A case of recurrent Miller-Fisher syndrome with multiple anti-ganglioside antibodies / 中国综合临床

Guillain-Barré syndrome (GBS) defines a kind of Immune-mediated acute inflammatory peripheral neuropathy. Miller-Fisher Syndrome (MFS) is a special variant of GBS, with mostly one-way course and rare clinical recurrence. Only a few recurrent cases have been reported in China. Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness, acute onset, with symptoms of upper respiratory tract infection before onset, accompanied by pupil abnormalities and autonomic nervous dysfunction, who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy. The patient had a triad of “ataxia, areflexia and ophthalmoplegia”. Cerebrospinal fluid showed protein-cell separation. Serum anti-Sulfatides antibody IgM, anti-GT1a antibody IgG, anti-GQ1b antibody IgG and anti-GM3 IgM were positive. Recurrent MFS was diagnosed and the symptoms improved after immunotherapy. This case suggests that MFS is clinically heterogeneous, a few patients can present with relapse and generally have a better prognosis with immunotherapy. Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.

Effect of cognitive behavioral therapy on quality of life in patients with Parkinson's disease： a Meta-analysis / 四川精神卫生

BackgroundDepression， anxiety， impulse control disorders， insomnia are prevalent non-motor symptoms of Parkinson's disease， severely impairing the quality of life of patients. Cognitive behavioral therapy （CBT） is a common psychological intervention for various clinical psychological conditions， which can improve anxiety， insomnia and depression in patients with Parkinson's disease. However， the current research evidence on the effects of CBT in improving quality of life in patients with Parkinson's disease remains inconsistent. ObjectiveTo assess the effects of CBT on the quality of life among patients with Parkinson's disease， so as to provide references for the clinical application of CBT in this population. MethodsOn May 25， 2023， a systematic search was conducted across PubMed， PsycINFO， Embase， CNKI， Wanfang Database and VIP Database to identify randomized controlled trials investigating the impact of CBT on the quality of life in patients with Parkinson's disease. Literature screening， quality evaluation and data extraction were performed， focusing on variables related to quality of life， anxiety， and depression. Meta-analysis was performed using Stata 13.0 and RevMan 5.3. ResultsA total of 11 studies with 456 participants were included， comprising 241 in the CBT group and 215 in the control group. The CBT group exhibited significantly higher quality of life compared with the control group （SMD=0.47， 95% CI： 0.27~0.67， P<0.01）. Anxiety and depression scores in CBT group were significantly lower than those in the control group （SMD=-0.63，95% CI：-0.84~-0.43， P<0.01； SMD=-0.83， 95% CI： -1.15~-0.51， P<0.01）. Among the 11 studies， 6 studies delivered CBT remotely and 5 studies implemented CBT face-to-face. Meta-analysis results revealed that remote CBT group yielded significantly higher quality of life （SMD=0.43， 95% CI： 0.17~0.70， P<0.01）， and lower anxiety and depression scores （SMD=-0.62， 95% CI： -0.91~-0.34， P<0.01； SMD=-0.78， 95% CI： -1.34~-0.21， P<0.01） compared with the control group. Similarly， face-to-face CBT group showed better outcomes than the control group in terms of quality of life， anxiety and depression （SMD=0.51， 95% CI： 0.22~0.81， P<0.01； SMD=-0.64， 95% CI： -0.93~-0.35， P<0.01； SMD=-0.90， 95% CI： -1.20~-0.60， P<0.01）. ConclusionCBT may contribute to alleviating anxiety and depression levels of patients with Parkinson's disease， and improving their quality of life.｛Funded by Shanghai 13th Five-Year Key Specialty Construction Project （number， shslczdzk04901）； Nature Fund Project of Shanghai Science and Technology Commission （number， 22ZR1459300）； Shanghai Municipal Health Commission Traditional Chinese Medical Science Non-drug Therapy Demonstration Center Project ［number， ZY（2021-2023） -0204-03］｝

Experience and influencing factors of endoscopic retrograde cholangiopancreatography intubation in children / 中华消化内镜杂志

Objective:To report pediatric endoscopic retrograde cholangiopancreatography (ERCP) intubation techniques and to analyze the influencing factors of pediatric ERCP in China.Methods:Retrospective analysis was performed on 90 cases of pediatric and adult ERCP operations respectively at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to June 2020. The anatomic data, intubation time, and endoscopic intubation measures were reviewed. The anatomic differences in duodenal papilla between the children and adults were analyzed to find the factors affecting ERCP intubation time in children.Results:There were 88 cases of successful infantile intubation with the success rate of 97.8%, and 90 cases of successful adult intubation with the success rate of 100.0%. The intubation time in the pediatric group was 187±67 s, and that in the adult group was 247±86 s with significant difference ( t=5.220, P<0.001). The duodenal diameter of pediatric patients was 3.38±1.57 cm, and that of adult patients was 5.94±1.87 cm with significant difference ( t=9.832, P<0.001). The horizontal distance from the duodenal bulb to the papilla in pediatric patients was 2.44±1.15 cm, which was significantly shorter than 4.22±1.43 cm in adult patients ( t=9.077, P<0.001). Most duodenal papillae in children were hemispherical [flat 26.1% (23/88), hemispherical 51.1% (45/88), cylindrical 22.7% (20/88)], while most of those in the adult patients were cylindrical [flat 9.1% (8/88), hemispherical 23.9% (21/88), cylindrical 67.0% (59/88)]. The factors influencing the intubation time of ERCP in children by univariate analysis included the shape of duodenal papilla, duodenal papilla hardness, visual region, distance from junction of duodenal bulb and descending part to duodenal papilla, distance from duodenal papilla to endoscope, and degree of incising. Conclusion:Shorter and stiffer duodenal papillae in children with normal papilla orientation are associated with shorter intubation time. These indicators are favorable factors for intubation.

The value of breast imaging reporting and data system classification combined with radiomics in differentiating benign from malignant breast lesions with different X-ray phenotypes / 中华放射学杂志

Objective:To evaluate the differential diagnostic efficacy of a predictive model of breast imaging reporting and data system (BI-RADS) classification combined with mammography radiomics classifier for various X-ray phenotype of breast lesions.Methods:A retrospective analysis was performed on 2 055 female patients who underwent mammography examination and were confirmed by pathology from May 2013 to August 2020 in Zhongda Hospital, Southeast University. Breast lesion was classified into mass or non-mass according to the fifth edition of BI-RADS. The mass was further divided into small mass (maximum diameter ≤ 2 cm) and large mass (maximum diameter>2 cm), the non-mass was further divided into asymmetric, calcification and structural distortions. By manually segmenting the region of interest of the lesion, the radiomics features were extracted and the model was constructed. Receiver operating characteristic curve and area under the curve (AUC) were used to assess the diagnostic efficacy of the BI-RADS classification, the radiomics model and the combined model for various phenotypes of breast lesions. Differences among the AUC were analyzed by the DeLong test.Results:The AUCs based on the BI-RADS classification, the radiomics model and the combined model were 0.924±0.006, 0.827±0.009 and 0.947±0.005 respectively. Compared with BI-RADS classification and the radiomics model, AUC of the combined model was the highest, and the differences were statistically significant ( Z=9.29, 14.94, P<0.001). For large mass, small mass and non-mass, combined model (AUC=0.958±0.007, 0.933±0.013, 0.939±0.008) showed the best performance when compared to the BI-RADS classification (AUC=0.937±0.010, 0.896±0.020, 0.916±0.011; Z=5.32, 3.90, 5.08, P<0.001) or the radiomics model (AUC=0.872±0.012, 0.851±0.021, 0.758±0.016; Z=7.86, 4.53, 12.13, P<0.001). The AUC of the combined model for benign and malignant asymmetric breast lesions (0.897±0.017) was higher than that of the BI-RADS classification (AUC=0.866±0.020, Z=4.27, P<0.001) and the radiomics model (AUC=0.633±0.029, Z=7.44, P<0.001); however, the AUC of the combined model for benign and malignant calcification and structural distortion of breast lesions (0.971±0.010, 0.811±0.057, respectively) was only higher than that of the radiomics model (AUC=0.827±0.021, 0.586±0.075, Z=7.40, 3.15, P<0.001), and there was no significant difference with the BI-RADS classification (AUC=0.959±0.012, 0.800±0.061, Z=1.87, 0.39, P>0.05). Conclusion:The combined model shows better differential diagnostic performance, which is valued in the clinical application.

Systematic review of cognitive behavioral therapy for insomnia in patients with cancer / 中华行为医学与脑科学杂志

Objective:To evaluate the effectiveness of cognitive behavioral therapy for insomnia treating insomnia in patients with cancer.Methods:PubMed, EMbase, Cochrane Library, PsycINFO, CBM and CNKI databases were searched to collect randomized controlled studies related to the treatment of insomnia patients with cancer with cognitive behavior therapy for insomnia(CBT-I). RevMan 5.2 software was used to analyse the literature data that met the inclusion criteria.Results:A total of 13 studies were included with a total of 1 326 patients, including 741 in the CBT-I group and 585 in the control group.The results of meta-analysis showed that, the subjective sleep latency (MD=-10.69, 95% CI =-14.91--6.48), subjective wake time after sleep onset (MD=-13.68, 95% CI=-19.36--8.00), insomnia severity index (SMD=-1.27, 95% CI=-1.98--0.56) and sleep quality score (SMD=-0.72, 95% CI=-0.90--0.53) in CBT-I group were lower than those in the control group, and the differences were statistically significant.The subjective sleep efficiency (MD=6.98, 95% CI=5.00-8.96) in CBT-I group was higher than that in the control group and the difference was statistically significant.The subjective total sleep time (MD=2.59, 95% CI=-10.43-15.61), objective sleep latency (MD=-2.66, 95% CI=-5.68-0.35), objective wake time after sleep onset (MD=-2.89, 95% CI=-8.48-2.70), objective total sleep time (MD=-15.26, 95% CI=-31.80-1.28), objective sleep efficiency (MD=0.92, 95% CI=-0.79-2.62), anxiety score(SMD=-0.19, 95% CI=-0.46-0.08)), depression score(SMD=-0.19, 95% CI=-0.46-0.07) and quality of Life score(SMD=0.13, 95% CI=-0.06-0.33) in CBT-I group and control group were not statistically significant. Conclusion:CBT-I has a certain effect on the sleep of patients with tumor insomnia.It not only improves the subjective sleep latency, wake time after sleep, sleep efficiency and sleep quality, but also reduces the severity of insomnia and fatigue.However, there was no significant improvement in objective sleep parameters, anxiety, depression and quality of life.Due to the limitations of the quality of the included studies, the conclusions of this study need to be verified by more larger sample and high-quality randomized controlled studies.

Clinical characteristics of coronavirus disease 2019 patients complicated with pneumothorax: analysis of 7 cases / 中华危重病急救医学

Objective:To analyze the clinical characteristics and prognosis of coronavirus disease 2019 (COVID-19) patients complicated with pneumothorax.Methods:The clinical data of 7 COVID-19 patients complicated with pneumothorax admitted to Huanggang Central Hospital from January 3 to March 10, 2020 were retrospectively analyzed. The clinical features, diagnosis and treatment were summarized, and experience in the treatment of COVID-19 was shared.Results:① General information: among the 7 patients, 5 were males and 2 were females. Four of them had no underlying disease, and 1 had a history of diabetes and hypertension. One patient had only a history of hypertension. There were 6 cases of right pneumothorax and 1 case of bilateral pneumothorax. The 7 patients had a long hospital stay, all over 4 weeks, mostly complicated with multiple organ dysfunction. ② Imaging examination: 1 case evolved from the early stage to the advanced stage within 1 week and to the severe stage within 2 weeks. Pneumothorax occurred 4 weeks later, and was absorbed within 2 weeks. The remaining 6 patients presented progressive stage on admission, all of them advanced to severe stage within 1 to 2 weeks, and most of them presented diffused consolidation shadows, striation shadows and fibrosis of both lungs, obvious pleural adhesion, and extremely slow lesion absorption. ③ Treatment: 1 severe patient with pneumothorax 4 weeks after onset was given non-invasive mechanical ventilation. The remaining 6 critically ill patients were treated with endotracheal intubation and mechanical ventilation. Five patients were treated with mechanical ventilation within 3 days after the occurrence of pneumothorax, and 1 patient was treated with mechanical ventilation after 11 days. ④ Outcome: 1 patient without endotracheal intubation was continuously given nasal high-flow oxygen therapy, and the condition was stable. Four of the 6 patients complicated with pneumothorax after endotracheal intubation died, and the other 2 patients successfully removed the drainage tube within 2 weeks of closed thoracic drainage, and their condition gradually stabilized.Conclusion:COVID-19 complicated with pneumothorax is a dangerous disease with poor prognosis, and should be paid adequate attention.

Repeatability and consistency of diffusion-weighted imaging parameters for breast cancer with mass and non-mass / 中华放射学杂志

Objective@#To study the repeatability and consistency among different operators while different b-value DWI was used to detect mass and non-mass breast lesions.@*Methods@#Between December 2010 and October 2017, we collected 131 female patients (one hundred and thirty-three lesions) from Zhongda Hospital Southeast University, they were diagnosed as non-cystic lesion of the mammary gland by contrast enhancement MRI (DCE-MRI),were examined with DWI and confirmed by surgical pathology. There were 94 cases of mass lesion (96 lesions) and 37 cases of non-mass lesion (37 lesions). All patients were examined with DWI before surgery,80 patients were examined with b-value of 0, 400, 800 and 1 000 s/mm2, there were 51 tumor lesions and 29 non-tumor lesions;53 patients were examined with b-value of 0, 400, 800 and 1 200,1 600 s/mm2,there were 45 tumor lesions and 8 non-tumor lesions. Two radiologists with the same qualifications used double-blind reading to measure ADC values. Paired t test was used to compare the differences in measurement parameters between the two physicians. The repeatability of data between the two physicians was analyzed by intraclass correlation coefficient (ICC) and Cronbach α coefficients. The consistency of data between the two physicians was evaluated by Bland-Altman analysis.@*Results@#In different b values (0,400,800,1 200,1 600 s/mm2), the ADC value of non-mass type breast cancer and mass type breast cancer was no statistically significance between the two operators (P>0.05).The ICC of the ADC values of the non-mass breast lesion under the different b values measured by 2 physicians were 0.72, 0.78, 0.87, 0.76, 0.74, and the repeatability was good or very good; The Cronbach α coefficients are 0.83, 0.88, 0.93, 0.86, 0.85, and the reliability is high. The ICC of the ADC values of the mass breast lesion under the different b values measured by 2 physicians were 0.88,0.95,0.97,0.93,0.91, and the repeatability was very good. the Cronbach α coefficients were 0.94,0.97,0.99,0.96,0.95, and the reliability was high. The results of the Bland-Altman image analysis showed that the ADC values of non-mass and mass lesion detected by different operators in different b values have good consistency. In different b values, there were 97.3% (36/37), 94.6% (35/37), 93.1% (27/29),8/8 and 8/8 points within the 95% consistency limit of non-mass breast lesions; there were 97.9% (94/96), 94.8% (91/96), 92.2% (47/51), 95.6% (43/45), 93.3% (42/45) within the 95% consistency limit of mass breast lesions.@*Conclusion@#The ADC values were measured under different b values, and different operators had favarable repeatability and consistency for different lesions of different types of breast cancer.

Target delivery of small interfering RNAs with vitamin E- loaded lipid nanoparticles in inhibition of hepatitis C virus core protein expression in mouse model / 中华肝脏病杂志

Objective@#To study the efficacy of vitamin E-loaded lipid nanoparticles (VE-DC) in the mouse model to target small interfering RNA (siRNA) for inhibition of hepatitis C virus(HCV) core protein expression. @*Methods@#A high-pressure hydrodynamic method was adopted to construct an animal model of liver-specific expression to inject the plasmid containing HCV core protein into mice tail vein. Western blotting and immunofluorescence techniques were used to evaluote the liver targeting property of VE - DC/siRNA nanoparticles and the effectiveness to repress HCV Core expression. Dual luciferase reporter gene assays and in vivo imaging in mice further confirmed the inhibiting effect of VE-DC/siRNA on gene expression mediated by HCV 5' untranslated region. The adverse reactions of VE-DC/siRNA were reported by detecting serum creatinine, white blood cells and interferon. Student’s t - test and one -way analysis of variance were used to compare the difference between the two groups, and P < 0.05 was considered statically significant. @*Results@#The dual luciferase reporter gene analysis showed that the luciferase activity of the VE-DC/siRNA treated group was 39.67 ± 15.53, which was significantly lower than 77.33±11.06 of the DC/siRNA group and 91.67 ± 13.65 of the siRNA treated group, P < 0.05. The difference was statistically significant, and there was no obvious organ toxicity and obvious immune response to VE-DC/siRNA. Nanoparticle VE-DC has a good liver targeting ability, which can transport siRNA to the liver and effectively inhibit the expression of HCV Core, with an average inhibition rate of 83.01%. @*Conclusion@#VE-DC could target the delivery of siRNA to the liver and inhibit the expression of HCV- related genes in a mouse model, showing high effectiveness and low toxicity.

National survey of blood specimen acceptability for clinical chemistry tests in 2017 / 临床检验杂志

Objective To investigate the status of blood specimen acceptability for clinical chemistry tests in routine medical laboratories of China. Methods The questionnaires were assigned to the laboratories which participated in the routine chemistry exter-nal quality assessment (EQA) programs proposed by National Health Commission for Clinical Laboratory. The questionnaires included general information of participants and information about unacceptable blood specimens. Participants were required to record all the in-formation concerning unacceptable blood specimen received from 1stto 31stJuly, 2017. The data from each laboratory were reported and collected via special online system.Results A total of 866 valid questionnaires were collected.Of 15 981 752 specimens received dur-ing the data collection period unqualified 122 00 specimens were rejected with overall rejection rate of 0.076%. The main reasons for unacceptable specimens were hemolysis (33.98%), insufficient specimen quantity (10.78%) and chylemia/lipemia (10.62%). The rejected specimens were related to the original laboratories, types of container and specimen, transportation manner and operating staff of blood collection. Conclusion Certain problems existed in the receiving and management system for unqualified blood specimen in our country and remaining to be perfected. The clinical laboratories should pay more attention for pre-examination stage, including routinely monitoring unacceptable specimens, analyzing related data at the most possible granular levels, identifying the main problem and taking effective measures.

Effect analysis of selective appointment process by items of medical care at the endoscope center / 中华医院管理杂志

Objective To learn the application effects of selective appointment by items of medical care at the endoscope center. Methods Data of the patients receiving gastroscopy examination scheduled by appointment with designated doctors in October through December of 2016 (the control group), and that in January through March scheduled by selective appointment by medical care items ( the improvement group) were selected for comparison.The appointment time, waiting time, workload, secondary waiting time, and patient/doctor satisfaction of the two appointment methods were documented, and compared using independent sample t test, and non-parameter Mann-Whitney U sum of ranks test. Results Compared with the control group, the appointment waiting time of the improvement group [(15.4 ± 2.0)days vs.(24.4 ± 2.2) days], waiting time[(40.0 ± 12.6) min vs.(54.8 ± 15.3) min] were shortened significantly( P<0.05), with much less secondary waiting patients in the improvement groups as well (24.5 ± 7.1 vs. 37.8 ± 9.0, P <0.05 ). Conclusions Design and application of this selective appointment IT system has shortened both appointment and waiting time of patients, securing better medical environment, higher patient satisfaction by means of IT-based and AI-based endoscope appointments.

Design and clinical application of the unified platform system for endoscopic reports and pathological specimen / 中华医院管理杂志

The article introduced the unified design effect platform system for both endoscopy reports and pathological specimens,and its clinical applications.Our study suggested that the system can perform multiple processes such as application for endoscopic and pathological specimen, two-dimensional code tracking,application fees collection and receipt.It can also reduce the error rate of pathological specimens, and shorten the handling time of endoscopic specimens,for higher patient satisfaction.

Formula compatibility regulation for prevention and treatment of infantile recurrent respiratory infection based on data mining / 重庆医学

Objective To explore the compound compatibility regulation of oral traditional Chinese medicines (TCM) for the prevention and treatment of infantile repeated respiratory infection.Methods The oral TCM compound literatures for the prevention and treatment of infantile repeated respiratory infection were collected from four databases,including China Biology Medicine disc,CNKI,VIP Periodical and Wanfanf Data.The retrieval time was from January 2006 to July 2006.Then the TCM oral compound prescriptions meeting the requirements were obtained by the literature arrangement and performed the terms standardized processing for extracting the information and establishing Excel table.Then the Kaiyuan software package R i386 3.3.0 was used to conduct the drug frequency,association rules analysis and clustering analysis.Results A total of 311 prescriptions were screened out and 208 kinds of traditional Chinese medicine were analyzed.It was found that the higher compatibility frequencies of TCM were atractylodes,radix glycyrrhizae,windproof,radix astragali,radix pseudostellariae,poria cocos,dried tangerine or orange peel,etc.;the strong association rules prompted that modified Yupinfeng Powder composed of core medicines such as astragalus,atractylodes and windproof was the basic formula for prevention and treatment of infantile repeated respiratory infection;the clusters analysis found some TCM societies such as emembranous Astragalus mongholicus-keel-oysters,Atractylodes-Poria cocos-licorice-Astragalus mongholicus-dangshen.Conclusion The drug frequency,association rules analysis and clustering analysis can reveal the compatibility rules of TCM prescriptions for preventing and treating infantile repeated respiratory to provide reference basis for optimizing the clinical prescription and improving the curative effect.

Significance of remote information exchanging platform to improve the goal attainment rate of hypertension patients / 中华健康管理学杂志

Objective To evaluate the clinical significance of improving the goal attainment rate by management of timely feedback of hypertension patients, which is carried out by using existing communication network. Methods Totally 423 hypertension patients who were hospitalized for treatment in Daping Hospital from Jan. 2012 to Jan 2013, the random numbers table was used to randomize the patients into 2 groups: control group (212 cases) and experiment group (211cases), the conventional treatment was used in control group. Besides the conventional treatment measures, the modern way of communication and network information platform was used by patients who timely feed back the blood pressure changing, and implement the cognitive treatment of hypertension at the same time in the experiment group. The Chi square test was used to compare the patient's medication compliance, the attainment rate and so on , the t test was used to compare the blood pressure in two groups of patients after the intervention. Results At the end of the intervention, the difference of heavy salt diet (reduced to 16.59%), regularly drinking (reduced to 13.74%), heavy sugar diet (reduced to 10.43%), abnormal blood lipid (reduced to 19.91%), smoking (reduced to 27.96%), the number of people who have a stable mood (up to 91.47%), body mass index (reduced to 29.38%) and exercise at ordinary times (reduced to 36.02%) were statistically significant (P< 0.05). Hypertension patients compliance increased significantly, of which the medical behavior of 84.83%, compared with 13.21%in the control group, there was statistically significant difference (χ 2=8.54,P< 0.05). And the awareness, treatment, success rate of blood pressure control were 94.79%, 84.36%, 82.94% in experimental group and 50.94%, 40.09%, 27.83% in control group, and the differences were statistically significant (P<0.05). Conclusion Use of the existing information interaction platform in order to strengthen the management of the blood pressure of hypertension patients and related cognitive behavioral intervention, the control of risk factors and treatment compliance have improved significantly. The remote interaction platform used to patients with hypertension management improve the attainment rate of high blood pressure.

Effect of remote-interactive cognitive behavioral therapy in patients with chronic insomnia / 中华行为医学与脑科学杂志

Objective To assess the effect of remote-interactive cognitive behavioral therapy in pa-tients with chronic insomnia.Methods A total of 62 patients with chronic insomnia were randomly divided into combined treatment group,cognitive behavioral therapy for insomnia ( CBTI) group and drug treatment group.The study lasted for 6-8 weeks.The curative effects were assessed using sleep diary and scales.Results The sleep onset latency (SOL) ((39.9±23.7)min) and wake time after sleep onset(WASO) ((79.1± 39.4) min) in the drug treatment group were higher than that in the combined treatment group ( ( 25.5 ± 11.2)min and (54.4±38.5)min,respectively) and CBTI group ((27.8±11.6)min and (51.8±29.0)min,re-spectively) at the end of treatment,the difference was statistical significance( P=0.018 and P=0.046 respec-tively).The sleep efficiency(SE) in drug treatment ((76.5±11.9)%) was lower than that in the other two groups((83.8±8.7)%and (82.8±7.0)%respectively),(P=0.042).And no similar difference were seen in TST after treatment(P>0.05).The Brief Version of Dysfunctional Beliefs and Attitudes about Sleep(DBAS-16) score in the drug treatment group (97.6±16.4) was higher than the other two groups((67.5±20.1) and ( 75.0±26.9) respectively) after treatment(P=0.000) .No significant difference was seen in scores of the oth-er scales among the three groups(P>0.05) .After treatment,a greater proportion of patients in the combined treatment group had withdrawn from hypnotics use completely (29%(6/20) vs 5%(1/18);odds ratio( OR ) was 7.286);and the combined treatment group produced significant reduction in frequency of hypnotics use ((3.35±3.05) nights/week) when compared with drug treatment group((5.56±2.33) nights/week, P=0.016) .Conclusions Remote-interactive cognitive behavioral therapy was effective and acceptable for treating pa-tients with chronic insomnia,combining drug treatment in the early period could quickly relieve the symptoms of in-somnia,and can avoid the adverse effect from the hypnotics.And the treatment method can reduce the dropout rate.

Correlation of quantitative perfusion parameters on dynamic contrast-enhanced MRI with ;prognostic factors and subtypes of breast carcinoma / 中华放射学杂志

Objective To investigate whether correlation exists between quantitative perfusion parameters obtained from dynamic contrast?enhanced magnetic resonance imaging (DCE?MRI) and different prognostic factors or immunohistochemical subtypes of breast cancers. Methods A retrospective analysis of DCE?MRI was performed in 87 breast cancer patients with 91 pathology confirmed breast lesions. All the patients underwent the immunohistochemistry after the operation, 80 breast cancer patients with 84 breast lesions were divided into different subtypes based on the immunohistochemical profiles. All the patients underwent plain MRI and DCE?MRI. The volume transfer constant (Ktrans), rate constant (kep) and volume of EES per unit volume of tissue (Ve) value were calculated. Results of the immunohistochemistry and observation results of the the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor?2 (HER?2) were recorded. Subtypes were also categorized. The degree of the expression of Ki?67 was observed simultaneously. Among the 87 breast cancer patients (with 91 breast lesions), 68 were ER?positive,18 were ER?negative, 60 were PR?positive, 26 were PR?negative;30 were HER?2 positive and 58 were HER?2 negative. Eighty breast cancer patients (with 84 breast lesions) were divided into different subtypes:19 were Luminal A, 49 were Luminal B, 7 were HER?2 positive subtype and 9 were triple negative breast cancer (TNBC). The quantitative perfusion parameters with diffierent expression of the receptors were analyzed through Mann?Whitney U test, the correlation between the degree of the expression of Ki?67 and quantitative perfusion parameters was obtained with Spearman test. Furthermore, the distributions of the perfusion parameters between groups according to immunohistochemical subtype were compared using the Kruskal?Wallis test. Results Ktrans and kep value were higher in tumors with ER?negative and PR?negative than with ER?positive and PR?positive and difference was statistically different ( P0.05). The degree of the expression of Ki?67 was 5%to 90%the mean value was 33%, the median and interquartile range of Ktrans, kep and Ve value was 1.33/min (0.88/min), 2.63/min (2.34/min) and 0.51 (0.22) respectively. There was no significant correlations between the degree of the expression of Ki?67 and Ktrans and kep value (r value was 0.24 and 0.22 respectively, P value was 0.03 and 0.04 respectively), and the degree of the expression of Ki?67 was not associated with Ve (r=0.00, P=0.97). Ktrans value was lower in Luminal A and Luminal B than that in HER?2 positive subtype and TNBC, kep value was lower in Luminal A and Luminal B than that in TNBC, and Ve value in Luminal A, Luminal B and HER?2 positive subtype were higher than that in TNBC, kep value was lower in Luminal B than that in HER?2 positive subtype, statistically significance was seen among them (P<0.05).Triple?negative breast cancer showed the highest kep value (3.99/min) and the lowest Ve value (0.41) than the other subtypes. Conclusion The different subtypes of breast cancer may be predicted to some extent with quantitative perfusion parameters, and there is no correlation between quantitative perfusion parameters and the prognostic factors.

SALL4 and its clinical application value in non-germ cell tumors / 国际肿瘤学杂志

Sal-like 4 (SALL4) plays an important role in promoting the cellular proliferation and maintaining the pluripotency of embryonic stem cells and tumor cells.In fully differentiated cells,the expression of SALL4 is silenced or down-regulated.However,the expression of SALL4 is found to be restored or up-regulated in a variety of non-germ cell tumors.Besides,the expression of SALL4 is often associated with disease progression,treatment effect and prognosis.Therefore,examining the expression level of SALL4 will be of great importance in the diagnosis of disease and monitoring the disease progression for non-germ cell tumors.

Construction of folate-modified nanoparticles as ultrasound contrast agent targeting breast cancer / 中国组织工程研究

BACKGROUND:Studies have testified that nano-ultrasound contrast agents have a strong permeability, making it possible to image the targeted tissues outside blood vessels and overcome the limitation that micron contrast agents are only available for the blood pool imaging. OBJECTIVE:To construct the folate-modified nanoparticles targeting breast cancer as ultrasound contrast agents, as wel as to observe their ability to specifical y bind to cel s and imaging effect in vitro. METHODS:Both contrast agents, pegylated lactic acid-glycolic acid copolymer wrapping liquid fluorocarbon formed nanoparticles (mPP/PFOB) and folate modified pegylated lactic acid-glycolic acid wrapping liquid fluorocarbon formed nanoparticles (mPPF/PFOB), were constructed by phacoemulsification-evaporation method. (1)Biocompatibility detection:HFF-1 and MCF-7 cel s in the logarithmic phase were cultivated with various concentrations (0, 0.005, 0.01, 0.02, 0.05, 0.1, 0.2 and 1 g/L) of mPP/PFOB or mPPF/PFOB for 24 hours respectively, and then the cel viability was measured. (2)Targeting ability detection in vitro:HFF-1 and MCF-7 cel s in the logarithmic phase were divided into three groups. Cy5-labled mPP/PFOB and mPPF/PFOB were added into groups A and B, respectively;the cel s in group C were pretreated with folate for 2 hours, and sequential y Cy5-labled mPPF/PFOB was added into group C. Fluorescence intensity was detected by flow cytometry after 0.5 hours of culture. The distribution of contrast agents in cel s was observed using confocal microscopy after 20 minutes of culture. (3)Ultrasound imaging in vitro:there were three groups:saline was as group A;the suspension of saline and mPPF/PFOB nanoparticles was prepared as group B;MCF-7 cel s were resuspended with the mixture of saline and mPPF/PFOB nanoparticles to prepare the suspension of nanoparticles and cel s as group C. In each group, the suspension was added into latex gloves, that were then tightened and immersed in water. Final y, the ultrasound was use to detect the ultrasound imaging effect in vitro. RESULTS AND CONCLUSION:Neither nanoparticles were with significant cytotoxicity. The flow cytometry showed that the mean fluorescence intensity in MCF-7 cel s of group B was significantly higher than that of groups A and C. But there were no significant differences in the mean fluorescence intensity in HFF-1 cel s among the three groups. It was observed that mPPF/PFOB mainly gathered around the MCF-7 cel membrane, while mPP/PFOB randomly distributed in the cytoplasm. After mPPF/PFOB binding to MCF-7 cel s, they could enhance ultrasound echo in vitro. These findings indicate that the targeted nanoparticles mPPF/PFOB have good biocompatibility and can specifical y bind to breast cancer MCF-7 cel s in vitro and enhance the imaging capability.

Validation of LC-MS in clinical laboratory / 中华检验医学杂志

Liquid Chromatography-Mass Spectrometry ( LC-MS) is becoming more and more widely used in clinical laboratory ,and LC-MS related quality management requires more rigid than it was .According to CLSI C62-A,this article provides a reference for the validation procedure of LC-MS assay, including limit of detection and lower limit of the measuring interval , linearity and dilution, imprecision, assay interferences and trueness.

Correlation between oxygen reduction index with blood lipid and renal function in OSAHS patients / 重庆医学

Objective To explore the correlation between oxygen reduction index(ODI) with blood lipid and renal function in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) .Methods Selected 208 patients by polysomnography (PSG) and diagnosed as OSAHS ,divided into four groups according to ODI(ODI ≤ 7 ,7 38) .Four groups were compared in total cholesterol (TC) ,triglyceride (TG) ,high‐density lipoprotein cholesterol (HDL‐C) ,low density lipo‐protein cholesterol (LDL‐C) ,apolipoprotein A1 (ApoA1) ,apolipoprotein B (ApoB) ,urea ,creatinine ,uric acid and other differ‐ences ,analysis the correlation between ODI with blood lipid and renal function .Results There were significant different in TC ,TG , HDL‐C ,LDL‐C ,ApoB ,urea ,creatinine ,uric acid in four groups with different degree of ODI (P< 0 .05) ;ODI were positively relat‐ed to TC ,TG ,LDL‐C ,ApoB ,urea ,creatinine ,uric acid levels ,and negatively related to the level of HDL‐C .Conclusion Abnormity of blood lipid metabolic and changes in renal function are associated with the increase of ODI in patients with OSAHS .

Effects of flavonoids from Cuscuta chinensis on intestinal calcium-binding protein mRNA expression in ovariectomized osteoporosis model rats / 中国组织工程研究

BACKGROUND:Cuscuta chinensis is a mature seed of Cuscutachinensis Lam., can warm kidney. Previous studies demonstrated that kidney compound composed of Cuscuta chinensis could apparently inhibit bone loss and improve bone density. OBJECTIVE:To explore the influence of flavonoids from Cuscuta chinensis on bone mineral density of femur, 1,25(OH)2D3 levels of serum and kidney, the expression of smal intestine CaBp-D9K mRNA in model rats with ovariectomized osteoporosis. METHODS:A total of 72 Sprague-Dawley female rats were equal y and randomly divided into six groups (n=12):sham surgery group, model group, vitamin D3 group and low-, moderate-and high-dose flavonoids groups. The sham surgery group only received sham operation and the other five groups were ovariectomized respectively. One week after ovariectomy, the rats were given flavonoids from low-, moderate-and high-dose Cuscuta chinensis and vitamin D3 (2 mg/kg) by intragastric administration for 3 consecutive months. Blood was obtained from the abdominal aorta. Serum was isolated. The kidney was obtained. Enzyme linked immunosorbent assay was used to determine 1,25(OH)2D3 contents of renal and serum. Rats were sacrificed at the end of experiment. The thighbone was taken out to determine bone mineral density. The second lumbar vertebra was taken out to measure the expression of lumbar vertebra and renal vitamin D receptor mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. The smal intestine was taken out to measure the expression of smal intestine CaBp-D9K mRNA using real-time fluorescent reverse transcription-polymerase chain reaction. RESULTS AND CONCLUSION:Compared with the sham operation group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA significantly decreased in model group, and the expression of smal intestine CaBp-D9K mRNA significantly decreased in model group. Compared with the model group, bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney, and the expression of the second lumbar vertebra vitamin D receptor mRNA, and the expression of smal intestine CaBp-D9K mRNA were increased in moderate-and high-dose flavonoids groups and vitamin D3 group. Results indicated that flavonoids from Cuscuta chinensis could significantly raise bone mineral density of femur, and 1,25(OH)2D3 levels of serum and kidney and the expression of lumbar vertebra vitamin D receptor mRNA and the expression of smal intestine CaBp-D9K mRNA, accelerate intestinal calcium absorption and osteoblast activity, and reinforce quality of the bone.