Direct synthesis of branched amines enabled by dual-catalyzed allylic C─H amination of alkenes with amines.

Direct conversion of hydrocarbons into amines represents an important and atom-economic goal in chemistry for decades. However, intermolecular cross-coupling of terminal alkenes with amines to form branched amines remains extremely challenging. Here, a visible-light and Co-dual catalyzed direct allylic C─H amination of alkenes with free amines to afford branched amines has been developed. Notably, challenging aliphatic amines with strong coordinating effect can be directly used as C─N coupling partner to couple with allylic C─H bond to form advanced amines with molecular complexity. Moreover, the reaction proceeds with exclusive regio- and chemoselectivity at more steric hinder position to deliver primary, secondary, and tertiary aliphatic amines with diverse substitution patterns that are difficult to access otherwise.

Unified metal-free intermolecular Heck-type sulfonylation, cyanation, amination, amidation of alkenes by thianthrenation.

Direct and site-selective C-H functionalization of alkenes under environmentally benign conditions represents a useful and attractive yet challenging transformation to access value-added molecules. Herein, a unified protocol for a variety of intermolecular Heck-type functionalizations of Csp2-H bond of alkenes has been developed by thianthrenation. The reaction features metal-free and operationally simple conditions for exclusive cine-selective C-H functionalization of aliphatic and aryl alkenes to forge C-C, C-N, C-P, and C-S bonds at room temperature, providing a general protocol for intermolecular Heck-type reaction of alkenes with nucleophiles (Nu = sulfinates, cyanides, amines, amides). Alkenes undergo cine-sulfonylation, cyanation, amination to afford alkenyl sulfones, alkenyl nitriles and enamines.

Organophotocatalysed synthesis of 2-piperidinones in one step via [1 + 2 + 3] strategy.

Six-membered N-containing heterocycles, such as 2-piperidinone derivatives, with diverse substitution patterns are widespread in natural products, drug molecules and serve as key precursors for piperidines. Thus, the development of stereoselective synthesis of multi-substituted 2-piperidinones are attractive. However, existing methods heavily rely on modification of pre-synthesized backbones which require tedious multi-step procedure and suffer from limited substitution patterns. Herein, an organophotocatalysed [1 + 2 + 3] strategy was developed to enable the one-step access to diverse substituted 2-piperidinones from easily available inorganic ammonium salts, alkenes, and unsaturated carbonyl compounds. This mild protocol exhibits exclusive chemoselectivity over two alkenes, tolerating both terminal and internal alkenes with a wide range of functional groups.

Access to Trifluoromethylketones from Alkyl Bromides and Trifluoroacetic Anhydride by Photocatalysis.

Aliphatic trifluoromethyl ketones are a type of unique fluorine-containing subunit which play a significant role in altering the physical and biological properties of molecules. Catalytic methods to provide direct access to aliphatic trifluoromethyl ketones are highly desirable yet remain underdeveloped, partially owing to the high reactivity and instability of trifluoroacetyl radical. Herein, we report a photocatalytic synthesis of trifluoromethyl ketones from alkyl bromides with trifluoroacetic anhydride. The reaction features dual visible-light and halogen-atom-transfer catalysis, followed by an enabling radical-radical cross-coupling of an alkyl radical with a stabilized trifluoromethyl radical. The reaction provides straightforward access to aliphatic trifluoromethyl ketones from readily available and cost-effective alkyl halides and trifluoroacetic anhydride (TFAA).

Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward / 神经科学通报·英文版

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.

Intermolecular Metal-Free Cyclopropanation and Aziridination of Alkenes with XH2 (X=N, C) by Thianthrenation.

Three-membered cyclic structures are widely existing in natural products and serve as enabling intermediates in organic synthesis. However, the efficient and straightforward access to such structures with diversity remains a formidable challenge. Herein, a general and practical protocol to aziridines and cyclopropanes synthesis using free XH2 (X=C or N) with alkenes by thianthrenation is presented. This metal-free protocol features the direct aziridination and cyclopropanation with unprotected XH2 . Free sulfonamides, amides, carbamates, amines, and methylene with acidic protons, are good precursors, providing an attractive alternative for straightforward synthesis of aziridines and cyclopropanes from easily available starting materials.

Synthesis of ß-Thiolated-α-arylated Ketones Enabled by Photoredox and N-Heterocyclic Carbene-Catalyzed Radical Relay of Alkenes with Disulfides and Aldehydes.

ß-Thiolated-α-arylated ketones are perversive in bioactive molecules and serve as potential bidentate ligands for catalysis. Herein, a straightforward protocol to access ß-thiolated ketones from aldehydes, alkenes, and disulfides enabled by the combination of photocatalysis and N-heterocyclic carbene catalysis is reported. The sequential radical addition to alkenes and subsequent radical-radical coupling cascade process simultaneously forge C-S and C-C bonds. The mild conditions allow for radical relay coupling with a broad functional group tolerance.

Metal-free allylic C-H nitrogenation, oxygenation, and carbonation of alkenes by thianthrenation.

Selective functionalization of allylic C-H bonds into other chemical bonds is among the most straightforward and attractive, yet challenging transformations. Herein, a transition-metal-free protocol for direct allylic C-H nitrogenation, oxygenation, and carbonation of alkenes by thianthrenation was developed. This operationally simple protocol allows for the unified allylic C-H amination, esterification, etherification, and arylation of vinyl thianthrenium salts. Notably, the reaction furnishes multialkyl substituted allylic amines, ammonium salts, sulfonyl amides, esters, and ethers in good yields. The reaction proceeds under mild conditions with excellent functional group tolerance and could be applied to late-stage allylation of natural products, drug molecules and peptides with excellent chemoselectivity.

Synthesis of gem-Difluoroalkenes via Zn-Mediated Decarboxylative/Defluorinative Cross-Coupling.

An efficient and mild Zn-mediated decarboxylative/defluorinative alkylation of α-trifluoromethyl alkenes using N-hydroxyphthalimide esters as radical precursors was developed. Several α-trifluoromethyl alkenes were readily coupled to a wide range of primary, secondary, and tertiary radicals, affording the desired gem-difluoroethylenes in moderate to excellent yields. This reaction protocol was also successfully applied to the construction of complex molecules such as the bioactive natural dehydroabietic acid and glycosyl groups bearing the gem-difluoroethylene moiety.

Synthesis of Monofluoroalkenes through Visible-Light-Promoted Defluorinative Alkylation of gem-Difluoroalkenes with 4-Alkyl-1,4-dihydropyridines.

In this study, a facile and efficient method to synthesize monofluoroalkenes by photoredox catalytic defluorinative alkylation of gem-difluoroalkenes with 4-alkyl-1,4-dihydropyridines under mild conditions (room temperature) is described. This novel strategy is applicable for a broad range of gem-difluoroalkene substrates with good functional group tolerance and a variety of 4-alkyl-1,4-dihydropyridines (including primary, secondary, and even tertiary alkyl radicals). Moreover, it also allows the challenging radical coupling with glycosyl-based 4-alkyl-1,4-dihydropyridines (DHPs) to synthesize monofluoroalkenylated saccharides.

MRI features of hepatic epithelioid hemangioendothelioma / 中华肝胆外科杂志

Objective:To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods:The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results:Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T 1 weighted imaging (T 1WI), high signal on T 2 weighted imaging (T 2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T 1WI, high signal on T 2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T 1WI, high signal on T 2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" . Conclusion:MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other; a " target sign" on T 2WI; a capsule " shriveled sign " ; and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.

Debridement and bone grafting with internal fixation via anterior approach for the treatment of tuberculosis of lower cervical vertebrae / 中国骨伤

OBJECTIVE@#To evaluate the clinical effects of debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae.@*METHODS@#The clinical data of 15 patients with tuberculosis of lower cervical vertebrae who accepted the treatment of one-stage debridement and bone grafting with internal fixation from June 2010 to December 2018 were retrospectively analyzed. There were 9 males and 6 females, aged from 39 to 72 years with an average of (54.67±10.75) years. The lesion segment was C to C. Pre- and post-operative neurologic functions were evaluated by ASIA grade. All the patients underwent the X-ray films of positive and lateral of cervical spine before and after the operation and accepted the periodic review of CT to evaluate the bone grafting.@*RESULTS@#All the 15 operations were successful, no neurological or vascular injury occurred during the operation, and all patients were followed up for 18 to 52 months. The clinical symptoms improved significantly during the follow-up period and CT showed good bone grafting fusion. One patient suffered a relapse of the illness 3 years later, but was healed during the follow-up visit by strengthening the anti tuberculosis therapy.@*CONCLUSION@#For the patients with vertebral destruction and loss of cervical stability, one-stage debridement and bone grafting with internal fixation via anterior approach has definite curative effects. On the basis of standard anti tuberculosis treatment before operation, the long-term standard anti-tuberculosis treatment after operation is the key to healing the tuberculosis of lower cervical vertebrae.

Imaging and pathological study of primary central nervous system lymphoma in special sites / 中华神经科杂志

Objective:To summarize the imaging and pathological features of primary central nervous system lymphoma in special sites, and analyze some misdiagnosed cases to provide help for clinical diagnosis.Methods:Thirty-nine patients with primary central nervous system lymphoma diagnosed by pathology from 2000 to 2019 in Wenzhou People′s Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The imaging and pathological features of primary central nervous system lymphoma in special sites were summarized, and the misdiagnosed cases in these special sites were analyzed.Results:Primary central nervous system lymphoma in special sites included one case of primary dural lymphoma, with thickening of dura mater and obvious enhancement; two cases with lesions in lateral ventricle, with homogeneous enhancement, involving ependyma and spreading to medulla oblongata; two cases with lesions in middle cerebellar peduncle, with patchy abnormal signals and no specific masses, mild to moderate enhancement after enhancement, and one misdiagnosed as demyelinating lesions; one case with lesions in the sellar region which obviously enhanced with a typical “dent sign”, misdiagnosed as invasive pituitary tumor. All the pathological findings indicated diffuse large B cell lymphoma.Conclusions:It is difficult to diagnose primary central nervous system lymphoma in special sites, which is easy to cause misdiagnosis. Understanding its imaging characteristics and pathology can help to diagnose the disease.

A clinical study of haploidentical hematopoietic stem cell transplantation in the treatment of pediatric patients with acquired severe aplastic anemia: single center experience / 中华血液学杂志

Objective: To investigate the efficacy of haplotype hematopoietic stem cell transplantation in the treatment of acquired severe aplastic anemia (SAA) in children. Methods: The clinical characteristics of 59 pediatric patients with SAA, including 26 cases VSAA, 37males and 22 females, 47 cases typeⅠ and 12 cases typeⅡ, undrerwent haplo-HSCT in our hospital between December 1st, 2011 and December 1st, 2017 were retrospectively analyzed. Among 59 patients, 56 patients with a median age of 4.5 (1.2-14.8) years and median weight of 43 (12-80) kg underwent their first HSCT and 3 patients underwent their second HSCT. All patients received the following conditioning regimen: busulfan, cyclophosphamide, and rabbit ATG or Bu (-, CTX) , fludarabineand rabbit ATG. The prophylaxis of acute graft versus host disease (aGVHD) was cyclosporine (CsA) , MMF and methotrexate. All patients received bone marrow transfusion on day 01 and peripheral stem cell transfusion on day 02 from haploid donor. The median dose of donor mononuclear cell counts was 15.60 (7.74-21.04) ×108/kg of recipient weight and CD34+ cell counts was 4.86 (3.74-7.14) ×106/kg of recipient weight. Results: Neutrophils and platelets of all 59 children were implanted. The median implantation time of granulocytes and platelets were 13 (10-19) d, 19 (9-62) d, respectively. The incidence of grade Ⅰ-Ⅱ aGVHD was 45.76% (27 cases) and grade Ⅲ/Ⅳ 13.56% (8 cases) , The incidence of chronic GVHD was 8.47% (5 cases) , The incidences of CMV and EBV viremia were 59.32% (35 cases) and 28.81% (17 cases) , respectively. The median follow-up was 30 (8-80) months, 57 patients survived with disease free, 2 patients died of GVHD. Both of the estimated 5-year OS and DFS rates were (96.4±2.5) %. Conclusion: Haplo-HSCT could improve the outcomes of SAA children.

A clinical study of haploid hematopoietic stem cells combined with third-party umbilical cord blood transplantation in the treatment of chronic granulomatous disease / 中国当代儿科杂志

OBJECTIVE@#To investigate the clinical efficacy of haploid hematopoietic stem cells (haplo-HSC) combined with third-party umbilical cord blood (tpCB) transplantation in the treatment of X-linked chronic granulomatous disease (X-CGD).@*METHODS@#The clinical data of 26 boys with X-CGD were retrospectively analyzed who were admitted to the Sixth Medical Center of PLA General Hospital between April 2014 and March 2018. All the patients were treated with haplo-HSC combined with tpCB transplantation. The median age of the patients was 3.5 years. The donor was the father in 25 cases and an aunt in 1 case. Transplantation was 5/6 HLA-matched in 9 cases, 4/6 in 12 cases, and 3/6 in 5 cases. The patients received busulfan, cyclophosphamide, fludarabine, or anti-thymocyte globulin for myeloablative preconditioning. Cyclosporine A and mycophenolate mofetil were used for prevention of acute graft-versus-host disease (aGVHD). Then the patients were treated with haploid bone marrow hematopoietic stem cells combined with tpCB transplantation on day 1 and haploid peripheral hematopoietic stem cells on day 2. The counts of median donor total nucleated cells, CD34 cells, and CD3 cells were 14.6×10/kg, 5.86×10/kg, and 2.13×10/kg respectively.@*RESULTS@#The median time to neutrophil and platelet engraftment was 12 and 23 days after transplantation respectively. Full donor hematopoietic chimerism was observed on day 30. Twenty-five cases were from haplo-HSC and 1 was from cord blood. No primary implant failure and implant dysfunction occurred, and secondary implant failure occurred in one case. The NADPH oxidase activity returned to normal one month after transplantation. The incidence of grade I-II aGVHD and grade III-IV aGVHD was 35% and 15% respectively. Chronic GVHD (cGVHD) of the skin occurred in one case, and no progression was observed after steroid administration. During the follow-up period of 6-51 months, 25 patients survived, of whom 24 were disease-free (23 patients without cGVHD and 1 with cGVHD of the skin) and NADPH oxidase activity returned to normal; one patient developed secondary implant failure but survived; one patient died of viral interstitial pneumonia 16 months after transplantation. The 5-year event-free survival rate and overall survival rate were 81%±12% and 89%±10% respectively.@*CONCLUSIONS@#Haplo-HSC combined with tpCB transplantation is one of the effective methods for the treatment of X-CGD in children.

Effect of Peiyuan Tongnao Capsule on Recovery of Neurological Impairment of Ischemic Stroke in Recovery Period and Its Mechanism of Action / 中国实验方剂学杂志

Objective: To discuss the effect of Peiyuan Tongnao capsules on neurological impairment of patients with ischemic stroke at convalescence, and discuss the mechanism of action in microcirculation improvement, anti-inflammation and neuroprotection. Method: One hundred and thirty one patients were randomly divided into control group (66 cases) and observation group (65 cases) by random number table. Patients in control group were given aspirin enteric-coated tablets, 0.1 g/day, simvastatin tablets, 10 mg/days, and treated by percutaneous nerve electrical stimulator for 30 times, 30 min/time, 1 time/day, 5 times/week. In addition of the therapy in control group, patients in observation group were also given Peiyuan Tongnao capsules, 3 grains/time, 3 times/days. A course of treatment was 12 weeks. Before treatment, and at the 4th, 8th and 12th weeks, neurological deficits in the national institutes of health (NIHSS), activity of daily life scale (ADL), berg balance scale (BBA), fugl-meyer scale (FMA) and traditional Chinese medicine (TCM) syndromes were scored. And levels of brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), homocysteine (Hcy) and serum cystatin C (Cys-C) and hemorheological indicators whole blood viscosity, high shear rate, low shear rate, reduced viscosity, plasma viscosity, platelet aggregation rate, fibrinogen (FIB) and blood sedimentation rate (ESR)were detected. Result: At the 8th and 12th week after treatment, score of NIHSS in observation group was lower than that in control group (PPPα, Hcy, Cys-C and hemorheological indices were all lower than those in control group (PPConclusion: Peiyuan Tongnao capsules can promote the recovery of neurological impairment at recovery period of ischemic stroke, regulate inflammatory factors, improve blood rheology, protect neural function, and improve the effect of routine western medicine rehabilitation therapy.

Characteristics of patients on methadone maintenance treatment in Taizhou City / 预防医学

Objective To investigate the characteristics of methadone maintenance treatment(MMT)clients, and to explore their retention rate and associated factors in Taizhou, Zhejiang Province. Methods Heroin or opiate addicts who started MMT between 2006 and 2014 in study area were included. Data including demographics, history of drug use and treatment information was extracted from the National MMT Data Management System and descriptive analysis were conducted. Multiple logistic regression models were used to explore factors associated with retention rate. Results In total, 2 262 MMT clients were included for analysis. Most of them were male(87.53%), single, divorced or widowed(55.75%), and had an education of junior middle school or below(88.68%). Almost all of them (98.32%)were heroin addicts, and the age at first drug use ranged from 9 years to 54 years, with average age of(25.06±6.34)years. A total of 1 123(49.65%)clients had a history of inject drug use and 81(3.58%)clients had ever shared needles with others. The average duration on MMT was 5.02±2.01 years, and the average methadone dosage during treatment was (34.49 ±22.69)mL. The MMT retention rate was 29.2% (661/2 262). In multivariable analysis, districts such as Huangyan District, Yuhuan County and Linhai City, aged≥40 years and average methadone dosage>20 mL during treatment were independently and positively associated with retention rate. Conclusion Most of MMT clients in Taizhou are male, unmarried, and had low education level. The retention rate is low in Taizhou but older patents and those receive high methadone dosage have a relatively higher retention rate.

Application of radical method to evaluation of antioxidant activity of Vleriana jatamansi Jones / 药学学报

The antioxidant activities of Vleriana jatamansi Jones were investigated and the relationship between the antioxidant effect and the chemical structure was explored. The free radical scavenging test, 2,2-diphenyl-1-picrylhydrazyl (DPPH•), was used to evaluate the antioxidant activities of the extracts of Vleriana jatamansi Jones with 0−100% menthol as extraction solvents. The polar and nonpolar HPLC conditions were conducted to isolate the main chemical compositions. The DPPH• tests were used in analysis of the free radical scavenging activities. Under polar HPLC separation conditions, 5 kinds of compounds were detected:chlorogenic acid, 3,5-dicaffeoylquinic acid, 4,5-dicaffeoylquinic acid, hesperidin, and coffeic acid; under nonpolar HPLC separation conditions, acevaltrate, 1β-acevaltrate and valtrate were founded. Chlorogenic acid, 3,5-dicaffeoylquinic acid, and 4,5-dicaffeoylquinic acid presented high DPPH• free radical scavenging activities. The results of antioxidant activity suggested that the coffee acyl from chlorogenic acid-like compounds had a high DPPH• free radical scavenging ability. Our investigation indicated that structure of the ortho hydroxyl phenol of chlorogenic acid-like compounds play a significant role in antioxidant activities. In addition, this work can also provide method and theory reference for improving the antioxidant activities of Vleriana jatamansi Jones.

Evaluation on the design and application effect of pure water analysis system of medical proton and heavy ion accelerator / 中国医学装备

Objective: To design an online pure water analysis system based on the proton and heavy ion accelerator (IONTRIS system) in Shanghai proton and heavy ion center (SPHIC), and to evaluate its application effect by operating data statistics. Methods: The system used the control system of Siemens S7-300 PLC to collect online data from sensors of pure water system. Analyzing the operation rules and setting the limiting value of alarm, and using WINCC software to develop monitoring and analysis system of central computer so as to real-time operate online data. The application effect of the system was evaluated by comparing the cost of one month consumables between before and after the system was applied. Results: After the system was applied, the real-time monitoring of pure water system was realized, and the efficiency of the consumables was enhanced. Conclusion: The application of the pure water analysis system has a good effect on the operation efficiency of the pure water system.

Diagnostic value of of Peptest in laryngopharyngeal reflux disease / 医学研究生学报

Objective At present,there are relatively few studies on the application of pepsin in the diagnosis of laryngopha -ryngeal reflux disease(LPRD)in China.This paper aimed to evaluate the application value of Peptest in the diagnosis of LPRD by measuring saliva/sputum pepsin in patients with chronic pharyngitis. Methods From January to June 2017,35 patients with chronic pharyngitis treated in our department were selected to undertake electronic laryngoscopy and evaluated by reflux finding score(RFS) and reflux symptom index(RSI)scoring.The patients'saliva/sputum samples were collected three times for pepsin concentration de-tection(PEPTEST).The first collection was before mouthwash in the morning,the second was 1h after lunch,and the third was the time of evident symptoms.Comparative research was carried out on the above results. Results The average RSI score and RFS score were11.31±6.21 and 5.97±1.98.The pepsin content in morning saliva/sputum[26.80(0,109.80)ng/mL]was significantly lower than that at 1 h after lunch[89.00(16.0,254.8)ng/mL]and that at the time of obvious symptoms[105.70(34.3,254.8)ng/mL](P<0.05).The area under ROC of Peptest in the morning[0.759(0.602, 0.917)],1h after lunch[0.824(0.670,0.978)], at the time of ob-vious symptoms were all greater than the combination of RSI and RFS, representing significant statistical differences(P<0.05). Conclusion Compared with traditional method(a combination of RSI and RFS),Peptest has more important clinical value in the diag-nosis of LPRD.