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Obstructive sleep apnea and chronic airway inflammatory diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are prevalent respiratory conditions, particularly among the elderly. These diseases significantly impact the health and quality of life of the general population. The coexistence of two or more of these conditions, known as overlap syndrome, exacerbates their impact and is frequently encountered in clinical practice. This article provides a comprehensive review of the progress in understanding overlap syndromes, focusing on their distinctive disease features, risk factors, pathophysiological mechanisms, symptoms, diagnostic approaches, and corresponding treatment strategies.

The feasibility of underground gasification of Yan 9 coal seam of the middle-lower Jurassic Yan ′an Formation in J148 area of Dongsheng gas field is systematically studied from the perspectives of geological structure, hydrogeology and coal gasification characteristics, and the prospects of carbon sequestration by using the pore layer, aquifer layer and tight gas layer in the deep coal gasification cavity are discussed.The results show that the coal seam of Yan 9 in this area is stable when the buried depth is 1 264~1 285 m and the dip angle is less than 1°.In the interior of the gasification target constituency, the structural faults are not developed, the joint cracks are not developed, there are occasional cracks but the section is fresh and closed, and the cavity of the coal seam after gasification has a good tightness, which has little influence on the construction and expansion of coal gasification furnace, and can meet the implementation of large-scale coal gasification projects.There is a continuous water barrier layer on the top and bottom of Yan 9 coal seam, which can prevent the influence of groundwater on the direct water filling of coal seam, and is conducive to the layout of underground gasifier.The thickness of the roof water-barrier layer is less than the height of the water-conducting fissure zone, there is a risk of indirect water filling through the roof aquifer, but the roof aquifer is a weak water-rich aquifer, and the risk of small water inflow is controllable.The thickness of the floor water barrier layer is greater than the safe thickness of the floor water barrier layer, which can effectively prevent the risk of direct water filling to the coal seam.In general, Yan 9 coal seam has moderate thickness, little waste, low ash, low sulfur, high calorific value non-stick coal, high coke reactivity, and has a good development prospect.In view of the large amount of CO2 emission from large-scale gasification mining of deep coal seam, the feasibility of CO2 safe geological storage by using coal seam burning and caving area, top and bottom aquifer and lower tight natural gas layer was discussed.The analysis shows that 60.8 % ~88.2 % of CO2 produced by coal seam gasification can be stored in the pore layer and the top and bottom aquifer in the gas-burning and air-burning zone of Yan 9 coal seam.Combined with the development of tight natural gas in the Upper Paleozoic of Dongsheng gas field, it is expected to achieve near-zero carbon emissions in the process of deep coal seam gasification mining by using CO2 generated by coal gasification for natural gas displacement and storage.

Objective To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.Methods Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.Results A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.Conclusions Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Objective To compare the perioperative blood loss and risk of allogeneic transfusion between hemophilia arthritis (HA) patients and osteonecrosis of the femoral head (ONFH) patients undergoing unilateral total hip arthroplasty (THA) under multimodal blood management measures. Methods Clinical data of HA patients treated with unilateral THA from January 2010 to June 2022 and ONFH patients matched 1:3 by gender were retrospectively collected at Peking Union Medical College Hospital, and the differences in indicators related to perioperative blood loss and complication rates were compared between the two groups. Results A total of 26 patients with HA and 76 patients with ONFH who met the inclusion and exclusion criteria were enrolled.Compared with ONFH patients, the total blood loss[(1927.08±956.59) mL vs.(1475.88±924.43) mL, P=0.036], major bleeding rate (38.46%vs. 14.47%, P=0.009), allogeneic transfusion rate (15.38%vs. 3.95%, P=0.046), and complication rate (34.62%vs. 7.89%, P=0.000) in HA patients were higher, and postoperative day 3 hemoglobin[(112.94±12.26) g/L vs.(117.40±11.17) g/L, P=0.000]and hematocrit[(29.44±7.96)%vs.(32.80±5.52)%, P=0.019]were lower. Conclusion The risk of perioperative blood loss and allogeneic transfusion is higher in HA patients treated with unilateral THA than in ONFH-THA patients, and further optimization of blood management strategies is needed.

Objective To explore the role of establishing general surgical emergency team in improving the efficiency of emergency surgical treatment. Methods All patients attending emergency surgery from August1, 2019 to July 31, 2021 were retrospectively analysed. The number of flow, observation and their ratio before and after the establishment of general surgical emergency team were compared. The clinical data, including age, gender, complication, diagnoses, the number of surgery, the grading of disease, preoperative preparation time, the ratio of transfer to ICU, the ratio of patients staying more than 30 days, and complication rate before and after the establishment were analysed. Length of stay and hospitalization costs were compared by surgical grading and disease severity grading. The factors affecting hospitalization costs in emergency surgery patients were analysed using univariate and multiple linear regression. Results A total of 37 945 flow patients were included. Before and after the establishment of the surgical team, the number of flow was 15 745 and 22 200, respectively (1312 and 1850 monthly), the number of observation was 1814 and 1622, respectively (151 and 135 monthly), and the ratio of observation to flow decreased from 11.6% to 7.3% (P=0.000), preoperative preparation time decreased from (1.5±0.7) days to (0.7±0.9) days (P=0.000), the ratio of transfer to ICU decreased from 37.9% to 23.7% (P=0.000), the ratio of patients staying more than 30 days decreased from 5.7% to 0.5% (P=0.000), the average length of stay (5 d vs. 3 d, P=0.028) and cost (34 000 vs. 13 000, P=0.000) were significantly reduced, and the total operation number were 317 and 919, respectively(26 vs. 77 monthly, P=0.000).There was no significant change in complication rate (P=0.548). Multiple linear regression showed that establishing emergency surgery team reduced the hospitalization cost, while high surgical grading, long hospitalization time and transfer to ICU increased the hospitalization cost. Conclusion The establishment of emergency surgery team can solve the current problem of emergency to some degree, such as evacuating emergency congestion, increasing emergency surgery turnover rate, reducing the medical burden, and improving the efficiency of emergency treatment.

Muscle relaxation induced by muscle relaxants is one of the important conditions for endotracheal intubation and fixation, but sometimes muscle functions recover incompletely after operations, which is called postoperative residual neuromuscular block (PRNB). It can cause a series of serious postoperative complications and even death. Hence, it is essential to prevent and treat PRNB in the early stage during anesthesia implementation. With the rapid development of surgical technology and the gradual extension of the life span of the population, the number of operations for elderly patients is gradually increasing. Meanwhile, due to the physiological and pathological changes of the elderly and the combined underlying diseases, the elderly are more likely to suffer from PRNB in different degrees after surgery, which seriously damages the prognosis of elderly patients and increases the loss of medical resources. In these years, the successful application of short-acting muscle relaxants, new antagonists (such as sugammadex), and multi-mode neuromuscular monitoring devices in clinical practice have greatly reduced the incidence of PRNB in elderly patients. Furthermore, the basic researches which mainly based on the neuromuscular junction structure and the pharmacokinetic and pharmacodynamic studies of the elderly provide a new theoretical basis for reducing the harm of PRNB to elderly patients. This paper reviews the research progress of the mechanism, adverse events and clinical interventions of PRNB in elderly patients after general anesthesia surgeries to provide reference for muscle relaxation management and postoperative antagonism in these people.

Objective: Verify the feasibility of the task scheduling and algorithm test platform of the materials transportation robots system based on the actual order data. Methods: This paper discusses the design of simulation experiment through the independently developed platform, focusing on the typical scenarios of pharmaceutical logistics. Aiming at the logistics scenario of task allocation strategy of multi robot with task classification, the Memory Elite Population based Catastrophe Adaptive Large Neighborhood Search(MEPCALNS) algorithm is designed. Results: Compared with ALNS algorithm, the efficiency of MEPCALNS algorithm is increased by 3.16% on average. Conclusion: By means of algorithm optimization research and simulation operation comparison of various scenarios. The value of the platform in algorithm verification is proved, which shows the effectiveness of MEPCALNS algorithm in typical scenarios.

In urban rail traction power supply system, DC catenary grounding is a common fault. As IGBT devices of PWM rectifier have no ability to withstand short-circuit current, controllable traction power supply rectifier equipment usually adopts PWM rectifier and diode rectifier in parallel mode to improve short-circuit withstand ability, but PWM rectifier and diode rectifier in direct parallel connection will introduce circulating current, resulting in damage to the diode rectifier. In order to solve the circulating current problem, firstly, the advantages and disadvantages of the common scheme of circulating current between PWM rectifier and diode rectifier are analyzed. Then, a new topology is proposed, which requires no additional hardware investment, and the circulating current is suppressed within the safe range by means of a specific angle carrier phase shift modulation algorithm between multiple PWM rectifiers. Finally, a simulation model of the traction power supply system is established based on the proposed rectifier equipment, and the system simulation and experimental verification are carried out. Experimental results show that the diode rectifier branch current is only 6.7 A when the equipment is running. The simulation results are consistent with the experimental results, and the rectifier equipment and its control strategy proposed in this paper can effectively suppress the circulating current, which verifies the effectiveness and feasibility of the scheme.

Volatile organic compounds (VOCs) are important precursors of ground-level ozone and secondary organic aerosol, and its monitoring and emission control are very necessary for national environmental protection. Under the guide of policy and demand, on-board monitoring technology for VOCs becomes popular. The on-board monitoring technology has high spatial and temporal resolution and high efficiency for VOCs monitoring, which has become the hotspot technology in VOCs rapid monitoring filed. However, when there are many target compounds with the same quality, there is only one peak in the mass spectrum for these compounds obtained by the traditional on-board monitoring technology with the method of single mass spectrometer, which reduces the detection precision. Therefore, dual mode VOCs on-board monitoring system including SPI-TOF MS model and fast GC-SPI-TOF MS model were established by developing fast gas chromatography (GC)-single photon ionization (SPI)-time of flight mass spectrometry (TOF MS) devices combing with mobile car. When VOCs were monitored by the on-board monitoring system, the SPI-TOF MS mode was firstly used to analyze the VOCs in air by the process of driving, and the results of real-time qualitative quantitative analysis for each point of VOCs were obtained. When high value point of VOCs pollution was found, the car was stopped, and the analysis mode was switched to GC-SPI-TOF MS to determine whether there were compounds with the same m/z, which aimed at ensuring the speed of onboard monitoring and improving the detection accuracy at the same time. During the research, the performance of the system was evaluated by PAMs and TO-15 standard gas. The results showed that the system had a good detection ability for isomers and co-effluent components from GC. The reproducibility error of signal intensities were lower than 5.00% for 92% compounds by both SPI-TOF MS mode and GC-SPI-TOF MS mode, the reproducibility error of retention time was lower than 0.30% for 100% compounds, and the detection limits for typical VOCs species were between 0.28×10-9 and 8.50×10-9, which were better than the national or local testing standard. The system was applied to VOCs monitoring at an industrial park. With high time resolution (in seconds) monitoring ability, m/z 120 was identified for normal propyl benzene which came from suspicious enterprises B. Rapid GC-SPI-TOF MS is a quick and accurate monitoring equipment for VOCs, which not only improves the ability of equipment for VOCs monitoring, but also provides data support for VOCs emission management and control in China.

Objective Postdoctoral program in clinical medicine is a new approach to China's exploration of medical elite training. Since 2016, the Department of Surgery of Peking Union Medical College Hospital has explored and gradually established an advanced training system in order to cultivate clinical post-doctoral skills. The purpose of this research is to review and analyze the construction process and training effects of the advanced skill-raining system, and discuss the advantages of the training system and the direction of further improvement. Methods Postdoctoral students of surgical clinical medicine from 2016 to 2019 were evaluated and analyzed on surgical skills, results of the establishment of the system, and the output of scientific research. Results With the currently established preliminary system of progressively training surgical skills, three generations of 26 clinical postdoctoral trainees of surgery have been successfully trained. The surgical postdoctoral students trained by this system have significantly higher annual assessment results of surgical skills than training residents of the same year. In addition, during the establishment of this system, 19 teaching-related reform projects have been established, and 14 papers related to this system have been published. Conclusions The advanced training system of surgical skills has shown obvious advantages in the training process of surgical postdoctoral doctors. The construction and perfection of the system still needs to be further improved in combination with the actual needs of postdoctoral surgeons in surgery and the goal of standardized training for residents.

Objective To investigate the influence of different feeding ways on the incidence rate of complication in patients with congenital cleft lip and their family satisfaction degree. Methods A retrospective analysis were con⁃ ducted from 90 cases underwent surgery of congenital cleft lip with clinical data, were randomly assigned to the control group and the observation group, 45 cases in each. The control group routinely take spoon feeding way after surgery, whereas patients in the observation group does not change the feeding way in the past, continuely taking the nipple feed⁃ ing or breastfeeding. Wound infection rate, wound rupture rate, crying in the process of feeding and parents' satisfaction were compared between the two groups. Results The wound infection rate and wound rate of the observation group were 2.2% and 0 respectively, the control group were 4.4% and 0 respectively. There was no significant difference be⁃ tween the 2 groups in the 2 index (P > 0.05). In the observation group, the crying children were less than the control group, In the observation group, the degree of coordination, parental satisfaction and acceptance of feeding were 84.4%, 88.9%, 93.3%, respectively, the control group were 55.6%, 60.0%, 66.7%. The observation group were better than the control group. The differences between groups was statistically significant (c2 coordination degree = 8.94, c2satisfaction degree = 9.87, 2c recognition degree = 10.00, P < 0.05). Conclusion Children under the age of 1 with congenital grade Ⅰ and Ⅱ cleft lip do not change the way of feeding after surgery , who continue to take the bottle or breastfeeding can better meet the needs of children fed liquid diet, crying reduce, get parents' recogniton and reduce the burden on parents than the control group conventionally fed with a spoon.

22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion disorder. Its phenotype is highly variable with incomplete penetrance. 22q11.2DS is a rare disease, and the research progress is relatively slow, which has restricted its treatment and intervention. In recent years, much progress has been made in the pathogenic mechanism and genome-wide association study of 22q11.2DS. In this review, the pathogenesis of 22q11.2DS was summarized. Thereafter, the molecular and pathological mechanisms of TBX1 and DGCR8 genes were clarified. Finally, factors affecting the penetrance of cardiac and immune system phenotypes were reviewed. This review may enhance the understanding of 22q11.2DS and has important clinical implications on the prenatal diagnosis, genetic counseling, treatment and intervention of this disease.

Extensive studies have been conducted on deicing nanomaterials to improve the cryoprotective effects on cells, tissues, and organs. The nanomaterials with different composition, sizes, and shapes can inhibit the formation and growth of ice crystals, thereby reducing the damage to the cryopreserved samples. In this study, the carbon composite particles (CCPs) with different sizes and shapes were prepared by the hydrothermal method. The results demonstrated that the cryoprotective effect of CCPs enhanced with the decrease in particle size. Compared with spherical CCPs, Janus nanoparticles and WSP nanoflower with special shapes demonstrated improved protective effects on cryopreserved cells. In addition, the combination of deicing micro/nanomaterials at appropriate concentrations with commercial cryoprotectants exerted improved cryoprotective effects on cells. The prepared deicing micro/nanomaterials can improve cell cryopreservation, demonstrating great application potential in biomedical research and cryopreservation.

Glioblastoma is a malignant and highly invasive tumor, which requires new approaches to search for chemotherapeutic agents. Sanggenon C (SC) mainly exists in the root bark of white mulberry. Although its anti-tumor effects have been reported in some cancers, the mechanism remains unclear. In this study, we used microscopic observation, transwell assay, and immunofluorescence assay to verify the effect of Sanggenon C on the migration and invasion of glioblastoma cells. We then carried out the gene set enrichment analysis (GESA), real-time qPCR assay and ubiquitination assay to delineate the molecule mechanism by which Sanggenon C affects the migration and invasion ability of glioblastoma. With the addition of Sanggenon C, glioblastoma cells were rounded up, with the migration and invasion ability weakened as verified by transwell assay and immunofluorescence assay. The results of GESA suggested that SC might regulate the expression of genes associated with migration and invasion and affect the activity of Wnt/β-catenin signaling pathway. Western blotting revealed that Sanggenon C promoted the ubiquitination of β-catenin to reduce the levels of β-catenin and its downstream proteins. This was further supported by the results of real-time qPCR analysis of target genes of β-catenin. Taken together, SC inhibits glioblastoma cell migration and invasion by enhancing β-catenin ubiquitination. Our work suggests a new direction for the treatment of glioblastoma.

Objective: To carry out prenatal diagnosis for a fetus with Meckel syndrome (MKS) and explore its genetic basis., Methods: A pregnant woman presented at Suzhou Municipal Hospital in February 2018 was selected as the study subject. Clinical data was collected. Muscle tissue sample from the abortus and peripheral blood samples from the couple were collected. Genomic DNA was extracted and subjected to chromosomal microarray analysis (CMA) and whole exome sequencing. Candidate variant was verified by Sanger sequencing., Results: The fetus was found to have microcephaly, oligohydramnios, polycystic kidneys and banana-shaped cerebellum at 18 weeks of gestation. After induction of labor, it was found to have encephalocele, renal cysts and polydactyly. CMA has found no abnormality. Whole exome sequencing revealed novel compound heterozygous variants c.296delA (p.Lys99SerfsTer6) and c.1243G>A (p.Val415Met) in the TMEM67 gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.296delA variant was predicted to be pathogenic (PVS1+PM2&#95;Supporting+PP4), whilst the c.1243G>A variant was predicted to be likely pathogenic (PM2&#95;Supporting+PM3+PP3&#95;Moderate+PP4)., Conclusion: The c.296delA and c.1243G>A compound heterozygous variants of the TMEM67 gene probably underlay the MKS in this fetus.

Scorpions, a group of oldest animals with wide distribution in the world, have a long history of medicinal use. Scorpio, the dried body of Buthus martensii, is a rare animal medicine mainly used for the treatment of liver diseases, spasm, and convulsions in children in China. The venom has been considered as the active substance of scorpions. However, little is known about the small molecules in the venom of scorpions. According to the articles published in recent years, scorpions contain amino acids, fatty acids, steroids, and alkaloids, which endow scorpions with antimicrobial, anticoagulant, metabolism-regulating, and antitumor activities. This paper summarizes the small molecule chemical components and pharmacological activities of scorpions, with a view to providing valuable information for the discovery of new active molecules and the clinical use of scorpions.

Objective: To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China. Methods: An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared. Results: Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates. Conclusions: The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

Objective: To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA)., Methods: A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination., Results: All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups ( P >0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups., Conclusion: There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC)-targeted-immune quadruple therapy in patients with intermediate and advanced-stage hepatocellular carcinoma (HCC). Methods: 101 patients with intermediate and advanced stage HCC were enrolled according to the inclusion and exclusion criteria, and then they were divided into a combination group and a control group. Patients in the combination group was treated with TACE-HAIC-targeted-immune quadruple therapy, while the control group was only treated with TACE therapy. The overall survival (OS), progression-free survival (PFS), and treatment-related adverse reactions were statistically analyzed in the two groups of patients. Statistical analysis was carried out by t-test, χ 2 test, rank sum test, Kaplan-Meier curve, log-rank test, Cox regression (or proportional hazards model) analysis according to different data. Results: The tumor objective response rate and disease control rate as evaluated by mRECIST 1.1 criteria in the combination group were 80% and 94%, respectively, which were significantly higher than those in the control group, 41.2% ( P <0.001) and 74.5% ( P =0.007). The OS and PFS of the combination group were 15.6 months [95% CI 11.3-NA ] and 8.8 months [95% CI 6.9-12.0], respectively, which were significantly better than the control group at 6.1 months [95% CI 5.3-6.6] ( P <0.001) and 3.2 months [95% CI 3.0-3.6] ( P <0.001). Gastric ulcer incidence was significantly higher in the combination group (9/50, 18%) than that in the control group (2/51, 3.9%) ( P =0.023). Conclusion TACE-HAIC-targeted-immune quadruple therapy is a more effective treatment mode for intermediate and advanced-stage HCC than TACE alone, and attention should be paid to the monitoring of target immune-related adverse reactions.

Objective: To investigate the efficacy, safety and prognostic factors of percutaneous biliary stent combined with iodine-125 seed chain brachytherapy (radiotherapy) in the treatment of malignant obstructive jaundice. Methods: Data of 107 cases with malignant obstructive jaundice treated with percutaneous biliary stent implantation from January 2017 to December 2020 were retrospectively analyzed. Among them, 58 cases received biliary stent combined with iodne-125 seed chain brachytherapy (study group), and 49 cases received biliary stent implantation (control group). The changes of bilirubin, stent patency time, complications, overall survival (OS) and prognostic factors were analyzed in both groups. Results: The incidence of complications in the study group and the control group were 17.2% and 18.3% respectively, and the difference was not statistically significant ( P =0.974). Serum total bilirubin levels were decreased significantly in both groups at one month after surgery ( P <0.001). Postoperative stent patency time was significantly better in the study group (10.0±1.6 months) (95% CI : 8.2～12.5) than that in the control group (5.2±0.4 months) (95% CI : 4.1～6.0, P <0.001). The median OS was longer in the study group (11.2±1.8 months) (95% CI : 9.2～12.8) than that in the control group (8.0±1.1 months) (95% CI : 8.0～12.8, P <0.001). Multivariate analysis result showed that stent combined with brachytherapy ( HR =0.08, 95% CI :0.04～0.15, P <0.001) and receiving further anti-tumor therapy after surgery ( HR =0.27, 95% CI :0.15~0.49, P <0.001) were independent risk factors affecting the patency of biliary stents. Preoperative percutaneous transhepatic biliary drainage ( HR =0.46, 95% CI :0.28～0.74, P =0.002), stent combined with brachytherapy ( HR =0.23, 95% CI :0.14～0.39, P <0.001) and receiving further anti-tumor therapy after surgery ( HR =0.37, 95% CI :0.22～0.61, P <0.001) were independent risk factors affecting OS. Conclusion: Percutaneous biliary stent combined with brachytherapy is safe and effective in the treatment of malignant obstructive jaundice, which can significantly prolong the patency time of biliary stent and the survival time of patients.

Objective: To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma. Methods: The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD 10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results: (1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD 10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P <0.05). Conclusions: FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.

Objective: To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 ( 125 Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods: 25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with 125 Ⅰseed strand. Tumor thrombus was controlled with 125 I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t -test, Chi-Squared test or Fisher's exact test. Results: TIPS combined with 125 Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ 2 = 4.771, P =0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ 2 =7.674, P =0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ 2 =13.246 , P =0.001). Conclusions: TIPS combined with 125 Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with 125 Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.

Objective: To investigate the population dynamics and Echinococcus infections in small rodents around human settlement in Yushu City, Qinghai Province., Methods: Rodents were captured using the mouse trap method in pastures from Batang Township and Longbao Township of Yushu City, Qinghai Province on May, August and October, 2018. The body weight and snout-vent length of all captured rodents were measured, and the species was identified according to the rodent morphology. Genomic DNA was extracted from rodent liver specimens and lesion specimens, and the mitochondrial cox1 gene of Echinococcus was amplified using PCR assay for identification of parasite species. In addition, the tissue specimens positive for PCR assay were sampled for pathological examinations. The prevalence of Echinococcus infections was estimated in rodents, and a phylogenetic tree was created based on Echinococcus cox1 gene sequences., Results: A total of 285 small rodents were captured, including 143 Ochotona curzoniae (50.2%), 141 Lasiopodomys fuscus (49.5%), and 1 Neodon irene (0.3%), and there was a remarkable variation in habitat selection among these three rodent species. The number of L. fuscus correlated positively with vegetation coverage ( r = 0.350, P = 0.264), with the greatest number seen in August, and the number of O. curzoniae negatively with vegetation coverage ( r = -0.371, P = 0.235), with the highest number seen in August and the lowest number in May. The female/male ratios of O. curzoniae and voles were 1:0.96 and 0.82:1, respectively. The body weight ( r = 0.519, P < 0.01) and snout-vent length ( r = 0.578, P < 0.01) of O. curzoniae showed a tendency towards a rise with month, while the body weight ( r = -0.401, P < 0.01) and snout-vent length ( r = -0.570, P < 0.01) of voles presented a tendency towards a reduction with month. No Echinococcus infection was detected in voles, while 2.1% prevalence of E. shiquicus infection was seen in O. curzoniae . Phylogenetic analysis revealed consistent sequences of cox1 gene from E. shiquicus in Yushu City of Qinghai Province and Shiqu County, Ganzi Tibetan Autonomous Prefecture of Sichuan Province., Conclusions: The small rodents around the human settlement in Yushu City of Qinghai Province mainly include O. curzoniae and L. fuscus , with the greatest numbers seen in May and August, respectively. Following the concerted efforts for echinococcosis control, the prevalence of Echinococcus infections is low in small rodents around the human settlement in Yushu City; however, there is still a risk of echinococcosis transmission.

Objective: To explore the genetic basis for a fetus with cerebellar dysplasia and widened lateral ventricles., Methods: The couple have elected induced abortion after careful counseling. Skin tissue sample from the abortus and peripheral venous blood samples from both parents were collected for the extraction of genomic DNA, which was then subjected to whole exome sequencing. Candidate variant was verified by Sanger sequencing., Results: Prenatal ultrasonography showed increased nuchal translucency (0.4 cm) and widened lateral ventricles. Magnetic resonance imaging revealed infratentorial brain dysplasia. By DNA sequencing, the fetus was found to carry compound heterozygous variants c.1A>G and c.1564G>A of the RARS2 gene, which were inherited from its father and mother, respectively. Among these, c.1A>G was known to be pathogenic, but the pathogenicity of c.1564G>A was unreported previously. Based on the American College of Medical Genetics and Genomics guidelines, the c.1564G>A variant of RARS2 gene was predicted to be likely pathogenic(PM2+PM3+PP3+PP4)., Conclusion: The compound heterozygous variants c.1A>G and c.1564G>A of RARS2 gene contributed to the fetus suffering from pontocerebellar hypoplasia type 6, which expanded variant spectrum of RARS2 gene.

Objective: The aims of this study were to investigate the effect of gas explosion on rats and to explore the pulmonary function alterations associated with gas explosion-induced acute blast lung injury (ABLI) in real roadway environment. Methods: In April 2018, the large coal mine gas explosion test roadway and explosion test system were used to simulate the real gas explosion roadway environment, fixed the cage and set the explosion parameters. 72 SD rats, male, SPF grade, were randomly divided into nine groups by completely random grouping method according to their body weight: control group, close range group (160 m) , and long range group (240 m) . In each group, there were wound groups (24 h group and 48h group, 8/group, total 48 in six groups) and no wound groups (8/group, total 24 in three groups) . Except for the control group, the other groups were placed in cages at different distances under anesthesia, the experiment of gas explosion was carried out by placing the rats in a position that could force the lungs. The changes of respiratory function of the rats in the non-invasive group were monitored with pulmonary function instrument at 2 h, 24 h, 48 h, 72 h and 168h after the explosion, and were killed under anesthesia 7 days later; the rats in invasive groups were anesthetized and killed at 24 h, 48 h and 168 h, respectively. Gross observation, lung wet-dry ratio and lung histopathology were performed. Results: Compared with the control group, f (respiratory frequency, f) , MV (minute ventilation, MV) , PEF (peak expiratory flow rate, PEF) , PIF (peak inspiratory flow rate, PIF) and EF50 (1/2 tidal volume expiratory flow, EF50) of rats in the close and long range groups decreased significantly after gas explosion 2 h. PAU (respiration pause, PAU) , Te (expiratory time, Te) , Ti (inspiratory time, Ti) and Tr (relaxation time, Tr) were significantly increased ( P <0.05) . After 48 h, TV (tidal volume, TV) , Penh (enhanced respiration pause, Penh) , PAU, and PIF of rats in the long range group were significantly increased ( P <0.05) . After 72 h, MV in the long range group was significantly decreased ( P <0.05) . Compared with the control group, Penh, PAU, Ti and Te were significantly decreased after 168 h in the close and long range groups, with statistical significance ( P <0.05) . At the same time, the body weight of rats in different range groups was significantly decreased ( P <0.05) . In addition, both HE staining and routine observation of lung tissues of rats in different range groups showed that gas explosion caused pulmonary edema, obviously congested pulmonary capillaries, a large number of inflammatory cells and infiltrated red blood cells. Conclusion: Gas explosion in real roadway environment can cause the change of respiratory function phase and lung tissue damage in rats, suggesting that the model of gas explosion-induced ABLI has been initially established successfully, which would provide a basis for further study on the pathogenesis of ABLI.

Objective: To study the orthopedic treatment strategy for hemophilia complicated with musculoskeletal disorders as well as the peri-operative consumption of clotting factor. Methods: Total 338 orthopedic surgeries were performed for 261 patients, average age of 30.6 y (6-65 y) , with hemophilia between January 1996 and December 2019 at our institute. Two hundred and twenty-six patients presented with bleeds within the joints. Sixty-one patients presented with intramuscular bleeds, 45 presented with hemophilic pseudotumors, and six presented with miscellaneous complaints. Strategy of clotting factor replacement therapy was designed as per differences in the level of the operation procedure. Information regarding clinical manifestation, operative strategy, clotting factor consumption, and re-operation for complications was retrospectively recorded. The costs for multiple joint procedure and single joint procedure were studied. Results: We found that 270 of the 338 surgical procedures were major surgical procedures (79.9%) . There were 203 procedures of joint arthroplasty (60%) . Fourteen patients underwent reoperations for local recurrence (4.2%) . The average factor Ⅷ consumption before the surgery was 44.4 ± 8.1 IU/kg. The average FⅧ consumption within postoperative 2 weeks was 40 962 IU (647±177 IU/kg) . Seven type A hemophilic patients developed F Ⅷ inhibitor following the surgical procedure, with an average level of 13.7±11.2 BU/mL. Sixty-eight patients underwent multiple joint procedures under one anesthesia session (26%) . There was no significant difference in the factor consumption between the multiple joint procedure and single joint procedure. Conclusions: Surgical treatment was found to be effective for hemophilic arthropathy and lesion of the musculoskeletal apparatus, with the clotting factor replacement therapy. Multiple joint procedures under one anesthesia were more cost effective for patients with hemophilia, with less factor consumption than staged single joint procedure.

Objective: To study the effect of gas explosion on brain nerve behavior of rats in real roadway environment., Methods: Before the gas explosion, the real gas explosion roadway environment was simulated by using the roadway and explosion test system of gas explosion test in a large coal mine in Chongqing Research Institute of China Coal Science & Technology Group, and cage fixation and explosion parameter setting were carried out. That was to use the equivalent of 9. 0% gas containing mixed air and to install special cage in roadway gas detonation distance at point 40 m, 160 m and 240 m. The SPF grade healthy adult SD male rats anesthetized with chloral hydrate were placed among them, and the rats were placed in a position that could force the head. At the same time, the trunk part below the occipital foramen and the mouth and face above the line of inner canthus were fully protected, and the gas explosion experiment was carried out. A total of 40 rats were randomly divided into four groups according to their body weight: control group, burn-blast combined injuries group(40 m), proximal group(160 m) and distance group(240 m). Ten rats in each group were placed in cages at different distance points under anesthesia except the normal control group. The general physiological behavior of the rats was observed 2 h and 7 d after the explosion, and the neurobehavioral indexes of the rats were monitored by open field behavior experiment. Gross observation and pathological examination of brain tissue were performed 7 days later., Results: The spirits of the rats in the 2 h exposure group after explosion were poor, and improved slightly after 7 d. The degree of surface burn was the most serious in group 40 m. The number of urination decreased while the number of feces increased(P&gt;0. 05). At the end of the experiment, it was found that cerebral edema and hyperemia were obvious in rats. Compared with the normal control group, the brain weight of rats in each exposure group increased, and the difference was statistically significant(P&lt;0. 05). Pathological observation showed that the brain tissues of rats in each exposed group showed irregular and disordered arrangement of nerve cells, interstitial edema, dense and deep staining of loose nuclear chromatin, formation of dense mass and other characteristics of apoptotic cells, as well as increased glia and aggregation of inflammatory cells. At 2 d and 7 h after the explosion, compared with the control group, the resting time of the neurobehavioral indicators of rats at different distance points was significantly prolonged(P&lt;0. 01), while the number of standing times, movement time and movement distance were significantly reduced, and the difference was statistically significant(P&lt;0. 01)., Conclusion: The gas explosion in real roadway environment can cause certain damage to the brain tissue of rats, and has obvious influence on its neural behavior.

Objective: To compare the effects of medical ozone oil and urea ointment for prevention and treatment of hand-foot skin reaction (HFSR) caused by sorafenib in patients with hepatocellular carcinoma (HCC)., Methods: A total of 99 patients diagnosed with advanced HCC according to National Comprehensive Cancer Network (NCCN) who were scheduled to receive sorafenib treatment for the first time were enrolled in this study between April, 2018 and January, 2020. The patients were randomized into medical ozone oil group ( n =49) and urea ointment group (control group, n =49) for treatment with local application of 1 mL medical ozone oil (experimental group) and 10% urea ointment (2 g) on the palm and plantar skin (including the fingers and joints) for 12 weeks (3 times per day) starting at the beginning of sorafenib treatment, respectively. The patients were observed for occurrence of HFSR every 2 weeks for 14 weeks., Results: Eight patients were excluded for poor compliance or protocol violations, leaving a total of 91 patients for analysis, including 44 in medical ozone oil group and 47 in urea ointment group. Sixteen (36.4%) of patients in ozone oil group developed HFSR, a rate significantly lower than that in urea ointment group (57.4%; P < 0.05). The incidence of grade 2/3 HFSR was also lower in ozone oil group than in urea ointment group (15.9% [7/44] vs 27.7 [13/47])., Conclusions: Medical ozone oil can significantly reduce the incidence and severity of HFSR to improve the quality of life of HCC patients receiving sorafenib treatment.

Objective: To investigate the mechanism underlying the regulation of the invasion and metastasis of oral squamous cell carcinoma (OSCC) by long-chain noncoding RNA (lncRNA) PCGEM1 through the transforming growth factor (TGF) β2/Smad2 signaling pathways., Methods: A total of 60 OSCC cases were collected. Cancer tissues and normal tissues more than 2 cm away from cancer tissues were also collected. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-148a and lncRNA PCGEM1 in OSCC, adjacent normal tissues, oral mucosa epithelial cells, KB, BcaCD885, SCC-4, CAL27, and SCC-15. The relationship between the expression of lncRNA PCGEM1 and miR-148a and the clinicopathological information of patients was analyzed. The lncRNA PCGEM1-silenced cell line KB-siPCGEM1 and negative control (KB-NC) group were constructed, and KB was used as the blank control group. The effects of lncRNA PCGEM1 on the proliferation, invasion, and migration of KB cells were determined via MTT, Transwell, and scratch assays. The bioinformatics website starBase was used to predict the complementary binding microRNA (miRNA) of lncRNA PCGEM1. Furthermore, the genes that the miRNA could target and bind were predicted in accordance with the website www.microRNA.org. Western blotting analysis was used to detect the expression of TGF β2/Smad2 signaling pathway proteins., Results: qRT-PCR results showed that the expression level of lncRNA PCGEM1 and miR-148a in OSCC tissues was higher than that in normal tissues (P<0.05). The expression of lncRNA PCGEM1 and miR-148a in the cancer tissues of patients with different TNM grades, lymph node metastasis, and tissue differentiation was statistically significant (P<0.05). Compared with those in the blank control group and the KB-NC group, OD492 nm value was significantly decreased and cell mobility was significantly reduced in the KB-siPCGEM1 group (P<0.05). Bioinformatics predictions showed that lncRNA PCGEM1 could bind to miR-148a in a complementary manner and that miR-148a had a targeted binding site with TGF β2. qRT-PCR and Western blotting analysis results showed that the expression levels of miR-148a, TGF β2, and p-Smad2 in the KB-siPCGEM1 group were significantly lower than those in the blank control and KB-NC groups (P<0.05), and no statistically significant difference between the blank control group and the KB-NC group was observed (P>0.05)., Conclusions: LncRNA PCGEM1 is highly expressed in OSCC. The high expression of lncRNA PCGEM1 may enhance the TGF β2/Smad2 signaling pathway by upregulating miR-148a, thus promoting the development of OSCC.

Objective: To analyze FOXC2 gene variant in a family affected with lymphodema-distichiasis syndrome (LDS)., Methods: Peripheral blood samples were collected for the extraction of DNA and protein. Whole-exome sequencing was carried out to detect variants in the proband. Suspected variant was validated by Sanger sequencing. Western blotting was used to detect changes in protein expression., Results: The proband and his mother were both found to carry a heterozygous nonsense variant c.177C>G (p.Tyr59X) of the FOXC2 gene, which was previously unreported. Down-regulated expression of FOXC2 was detected by Western blotting. Prenatal ultrasonography of the fetus indicated increased nuchal thickness. Amniocentesis was performed at 21+1 weeks of pregnancy, genetic testing suggested that the fetus also carried the c.177C>G variant., Conclusion: The patients' condition may be attributed to the heterozygous nonsense variant c.177C>G of the FOXC2 gene, which resulted in a significant decrease in FOXC2 expression. Increased nuchal thickness may also be related with decreased FOXC2 expression. Above finding has expanded the variant spectrum of the FOXC2 gene.

Objective: To detect potential variant in a male fetus suspected for Ectrodactyly, Ectodermal dysplasia, Cleft lip/palate (EEC) syndrome., Methods: Peripheral blood samples of the fetus and his parents were collected for the extraction of DNA. Whole-exome sequencing was carried out to detect potential variants. Suspected variants were verified by Sanger sequencing., Results: The fetus was found to carry a heterozygous c.673C>T missense variant of the Tp63 gene, which was known to underlie split-hand/split-foot malformation. The same variant was not found in either parents., Conclusion: The heterozygous c.673C>T missense variant of the Tp63 gene probably underlies the EEC syndrome in the fetus. Above finding also expanded the phenotypic spectrum for this variant.

The drug Fei Lian() in the unearthed medical book the Prescription for Nurturing Vitality () has been interpreted as Fei Lian(, an insect medicine) in Shennong Bencao Jing (, Shennong ' s Classic of Materia Medica ). This article interprets it as herbal medicine Fei Lian(), not insect medicine Fei Lian() in Shennong Bencao Jing, based on the mutual evidence of unearthed documents and handed down documents, also the methods of phonology and exegesis. The word "Fei Lian" has rich cultural connotations, its etymology is related to "wind" , its semantics has the meaning of "light and fast speed" . It is used as the name of related totem image, legendary figures, historical figures, medicines, architecture and so on.

Objective: To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods: A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m (2) (range: 15.6-38.1 kg/m(2)). Results: In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170). Conclusions: Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.

Objective: To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU., Methods: Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases., Results: There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71:1 and 2.0:1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62., Conclusions: ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.

Zhang Ji was a famous Chinese medical scholar, medical historian and medical educator in Sichuan province during the Republic of China. His book Jigu Yixue Congshu (, the Series of Collecting Ancient Medical Books ) was an anthology of his experience and writings on medical research. After his middle age, he opened the pharmacy called Yisheng Tang, and the charitable institution called Guji Yuan in Chengdu. And then, he founded a medical school called Jigu with Sun Zifang to teach their students. During his old age, he devoted himself to Sichuan medical college. Zhang Ji was very knowledgeable, and he was also good at doing textual research. Besides, Zhang Ji was rich in clinical experience. In a word, his medical achievements were mainly in writing books and education. And he also contributed to local history recorder studies.

Many factors contribute to a successful total knee arthroplasty, and postoperative coronal lower limb alignment has always been a focus of joint surgeons. Previous researches have suggested that neutral alignment can bring higher prosthesis survival rate and better knee function. However, the theory has been challenged in recent years.In this article, the author introduces the axis, alignment and osteotomy of total knee arthroplasty briefly and reviews the studies on the neutral alignment and kinematic alignment of recent years in order to provide some advice for the clinical operation.

Glioblastoma is a common brain tumor and the overall survival rate of the patients is very low, so it is an effective way to develop the potential chemotherapy or adjuvant chemotherapy drugs in glioblastoma treatment. As a well-known antimalarial drug, artesunate(ARTs) has clear side effects, and recently it has been reported to have antitumor effects, but rarely reported in glioblastoma. Different concentrations of ARTs were used to treat the glioblastoma cells, and then the inhibitory effect of ARTs on glioblastoma proliferation was detected by MTT assay; Ki67 immunofluorescence assay was used to detect the proliferation of cells; Soft agar experiment was used to explain the clonal formation abilities in vitro ; Flow Cytometry was used to detect the cell cycle; and Western blot assay was used to determine the expression of key cell cycle protein. MTT assay results indicated that ARTs-treated glioblastoma cell A172, U251, U87 were significantly inhibited in a time-and-dose dependent manner as compared to the control group(DMSO treatment group). Soft agar experiment showed that ARTs could significantly reduce the clonal formation ability of glioblastoma. Furthermore, Flow cytometry analysis showed that ARTs could obviously increase the cell proportion in G₀/G₁ phase and reduce the cell proportion in S phase. Western blot results showed that the expressions of cell cycle-related proteins CDK2, CDK4, cyclin D1 and cyclin B1 were all obviously down-regulated. Above all, ARTs may inhibit the proliferation of glioblastoma cells by arresting cell cycle in G₀/G₁ phase through down-regulating the expression of CDK2, CDK4, cyclin D1, cyclin B1. These results may not only provide a novel method for rediscovering and reusing ARTs but also provide a new potential drug for treating glioblastoma., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

Objective: To evaluate the clinical efficacy of Total hip arthroplasty (THA) in treating the hip joint involvement of Psoriatic arthritis (PsA). Methods: From January 2005 to December 2016, a total of 15 PsA patients (20 hip joints) underwent THA in Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. All the patients had obvious restriction in daily life before operation. The mean Harris score was 25.2 averagely and the mean total range of the hip joint movement was 39.6° before surgery. All the prosthesis were biotype and ceramic to ceramic. Results: All patients were followed up with an average of 35.7 months and could take care of themselves. The Harris score of hip joint was 83.2 averagely, including 15 hips excellent, 3 good, and 2 passable, with an excellent and good rate of 90%. The mean total range of the hip joint movement was 175° after surgery. There was no infection, nerve injury or loosening of the prosthesis. 1 hip appeared avulsion fracture of greater trochanter of femur, and the joint function was satisfying at the last time of follow-up. Conclusion: THA is an effective method in treating affected hip joint of PsA. It can restore the hip function and improve the life quality of the PsA patients.

In photoacoustic imaging the ultrasonic signals are usually detected by contacting transducers. For some applications, contact with the tissue should be avoided, e.g. in those of brain functional imaging. As alternatives to contacting transducers interferometric techniques can be used to acquire photoacoustic signals remotely. Here, a system for non-contact photoacoustic tomography imaging (NCPAT) has been established. This approach enables NCPAT not to exceed laser exposure safety limits. The stimulated source of NCPAT utilized a laser with center wavelength of 532 nm and output intensity of 17.5 mJ/cm 2 , and a laser heterodyne interferometry was used to receive the photoacoustic signals. The NCPAT was used to implement on a rotational imaging geometry for photoacoustic tomography with a real-tissue phantom. The photoacoustic imaging was obtained by applying a reconstruction algorithm to the data acquired for NCPAT. Experiments results showed that the NCPAT system with detection 15 dB bandwidth of 2.25 MHz could resolve spherical optical inclusions with dimension of 500 μm and multi-layered structure with optical contrast in strongly scattering medium. The method could expand the scope of photoacoustic and ultrasonic technology to in-vivo biomedical applications where contact is impractical.

In order to achieve the automatic identification of liver cancer cells in the blood, the present study adopted a principal component analysis (PCA) and back propagation (BP) algorithm of feedforward neural networks to identify white blood cells and red blood cells in mice and human liver cancer cells, HepG2. The present paper shows the process in which PCA was carried out after obtaining spectral data by fiber confocal back-scattering spectrograph, selecting the first two principal components as spectral features, and establishing a neural network pattern recognition model with two input layer nodes, eleven hidden layer nodes and three output nodes. In order to verify whether the model would give accurate identification of cells, we chose 195 object data to train the model with 150 sets of data as training set and 45 sets as test set. According to the results, the overall recognition accuracy of the three cells was above 90% with the average relative deviation only 4.36%. The results showed that PCA+BP algorithm could automatically identify liver cancer cells from erythrocyte and white blood cells, which will provide a useful tool for the study of metastasis and biological metabolism characteristics of liver cancer.

Objective: To investigate the clinical outcomes of total knee arthroplasty (TKA) by using the condylar constrained knee prosthesis in the treatment of destructive hemophilic arthritis., Methods: Between September 2007 and July 2015, 8 cases (8 knees) of destructive hemophilic arthritis accepted TKA by using condylar constrained knee prosthesis. All patients were male, aged 22 to 56 years, with an average age of 35 years. The disease course of hemophilia A was 3-30 years (mean, 17.3 years). Preoperative range of motion (ROM) was (68.1±32.6)°; the flexion deformity was (14.38±16.13)°. Six patients had valgus of 7-35° (mean, 17.3°), of whom, one had fixed dislocation of patella; and one had varus of 15°. Hospital for Special Surgery (HSS) knee score was 52.5±12.9. Pre-operative X-ray film examination demonstrated narrowing of the knee gap and cystic degeneration of articular cartilage and subchondral bone., Results: All patients achieved primary wound healing, and were followed up 1-9 years (mean, 5 years). Tense blister with common peroneal nerve damage and extension penetrating into distal tibial cortex occurred in 1 case respectively, which were cured corresponding treatment. At last follow-up, the knee ROM and the flexion deformity were significantly improved to (98.1±8.9)° and (0.63±1.77)° ( t =-2.527, P =0.036; t =2.396, P =0.047). At 2 weeks after operation and last follow-up, the HSS scores were significantly increased to 77.3±11.0 and 85.0±9.0 ( P <0.05). X-ray film showed that lower extremity alignment returned to normal in patients with varus and valgus., Conclusion: Good curative effect can be get by using condylar constrained knee prosthesis in TKA for the treatment of destructive hemophilic arthritis.

Objective: To investigate the efficacy of sequential treatment with adductor canal nerve block (ACNB) and cyclooxygenase 2 (COX-2) selective inhibitor (parecoxib and celecoxib) after primary total knee arthroplasty (TKA)., Methods: Between January 2015 and December 2015, 90 osteoarthritis patients who met the inclusion criteria were treated, and randomly divided into 3 groups:ACNB+COX-2 group (group A, n =30), COX-2 group (group B, n =30), and control group (group C, n =30). There was no significant difference in gender, age, body mass index, side, and osteoarthritis duration between groups ( P >0.05), and the data were comparable. ACNB was used in group A at the end of TKA. Intravenous injection of parecoxib (40 mg per 12 hours) was administrated at the first three postoperative days, and followed by oral celecoxib (200 mg per 12 hours) until 6 weeks after operation in groups A and B; while placebo was given at the same time point in group C. Oral tramadol or intravenous morphine, as remedial measures, were introduced when patients had a visual analogue scale (VAS) score more than 4. The following indicators were compared between groups:the operative time, drainage volume at 24 hours after operation, length of hospital stay, and incidence of side effect; VAS pain scores, morphine consumption, range of motion (ROM) of the knee joint, and inflammatory cytokines levels at pre-operation and at 1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation; morphine consumption within first 24 hours and at 24 hours to 6 weeks after operation; the American Hospital for Special Surgery (HSS) score at 1, 2, 4, and 6 weeks after operation; and the serum coagulation parameters at pre-operation, and at 1, 3, and 14 days after operation., Results: The length of hospital stay was significantly shorter and the incidence of postoperative nausea and vomiting was significantly lower in groups A and B than group C ( P <0.05). The VAS scores at rest (VASR) of groups A and B were significantly lower than that of group C at 1, 2, and 3 days after operation ( P <0.05); difference in the VAS scores at walking (VASW) was significant between groups at 1 day after operation ( P <0.05), and group A had the lowest VASW; and the VASW of groups A and B were significantly lower than that of group C at 2 and 3 days and at 1, 2, 4, and 6 weeks after operation ( P <0.05). The difference in morphine consumption was significant between groups within the first 24 hours after operation ( P <0.05), and group A exhibited the lowest consumption; and the morphine consumption in groups A and B was significantly lower than that in group C at 24 hours to 6 weeks after operation ( P <0.05). Significant difference was found in HSS scores between groups at 1, 2, 4, and 6 weeks after operation, and group A showed the highest score ( P <0.05). At 1 and 2 days after operation, group A showed the highest ROM ( P <0.05), and ROM of groups A and B was significantly higher that of group C at 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation ( P <0.05). Groups A and B were significantly lower than group C in the serum erythrocyte sedimentation rate at 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks, in C-reactive protein levels at 1, 2, and 3 days, in interleukin 6 (IL-6) and TNF-α levels at 1 day to 6 weeks, and in IL-8 level at 2 and 3 days ( P <0.05). The drainage volume within the first 24 hours and the serum coagulation parameters within the 2 weeks after operation showed no significant difference between groups ( P >0.05)., Conclusions: Sequential treatment with ACNB and COX-2 selective inhibitor is a safe and effective approach for postoperative pain management after primary TKA, and it can alleviate postoperative pain, promote the joint function recovery, and reduce the risk of adverse reactions.

Objective: To evaluate the clinical efficacy and safety of vancomycin and linezolid for the treatment of gram-positive neonatal bacterial sepsis., Method: The data of neonates diagnosed as gram-positive bacterial sepsis in neonatology department of Suzhou Municipal Hospital from June 2009 to December 2015 were retrospectively collected. These neonates were divided into vancomycin group and linezolid group. Propensity score matching (PSM) on baseline variables was used to balance the two groups by identifying a comparable group of neonates who received vancomycin and linezolid therapy. Clinical and microbiologic success rates were compared by chi-square test, and changes of laboratory parameters before and after treatment at the end of treatment were then directly compared by rank-sum test between the matched groups. In vancomycin group, correlation between trough concentration of vancomycin and clinical efficacy were evaluated., Result: Totally 108 and 209 cases were respectively selected in vancomycin and linezolid groups; 108 cases with well-matched baseline characteristics were included in matched linezolid group. The clinical success rates of vancomycin vs. linezolid therapy were 86.1%(93/108) and 88.9%(96/108)(P=0.681), and the microbiologic success rates were 91.7%(99/108) and 93.5%(101/108)(P=0.795). The average trough concentration of vancomycin was (12±8) mg/L. The rate of reaching the high trough concentration standard was only 33.3%(36/108). In 50 (46.3%) cases the dose was adjusted according to the initial concentration data. Compared to less than 10 mg/L, the clinical efficacy of trough concentration in 10-20 mg/L was much higher(93.9%(46/49) vs. 78.6%(33/42), P=0.031). Total bilirubin and platelet count had significant difference between the two-matched groups (34.1(14.9, 91.0)μmol/L vs. 53.0(27.0, 121.6)μmol/L, P=0.034; 301.0(198.8, 416.0)×10(9)/L vs. 195.5(94.0, 283.2)×10(9)/L, P=0.000). The incidence of linezolid related thrombocytopenia was 13.4%(28 cases)., Conclusion: The clinical effect of vancomycin and linezolid on gram-positive bacterial sepsis in neonates is comparable. The rate of trough concentration of vancomycin reaching the high trough concentration standard is low, and the clinical efficacy is related to trough concentration. Linezolid have an effect on bilirubin and platelet count, the risk of thrombocytopenia should be monitored closely during linezolid treatment.

Objective: To investigate the effect of Keap1-Nrf2 pathway on cell proliferation, metastasis and drug resistance of human lung cancer A549 cell line., Methods: A549-Keap1 cell line, constantly expressing wild type Keap1, was established by lentiviral transfection. Real-time RT-PCR and western blot were used to determine the expression of Nrf2 and its target gene in A549 cells. Sulforhodamine B (SRB) assay, flow cytometry, colony formation assay, transwell assay, and cell wound-healing assay were performed to explore the effect of wild type Keap1 expression on the proliferation, invasion, migration and drug resistance of A549 cells., Results: Over-expressed Keap1 decreased the expression of Nrf2 protein and the mRNA level of its downstream target genes and inhibited the ability of cell proliferation and clone formation of A549 cells. Keap1 overexpression induced G0/G1 phase arrest. The percentage of A549-Keap1 cells in G0/G1 phase was significantly higher than that of A549-GFP cells (80.2±5.9)% vs. (67.1±0.9%)(P<0.05). Compared with the invasive A549-Keap1 cells (156.33±17.37), the number of invasive A549-GFP cells was significantly higher (306.67±22.19) in a high power field. Keap1 overexpression significantly enhanced the sensitivity of A549 cells to carboplatin and gemcitabine (P<0.01). The IC50s of carboplatin in A549-Keap1 and A549-GFP cells were (52.1±3.3) μmol/L and (107.8±12.9) μmol/L, respectively. The IC50s of gemcitabine in A549-Keap1 and A549-GFP cells were (6.8±1.2) μmol/L and (9.9±0.5) μmol/L, respectively., Conclusion: Keap1 overexpression significantly inhibits the expression of Nrf2 and its downstream target genes, suppresses tumor cell proliferation and metastasis, and enhances the sensitivity of A549 cells to anticancer drugs.