Experience in radiation protection management in the tertiary general hospital / 中国辐射卫生

@#With widespread popularization, the radiological diagnosis and treatment technology has played an increasingly important role in clinical practice. The tertiary general hospital is generally featured as multiple types of radioisotope and radiation equipment, wide involvement of departments and persons, and many ways of use and potential harms of the radiological diagnosis and treatment technology. Radiation protection has become a content that cannot be ignored in hospital management. This article analyzes the radiation protection management structure of the tertiary general hospital - Guangdong Provincial People’s Hospital. The hospital radiation protection management is gradually improved by clarifying the main leading department, refining duties and responsibilities, strengthening multi-departmental communication and cooperation, and sorting out key connection links. A closed loop of refined management is formed through digging and correcting problems and continuously improving the management level and work efficiency. Valid qualifications are ensured to be obtained in time by radiation workers, radioactive drugs, equipment, and the venues to guarantee the radiation safety of radiation workers and patients and to further promote the construction of the Safe Hospital.

Construction and validation of a Nomogram-based prediction model for the risk of gout in men / 中华内分泌代谢杂志

Objective:To investigate the risk factors of gout and establish a columnar graph model to predict the risk of gout development.Methods:A total of 1 032 Han Chinese men attending the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, People′s Hospital of Xinjiang Uygur Autonomous Region, and the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2020 were selected as study subjects and divided into training set(722 cases)and validation set(310 cases)by simple random sampling method in the ratio of 7∶3. General information and biochemical indices of the subjects were collected. The collected information was used to assess the risk of gout prevalence. LASSO regression analysis of R Studio software was used to screen the best predictors, and was introduced to construct a column line graph model for predicting gout risk using receiver operating characteristic(ROC)curves, and the Hosmer-Lemeshow test was used to assess the discrimination and calibration of the column line graph model. Finally, decision curve analysis(DCA)was performed using the rmda program package to assess the clinical utility of the model in validation data.Results:Age, uric acid, body mass index, total cholesterol, and waist-to-hip ratio were risk factors for gout( P<0.05). The column line graph prediction model based on the above five independent risk factors had good discrimination(AUC value: 0.923 for training set validation and 0.922 for validation set validation)and accuracy(Hosmer-Lemeshow test: P>0.05 for validation set validation); decision curve analysis showed that the prediction model curve had clinical practical value. Conclusion:The nomogram model established by combining age, uric acid, body mass index, total cholesterol, and waist-to-hip ratio indicators can predict the risk of gout more accurately.

Impact of interaction between NLRP3, TLR4 gene polymorphisms and triglyceride-glucose index on gout / 中华内分泌代谢杂志

Objective:To explore the effect of triglyceride glucose(TyG) index, single nucleotide polymorphism of Toll-like receptor 4(TLR4) and NOD-like receptor thermal protein domain associated protein 3(NLRP3) genes, and its interaction on the risk of gout.Methods:A total of 315 male patients with gout and 499 men for health checkup at the same period were selected. General data were collected through questionnaires, and peripheral venous blood was collected for biochemical test. Three single nucleotide polymorphisms(SNPs) of NLRP3 and TLR4 were detected with multiplex ligase assay reaction, and logistic regression analysis was applied to compare the correlation between NLRP3 and TLR4 alleles and gout risk. The interaction of SNP and TyG index with gout was analyzed by generalized multi-factor dimensionality reduction(GMDR) model and logistic regression.Results:After adjusting for smoking, drinking, and other factors, the risk of gout increased by 61.1% for each standard deviation increase in TyG index. CC genotypes of rs10754558, rs10759932, and rs7525979 were high risk genotypes of gout in Han ethnicity. GMDR results showed significant differences in the interaction models of rs10754558-TyG index, rs7525979-TyG index, and rs10759932-TyG index between control group and gout group( P<0.05), suggesting an interaction between the three genotypes of SNPs selected and TyG index. Stratified analysis of the three selected SNPs and TyG index showed that after adjusting for age, smoking, and other factors, the high TyG index patients carrying C/C or C/G genotype at rs10754558 displayed an increased risk of gout compared with those carrying GG genotype and low TyG index( OR=2.127, P<0.05). Conclusion:The CC genotypes of rs10754558, rs10759932, and rs7525979 are high risk genotypes for gout in Han ethnicity. The interaction between rs10754558 and TyG index may increase the risk of gout development.

Study on the influence of job burnout and anxiety symptoms on work ability of biosafety laboratory staff in Xinjiang Uygur Autonomous Region / 中国职业医学

{L-End}Objective To understand the influence of job burnout and anxiety symptoms on work ability of biosafety laboratory (BSL) workers in Xinjiang Uygur Autonomous Region. {L-End}Methods A total of 5 808 BSL workers in Xinjiang Region were selected as the research subjects using cluster sampling method. The Job Burnout Questionnaire, Anxiety Self-rating Scale and Work Ability Index Questionnaire were used to evaluate their job burnout, anxiety symptoms and work ability. The mediation effect of anxiety symptoms on the relationship between job burnout and work ability was tested by stepwise regression analysis. {L-End}Results The detection rate of job burnout, anxiety symptoms and poor working ability was 83.1% (4 829/5 808), 37.2% (2 160/5 808) and 5.8% (339/5 808), respectively. There was a positive correlation between job burnout and anxiety symptoms score in BSL workers ［correlation coefficient (r) was 0.48, P<0.01］. The score of job burnout and anxiety symptoms was negatively correlated with the work ability score (r were -0.58, -0.51, both P<0.01). The results of mediation effect analysis show that the total effect of job burnout on work ability was -0.31, with the direct effect of -0.15. The mediation effect of anxiety symptoms on the relationship between job burnout and work ability was -0.16, accounting for 51.6% of the total effect. {L-End}Conclusion The detection rates of job burnout and anxiety symptoms among BSL workers in Xinjiang Region are relatively high. Anxiety symptoms show a mediate effect on the relationship between job burnout and work ability. The work ability of BSL workers can be improved by improving job burnout and anxiety symptoms.

Clinical characteristics and prognosis analysis of cytomegalovirus reactivation in patients with liver failure / 中华传染病杂志

Objective:To investigate the clinical characteristics and prognosis of cytomegalovirus (CMV) reactivation in patients with liver failure.Methods:A total of 75 patients diagnosed with liver failure and tested for serum CMV DNA between January 2016 and June 2019 in Huashan Hospital, Fudan University were retrospectively analyzed. According to the CMV DNA test results, the patients were divided into CMV DNA positive group and CMV DNA negative group. The classification of liver failure, the use of glucocorticoids, the proportions of T lymphocyte subsets of the two groups were compared and the prognosis was evaluated. Mann-Whitney U test and chi-square test were used to analyze the data. Results:Of the 75 patients with liver failure, 17 were CMV DNA positive and 58 were CMV DNA negative. Among the 17 CMV DNA positive patients, nine were acute (subacute) liver failure, and 13 were treated with glucocorticoids, which were all significantly higher than those in the CMV negative group (20.7%(12/58) and 20.7%(12/58), respectively). The differences were both statistically significant ( χ2=6.70 and 18.40, respectively, both P<0.05). The proportions of CD3 + T lymphocytes and CD8 + T lymphocytes in the CMV DNA positive group were both higher than those in the CMV DNA negative group, and the proportions of CD4 + T lymphocytes, the ratio of CD4 + /CD8 + T lymphocytes and the proportion of B lymphocytes were all lower than those in the CMV DNA negative group. The differences were all statistically significant ( U=274.50, 165.50, 273.00, 185.00 and 189.00, respectively, all P<0.05). Acute (subacute) liver failure (odds ratio ( OR)=4.3, 95% confidence interval ( CI) 1.3-12.6) and glucocorticoid use ( OR=12.5, 95% CI 3.4-38.3) were risk factors for CMV reactivation in patients with liver failure. The disease improvement rate in the CMV DNA negative group was 56.9% (33/58), and five out of 17 patients improved in the CMV DNA positive group, with a statistically significant difference ( χ2=1.99, P=0.04). Conclusions:The use of glucocorticoids increases the risk of CMV reactivation in patients with liver failure, and CMV reactivation in patients with liver failure presents immune disorders which seriously affect their prognosis. Therefore, it is important to pay attention to CMV DNA monitoring in patients with liver failure using glucocorticoids.

Analysis of clinical characteristics and prognosis of Epstein-Barr virus-related diseases in adults / 中华传染病杂志

Objective:To investigate the clinical characteristics and prognosis of Epstein-Barr virus-related diseases in adults.Methods:The clinical data of 59 patients with Epstein-Barr virus-related diseases in Huashan Hospital, Fudan University, Shanghai from January 2017 to August 2019 were analyzed retrospectively. The clinical manifestations of patients with infectious mononucleosis (IM), chronic active Epstein-Barr virus infection (CAEBV) and lymphoma in patients were compared. Patients were divided into acute course group (IM) and chronic course group (CAEBV+ lymphoma), and the results of labratory indications (blood rontine, liver function, imflammatory indications, Epstein-Barr virus DNA, Epstein-Barr virus antibody and T lymphocyte) were compared between two groups. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Fisher exact probability test. Results:Among the 59 patients, 23 cases (39.0%) were diagnosed with IM, 23 cases (39.0%) were lymphoma and 13 cases (22.0%) were CAEBV. The clinical manifestations of patients with Epstein-Barr virus-related diseases were fever (57/59, 96.6%), lymphadenopathy (37/59, 62.7%) and splenomegaly (36/59, 61.0%). There were 17 patients in the chronic course group experienced hemophagocytic lymphohistiocytosis (HLH). The white blood cell counts, hemoglobin levels and platelet counts of patients in the chronic course group (4.07(1.94, 8.35)×10 9/L, 89.5(74.5, 108.0) g/L and 100(37, 161)×10 9/L, respectively) were all lower than those in the acute course group (9.91(6.75, 17.38)×10 9/L, 132.5(118.2, 152.0) g/L and 197(129, 233)×10 9/L, respectively), with statistically significant differences ( U=3.69, 5.22 and 3.61, respectively, all P<0.01). The levels of procalcitonin, C-reactive protein and serum ferritin in the chronic course group (0.45(0.15, 1.13) μg/L, 47.75(17.57, 84.67) mg/L and 2 000(682, 2 002) μg/L, respectively) were all higher than those in the acute course group (0.12(0.07, 0.28) μg/L, 6.39(3.13, 11.38) mg/L and 482(159, 1 271) μg/L, respectively), with statistically significant differences ( U=-2.95, -3.77 and -4.16, respectively, all P<0.01). The counts of CD4 + T lymphocytes, CD8 + T lymphocytes, CD19 + B lymphocytes and natural killer cells in the chronic course group (259.15(101.98, 509.26), 214.69(119.31, 529.47), 46.14(4.44, 135.87) and 81.09(41.53, 118.46)/μL, respectively) were all lower than those in the acute course group (738.88(592.20, 893.94), 1 609.17(920.88, 3 952.34), 144.52(83.65, 215.14) and 309.82(123.78, 590.68)/μL, respectively), with statistically significant differences ( U=3.66, 3.80, 2.90 and 3.40, respectively, all P<0.01), while the CD4 + /CD8 + T lymphocytes ratio in the chronic course group was higher (0.90(0.60, 1.70) vs 0.45(0.10, 1.28))( U=-2.29, P=0.02). Twenty-three patients with IM were all cured, while 10 patients with lymphoma died and 13 received chemotherapy. Seven patients with CAEBV died and six improved. Conclusions:The clinical characteristics of Epstein-Barr virus-related diseases in adults are fever, lymphadenectasis, splenomegaly.Chronic Epstein-Barr virus infection may be associated with HLH. The prognosis of adults with acute Epstein-Barr virus infection is good, while that of long-term chronic Epstein-Barr virus infection is poor.

Analysis of psychological stress of community healthcare staff in Shanghai during public health emergencies / 中华医院管理杂志

Objective:To investigate the psychological stress and related factors of community medical staff in Shanghai during infectious public health emergencies.Methods:Random cluster sampling, questionnaires combining general demographic information, self-rating anxiety scale(SAS), self-rating depression scale(SDS)and yale-brown obsessive compulsive scale(YB)were administrated to investigate the psychological stress of medical staff from 20 community healthcare centers in 10 Shanghai districts.Results:A total of 696 valid questionnaires were collected. 17.36% of the staff had SAS scores exceeding the boundary value. Nurses, staff with per capita monthly family income<5 000 yuan, or with below-average family relations presented higher SAS scores. 28.19% of the staff had SDS scores exceeding the boundary value. Staff with 5-10 years seniority, nurses, with per capita monthly family income<5 000 yuan, and with poor family relations presented higher SDS scores. 6.68% of the staff had YB score≥16. Nurses presented a higher YB score.Conclusions:Some community healthcare center staff experienced psychological stress during public health emergencies.Factors associated with psychological stress, such as 5-10 years′ seniority, nurses, per capita monthly family income<5 000 yuan, below-average or poor family relations, deserve more attention in order to prevent from or alleviate harmful psychological stress.

Performance evaluation of the automated SNPs analyzer for the detection of JAK2 V617F mutation / 中华检验医学杂志

Objective To test and evaluate the JAK2 gene V617F mutation in patients with myeloproliferative tumors based on i-densy IS-5320 platform according to ISO15189 accreditation requirements.Methods Instrument performance verification.Selected from December 2014 to February 2017, 20 cases of JAK2 V617F mutation positive peripheral blood samples from Huashan Hospital of the Shanghai FuDan University Medical College and 20 cases of peripheral blood samples with negative JAK2V617F mutation.The Realtime PCR with TaqMan MGB probe was selected as the control method to verify and evaluate the accuracy of testing JAK 2 V617F mutation on i-densy IS-5320 platform.Whole blood samples were used to evaluate the reproducibility , cross-contamination and anti-interference ability of this platform.The ability of mutation load was verified by detecting mixtures of human erythnoleukemia cells and colorectal cancer cell HCT116 with 12 different proportions.Results I-densy IS-5320 platform and TaqMan MGB probe real-time fluorescence quantitative PCR show the same result .The within-run reproducibility and between-run reproducibility are both 100%.There is no observed contamination .High bilirubin and high triglyceride blood samples have no obvious interference on mutation detection .The mutation ratio with a load as low as 0.25%could be tested stably by i-densy IS-5320 platform.The detecting peak of melting curve can reflect the ratio of JAK2 V617F mutation to some extent.Conclusions I-densy IS-5320 can detect the mutation of JAK2 V617F gene in the whole blood directly.It has high sensitivity, accuracy and stability, and is easy to operate, and also can reflect the mutation load of JAK2 V617F, which could meet the clinical requirements for the detection of mutations.

Burden of care, quality of life and related factors in family members of patients with schizophrenia / 中国心理卫生杂志

Objective:To analyze the level and related factors of burden of care,quality of life in family members of patients with schizophrenia.Methods:Totally 312 family members of patients with schizophrenia in 5 blocks of Jing'an District,Shanghai,who consented the investigation,were investigated.Burden of care were evaluated with the Zarit Caregiver Burden Interview (ZBI),and quality of life of the relatives by World Health Organization Quality of Life BREF (WHOQOL-BREF) and Chinese Residents SWB abridged (SWBS-CC20).ZBI score equal or higher than 39 indicated a heavy burden of care,while the score less than 39 indicated a low burden of care.Results:Totally 199 cases (63.8％) were in a heavy burden,whose ZBI score was (52.1 ± 10.8),and 113 cases (36.2％) were in a low burden with a mean score of (23.1 ± 10.4).Their WHOQOL-BREF score and SWBS-CC20 score were lower than normal model (Ps ＜ 0.001).The burden was heavy to those whose spouse was involved (β =-7.76).Patient's age was negatively correlated with quality of life (β3 =-0.18).Relationship with the patient,education level and monthly family income were positively correlated with quality of life (β =1.65,1.68,1.66).Conclusion:Those families of patients with schizophrenia,who are aged,low educated,low paid,or whose spouse have been diagnosed with schizophrenia,may have a heavy burden of care,and low quality of life.

Efficacy and safety of oseltamivir in children with suspected influenza: a multicenter randomized open-label trial / 中华儿科杂志

Objective@#To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children.@*Method@#A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days.@*Result@#No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting).@*Conclusion@#The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.

Correlation between Mental Health and Coping Style of Family Members of Patients with Schizophrenia / 中国康复理论与实践

Objective To study the correlation between the mental health of family members of patients with schizophrenia and their coping style. Methods From December, 2014 to January, 2015, a total of 312 family members of patients with schizophrenia in 5 blocks were included. They were surveyed with self-made questionnaire, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Simplified Coping Style Questionnaire. The results were compared with the national normal model, and the correlation between SDS, SAS and the coping style was also analyzed. Results Compared with the normal model, the SDS (t=34.39, P<0.001), SAS (t=73.09, P<0.001) scores were higher in schizophrenia families, and they used positive coping style (n=128, 41%) less (t=-16.70, P<0.001), and more often used negative coping style (n=184, 59%) (t=-66.24, P<0.001). The SDS (r=-0.14, P<0.05), SAS (r=-0.15, P=0.01) scores were negatively correlated with positive coping style, the SAS score was positively correlated with negative coping style (r=0.27, P<0.001). Multivariate Lo-gistic regression analysis showed that women were prone to be anxiety and depressed compared with men (P<0.05); the divorcees were prone to be depressed compared with thoses not divorced. Education level and average monthly household income were factors influencing their coping style (P<0.05). Conclusion The mental health of family members of patients with schizophrenia is not optimistic, the female family members are more likely to be depressed and anxious than males. People with low education level and poor economic conditions more often use negative coping style, which need to be focused on, and to take appropriate and effective intervention.

Prevalence and metabolic risk factors of nonalcoholic fatty liver disease in a middle-aged and elderly population in Guangzhou / 中华流行病学杂志

Objective To investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) and understand the relationship between NAFLD and metabolic risk factors in middle-aged and elderly adults.Methods This cross-sectional study recruited 2 935 subjects in Guangzhou,Guangdong province.Face-to-face interviews and laboratory analyses were conducted to collect general information and other covariates.Analysis of covariance and logistic regression analysis were performed to investigate the relationship between metabolic factors and the prevalence of NAFLD.NAFLD was diagnosed based on standard criteria recommend by the Fatty Liver Disease and Alcoholic Liver Disease Branch of Chinese Hepatology Society,and the degree of steatosis was assessed (mild,moderate or severe).Results Compared with normal subjects,those with NAFLD had higher levels of WC,BMI,FPG,TG,SBP,DBP and greater prevalence of metabolic syndrome,but lower levels of physical activity and HDL-C.After adjusted for covariates,the OR for each standard deviation change was 2.70(95％CI:2.45-2.98) for WC,1.47(95％ CI:1.35-1.59) for SBP,1.48 (95％CI:1.37-1.60) for DBP,1.88 (95％CI:1.66-2.12) for TG,1.25 (95％ CI:1.15-1.36) for FPG and 0.51 (95％CI:0.47-0.56) for HDL-C (all P＜0.001).Higher levels of WC,BMI,TG,SBP,DBP and FPG were significantly related with the increase in degree of NAFLD (P-trend＜0.001).Conclusion There is a relatively high prevalence of NAFLD in middle-aged and elderly adults in China.NAFLD is closely related with the different forms of metabolic syndrome,and WC is the leading risk factor for NAFLD.

Clinical and side effect of the short term radiotherapy combining with chemotherapy on nasopharyngeal carcinoma patients with stages Ⅲ and ⅣA / 中国综合临床

Objective To explore the short term treatment effectiveness and the side-effect of radiotherapy combined with two kinds of chemotherapy scheme on nasopharyngeal carcinoma patients with stage Ⅲ and Ⅳa.Methods One hundred and fifty nasopharyngeal carcinoma cases with stage Ⅲ/Ⅳa were randomly divided into A and B group.Patients in A group (75 cases) were received radiotherapy combined with 2 courses ((21-28) d/course) paclitaxel (135 mg/m2) + cis-platinum complexes (DDP) 80 mg/m2 chemotherapy concurrently,while patients in B group (75 cases) were received radiotherapy combined with 6 courses DDP 30 mg/m2 per week chemotherapy concurently.The short term treatment effectiveness and the sideeffect of radiotherapy combined with two kinds of chemotherapy scheme were observed.Result After the treatment,the primary lesion complete remission(CR) rate in A group and B group were 68％ (51/75),52％ (39/75).The CR rate of lymph node of neck in A and B group was 64.0％ (48/75),48.0％ (36/75) and 45.3％ (34/75),20.0％ (15/75) of primary lesion and lymph node of neck.The differences were significant(x2=4.25,3.90,10.94 ;P ＜0.05).After 3 months of treatment,there was no significant difference between A and B group in terms of CR rate of the primary lesion,lymph node of neck and primary lesion and lymph node of neck (P ＞0.05).During the treatment,the rate of bone marrow depression at grade Ⅲ in A group and B group were 38.67％ (29/75) and 21.33％ (16/75),21.33％ (16/75) and 6.67％ (5/75) in terms of the rate of grade gastrointestinal reaction at stage Ⅲ,46.66％ (35/75) and 21.33％ (16/75) regarding of oral cavity mucomembranous injury at stage Ⅲ,21.33％ (16/75) and 9.34％ (7/75) in terms of the rate of radioactivity skin destruction at stage Ⅲ.All differences were significant (P ＜ 0.05).During the short-term follow up (1-3 years),both the rate of local recurrence and the rate of metastasis in A group was as same as that in B group(P ＞0.05).Conclusion During the treatment,the side-effect of approach of paclitaxel (135 mg/m2) + DDP 80 mg/m2 in stage Ⅲ/Ⅳa nasopharyngeal carcinoma patients is more severity than that of DDP 30 mg/m2 per week chemotherapy.However,there is no significant difference in terms of the short term treatment effectiveness.The prospective efficacy needs to be further investigation.

Simultaneous detection of JAK2 V617F mutation and JAK2 exon12 mutations by multiplex PCR and high-resolution melting curve analysis / 中华检验医学杂志

Objective To establish a single-tube detecting system for the simultaneous identification of JAK2 V617F and JAK2 exon12 mutations.Methods Genomic DNA of cell line PC-3 was utilized as the wild type control,while genomic DNA of cell line HEL and plasmids with diverse JAK2 exon 12 mutations were used as the positive controls for JAK2 V617F and exon12 mutations.Multiplex PCR was performed to amplify the different amplicons combined with high-resolution melting (HRM) analysis,which established the multiplex detecting system for JAK2 V617F and exon12 mutations.Meanwhile 42 cases of polycythemia vera patients were collected to detect 2 kinds of JAK2 mutations by the above system and routine methods.Results The multiplex JAK2 mutations detecting system was successfully established by multiplex PCR combined with high-resolution melting curve analysis,which could simultaneously detect JAK2 V617F and JAK2 exon12 mutations.The analytical sensitivities of 2 mutations in this system were both up to 5％ and the precision (coefficient of variation) of intra-and inter-assay of the melting temperature (Tm) of 2 amplicons were separately less than 0.01％.37 cases were identified JAK2 V617F mutations from 42 polycythemia vera patients,while 2 JAK2 exon12 mutations cases were found from 5 JAK2 V617F negative patients.Compared with routine methods,the results matched the rate of 100％.Two cases of JAK2 exon 12 mutations were confirmed to the mutation types of H538K539delinsL and F537-I546dul10 + F547L by cloning and sequencing.Conclusions This method can simultaneously detect two kinds of JAK2 mutations in the peripheral blood and will contribute to the molecular diagnosis of myeloproliferative neoplasms,especially polycythemia vera.

Design and validation of a clinical DNA sequencing assay for drug-resistance genes in hepatitis B virus / 中华检验医学杂志

Objective Under the ISO15189 and America Association of Pathologists ( CAP ) laboratory accreditation system, to establish the performance verification standards for detecting hepatitis B virus resistance gene by sanger sequencing.Methods 25 cases of HBV drug resistance outpatients and inpatients were collected from August 2012 to December in Hepatitis Clinic of Huashan Hospital Affiliated to Fudan University.Analytical performance parameters including analytical sensitivity, precision, accuracy, analytical specificity, reference range/reportable range, etc were evaluated.Sequencing quality evaluation parameters included fluorescence signal intensity overall sequencing chromatogram, signal to noise ratio, trace scores and QV value.Results 10%-20% mutation could be detected under wild-type background. The methool had good precision and accuracy.No obvious interference and cross contamination were observed.Conclusions Performance validation of the sequencing should combine with the practical application.Especially in view of the different detection subjects, and appropriately adjusted to meet the clinical needs.Detection of hepatitis B virus resistance gene by the in the test method in this study can be used in clinical detection.

Clinical research on correlationship between thrombomodulin level,dose-volume parameters with acute radiation pneumonitis / 重庆医学

Objective To study the relationship between the level of serum thrombomodulin (TM ) ,radiation dose-volume factors with acute radiation pneumonitis (ARP) .Methods 54 patients with lung cancer were given the routine 3 -dimensional conformal radiation therapy(3DCRT) and chemotherpy ,20 cases received the concurrent radiochemotherapy and 34 cases were performed the the sequential chemotherapy .The serum TM level was measured with enzyme-linked immunosorbent assay(ELISA) before radio-therapy(B-RT) and at 30 Gy(M-RT) in radiotherapy .The ARP grade was evaluated according to the criteria of the Common Ter-minology Criteria for Adverse Events(CTCAE v3 .0) by the National Caner Institute(NCI) ,grade 2 or more was taken as ARP . The relationship between the serum TM level ,dose-volume factors with ARP was analyzed .Results 20 cases (37% ) had ARP .12 cases got grade 2 ARP and 8 cases had grade 3 .The occurrence rates of ARP in the minimal lethal dose (MLD) Gy 10 groups ,V5 < 50% and ≥ 50% groups ,V10 < 40% and ≥ 40% groups ,V20 < 25% and ≥ 25% groups ,V30 < 13% and ≥ 13%groups ,TM decrease group and TM increase group after 30 Gy radiation were 8% vs .62% ,7% vs .69% ,21% vs .75% ,28% vs . 56% ,15% vs .57% and 50% vs .13% respectively ,the differences had statistical significance (χ2 = 16 .83 ,22 .29 ,14 .05 ,3 .97 , 10 .08 ,6 .46 ,P<0 .05);in the ARP group and non-ARP group ,MLD ,V5 ,V10 ,V20 and V30 were (12 ± 2) vs .(9 ± 2) ,(58 ± 10) vs .(43 ± 10) ,(42 ± 8) vs .(30 ± 8) ,(23 ± 3) vs .(19 ± 6) ,(15 ± 4) vs .(11 ± 4) respectively ,the differences had statistical signifi-cance (t= -4 .96 ,-5 .27 ,-5 .70 ,-3 .37 ,-3 .61 ,P<0 .05) .Conclusion Multiple dose-volume parameters are associated with the occurrence rate of ARP .The patients with decreased serum TM level after radiotherapy are liable to develop ARP .

Establishment and analytical validation of JAK2 V617F mutation assay by fluorescence PCR combined with melting curve analysis / 中华检验医学杂志

Objective According to the requirements of the College of American Pathologists (CAP),to validate the laboratory developed test-JAK2 V617F mutation.Methods This is a clinical laboratory diagnosis study.Fifty-seven peripheral blood and bone marrow samples were collected from the BCR/ABL-negative myeloproliferative neoplasms (MPN) patients in Huashan Hospital from Apr 2010 to Dec 2010.JAK2 V617F mutation was detected by fluorescence PCR combined with melting curve analysis.The accuracy,precision,analytical sensitivity,and anti-interference ability of the assay were validated.The Kappa test was used to evaluate accuracy.Coincidence rate was used to evaluate the repeatability.Paired t test was used to evaluate analytical sensitivity.Results There was a close agreement between the reference method(sequencing) and the test method (fluorescence melting curve analysis) (Kappa =0.89).The coincidence rate was 100％.The results of the assay was not affected by lipoprotein (＜ 24 mmol/L) or bilirubin (＜450 μmol/L).The detection limit of the assay was 5％.Conclusion JAK2 V617F mutation assay by fluorescence PCR combined with melting curve analysis could be applied to the clinical laboratory.

Observation on the curative effect of neurotropin combined with etoricoxib in the treatment of pain in patients with ankylosing spondylitis / 中国基层医药

Objective To discuss the curative effect of neurotropin combined with etoricoxib in the treatment of pain in patients with ankylosing spondylitis (AS).Methods 30 AS patients were randomly divided into two groups.The control group was treated with 7.2Nu neurotropin injection for two weeks.The observation group was given neurotropin injection and 60mg etoricoxib tablets oral per day for two weeks.The Bath AS activity index(BASDAI),Bath AS functional index (BASFI),rachiodynia,hypnalgia and morning stiffness were observed.Results The total effective rate of observation group was superior to the control group,the difference was significant (P ＜ 0.05).No severe adverse reaction was observed.Conclusion Neurotropin combined with etoricoxib has definite effect on AS.

Double wedge osteotomy of the first metatarsal for correction of severe hallux valgus / 中华骨科杂志

Objective To explore the curative effect of the operation of double wedge osteotomy of the first metatarsal for correction of severe hallux valgus.Methods The data of 62 patients (87 feet) with severe hallux valgus caused by enlarged distal metatarsal articular angle (DMAA) who were followed up after receiving the treatment of double wedge osteotomy of the first metatarsal from January 2008 to December 2011 were analyzed retrospectively.There are 9 males (14 feet),and 53 females (73 feet),with an average age of 56 years (range,28-70 years).Preoperative radiographs showed hallux valgus angle (HVA) was 48.6° in average,intermetatarsal angle (IMA) was 19.8° in average,and DMAA was 22.1° in avcragc.Thc opcration plan was made based on the preoperative deformity,and the osteotomy site,the angle,the capacity of osteotomy was all based on preoperative measurement.Compare the changes of HVA,IMA,DMAA before and after operation.The changes were also compared before and after the internal fixation extraction.The curative effect was observation based on American Orthopaedic Foot and Ankle Society (AOFAS) propodium score standard.Results Sixty-two patients (87 feet) were followed up for 10 to 57 months,with an average of 21 months.HVA (14.6°±1.2°),IMA (7.9°±0.7°),DMAA (7.7°±0.9°) were all satisfied 6 months after the operation.Stiff occurred in 2 patients after the operation.Cutaneous nerve injury occurred in 2 patients,and metastatic metatarsalgia occurred in 1 patient.No sever recurrence of deformity,bone nonunion and bone necrosis was found in all the patients.AOFAS score reached 91.8±1.8 one year after the operation,which was 28.4±9.1 preoperatively.Among them,49 feet were rated as excellent,31 as good,and 7 as fair.The excellent and good rate was 92％ (80/87).Conclusion The first metatarsal double osteotomy can effectively correct the severe hallux valgus deformity with enlarged DMAA with few complications.It achieves good effect.Patients can bear part of the loading in the early stage of recovery after operation.

The association of BANK1 single nucleotide polymorphisms with rheumatoid arthritis in Chinese Han population / 中华风湿病学杂志

ObjectiveTo investigate the association of BANK1 single nucleotide polymorphisms (SNPs) with rheumatoid arthritis(RA) in Chinese Han. MethodsTwo hundreds and twenty-one RA patients and 310 healthy controls who were Chinses Han population from Huashan Hopital and Changzheng Hospital in Shanghai,China were included.DNAs were extracted from peripheral whole blood for study.Samples were genotyped for three variants rs10516487,rs17266594 and rs3733197 in BANK1 by unlabelled probe high resolution melting (HRM) assay.The genotype frequencies of the detected polymorphisms were analyzed in relation to RA and the production of autoantibodies in RA patients.ResultsThe Tr genotype frequency was much higher in RA patients than in healthy controls(X2=6.241,P=0.044).The frequencies of rs10516487 G allele,rs17266594 T allele and rs3733197 G allele were increased among RA patients compared with healthy controls,although they didn't reach statistical significance.The rs10516487 and rs17266594 were found in strong linkage disequilibrium(D'=0.993,r2=0.985).And also the major TGG haplotype of 3-SNP was significantly associated with RA patients[P=0.037,OR =1.345,95％CI (1.018-1.776)].ConclusionBANK1 rs17266594 polymorphism is susceptible to RA,while rs10516487 and rs17266594 are linked in Chinese Han population.BANK1 SNPs TGG haplotype may contribute to RA susceptibility,too.