promoted the realization of policy targets of Basic Medical Insurance System. CONCLUSION: Basic Medical Insurance System should play a promotion role in the implementation of Essential Drug System.

The exploration to improve the quality of ultrasound medical postgraduate / 中华医学教育探索杂志

Education of ultrasound professional postgraduate is an important way to cultivate high-quality,high-level ultrasound professionals. This paper has given the initial exploration on how to improve the quality of post-graduates,from such aspects as the clinical skills,research and innovation capability,and quality education etc.

Ultrasound clinical teaching statues of graduates in Guangzhou TCM / 中华医学教育探索杂志

Objective The thesis is written for the purpose of getting understanding of the ultrasound clinical teaching statues. Methods Conducting cluster surveys through clinical graduates of Grade 2006 and the seven-year-program students of Grade 2002 of Guangzhou TCM. Data is analyzed through statistics of SPSS13.0. Results It shows that the time of students practicing in ultrasound division is generally and comparably less,and graduates are generally poor in ultrasound basic knowledge. At the same time,the teaching in ultrasound division has been considered to be normative,however,the teaching level of teachers are not in the same standard,and teaching contents are in poor targets,which will bring about adverse impacts to the professional studies for graduates. Conclusion Ultrasound Clinical Teaching Status of graduates is not optimistic for Guangzhou TCM,and we should regulate or make some adjustments of enhancing the teaching standards of teachers,teaching contents and teaching methods,etc.