Key to successful treatment of COVID-19: accurate identification of severe risks and early intervention of disease progression

BackgroundCOVID-19 is a new and highly contagious respiratory disease that has caused global spread, high case fatality rate in severe patients, and a huge medical burden due to invasive mechanical ventilation. The current diagnosis and treatment guidelines are still need to be improved, and more excellent clinical experience is needed to provide reference. MethodsWe analyzed and summarized clinical data of 97 confirmed COVID-19 adult patients (including 26 severe cases) admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, 2020 to March 10, 2020, included laboratory examination results, imaging findings, treatment effect, prognosis, etc, in order to put forward prediction index of severe COVID-19 patients, principles of early intervention and methylprednisolone usages in COVID-19 patients. ResultsO_LIHypoxemia, hyperlactic acid, hypoproteinemia, and hypokalemia were prevalent in COVID-19 patients. The significant low lymphocyte count, hypoproteinemia, hypokalemia, the persistent or worsen high CRP, high D-dimer, and high BNP, and the occurrence of hemoptysis and novel coronavirus (SARS-CoV-2) viremia were important indicators for early diagnosis and prediction of severe disease progression. C_LIO_LICharacteristic images of lung CT had a clear change in COVID-19, Ground-glass opacity (GGO) and high-density linear combinations may indicate different pathological changes. Rapid lobular progression of GGO suggests the possibility of severe disease. C_LIO_LIBasic principles of early intervention treatment of COVID-19: on the premise of no effective antiviral drugs, treatment is based on supportive and symptomatic therapy (albumin supplementation, supplement of potassium, supplement blood plasma, etc.) in order to maintain the stability of the intracellular environment and adequately reactivate body immunity to clean up SARS-CoV-2. C_LIO_LIAccording to severity, oxygenation index, body weight, age, underlying diseases, appropriate amount methylprednisolone application on severe/critical COVID-19 patients on demand, improved blood oxygen and reduced the utilization rate of invasive mechanical ventilation, case fatality rate and medical burden significantly. The most common indications for invasive mechanical ventilation should be strictly control in critical COVID-19 patients. C_LI ConclusionsO_LIAccurate and timely identification of clinical features in severe risks, and early and appropriate intervention can block disease progression. 2. Appropriate dose of methylprednisolone can effectively avoid invasive mechanical ventilation and reduce case fatality rate in critical COVID-19 patients. C_LI

A high efficient hospital emergency responsive mode is the key of successful treatment of 100 COVID-19 patients in Zhuhai

BackgroundSince December 2019, Coronavirus Disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. The mortality of novel coronavirus pneumonia (NCP) in severe and critical cases is very high. Facing this kind of public health emergency, high efficient administrative emergency responsive mode in designated hospital is needed. MethodAs an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Dont stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. Results1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effect: Among 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3. Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital. ConclusionsIn our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation.

Evidence for gastrointestinal infection of SARS-CoV-2

The new coronavirus (SARS-CoV-2) outbreak originating from Wuhan, China, poses a threat to global health. While its evident that the virus invades respiratory tract and transmits from human to human through airway, other viral tropisms and transmission routes remain unknown. We tested viral RNA in stool from 73 SARS-CoV-2-infected hospitalized patients using rRT-PCR. 53.42% of the patients tested positive in stool. 23.29% of the patients remained positive in feces even after the viral RNA decreased to undetectable level in respiratory tract. The viral RNA was also detected in gastrointestinal tissues. Furthermore, gastric, duodenal and rectal epithelia showed positive immunofluorescent staining of viral host receptor ACE2 and viral nucleocapsid protein in a case of SARS-CoV-2 infection. Our results provide evidence for gastrointestinal infection of SARS-CoV-2, highlighting its potential fecal-oral transmission route.

Incidence and Survival Changes in Patients with Esophageal Adenocarcinoma during 1984-2013.

PURPOSE: The morbidity of esophageal adenocarcinoma (EAC) has significantly increased in Western countries. We aimed to identify trends in incidence and survival in patients with EAC in the recent 30 years and then analyzed potential risk factors, including race, sex, age, and socioeconomic status (SES). METHODS: All data were collected from the Surveillance, Epidemiology, and End Results or SEER database. Kaplan-Meier analysis and the Cox proportional hazards model were conducted to compare the differences in survival between variables, including sex, race, age, and SES, as well as to evaluate the association of these factors with prognosis. RESULTS: A total of 16,474 patients with EAC were identified from 1984 to 2013 in the United States. Overall incidence increased every 10 years from 1.8 to 3.1 to 3.9 per 100. Overall survival gradually improved (p < 0.0001), which was evident in male patients ((hazard ratio (HR) = 1.111; 95% confidence interval (CI) (1.07, 1.15)); however, the 5-year survival rate remained low (20.1%). The Cox proportional hazards model identified old age, black ethnicity, and medium/high poverty as risk factors for EAC (HR = 1.018; 95% CI (1.017, 1.019; HR = 1.240, 95% CI (1.151,1.336), HR = 1.000, 95% CI (1.000, 1.000); respectively). CONCLUSIONS: The incidence of EAC in the United States increased over time. Survival advantage was observed in white patients and patients in the low-poverty group. Sex was an independent prognostic factor for EAC, but this finding has to be confirmed by further research.

Diagnostic value of MRI and mammography in ductal carcinoma in situ of the breast / 中国基层医药

Objective@#To investigate the diagnostic value of MRI and molybdenum target in ductal carcinoma in situ (DCIS).@*Methods@#From June 2014 to June 2018, 58 patients diagnosed as DCIS in Heji Hospital Affiliated to Changzhi Medical College were chosen.MRI and mammography were performed, and the diagnostic potency of the two methods was observed.@*Results@#The coincidence degree of molybdenum target X-ray and MRI diagnosis: the coincidence coefficient kappa=0.452 of molybdenum target X ray and MRI showed that the two diagnostic methods were in general anastomosis.The diagnostic consistency of different examination methods: the diagnostic consistency of molybdenum target combined with MRI (96.6%) was significantly higher than that of molybdenum target X(82.8%), the difference was statistically significant (χ2=5.95, P<0.05), and there was no statistically significant difference compared with MRI(89.7%) (χ2=2.43, P>0.05).@*Conclusion@#Molybdenum target and MRI in diagnosis of DCIS have their own characteristics.Combined application can improve the diagnostic effect.

Diagnostic value of MRI and mammography in ductal carcinoma in situ of the breast / 中国基层医药

Objective To investigate the diagnostic value of MRI and molybdenum target in ductal carcinoma in situ (DCIS).Methods From June 2014 to June 2018,58 patients diagnosed as DCIS in Heji Hospital Affiliated to Changzhi Medical College were chosen.MRI and mammography were performed,and the diagnostic potency of the two methods was observed.Results The coincidence degree of molybdenum target X-ray and MRI diagnosis:the coincidence coefficient kappa=0.452 of molybdenum target X ray and MRI showed that the two diagnostic methods were in general anastomosis.The diagnostic consistency of different examination methods:the diagnostic consistency of molybdenum target combined with MRI ( 96. 6%) was significantly higher than that of molybdenum target X (82.8%),the difference was statistically significant (χ2 =5.95,P＜0.05),and there was no statistically significant difference compared with MRI (89.7%) ( χ2 =2.43, P >0.05). Conclusion Molybdenum target and MRI in diagnosis of DCIS have their own characteristics.Combined application can improve the diagnostic effect.

Application of intracranial lead reconstruction in deep brain stimulation therapy in patients with Parkinson's disease / 南方医科大学学报

OBJECTIVE@#To evaluate the feasibility of applying intracranial lead reconstruction in deep brain stimulation (DBS) therapy for Parkinsonism.@*METHODS@#We retrospectively collected the clinical data from 27 patients with Parkinson's disease (PD), who received bilateral subthalamic nucleus (STN) DBS therapy between January, 2016 and December, 2017. According to the position of the selected optimal stimulating contact of the implanted leads, the patients were divided into group A with the stimulating contacts of the bilateral leads in the STN, group B with unilateral stimulating contacts in the STN, and group C with bilateral stimulating contacts outside the STN. All the patients were assessed for improvement using Hoehn-Yahr stage, the third part of United Parkinson's Disease Rating Scale (UPDRS Ⅲ), Schwab and England Activities of Daily Living (SE-ADL), and L-dopa equivalent daily dose (LEDD). The consistency between the optimal stimulating contact selected by lead reconstruction and that by standard postoperative programming procedure was also evaluated.@*RESULTS@#The patients in all the 3 groups showed postoperative improvements in Hoehn-Yahr stage, UPDRS Ⅲ score, SE-ADL score, and LEDD in the medication-off state. But at 12 months of the follow-up, such improvements were maintained only in the patients of group A. The optimal stimulating contacts selected by lead reconstruction and standard postoperative programming procedure had a matching rate of up to 77.78% (42/54), and the coordinates of the optimal contacts selected by the two methods showed no significant difference.@*CONCLUSIONS@#Intracranial lead reconstruction facilitates the study of the association between the implant site of the leads and the clinical outcome of DBS therapy for PD and allows the precise selection of the optimal contact of the implanted leads in postoperative programming of DBS.

Role of TLR4 in process of colonic inflammation recovery induced by LPS / 中国病理生理杂志

AIM: To study the roles of Toll-like receptor 4 ( TLR4 ) and TLR4 activator lipopolysaccharide ( LPS) in colonic inflammation recovery .METHODS:Normal intestinal epithelial cells were cultured with LPS in vitro. The subgroups of the intestinal epithelial cells with differential expression of TLR 4 ( low, normal and high ) were construc-ted by the technique of lentivirus transfection .The cells with normal and high expression of TLR 4 were induced by LPS for 0 h, 2 h and 4 h.Inflammatory cytokines TNF-α, IL-6 and IL-8 in the culture supernatant were detected by ELISA .The mRNA levels of TNF-α, IL-6, IL-8, IL-10 and IL-1βwere detected by qPCR .The cell mobility was also monitored by wound healing assay .RESULTS:The protein expression of TLR 4 was significantly higher after LPS treatment than that in control groups of both cells with TLR4 normal and high expression (P<0.05).The inflammatory cytokines TNF-α, IL-6, IL-8 and IL-1βat mRNA and protein levels were also significantly increased after LPS treatment compared with control group (P<0.05).The protein levels of TNF-α, IL-6 and IL-8 between the 2 groups were also different with statistical sig-nificance ( P<0.05 ) .Higher mobility was observed in the cells with TLR 4 high expression compared to control cells . CONCLUSION:LPS induction might play a role in the activation of TLR 4-mediated inflammatory pathways by up-regula-ting the expression of inflammatory cytokines at both transcriptional and translational levels .

Influence of CCL21 on the invasion and metastasis of colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of CCL21 on the invasion and metastasis of colorectal cancer (CRC).</p><p><b>METHODS</b>CCL21 over-expressing CRC cell line was constructed by lentivirus infection and CCL21 low-expressing CRC cell line was constructed by lipofection. The effects of CCL21 on the invasion and metastasis of CRC cells and the stem cell-like phenotype were investigated by Transwell migration, invasion assay, wound healing assay and sphere formation assay.</p><p><b>RESULTS</b>Real-time quantitative PCR and western blot confirmed that the expression of CCL21 was up-regulated by lentiviral transfection and down-regulated by siRNA liposome transfection. In vitro, Transwell assays showed that the invasion and migration in CCL21 over-expressing CRC cells decreased significantly as compared to those of CCL21 low-expressing cells. In wound healing assay, the CCL21 over-expressing CRC cells showed a significantly lower rate of migration. In addition, the sphere formation rate and density of CCL21 over-expressing CRC cells were lower than those with low-expression of CCL21.</p><p><b>CONCLUSION</b>CCL21 can suppress the migration and invasion of CRC cells and weaken their stem cell-like phenotype.</p>

Clinical observation on electroacupuncture plus tuina for chronic tension-type headache / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of electroacupuncture (EA) combined with tuina for chronic tension-type headache (CTTH). Methods:A total of 97 CTTH cases were randomly allocated into an observation group (n=52) and a control group (n=45). Patients in the observation group were treated with EA plus tuina based on pattern identification, whereas patients in the control group were treated with oral amitriptyline and oryzanol. Patients in both groups were treated for 8 weeks. A follow-up was conducted 3 months after the treatment. The intensity, duration, and frequency of the headache were recorded and compared before and after the treatment. Additionally, the patients' psychological state and quality of life (QOL) were compared between the two groups. Results:There were intra-group statistically significant differences in headache intensity score, headache duration, and headache frequency after the treatment and during the follow-up compared with those before the treatment (allP0.05). The World Health Organization quality of life-BREF (WHOQOL-BREF) scores were significantly reduced in both groups after the treatment or during the follow-up (allP<0.05); and the scores in the observation group were significantly lower than those in the control group (allP<0.05) during the same time frame. The total effective rate was 88.0% in the observation group, versus 71.4% in the control group, showing a significant difference (P<0.05). Conclusion:EA combined with tuina can significantly decrease the frequency of chronic tension-type headache, alleviate headache intensity, shorten headache duration, and improve the patients' wellness. It is better than amitriptyline plus oryzanol.

Intraperitoneal injection of bleomycin induces pulmonary fibrosis in mice:a long-term stability evaluation / 中国组织工程研究

BACKGROUND:There is no effective drug for idiopathic pulmonary fibrosis (IPF), because of a lack of the animal model imitating the complete pathogenesis of human IPF. Therefore, it is critical to establish an ideal animal IPF model used for investigating the underlying pathogenesis and developing a kind of effective drug. OBJECTIVE:To establish an animal model that can mimic more characters of human IPF. METHODS:Seventy male C57BL/6 mice were randomly divided into two groups, fol owed by subjected to the intraperitoneal injection of bleomycin (35 mg/kg) on days 1, 4, 8, 11, 15, 18, 22, and 25, twice (group A) or once (group B) a week. Mice were sacrificed at 2, 4, 6, 8, and 10 weeks after the eighth injection, and the lung tissues were moved used for hematoxylin-eosin, Masson and immunohistochemical stainings. RESULTS AND CONCLUSION:There were various degrees of alveolitis and pulmonary fibrosis in the two groups at different time points after the last injection. The scores of alveolitis and pulmonary fibrosis in the group A began to gradual y increase from the 2nd week and reached the highest level at the 6th-8th weeks until the 10th week. In contrast, the scores of alveolitis and pulmonary fibrosis in the group B peaked at the 2nd week, then fluctuately decreased, and were significantly lower than those in the group A at the 6th week (P<0.05). Immunohistochemistry showed that type I col agen deposition was mainly distributed in the subpleural region, peri-vascular region and alveolar septa, which was consistent with Masson staining findings. The expression levels of transforming growth factorβ1 (TGF-β1) andα-smooth muscle actin (α-SMA) in the regions developing alveolitis and pulmonary fibrosis were significantly increased. In the group A, the expression levels of type I col agen, TGF-β1,α-SMA, and the hydroxyproline content in the lung tissues reached the peak level at 6-8 weeks. However, in the group B, al above indicators reached the highest level at the 2nd week, but gradual y decreased thereafter. At the 4th week, the expression Levels of TGF-β1 andα-SMA in the group B were significantly lower than those in the group A (P<0.05). At the 6th week, the hydroxyproline and type I col agen levels in the group B were significantly lower than those in the group A (P<0.05). In conclusion, the mouse model of pulmonary fibrosis induced by intraperitoneal injection of 35 mg/kg bleomycin twice weekly can be used to mimic the repetitive wound healing process, pathological morphology and cytokine changes of human IPF, which is prone to administration, with better stability and repeatability. This model is of great significance for the study on IPF. Subject headings:Disease Models, Animal;Pulmonary Fibrosis;Bleomycin

Risk factors of early surgical intervention in Crohn's disease patients with spontaneous intra-abdominal abscess / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of early surgical intervention in Crohn's disease (CD) patients with spontaneous intra-abdominal abscess.</p><p><b>METHODS</b>Clinical data of 94 CD patients with spontaneous intra-abdominal abscess admitted to The Sixth Affiliated Hospital of Sun Yat-sen University between May 2008 and Dec 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate the early surgery risk of CD patients with spontaneous intra-abdominal abscess using logistic regression model.</p><p><b>RESULTS</b>A total of 94 eligible patients were identified from our registry, including 70 males and 24 females. The mean age at the diagnosis of CD and at development of abscess was 28.4 years and 30.4 years old, respectively. The median duration of CD between the diagnosis and development of an abscess was 3 years. According to the Montreal classification, L3 (ileocolonic) was the most common disease location (81.9%) in these patients. Most of the patients(76.6%) developed a single abscess, while multiple abscesses were detected in 22 patients(23.4%). Forty-four patients(46.8%) underwent surgery within 60 days after hospitalization due to spontaneous intra-abdominal abscess complicating CD. Multivariate logistic regression analysis revealed that history of abdominal surgery(OR=3.23, 95%CI:1.12 to 9.31, P=0.030), concomitant intestinal stenosis (OR=3.52, 95%CI:1.26 to 9.85, P=0.017) and concomitant intestinal fistula (OR=4.31, 95%CI:1.25 to 14.80, P=0.020) were the independent risk factors of early surgical intervention, while enteral nutrition (OR=0.18, 95%CI:0.05 to 0.62, P=0.007) was the independent protective factor.</p><p><b>CONCLUSIONS</b>Nearly half of CD patients with spontaneous intra-abdominal abscess will undergo early surgical intervention. Patients with history of abdominal surgery, concomitant intestinal stenosis and concomitant intestinal fistula have higher risk of early surgical intervention, and appropriate application of enteral nutrition may reduce the risk.</p>

Expression and clinical significance of G protein-coupled receptor 31 in colorectal cancer tissue / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression and clinical significance of G protein-coupled receptor 31 (GPR31) in colorectal cancer tissue.</p><p><b>METHODS</b>Cancer tissues and adjacent normal tissues of 321 cases with colorectal cancer confirmed by pathology and undergoing resection in the First Affiliated Hospital of Sun Yat-sen University from January 1996 to December 2008 were collected. The expression of GPR31 was examined by immunohistochemical staining. According to the expression level of GPR31 (A value=0.051), all the patients were divided into low GPR31 expression group and high GPR31 expression group. Clinicopathology and prognosis between the two groups were compared. Risk factors affecting prognosis were investigated.</p><p><b>RESULTS</b>GPR31 expression was significantly higher in colorectal cancer tissues compared to adjacent normal tissues (mean A, 0.063±0.014 vs. 0.045±0.020, P<0.001). A total of 197 cancer tissue samples were defined as low expression and 124 as high expression. Significant difference was observed in the number of patient in pM classification between the two groups (P=0.007). High expression group had obviously higher distant metastasis rate than low expression group [12.1% (15/124) vs. 4.1% (8/197), P=0.007]. The 5-year survival rate and tumor-free survival rate were 84.3% and 82.2% in the low expression group, and both 59.7% in high expression group (all P<0.05). Multivariate analysis revealed elderly, abnormal CEA, lymphatic metastasis, distant metastasis and up-regulated GPR31 expression were independent risk factors of overall survival and disease-free survival in colorectal cancer patients (all P<0.05).</p><p><b>CONCLUSIONS</b>GPR31 expression is significantly up-regulated in colorectal cancer tissues. High GPR31expression indicates poor prognosis of colorectal cancer, and may be used as a predictive marker.</p>

Intravenous injection of bleomycin induces pulmonary fibrosis in mice：a stability evaluation / 中国组织工程研究

BACKGROUND:It is particularly important to establish an ideal animal model of pulmonary fibrosis to investigate the underlying pathogenesis and screen effective drugs to prevent and control pulmonary fibrosis. OBJECTIVE: To establish a modified scheme of establishing mouse models that can reflect pulmonary fibrosis formation in humans. METHODS: Fifty-six male C57BL/6 mice were randomly divided into two groups: A (a single large-dose injection) and B (multiple smal-dose injections). Mice in group A were subjected to a single intravenous injection of bleomycin 200 mg/kgviathe tail vein; and mice in group B received intravenous injections of bleomycin 50 mg/kg via the tail vein per week, totaly for 6 weeks. 

Expression and prognostic significance of interleukin-36α in colorectal cancers / 中国医师杂志

Objective To investigate the expression and prognostic significance of Interleukin-36α (IL-36α) in colorectal cancer.Methods The expression of IL-36α was tested by immunohistochemical staining in 329 cases of colorectal cancer.According to the intensity and the proportion of positive tumor cells,all the patients were divided into IL-36α low and high expression groups.The clinicopathological factors and prognosis of patients between IL-36α low high expression groups were compared.Results Significant differences were observed in the number of patients in tumor differentiation and pM classification between patients in the IL-36α low and high expression groups (P ＜ 0.05).The 5-year overall and tumorfree survival rates of patients were 79.3％ and 77.2％ in IL-36α low expression group,and 66.3％ and 65.3％ in IL-36α high expression group (P ＜0.05).COX proportional hazard regression model revealed that high expression of IL-36α was associated with short overall survival time and tumor-free survival time of colorectal cancer patients (P ＜ 0.05).Multivariate analysis identified IL-36α expression in colorectal cancer as an independent prognosticator (P ＜ 0.05).Conclusions High expression of IL-36α was correlated with tumor differentiation and pM classification of colorectal cancers,and it is an independent predictor of poor survival for patients with colorectal cancer.

Therapeutic Efficacy and ADR Evaluation of Amphotericin B in the Treatment of AIDS Complicating with Fungal Infections / 中国药房

OBJECTIVE:To evaluate therapeutic efficacy and ADR of amphotericin B in the treatment of AIDS combined with fungal infections retrospectively. METHODS:The cases of amphotericin B in the treatment of AIDS combined with fungal in-fections were collected our hospital. Total therapeutic efficacy,distribution of pathogenic bacteria,clearance rate and ADR were evaluated. RESULTS:89 patients were involved totally,among which 45 cases were marked effect,32 cases improved and 12 cas-es failed,with effective rate of 86.5%. The fungus were found or cultured in 76 cases,among which 64 strains were cleared,but 12 strains were not,with total clearance rate of 84.2%. There were 41 ADR cases(46.1%),while all completed the treatment ex-cept 2 developing severe renal failure(2.2%). CONCLUSIONS:Domestic amphotericin B could effectively treat AIDS complicat-ing with fungal infections,and the ADRs were acceptable.

The clinical analysis of retreatment with erlotinib in advanced non-small cell lung cancer / 中国癌症杂志

Background and purpose:It has a signiifcant effect for erlotinib on treatment of patients with epidermal growth factor receptor mutation in advanced non-small cell lung cancer (NSCLC). But almost all patients will eventually progress for the resistance of drug. This study was to evaluate the efifcacy and safety of retreatment of erlotinib in patients with advanced NSCLC. Methods:It was a retrospective analysis of the 46 advanced NSCLC patients who previously treated with erlotinib and had clinical beneift. The patients were given erlotinib 150 mg orally once daily after failure to other medications until disease progression or the occurrence of intolerable toxicity. The clinical features, therapeutic effect and survival were analyzed. Results: The objective response rate of retreatment with erlotinib was 28.3%. The disease control rate was 60.9%. The rate of symptom relief was 45.7%. The median progression-free survival was 3.6 months. The median overall survival was 7.3 months. One-year survival rate was 8.7%. The median progression-free survival was signiifcant longer in the patients who stopped taking erlotinib more than 6 months than those less than 6 months (P=0.002). The median overall survival was signiifcant longer in the patients whose ECOG ≤2 than those ECOG >2 (P=0.038). The most common drug-related adverse events were rash and diarrhea. Conclusion:The retreatment of erlotinib could possibly prolong the survival time of patients who previously treated with erlotinib and had clinical beneift.

The relationship between the activity of platelet and the chronic cor pulmonale / 中国综合临床

Objective To investigate the clinical significance of piatelet activity in patients with chronic cor Dulmonale.Methods PAC-1 and CD62p was measured with flow cytometry in whole blood samples from 40 patients and 30 normal controls.The pulmonary arterial pressure was detected through Doppler echocardiography.The arterial partial pressure of oxygen and the carbon dioxide were also analyzed.Results PAC-1 and CD62p increased significantiy (P<0.01).Conclusion Platelet activity is positively related to pulmonary artrial systolic pressure,CO2 partial pressure,and negatively related to O2 partial pressure.

New Solutions of Translation Initiation Site Prediction for Prokaryotic Genomes / 生物化学与生物物理进展

Accurate prediction of the translation initiation site (TIS) is an important issue for prokaryotic genome annotation. However, it is still a challenge for the existing methods to predict the TIS in the genomes over a wide variety of GC content. Besides, the existing methods have not yet undergone a comprehensive evaluation, leaving prediction reliability as a largely open problem. A new algorithm MED-StartPlus, a tool that predicts TIS in prokaryotic genomes with a wide variety of GC content was presented. It makes several efforts to model the nucleotide composition bias, the regulatory motifs upstream of the TIS, the sequence patterns around the TIS, and the operon structure. Tests on hundreds of reliable data sets, with TISs confirmed by experiments or having annotated functions, show that the new method achieves a totally high accuracy of TIS prediction. Compared with existing TIS predictors, the method reports a totally higher performance, especially for genomes that are GC-rich or have complex initiation mechanisms. The potential application of the method to improve the TIS annotation deposited in the public database was also proposed.

A Moditied Island Flap Technique For Repair of Severe Hypospadias / 中国医师杂志

Objective To present a moified technique of island flap (Duckett+Perovic's method)for repair of severe hypospadias.Methods Between January 1996 and May 2002,26 cases of severe hypospadias were repairs using Perovic's method in a lonely or using Duckett's method plus Perovic's method.In all patients,we employed island flaps in one stage.Suprapubic diversion was used for drainage,and 10F or 12F tube was inserted to the proximal end of new urethra.Ceftriaxone was used after the operation on all of patients for one week.Urethral tubes were removed at 6 or 8 days postoperation and the suprapubic tubes at 10 or 12 days postoperation.Results One stage healing was successfully achieved in 23 patients.Three patients suffered from fistula,of them were healed through re-operation at six months later.After the operation,normal function was recovered and perfect appearance was achieved.Conclusion The result of repair turned out to be satisfactory and we believe that the technique is a good alternative for severe hypospadias.