Peritoneal dialysis-related peritonitis caused by Campylobacter fetus: a case report and literature review / 中华肾脏病杂志

This paper reports a case of peritonitis caused by Campylobacter fetus in a continuous ambulatory peritoneal dialysis (CAPD) patient. The patient was a middle-aged man, with chronic kidney disease stage 5 secondary to chronic glomerulonephritis, and had been on CAPD for 6 years. He was admitted to our department with a 7 day history of abdominal pain and cloudy effluent. Peritoneal effluent culture was negative and metagenomic next-generation sequencing suggested Campylobacter fetus. Intraperitoneal treatment with amikacin was failed. Peritoneal dialysis catheter was removed and hemodialysis treatment was performed. After treatment of erythromycin oral for 4 weeks, the patient's symptoms was improved and discharged.

Ureaplasma parvum-induced peritoneal dialysis-associated peritonitis: a case report / 中华肾脏病杂志

Pathogen detection is very important to improve the prognosis of patients with peritoneal dialysis-associated peritonitis. The paper reported a case of peritonitis caused by Ureaplasma parvum diagnosed by metagenomics next-generation sequencing（mNGS）technology. The patient was a middle-aged woman and hospitalized due to abdominal pain and muddy effluent. Anti-infective treatments such as ceftazidime and vancomycin were given but the effect was poor. The result of traditional culture was negative. Ureaplasma parvum was detected by mNGS. After using doxycycline，the patient's inflammation was controlled. It is suggested that mNGS plays an important role in the detection of the pathogens in peritoneal dialysis-associated peritonitis patients with negative culture. Through this case report and literature review，clinical experience is provided for the diagnosis and treatment in such patients.

Pituitary immune-related adverse events induced by programmed cell death protein 1 inhibitors in advanced lung cancer patients: A report of 3 cases / 北京大学学报(医学版)

Pituitary immune-related adverse events induced by programmed cell death protein 1 inhibitors in advanced lung cancer patients: A report of 3 cases SUMMARY Programmed cell death protein 1 (PD-1) and its ligand 1 (PD-L1) have been widely used in lung cancer treatment, but their immune-related adverse events (irAEs) require intensive attention. Pituitary irAEs, including hypophysitis and hypopituitarism, are commonly induced by cytotoxic T lymphocyte antigen 4 inhibitors, but rarely by PD-1/PD-L1 inhibitors. Isolated adrenocorticotropic hormone(ACTH) deficiency (IAD) is a special subtype of pituitary irAEs, without any other pituitary hormone dysfunction, and with no enlargement of pituitary gland, either. Here, we described three patients with advanced lung cancer who developed IAD and other irAEs, after PD-1 inhibitor treatment. Case 1 was a 68-year-old male diagnosed with metastatic lung adenocarcinoma with high expression of PD-L1. He was treated with pembrolizumab monotherapy, and developed immune-related hepatitis, which was cured by high-dose methylprednisolone [0.5-1.0 mg/(kg·d)]. Eleven months later, the patient was diagnosed with primary gastric adenocarcinoma, and was treated with apatinib, in addition to pembrolizumab. After 17 doses of pembrolizumab, he developed severe nausea and asthenia, when methylprednisolone had been stopped for 10 months. His blood tests showed severe hyponatremia (121 mmol/L, reference 137-147 mmol/L, the same below), low levels of 8:00 a.m. cortisol (< 1 μg/dL, reference 5-25 μg/dL, the same below) and ACTH (2.2 ng/L, reference 7.2-63.3 ng/L, the same below), and normal thyroid function, sex hormone and prolactin. Meanwhile, both his lung cancer and gastric cancer remained under good control. Case 2 was a 66-year-old male with metastatic lung adenocarcinoma, who was treated with a new PD-1 inhibitor, HX008, combined with chemotherapy (clinical trial number: CTR20202387). After 5 months of treatment (7 doses in total), his cancer exhibited partial response, but his nausea and vomiting suddenly exacerbated, with mild dyspnea and weakness in his lower limbs. His blood tests showed mild hyponatremia (135 mmol/L), low levels of 8:00 a.m. cortisol (4.3 μg/dL) and ACTH (1.5 ng/L), and normal thyroid function. His thoracic computed tomography revealed moderate immune-related pneumonitis simultaneously. Case 3 was a 63-year-old male with locally advanced squamous cell carcinoma. He was treated with first-line sintilimab combined with chemotherapy, which resulted in partial response, with mild immune-related rash. His cancer progressed after 5 cycles of treatment, and sintilimab was discontinued. Six months later, he developed asymptomatic hypoadrenocorticism, with low level of cortisol (1.5 μg/dL) at 8:00 a.m. and unresponsive ACTH (8.0 ng/L). After being rechallenged with another PD-1 inhibitor, teslelizumab, combined with chemotherapy, he had pulmonary infection, persistent low-grade fever, moderate asthenia, and severe hyponatremia (116 mmol/L). Meanwhile, his blood levels of 8:00 a.m. cortisol and ACTH were 3.1 μg/dL and 7.2 ng/L, respectively, with normal thyroid function, sex hormone and prolactin. All of the three patients had no headache or visual disturbance. Their pituitary magnetic resonance image showed no pituitary enlargement or stalk thickening, and no dynamic changes. They were all on hormone replacement therapy (HRT) with prednisone (2.5-5.0 mg/d), and resumed the PD-1 inhibitor treatment when symptoms relieved. In particular, Case 2 started with high-dose prednisone [1 mg/(kg·d)] because of simultaneous immune-related pneumonitis, and then tapered it to the HRT dose. His cortisol and ACTH levels returned to and stayed normal. However, the other two patients' hypopituitarism did not recover. In summary, these cases demonstrated that the pituitary irAEs induced by PD-1 inhibitors could present as IAD, with a large time span of onset, non-specific clinical presentation, and different recovery patterns. Clinicians should monitor patients' pituitary hormone regularly, during and at least 6 months after PD-1 inhibitor treatment, especially in patients with good oncological response to the treatment.

Immune checkpoint inhibitors induced pituitary immune-related adverse events: diagnosis and management / 中华肿瘤杂志

Immune checkpoint inhibitors (ICIs) have been used in treating a wide variety of cancers, but they challenge clinicians with a series of special immune related adverse events (irAEs) resulting from activated immune system. Since June 2018, when the first programmed cell death 1 (PD-1) inhibitor, nivolumab, was approved by the National Medical Products Administration (NMPA), abundant experience has been accumulated in coping with irAEs from PD-1 and PD-1 ligand 1 (PD-L1) blockade therapies. In October 2021, the first CTLA-4 inhibitor, ipilimumab, which has a different spectrum of irAEs was also approved by NMPA. The discrepancy in clinical features of pituitary irAEs is obvious between these two types of ICIs. Pituitary irAEs include hypophysitis and hypopituitarism. In this review of latest literature, we have summarized the incidence, possible mechanisms, time of onset, clinical presentations, hormone test, pituitary imaging, treatment strategies and recovery patterns of pituitary irAEs. By referring to domestic and foreign clinical guidelines, we have proposed practical suggestions for screening, diagnosing and treating pituitary irAEs.

Effects of different dialysis modalities on long-term prognosis after parathyroidectomy in patients with secondary hyperparathyroidism / 中华肾脏病杂志

Objective:To compare the survival rate of secondary hyperparathyroidism (SHPT) patients with different dialysis modalities after parathyroidectomy (PTX), and analyze the influencing factors of survival prognosis.Methods:Clinical data of dialysis patients diagnosed with SHPT and treated with PTX in the First People′s Hospital of Foshan from April 2014 to May 2019 were retrospectively collected and analyzed. The patients were divided into hemodialysis (HD) group and peritoneal dialysis (PD) group according to preoperative dialysis modalities, and the differences in baseline clinical data and cardiac ultrasound results were compared between the two groups. Kaplan-Meier survival analysis was used to compare the difference in cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the influencing factors of all-cause death. Receiver operating characteristic curve (ROC curve) was used to predict the risk of all-cause death.Results:A total of 99 patients were enrolled in this study, and 94 patients completed follow-up, including 23 patients who died. Compared with PD group ( n=45), HD group ( n=54) had higher dialysis age, blood pressure, intact parathyroid hormone, alkaline phosphatase, total heart valve calcification rate, mitral valve calcification proportion, interventricular septal thickness (IVST) and left ventricular mass index (all P<0.05). The median follow-up time was 46.00(32.75, 60.25) months. Kaplan-Meier survival analysis showed that there was no significant difference in cumulative survival rate between HD group and PD group (Log-rank test χ2=0.414, P=0.520). Multivariate Cox regression analysis showed that increasing age ( HR=1.066, 95% CI 1.017-1.118, P=0.008), systolic blood pressure>140 mmHg ( HR=2.601, 95% CI 1.002-6.752, P=0.049) and increasing IVST ( HR=1.269, 95% CI 1.036-1.554, P=0.021) were independent influencing factors for all-cause death in dialysis patients after PTX. ROC curve analysis results showed that the cut-off values of age, dialysis age and IVST for predicting all-cause death after PTX were 51.5 years old ( AUC=0.673, 95% CI 0.545-0.802, P=0.013) and 75.0 months ( AUC=0.654, 95% CI 0.528-0.780, P=0.027) and 13.5 mm ( AUC=0.680, 95% CI 0.557-0.803, P=0.010) respectively. The area under the ROC curve for age, dialysis age, IVST, left ventricular hypertrophy in combination with systolic blood pressure>140 mmHg in the prediction of all-cause death after PTX was 0.776(95% CI 0.677-0.875, P<0.001). Conclusions:There is no significant difference in cumulative survival rate between HD and PD patients with SHPT after PTX. Increasing age, systolic blood pressure>140 mmHg and increasing IVST are independent risk factors for all-cause death in dialysis patients with SHPT after PTX.

Non-canonical Ubiquitination Mediated by the Effectors from Legionella pneumophila / 中国生物化学与分子生物学报

Ubiquitination is a unique protein post-translational modification in eukaryotic cells. It regulates a variety of physiological processes, such as protein homeostasis, cell cycle, immune response, DNA repair, and vesicle transport. In view of the importance of ubiquitin in live cells, pathogens have derived a series of effector proteins targeting the host ubiquitin process in the long-term evolutionary process, aiming to regulate the ubiquitin process in the host and render an internal environment suitable for the growth and reproduction of pathogens. Legionella pneumophila is a gram-negative bacterium that is responsible for Legionella pneumoniae pneumonia, causing fever and lung infection with a fatality rate of 15% ~ 30% in severe cases. The Dot / Icm type IV secretory system is the most important virulence system in the infection of Legionella pneumophila. In the process of infecting host cells, Legionella pneumophila uses this secretion system to secrete more than 330 effector proteins to assist bacterial survival, proliferation and escape in host cells. Several effector proteins of Legionella pneumophila regulate the host ubiquitination process directly or indirectly. Recent studies found that some effectors can mediate non-canonical ubiquitination of host proteins, which is different from the classical ubiquitination process. Here, we introduce the latest research progress of novel ubiquitination mediated by effecting proteins of Legionella pneumophila, providing a reference for understanding the important role of ubiquitination in the pathogenesis of Legionella pneumophila.

Functional metagenomic analysis of quorum sensing signaling in a nitrifying community.

Quorum sensing (QS) can function to shape the microbial community interactions, composition, and function. In wastewater treatment systems, acylated homoserine lactone (AHL)-based QS has been correlated with the conversion of floccular biomass into microbial granules, as well as EPS production and the nitrogen removal process. However, the role of QS in such complex communities is still not fully understood, including the QS-proficient taxa and the functional QS genes involved. To address these questions, we performed a metagenomic screen for AHL genes in an activated sludge microbial community from the Ulu Pandan wastewater treatment plant (WWTP) in Singapore followed by functional validation of luxI activity using AHL biosensors and LC-MSMS profiling. We identified 13 luxI and 30 luxR homologs from the activated sludge metagenome. Of those genes, two represented a cognate pair of luxIR genes belonging to a Nitrospira spp. and those genes were demonstrated to be functionally active. The LuxI homolog synthesized AHLs that were consistent with the dominant AHLs in the activated sludge system. Furthermore, the LuxR homolog was shown to bind to and induce expression of the luxI promoter, suggesting this represents an autoinduction feedback system, characteristic of QS circuits. Additionally, a second, active promoter was upstream of a gene encoding a protein with a GGDEF/EAL domain, commonly associated with modulating the intracellular concentration of the secondary messenger, c-di-GMP. Thus, the metagenomic approach used here was demonstrated to effectively identify functional QS genes and suggests that Nitrospira spp. maybe QS is active in the activated sludge community.

A Viral Fragmentation Signature for SARS-CoV-2 in Clinical Samples Correlating with Contagiousness

The viral load of SARS-CoV-2 in clinical samples as measured by the primary diagnostic tool of RT-PCR is an imperfect readout for infection potential as most targeted assays designed for sensitivity, indiscriminately detect short and long RNA fragments, although infectivity is embodied only in the whole virus and its intact genome. Here, we used next-generation sequencing (NGS) to characterize 155 clinical samples and show sensitive and quantitative detection of viral RNA which confirmed subgenomic RNA in 57.6% of samples and provided a novel method to determine relative integrity of viral RNA in samples. The relative abundance of long fragments quantified as a viral fragmentation score was positively associated with viral load and inversely related to time from disease onset. An empirically determined score cut-off for presence of substantially fragmented RNA was able to identify 100% of samples collected after 8 days of illness with poor infection potential in line with current clinical understanding of infectiousness of SARS-CoV-2. The quantification of longer fragments in addition to existing short targets in an NGS or RT-PCR-based assay could provide a valuable readout of infection potential simultaneous to the detection of any fragments of SARS-CoV-2 RNA in test samples.

MassMark: A Highly Scalable Multiplex NGS-based Method for High-Throughput, Accurate and Sensitive Detection of SARS-CoV-2 for Mass Testing

Mass testing has been proposed as a strategy to address and contain the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic1,2. We have developed MassMark, a novel and highly scalable multiplex method that employs next generation sequencing for high-throughput, accurate and sensitive detection of SARS-CoV-2, while minimizing handling complexity and resources by utilizing a serial pooling strategy to accommodate over 9,000 samples per workflow. Analytical validation showed that MassMark was able to detect SARS-CoV-2 RNA down to a level of 100 copies per reaction. We evaluated the clinical performance of MassMark in a simulated screening testing with 22 characterized samples from three different sources (nasopharyngeal swabs, nasal swabs and saliva), comprising of 12 SARS-CoV-2 positive samples with mid to late Ct values (range: 22.98-32.72) and 10 negative samples. There was one false negative and no false positives, giving an overall sensitivity and specificity of 91.67% and 100% respectively, when compared against an optimized RT-PCR test with a target size within 70 bp (CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel3).

Long-term PM2.5 exposure increases the risk of non-small cell lung cancer (NSCLC) progression by enhancing interleukin-17a (IL-17a)-regulated proliferation and metastasis.

PM2.5 is a class of airborne particles and droplets with sustained high levels in many developing countries. Epidemiological studies have indicated that PM2.5 is closely associated with the increased morbidity and mortality of lung cancer in the world. Unfortunately, the effects of PM2.5 on lung cancer are largely unknown. In the present study, we attempted to explore the role of PM2.5 in the etiology of NSCLC. Here, we found that long-term PM2.5 exposure led to significant pulmonary injury. Epithelial-mesenchymal transition (EMT) and cancer stem cells (CSC) properties were highly induced by PM2.5 exposure. EMT was evidenced by the significant up-regulation of MMP2, MMP9, TGF-ß1, α-SMA, Fibronectin and Vimentin. Lung cancer progression was associated with the increased expression of Kras, c-Myc, breast cancer resistance protein BCRP (ABCG2), OCT4, SOX2 and Aldh1a1, but the decreased expression of p53 and PTEN. Importantly, mice with IL-17a knockout (IL-17a-/-) showed significantly alleviated lung injury and CSC properties following PM2.5 exposure. Also, IL-17a-/--attenuated tumor growth was recovered in PM2.5-exposed mice injected with recombinant mouse IL-17a, accompanied with significantly restored lung metastasis. Taken together, these data revealed that PM2.5 could promote the progression of lung cancer by enhancing the proliferation and metastasis through IL-17a signaling.

Structural Basis for the Inhibition of the RNA-Dependent RNA Polymerase from SARS-CoV-2 by Remdesivir

The pandemic of Corona Virus Disease 2019 (COVID-19) caused by SARS-CoV-2 has become a global crisis. The replication of SARS-CoV-2 requires the viral RNA-dependent RNA polymerase (RdRp), a direct target of the antiviral drug, Remdesivir. Here we report the structure of the SARS-CoV-2 RdRp either in the apo form or in complex with a 50-base template-primer RNA and Remdesivir at a resolution range of 2.5-2.8 [A]. The complex structure reveals that the partial double-stranded RNA template is inserted into the central channel of the RdRp where Remdesivir is incorporated into the first replicated base pair and terminates the chain elongation. Our structures provide critical insights into the working mechanism of viral RNA replication and a rational template for drug design to combat the viral infection.

Clinical effects of combined muscle double fixation on blepharoplasty / 中华医学美学美容杂志

Objective:To explore the effect of combined orbicularis muscle double stitch operated on blepharoplasty.Methods:A total of 90 patients, 79 females and 11 males, aged 18-49 years, were treated by using combined orbicularis muscle double stitch procedure, that is, to fix upper lifting muscle, to remove partial fat, and to perform blepharoplasty.Results:All 90 cases＇ incisions were healed at the first phase, no obvious swelling and bleeding. Within 3-24 months follow up, all patients＇ upper eyelids were significantly improved. The skin was smoothy when closing eyes, and eyelash was up when opening eyes, and arc was natural and satisfactory.Conclusions:This method can improve the shape of the upper eyelid swelling and get long-lasting and stable physiological eyelid.

Early stage elevated platelet count is an independent risk factor for the poor prognosis of peritoneal dialysis-associated peritonitis / 中华肾脏病杂志

Objective:To determine whether the early stage platelet count can predict the outcome of peritoneal dialysis-associated peritonitis (PDAP).Methods:A retrospective cohort study was conducted by selecting PDAP patients who were hospitalized in the First People's Hospital of Foshan from January 2012 to January 2019. According to the final treatment outcome, the patients were divided into cured group and withdrawn group. The withdrawn group included patients who transferred to hemodialysis or died. Basic data on demography, blood routine examination, peritoneal fluid, biochemical indicators were compared between the two groups. Logistic regression analysis was used to analyze the withdrawn risk factors of PDAP.Results:There were 180 patients included in the study, including 112 cases in the cured group and 68 cases in the withdrawn group. Compared with the cured group, there were older age [(53.38±14.17) years old vs (48.41±13.04) years old, t=2.407, P=0.017], longer age of dialysis [(49.20±26.05) months vs (30.36±32.97) months, t=4.034, P<0.001], longer hospital stay [(23.88±11.50) d vs (17.80±3.95) d, t=5.133, P<0.001] and higher platelet count [(285.55±107.23)×10 9/L vs (234.90±74.03)×10 9/L, t=3.450, P=0.001], lower serum albumin [(31.72±7.47) g/L vs (35.40±4.93) g/L, t=-3.972, P<0.001] in the withdrawn group. Multivariate logistic regression analysis showed that longer dialysis age ( OR=1.012, 95% CI 1.007-1.024, P=0.015) and higher platelet count ( OR=1.013, 95% CI 1.004-1.026, P=0.008) were independent risk factors, and higher serum albumin ( OR=0.941, 95% CI 0.896-0.988, P=0.005) was an independent protective factor of withdrawal from peritoneal dialysis in PDAP patients. Conclusions:The long dialysis age, early high platelet count are independent risk factors and high serum albumin level is an independent protective factor for withdrawal from peritoneal dialysis in PDAP patients.

Prognostic risk factors of patients with refractory acute left heart failure treated by continuous renal replacement therapy / 中华肾脏病杂志

Objective:To find out the prognostic influencing factors of patients undergoing continuous renal replacement therapy (CRRT) for refractory acute left heart failure.Methods:Through the medical system and hemodialysis system in Foshan First People's Hospital, all patients who received CRRT for refractory acute left ventricular heart failure from January 1, 2012 to January 1, 2019 were searched. All patients were divided into two groups by the final outcome: survival group and death group. Age, sex, initial mean arterial pressure (MAP), primary heart disease, use of vasoactive drugs, urine output before treatment, hemoglobin, serum creatinine, serum albumin, C-reactive protein(CRP), brain natriuretic peptide (BNP), cardiac ejection fraction (EF) and CRRT treatment time were analyzed to find out the prognostic influencing factors.Results:A total of 130 cases were collected, including 96 cases in the survival group and 34 cases in the death group, with a total mortality rate of 26.15%. Compared to that in the death group, there were higher proportion of males (71.88% vs 50.00%, χ2=5.366, P=0.021), significantly higher initial MAP ( t=4.677, P<0.001), much more urine output before treatment ( Z=3.904, P<0.001), significantly higher serum creatinine ( Z=2.866, P=0.004) , significantly lower hemoglobin ( Z=-2.587, P=0.011), significantly shorter time of CRRT ( Z=-3.447, P=0.001) in the survival group. Multivariate logistic regression analysis showed that female ( OR=2.950, 95% CI 1.102-7.898, P=0.031) and higher levels of hemoglobin ( OR=1.024, 95% CI 1.004-1.045, P=0.019) were the risk factors of death in patients undergoing CRRT for refractory acute left heart failure, while higher levels of mean arterial pressure before treatment ( OR=0.959, 95% CI 0.930-0.989, P=0.008) and urine volume before treatment ( OR=0.998, 95% CI 0.997-0.999, P=0.004) were the protective factors for patients' prognosis. Conclusion:The mortality of patients with refractory acute left heart failure undergoing CRRT therapy is still very high. Female and higher level of hemoglobin are the risk factors for death, while more urine volume before treatment and higher MAP before treatment are protective factors for survival.

Prognostic risk factors of patients with refractory acute left heart failure treated by continuous renal replacement therapy / 中华肾脏病杂志

Objective@#To find out the prognostic influencing factors of patients undergoing continuous renal replacement therapy (CRRT) for refractory acute left heart failure.@*Methods@#Through the medical system and hemodialysis system in Foshan First People's Hospital, all patients who received CRRT for refractory acute left ventricular heart failure from January 1, 2012 to January 1, 2019 were searched. All patients were divided into two groups by the final outcome: survival group and death group. Age, sex, initial mean arterial pressure (MAP), primary heart disease, use of vasoactive drugs, urine output before treatment, hemoglobin, serum creatinine, serum albumin, C-reactive protein(CRP), brain natriuretic peptide (BNP), cardiac ejection fraction (EF) and CRRT treatment time were analyzed to find out the prognostic influencing factors.@*Results@#A total of 130 cases were collected, including 96 cases in the survival group and 34 cases in the death group, with a total mortality rate of 26.15%. Compared to that in the death group, there were higher proportion of males (71.88% vs 50.00%, χ2=5.366, P=0.021), significantly higher initial MAP (t=4.677, P<0.001), much more urine output before treatment (Z=3.904, P<0.001), significantly higher serum creatinine (Z=2.866, P=0.004) , significantly lower hemoglobin (Z=-2.587, P=0.011), significantly shorter time of CRRT (Z=-3.447, P=0.001) in the survival group. Multivariate logistic regression analysis showed that female (OR=2.950, 95%CI 1.102-7.898, P=0.031) and higher levels of hemoglobin (OR=1.024, 95%CI 1.004-1.045, P=0.019) were the risk factors of death in patients undergoing CRRT for refractory acute left heart failure, while higher levels of mean arterial pressure before treatment (OR=0.959, 95%CI 0.930-0.989, P=0.008) and urine volume before treatment (OR=0.998, 95%CI 0.997-0.999, P=0.004) were the protective factors for patients' prognosis.@*Conclusion@#The mortality of patients with refractory acute left heart failure undergoing CRRT therapy is still very high. Female and higher level of hemoglobin are the risk factors for death, while more urine volume before treatment and higher MAP before treatment are protective factors for survival.

Hippocampal Subfield Volumes before and after Treatment for Mild Alzheimer's Disease: Study with Magnetic Resonance Imaging / 中国康复理论与实践

Objective:To investigate the hippocampal subfield volumes before and after taking hydrochloric donepezil in patients with mild Alzheimer's disease (AD). Methods:From January, 2017 to June, 2018, 25 mild AD patients accepted hydrochloric donepezil (treatment group), 25 patients accepted placebo (placebo group) and 25 age- and gender-matched healthy old people (control group) were scanned with magnetic resonance imaging (MRI) under 3D-T1 TFE sequence before and after a six-month treatment, and the automated segmentation of the hippocampus subfields was fulfilled with FreeSurfer and the hippocampus subfield volumes were compared, while the patients were assessed with Mini-Mental State Examination (MMSE). Results:Compared with the control group, the volumes of left CA1， CA2-3 and CA4-DG, and right CA1 and CA2-3 were reduced in patients before treatment (t > 2.294, P < 0.05). The volume of left CA4-DG increased in the treatment group compared with that of the placebo group after treatment (t = 2.196, P < 0.05), and the volume of bilateral CA1 and CA2-3 tended to increase but not significantly (t < 1.888, P > 0.065). The MMSE score was more in the treatment group than in the placebo group after treatment (t = 2.764, P < 0.05). Conclusion:The association with asymmetric atrophy in the hippocampal subfields has been found in mild AD patients, especially in left CA4-DG, which may be used as a valuable marker for diagnosis and evaluation for treatment at early stage.

Suspension method of double-ring breast fascia flap in treatment of sagging breast / 中华医学美学美容杂志

Objective To study the suspension method of double ring breast fascia flap in the treatment of sagging breast.Methods By double-ring skin full-thickness resection,suspension method of breast fascia flap was used in the treatment of sagging breast.The pedicle in the upper half of the breast fascia flap was vertically pulled down and then sutured in the lower quadrant of the breast and the pectoralis major.The sagging breast tissue was left and breast shape rebuilt.Results In the 50 patients their incision healed in phase 1.No skin necrosis and fat liquefaction occured.Nipple and areola had no blood barrier and disordered.Within 3 to 24 months visiting,incisions were without obvious scar.There was no sagging breast and breast shapes were satisfied.Conclusions This method reduces postoperative complications.It can restore the perfect breast shape and it is an ideal surgical method for sagging breast.

Application of metronomic chemotherapy in the treatment of advanced non-small cell lung cancer / 国际肿瘤学杂志

Metronomic chemotherapy is a brand-new and multi-target chemotherapy strategy.Totally different from the traditional chemotherapy,metronomic chemotherapy can exert synergistic and durable anti-tumor effects via multiple mechanisms,including cytotoxic effect,anti-angiogenesis,immune regulation and so on.Single and combined therapy modes of metronomic oral vinorelbine have good curative effects and safeties for the treatment of advanced non-small cell lung cancer.With the in-depth understanding of metronomic chemotherapy,it will certainly become an important treatment mode for advanced non-small cell lung cancer.

Elevated serum uric acid is an independent risk factor for the loss of renal function / 中华肾脏病杂志

Objective To investigate the relationship between serum uric acid level and renal function decline by retrospective cohort study.Methods Through the physical examination system of the First People's Hospital of Foshan,the physical examination data from 2015 to 2018 of a public institution in Foshan city were obtained.The gender,age,blood cell analysis,liver function,serum creatinine,uric acid,fasting blood glucose were obtained.The change of eGFR (△eGFR=eGFR2018-eGFR2015) was analyzed.Results A total of 2505 subjects were followed up for four years.The subjects were divided into △eGFR ≥0 group and △eGFR ＜ 0 group.There were 845 subjects in △eGFR ≥0 group,and 1660 subjects in △eGFR ＜ 0 group.Compared with that in △eGFR ＜ 0 group,the base-level of uric acid in △eGFR ≥ 0 group was higher [(349.48±87.62) μmol/L vs (325.72±82.58) μmol/L,t=6.669,P ＜ 0.001],but the rate of uric acid decline was greater [-15.00(-53.50,17.00) μmol/L vs 15.50(-18.00,49.00) μmol/L,Z=-13.470,P ＜ 0.001].According to the levels of uric acid in 2015 and 2018,then the subjects were divided into four groups,normal to normal group (N-N,1551 cases),normal change into high uric acid group (N-H,299 cases),high uric acid drop to normal group (H-N,238 cases),and high to high uric acid group (H-H,417 cases).The △eGFR was-1.58(-4.17,1.01) ml · min-1 · (1.73 m2) 1 in N-N group,and-3.60(-7.24,-0.98) ml · min-1 · (1.73 m2)-1 in N-H group,-0.20(-3.14,3.27) ml· min-1· (1.73 m2)-1 in H-N group,-0.96(-4.07,1.93) ml· min-1· (1.73 m2)-1 in H-H group,respectively.The △eGFR decreased most significantly in N-H group than the other three groups (x2=103.130,P ＜ 0.001).Multivariate logistic regression analysis showed that elevated uric acid was an independent risk factor for eGFR decline (OR=1.739,95％CI 1.587-1.906,P ＜ 0.001),while elevated indirect bilirubin (OR=0.968,95％CI 0.943-0.993,P=0.013),elevated red blood cells (OR=0.815,95％ CI 0.680-0.976,P=0.026) were independent protective factors for eGFR decline.Conclusion Elevated uric acid is an independent risk factor for the decline of renal function.Good control of hyperuricemia is beneficial to the protection of renal function.

A long-term effect of in situ artificial anal reconstruction using five combined operations / 中华整形外科杂志

Objective@#To explorea long-term effect of in situ artificial anal reconstruction using five-combined-operation technique after lower rectal cancer resection.@*Methods@#After miles operation, 60 patients suffered with lower rectal cancers underwent in situ artificial anal reconstruction using five-combined-operation technique, which included internal and external anal sphincter, rectal flap, rectal angle, and anoperineal reconstruction.@*Results@#All cases in this study were performed successfully, with primary healing in the wounds. Awareness of defecation had reoccurred in all cases since 1 week postoperatively and self-control of defecation had been regained since 3 weeks postoperatively with formed stool excreted once or twice a day. Long-term follow-ups: ①In 95% cases, rectal controlled discharge time was longer than 2 minutes, which was significantly higher than that of sphincter reconstruction group as a control(P<0.05). ② Five-year survival rate reached to 88%, which was significantly higher than that of the control group(P<0.05).@*Conclusions@#Anal reconstruction using five-combined operation method after Miles operation could be a safe and effective surgical procedure, which could completely cure tumor, and improve patients′ life quality and long-term survival rate.