Treatment of advanced non-small cell lung cancer with driver mutations: current applications and future directions / 医学前沿

With the improved understanding of driver mutations in non-small cell lung cancer (NSCLC), expanding the targeted therapeutic options improved the survival and safety. However, responses to these agents are commonly temporary and incomplete. Moreover, even patients with the same oncogenic driver gene can respond diversely to the same agent. Furthermore, the therapeutic role of immune-checkpoint inhibitors (ICIs) in oncogene-driven NSCLC remains unclear. Therefore, this review aimed to classify the management of NSCLC with driver mutations based on the gene subtype, concomitant mutation, and dynamic alternation. Then, we provide an overview of the resistant mechanism of target therapy occurring in targeted alternations ("target-dependent resistance") and in the parallel and downstream pathways ("target-independent resistance"). Thirdly, we discuss the effectiveness of ICIs for NSCLC with driver mutations and the combined therapeutic approaches that might reverse the immunosuppressive tumor immune microenvironment. Finally, we listed the emerging treatment strategies for the new oncogenic alternations, and proposed the perspective of NSCLC with driver mutations. This review will guide clinicians to design tailored treatments for NSCLC with driver mutations.

Safety of thoracic radiotherapy followed by PD-1/PD-L1 inhibitor after induction therapy for extensive-stage small cell lung cancer / 中华放射肿瘤学杂志

Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.

Clinical study of endoscopic surgery through thoraco mammary approach in treatment of thyroid papillary carcinoma / 中华内分泌外科杂志

Objective:To investigate the effect of endoscopic thyroidectomy through breast milk approach in patients with papillary thyroid carcinoma and its influence on Wnt and integrin signaling pathways.Methods:A total of 136 patients diagnosed with papillary thyroid carcinoma in our hospital from Jul. 2018 to Mar. 2020 were selected and were hospitalized for surgical treatment. According to different surgical procedures, they were divided into a study group (68 cases) and a control group (68 cases) . The control group was treated with open thyroidectomy and the study group was treated with thoracoscopic thyroidectomy. The two groups were compared in terms of immune function [CD4+, CD8+ and CD4+/CD8+], and pain index [PGE2, IL-6, Cor and VAS score]. RT-PCR method was used to detect WNT1, β-catenin, GSK3β and integrin Signal pathway before and after surgery.Results:Three days after operation, compared with the control group, the study group had significantly higher CD4+ and CD4+/CD8+ levels [ (27.62±2.52) vs (24.63±2.67) , (0.66±0.18) vs (0.52±0.13) ], while the CD8+ level was significantly lower [ (41.62±3.54) vs (45.62±3.63) ] ( P<0.001) ; PGE2, IL-6, Cor, VAS of the study group were significantly lower than the control group [ (48.54±9.86) vs (57.21±8.12) , (5.13±0.71) vs (6.99±0.95) , (511.23±67.52) vs (633.12±71.47) , (1.26±0.56) vs (3.99±2.06) ] ( P<0.001) ; WNT1, β-catenin, GSK3β, integrin β1, FAK, Ras, and MAPK mRNA expression levels in the study group were significantly lower than those of the control group[ (1.79±0.15) vs (2.85±0.25) , (1.94±0.15) vs (2.64±0.24) , (2.13±0.19) vs (2.97±0.28) , (1.95±0.17) vs (2.58± 0.23) , (2.15±0.16) vs (2.87±0.22) , (1.95±0.18) vs (2.91±0.27) , (1.89±0.12) vs (2.87±0.31) ] ( P<0.001) . Conclusion:Endoscopic thyroidectomy through thoracolumbar approach can effectively reduce postoperative pain in patients with papillary thyroid cancer, have a smaller impact on immune function, and block the expression of Wnt and integrin signaling pathways to reduce tumor metastasis risk.

Current Progress and Future Developments of Antibody Drug Conjugates in Lung Cancer / 中国肺癌杂志

Antibody drug conjugates (ADCs) are a novel class of anti-cancer drugs, which combined the specificity of monoclonal antibodies with the cytotoxic palyload via the linkers. Many ADCs have not only verified impressive activity in a variety of cancers, including breast cancer and hematological system tumors, but also in lung cancer. The aim of this study was to provide informations for practice by summarizing the mechanism of action, clinical application and problems and challenges of ADCs.
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Formation of the Looming-evoked Innate Defensive Response during Postnatal Development in Mice / 神经科学通报·英文版

Environmental threats often trigger innate defensive responses in mammals. However, the gradual development of functional properties of these responses during the postnatal development stage remains unclear. Here, we report that looming stimulation in mice evoked flight behavior commencing at P14-16 and had fully developed by P20-24. The visual-evoked innate defensive response was not significantly altered by sensory deprivation at an early postnatal stage. Furthermore, the percentages of wide-field and horizontal cells in the superior colliculus were notably elevated at P20-24. Our findings define a developmental time window for the formation of the visual innate defense response during the early postnatal period and provide important insight into the underlying mechanism.

Effects of infrasound with electroacupuncture on learning, memory and the CaMKⅡ-Tau protein signaling pathway / 中华物理医学与康复杂志

Objective:To observe the effect of electroacupuncture at the Baihui acupoint on learning and memory ability and on the calmodulin kinase (CaMK)Ⅱ-Tau protein signal pathway in rats exposed to infrasound, and to explore its mechanism.Methods:Forty-eight Sprague-Dawley rats were randomly divided into a blank group, an infrasound group, a Baihui group and a non-acupoint group, each of 12. The rats in the blank group were placed in an infrasound chamber without infrasound for 2 hours daily. Those in the other 3 groups were exposed to 8Hz, 130dB infrasound in the chamber for 2 hours daily for 7 consecutive days. The rats in the Baihui and non-acupoint groups were given electroacupuncture within 2 hours after the infrasound exposure at the Baihui acupoint or elsewhere respectively. The rats in the blank and infrasound groups were given the same grasping and fixation, but no electroacupuncture. On the 6th and 7th day of intervention, Morris water maze positioning and navigation experiments and spatial exploration experiments were used to quantify the rats′ spatial learning and memory ability. Nissl staining was used to observe any changes in the morphology of the neurons in the hippocampus of 6 rats in each group. The expression of phosphorylated calmodulin-dependent protein kinase II (P-CaMKⅡ) and phosphorylated Tau protein (P-Tau) in the hippocampus was also documented using western blotting.Results:After 6 or 7 days the average escape latency of the rats in the infrasound group was significantly longer than the blank group′s average. Platform quadrant time and distance ratios and the number of times crossing the platform area were also significantly lower. Compared with the infrasound group, the average escape latency of the Baihui group was significantly shorter, with the platform quadrant time and distance ratios and the number of times crossing the platform area significantly higher. After 7 days, the damage to hippocampal neurons among the rats in the infrasound group was significantly aggravated and the number of neurons was reduced significantly compared with the blank group. Compared with the infrasound group, significantly fewer neurons in the hippocampus were damaged in the Baihui group and the number of neurons had increased significantly. After the intervention the levels of P-CaMKⅡand P-Tau protein in the infrasound group had increased significantly compared with the blank group, but those levels in the Baihui group were significantly lower, on average.Conclusion:Electroacupuncture at the Baihui acupoint can improve the learning and memory ability of rats exposed to infrasound, and has some protective effect against infrasound brain damage. That may be due to its inhibiting Tau protein hyperphosphorylation in the hippocampus by reducing CaMKⅡ activity.

Application of staged respiratory training in pulmonary rehabilitation nursing of patients with high spinal cord injury / 中国实用护理杂志

Objective:To explore the effect of staged respiratory training in pulmonary rehabilitation nursing of patients with high spinal cord injury.Methods:A total of 76 patients with high spinal cord injury in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2019 were selected as the study subjects, and were divided into the control group and the observation group with random number table method, 38 cases each. The control group was given conventional respiratory training, while the observation group was given staged respiratory training. Both groups were intervened 6 days a week for 8 weeks. The differences of basic indexes, pulmonary ventilation function, respiratory muscle strength and incidence of pulmonary infection between the two groups before and after intervention were compared.Results:After 8 weeks of intervention, the blood oxygen saturation was 0.95±0.04 in the observation group and 0.90±0.04 in the control group, there was significant difference ( t value was 4.229, P<0.001). The percentages of predicted values of maximal vital capacity, forced expiratory vital capacity, forced expiratory volume in 1s, and maximal ventilation were (69.21±11.38)%, (61.83±11.53)%, (56.50±7.86)%, (51.62±8.73)% in the observation group after 8 weeks of intervention, and (56.70±14.65)%, (49.82±15.06)%, (45.61±10.32)%, (42.30±15.11)% in the control group, there was significant difference ( t values were 3.610-4.967, P<0.001). The inspiratory muscle strength index was (56.12±18.31) cmH 2O(1 cmH 2O= 0.098 kPa) in the observation group after intervention, and (46.61±11.62) cmH 2O in the control group, there was significant different ( t value was 2.806, P<0.01). The incidence of pulmonary infection was 5.26% (2/38) in the observation group and 15.78% (6/38) in the control group, there was no significant difference ( χ2 value was 2.235, P>0.05). Conclusions:Stage respiratory training can promote lung rehabilitation of patients with high spinal cord injury, which is worthy of promotion and application.

Chinese Experts Consensus on Immune Checkpoint Inhibitors for Non-small Cell Lung Cancer (2020 Version) / 中国肺癌杂志

Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer. The systemic antitumor therapy of advanced NSCLC has undergone renovations of chemotherapy, targeted therapy and immunotherapy, which results in greatly improved survival for patients with advanced NSCLC. Immune checkpoint inhibitors (ICIs), especially targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), has changed the treatment paradigm of NSCLC. ICIs have become the standard treatment for advanced NSCLC without epidermal growth factor receptor(EGFR) mutation or anaplastic lymphomakinase(ALK) translocation in the first- or second-line setting, and for locally advanced NSCLC following concurrent radiotherapy and chemotherapy. ICIs are also promising in adjuvant/neoadjuvant therapy. More and more ICIs have been approved domestically for the treatment of NSCLC. Led by the NSCLC expert committee of Chinese Society of Clinical Oncology (CSCO), this consensus was developed and updated based on thoroughly reviewing domestic and foreign literatures, clinical trial data, systematic reviews, experts' discussion and the consensus(2019 version). This consensus will aid domestic clinicians in the treatment of NSCLC with ICIs.
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Classification and treatment of intercondylar spine fractures complicated with tibial plateau fracture / 中华创伤骨科杂志

Fracture of the tibial spine, insertion of the anterior cruciate ligament, is one of the most common concomitant injuries seen in tibial plateau fractures. Anatomical reduction and healing of the tibial spine fragments are essential to the stability and function of the knee. Clinical management of the tibial spine fractures associated with tibial plateau fracture should be based on their classification after comprehensive assessment of intra-articular injuries, in order to restore tension of the cruciate ligament and articular congruity. The purpose of this review is to briefly summarize the research updates in recent 5 years regarding the classification, operation methods and fixation options for these complex fractures.

An animal experimental study of a new portable endoscopic system for upper gastrointestinal endoscopy / 中华消化内镜杂志

Objective:To evaluate the operating performance, effectiveness and safety of a new portable endoscopic system for upper gastrointestinal endoscopy in an animal model.Methods:A parallel control, non-inferiority study was designed. Ten healthy Bana pigs were selected as the study subjects, and underwent upper gastrointestinal endoscopy using portable endoscope followed by Olympus GIF-Q260 endoscope. The instrument quality, image quality and safety of the new system were evaluated by means of quantitative scores.Results:The time for deployment and installing of the new portable endoscopic system during single operation was 110.24±8.93 s and 91.33±11.59 s, respectively, and the time for the endoscope with disposable protective cover was 233.48±17.06 s. The time of attracting 400 mL normal saline of the portable endoscope and Olympus endoscope was 56.44±5.18 s and 33.71±3.56 s, respectively. The water vapor attraction performance of the portable endoscope was not as good as the Olympus endoscope, but still met the technical requirements of medical devices (attraction capacity >400 mL/min). While in terms of the seal property, biopsy channel, softness and curvature of gastroscopy body, knob operation, and field of view, the two endoscopic systems were equivalent. In terms of image quality evaluation, including clarity, distortion, color resolution, illumination and quality comprehensive evaluation, the performance of the new portable endoscopic system was similar to that of the Olympus endoscopic system. One pig developed nausea during operation with the Olympus endoscope. No adverse events occurred during operation with the new portable endoscope.Conclusion:The new portable endoscopic system is easy to assemble. In terms of device quality, image quality and safety, the new portable endoscopic system is similar to the clinically used Olympus endoscopic system. Therefore, the new portable endoscope system is safe and effective for upper gastrointestinal endoscopy.

Endoscopic ultrasonography-guided transgastric drainage of pancreatic fluid collections with a novel lumen-apposing metal stent / 中华消化内镜杂志

Objective@#To evaluate the efficacy and safety of a novel lumen-apposing metal stent(LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections(PFC).@*Methods@#A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact.@*Results@#A total of 49 LAMS were placed in 46 patients (2 LAMS were placed in 3 patient respectively for multiport access). The operation success rate was 95.9%(47/49), complications occurred in 14 patients(31.8%), including 2 severe complications (delayed hemorrhage and peritonitis). Additional intervention was performed in 10 patients(22.7%). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18.4 months (9-28 months). Treatment success was achieved in 40 patients(90.9%). Stent removal was performed after a mean time of 59.4 days (20-142 days), and recurrence rate was 10%(4/40) during the follow-up period.@*Conclusion@#Drainage of PFC using LAMS with special design is effective and relatively safe.

Endoscopic ultrasonography-guided transgastric drainage of pancreatic fluid collections with a novel lumen-apposing metal stent / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of a novel lumen-apposing metal stent (LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections (PFC). Methods A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact. Results A total of 49 LAMS were placed in 46 patients ( 2 LAMS were placed in 3 patient respectively for multiport access ) . The operation success rate was 95. 9％( 47/49 ) , complications occurred in 14 patients ( 31. 8％) , including 2 severe complications ( delayed hemorrhage and peritonitis ) . Additional intervention was performed in 10 patients(22. 7％). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18. 4 months ( 9-28 months) . Treatment success was achieved in 40 patients( 90. 9％) . Stent removal was performed after a mean time of 59. 4 days ( 20-142 days) , and recurrence rate was 10％( 4/40) during the follow-up period. Conclusion Drainage of PFC using LAMS with special design is effective and relatively safe.

The change of retinal microstructure and the correlation with visual outcome in central serous chorioretinopathy after laser treatment / 中华眼底病杂志

Objective To observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment.Methods This is a retrospective study.From April 2016 to February 2017,a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study.The were 46 patients (46 eyes) and 6 males (6 eyes),with the mean age of 43.92± 8.62 years.The healthy fellow eyes (49 eyes) were selected as control.All patients were underwent BCVA and SD-OCT examination.According to the OCT images for all patients,the thickness of central foveal (CFT),outer nuclear (ONL),inner segment (IS),outer segment (OS) were measured.The status of ellipsoid zone (EZ),interdigitation zone (IZ) and RPE were also evaluated at fovea.Comparing the change of SD-OCT microstructures in two time points,the first visit after SRF absorbed and the last visit respectively.Spearman correlation analysis was used to analyze the relation between BCVA and ONL,IS,OS.Results At the first visit after SRF absorbed,compared with control eyes,the thickness of CFT (182.55 ± 24.14 μm),ONL (72.86 ± 17.39 μm),IS (41.23 ± 5.14 μm),OS (18.52 ± 10.26 μm) in CSC eyes were decreased (P＜ 0.001).Meanwhile,the mean BCVA of CSC eyes was 81.27± 6.39 letters,which was also significantly decreased comparing with control eyes (P＜ 0.001).At last visit,the thickness of CFT,ONL,IS,OS were 195.19±22.10,75.44±16.33,44.56±4.09,26.60± 11.39 μm,and the mean BCVA was 85.50±5.95 letters.All recovered significantly comparing with first visit (P＜0.05).At first visit,the BCVA of patients with integrate EZ (83.38± 5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90± 5.97 letters) (P=0.003).And the BCVA of patients with smooth RPE (82.72± 5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00± 6.31 letters) (P=0.020).The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423,0.416;P=0.002,0.002).Conclusions In CSC,the thickness of ONL,IS,OS were decreased,and the integrality of EZ,IZ,the smooth of RPE were disrupted in different extent.After laser treatment,with retinal reattachment,those microstructures including ONL,IS,OS,EZ,IZ recovered slowly.The thickness of OS,the integrality of EZ and the smooth of RPE were associated with visual acuity.

Effect of ultrasound-guided serratus anterior plane block on postoperative pain in patients under-going breast prosthesis implantation / 临床麻醉学杂志

Objective To investigate the effect of ultrasound-guided serratus anterior plane (SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 25 each) : SAP block group (group N) and control group (group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375％ ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale (VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N (P ＜ 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.

Impact of previous abdominal surgery on the outcomes of laparoscopic resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of previous abdominal surgery(PAS) on laparoscopic resection of colorectal cancer.</p><p><b>METHODS</b>The retrospective cohort study was adopted.Clinical data of consecutive colorectal cancer patients with PAS history (past history of at least one abdominal surgery, exclusion of previous inguinal hernia repair, simple laparoscopic approach, appendectomy of the right lower quadrant and endoscopic therapy) undergoing laparoscopic surgery at the Cancer Hospital of Chinese Academy of Medical Sciences between 2010 and 2015 were collected, meanwhile other colorectal cancer patients without PAS history were selected according to 1 to 1 match in age, sex, body mass index, American Society of Anesthesiologists score, tumor location, type of surgery, and staging of tumor. A total of 464 pairs were successfully matched. Intraoperative and postoperative conditions, perioperative complications and prognosis were compared between the two groups.</p><p><b>RESULTS</b>In PAS group, there were 341 males (73.5%) and 123 females (26.5%) with a median age of 62 (24-85) years; 317(68.3%) cases with only one previous abdominal surgery and 147(31.7%) with more than one; 389(83.8%) cases with abdominal midline incisions, 37(8.0%) with transverse incisions, 34(7.3%) with right subcostal incision and 4(0.9%) with left subcostal incision; 146(31.5%) cases undergoing gynecologic surgery, 84(18.1%) cholecystectomy, 52(11.2%) gastroduodenal surgery, 89(19.2%) colorectal surgery, 11(2.4%) small intestine surgery, 23(5.0%) hapatectomy, 16(3.4%) pancreatic surgery, 8(1.7%) urological surgery, 18(3.9%) retroperitoneal tumor resection and 1(0.2%) other surgery. In no PAS group, there were 328 males (70.7%) and 136 females (29.3%) with a median age of 62(24-86) years. No significant differences in baseline data were found between the two groups (all P>0.05). As compared to no PAS group, PAS group had longer mean operative time [(208.0±27.0) minutes vs. (179.0±15.3) minutes, t=4.695, P=0.003] and higher rate of conversion to laparotomy [18.1%(84/464) vs. 11.6%(54/464), χ=7.217, P=0.003]. In the PAS group, conversion to laparotomy was more common due to adhesion reaction [8.8%(41/464) vs. 4.5%(21/464), χ=4.886, P=0.007]. There were no significant differences between the two groups in intraoperative bleeding and transfusion, lymph node dissection, circumferential margin and surgical margin, time to the first diet and postoperative hospital stay(all P>0.05). No significant differences in intraoperative and postoperative morbidity of complication were found between PAS group and no PAS group [3.7%(17/464) vs. 2.8%(13/464), P=0.346; 20.3%(94/464) vs. 18.5%(86/464), P=0.739]. Median follow-up of the whole patients was 32.0(0.5-79.0) months, and there was no significant difference between the two groups [PAS group 31.0(0.5-79.0) months vs. no PAS group 33.0(1.0-75.0) months, P=0.391]. In PAS and no PAS group, the 3-year disease-free survival rate was 68.1%(95%CI: 62.0%-74.2%) and 68.5%(95%CI: 63.0%-74.0%)(P=0.764), and 3-year overall survival rate was 78.5%(95%CI: 72.8%-81.4%) and 80.2%(95%CI:74.3%-86.1%)(P=0.528) respectively, whose differences were not significant.</p><p><b>CONCLUSION</b>Except higher risk of conversion to laparotomy due to adhesion reaction, laparoscopic resection of colorectal cancer is safe and feasible in patients with PAS, and the prognosis is not affected by PAS.</p>

Discussion on Dilemma and Countermeasures of Ethical Clinical Practice Education for Imaging Medical Students / 中国医学伦理学

This paper expounded the problems and dilemma existing in the ethical practice education of ima-ging medical students, which was the separation between professional education and ethical education, and the sep-aration between medical ethics and medical education, and formed "two layers of skin". This paper analyzed the reason was that the education department and education manager neglected management;the quality of teachers was not high and the ability was weak;students had no enthusiasm and interest in ethical education and lack of medical ethics practice education platform. This paper put forward the strategy of integration of professional and ethical edu-cation, the objective of integration, integration content and the six paths and methods of integration. Namely: the scientific design and organization implementation of education manager;improving teachers' quality ability;paying attention to teachers ' words and deeds to influence students; reforming traditional teaching mode and innovating teaching methods;constructing ethical clinical practice education platform using medical imaging, and constructing education platform of consultation and case discussion.

Status of intra-aortic balloon pump application and related factors in Chinese patients with acute myocardial infarction / 中华心血管病杂志

Objective@#To investigate the current status of application of intra-aortic balloon pump(IABP) and analyze the factors which might impact the application of IABP in patients with acute myocardial infarction complicated with cardiac shock in China.@*Methods@#In China Acute Myocardial Infarction (CAMI) Registry,a nationwide, multicenter(107 hospitals), prospective study, 26 592 patients with acute myocardial infarction were enrolled consecutively between January 1, 2013 and September 30, 2014. After excluding of 30 cases due to missing important data,26 562 cases were analyzed.The application status of IABP was analyzed and multivariate logistic regression analysis was performed to determine the factors related to IABP application.@*Results@#A total of 785(3.0%) patients with acute myocardial infarction received IABP implantation, and 381(49.9%) patients belonged to preventive application of IABP before primary percutaneous coronary intervention,and 6(0.8%) patients were complicated with mechanical complications.There were 118(15.0%) patients with cardiac shock received IABP implantation, which accounted for 12.0%(118/984) of all patients with cardiac shock.Multivariate logistic regression analysis showed that the clinical independent factors of the decision of IABP insertion included dyslipidemia (OR=2.858, 95%CI 1.397-5.846, P=0.004),left ventricular ejection fraction (OR=0.977, 95%CI 0.961-0.994, P=0.009),usage of dopamine (OR=2.817, 95%CI 1.495-5.308, P=0.001), left main disease (OR=2.817, 95%CI 1.495-5.308, P=0.001), GRACE score (OR=1.006, 95%CI 1.000-1.011, P=0.034), receiving primary percutaneous coronary intervention (OR=4.508, 95%CI 1.673-12.146, P=0.003), teritiary hospitals (OR=2.562, 95%CI 1.498-4.384, P=0.001), and higher education of the patients (OR=2.183, 95%CI 1.056-4.509, P=0.016).@*Conclusions@#Among the Chinese acute myocardial infarction patients who received IABP implantation, nearly half application of IABP are preventive implantation before primary percutaneous coronary intervention. Only a few patients complicated with cardiac shock received IABP insertion. The clinical conditions, grade of hospitals, degree of education impact the decision of IABP insertion for the patients with acute myocardial infarction. Clinical Trial Registry National Institutes of Health, NCT018746.

Artificial intelligence based on deep learning for automatic detection of early gastric cancer / 中华消化内镜杂志

Objective To develop and validate a model based on deep learning for automatic diagnosis of early gastric cancer ( EGC) to improve detection and diagnosis of EGC. Methods A total of 5159 images ( including 1000 images of EGC and 4159 images of other benign lesions or normal patients) obtained from May 2014 to December 2016 were collected from endoscopic database in changhai Hospital. Then 4449 images were selected randomly for a deep convolutional neural network ( CNN ) training, of which 768 were diagnosed as EGC and 3681 diagnosed as other benign lesions or normal. The remaining 710 images were used to test the model by comparing with diagnostic results of four endoscopists. Results The deep learning model showed accuracy of 89. 4％ ( 635/710 ) , sensitivity of 88. 8％ ( 206/232 ) and specificity of 89. 7％ ( 429/478) for EGC. The mean time required for diagnosis was 0. 30 ± 0. 02 s. The performance of the model was superior to that of four endoscopists. Conclusion The model based on deep learning has high accuracy,sensitivity and specificity for detecting EGC,which could assist endoscopists in real-time diagnosis.

Role of microRNA-92b in the pathophysiology of acute transverse myelitis in children / 中华实用儿科临床杂志

Objective To explore microRNAs that play key regulatory roles in the pathophysiology of acute transverse myelitis in children,and to find therapeutic targets.Methods Twelve patients with acute transverse myelitis were enrolled as ATM group and three children with normal cerebrospinal fluid as the control group.MicroRNA in cerebrospinal fluid of children with acute transverse myelitis was detected by using microarray4.0 chip.Bioinformatics was used to demonstrate microRNA,which plays a key regulatory role,and to predict target genes.Real-time quantitative polymerase chain reaction (qPCR) technique was adopted for in biology and technology duplication.Enzyme-linked immunosorbent assay (ELISA) and Western blot technique were used to detect the expression of key miRNA target protein.The key candidate microRNA was inhibited/overexpressed in dorsal root ganglion neurons,and the function was verified in vitro.Flavopiridol was used to inhibit the activity of CDKs to verify that miR-92b worked through p57-CDKs-GAP-43 pathway.Results The characteristic elevation of miR-92b in cerebrospinal fluid samples of acute transverse myelitis was significant.Bioinformatics analysis showed that p57 was the target gene of miR-92b.The expression of miR-92b was contrary to the p57 protein.In vitro experiments showed that the length of axons in miR-92bmimics group was significantly shorter than that in the blank group.The axons of neurons in antimiR-92b group were obviously prolonged.In the miR-92b mimics + Flavopiridol groups,the axons of neurons were still significantly prolonged compared with that in the blank group.Western blot showed that p57 and GAP-43 protein expression in miR-92b mimics group was lower than that in blank group.The expression of p57 and GAP-43 protein in antimiR-92b group was significantly higher than that in blank group.But in miR-92b mimics + Flavopiridol group,the expression of p57 was lower compared with that in blank group,and the expression of GAP-43 protein was higher compared with that in blank group.Conclusions Up-regulation of miR-92b in children with acute transverse myelitis leads to a down-regulation of p57.The activity of CDKs is enhanced,which inhibits the expression of GAP-43 protein and the regeneration of axons in spinal cord injury region.MiR-92b is one of the key targets in the treatment of children with acute transverse myelitis.

rs12122341 polymorphism is not associated with risk of ischemic stroke in Chinese Han population / 国际脑血管病杂志

Objective To investigate correlation between the rs12122341 polymorphism and ischemic stroke and its major subtypes in Chinese Han population.Methods The patients with ischemic stroke and matched healthy controls in Chinese Han population were enrolled.The rs12122341 genotype was detected by the improved multiple ligase detection reaction (iMLDR).Results A total of 776 patients with ischemic stroke (415 large artery atherosclerotic stroke and 361 small artery occlusive stroke) and 776 healthy controls were enrolled.Genotyping showed that only rs12122341 CC and CG genotypes were detected in all subjects,and no GG genotype was detected.There was no significant difference in frequencies of allele and genotype between the patient group and the control group.Multivariate logistic regression analysis showed that there were no significant correlations between rs12122341 polymorphism and ischemic stroke (odds ratio [OR] 1.482,95％ confidence interval [CI]0.641-3.421;P =0.447),large artery atherosclerotic stroke (OR 1.972,95％ CI 0.655-6.034;P=0.227),and small arterial occlusive stroke (OR 1.632,95％ CI 0.437-6.262;P =1.000).Conclusions There is no significant correlation between the rs12122341 polymorphism and risk of ischemic stroke and its major subtypes in Chinese Han population.