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患者女，57岁。2016年5月因甲状腺肿物在外院行双侧结节性甲状腺肿物切除术，术后患者发现右颈部一肿物逐渐增大，遂于2017年2月在中山大学孙逸仙纪念医院行右颈Ⅱ区肿物切除术，病理考虑异位甲状腺，结节性甲状腺肿。2018年5月患者发现肋骨肿物，活检病理诊断甲状腺滤泡癌转移。为下一步行I

To analyze the usage and loss of the COVID-19 vaccine in ten districts of Suzhou city from December 18, 2020 to April 30, 2021.The results showed the loss rate was 0.222‰ in Suzhou city. The loss rate of pre-filled packaging COVID-19 vaccine was higher than that of vial packaging. The loss rate of 40 packaging was the lowest in vial packaging. The loss rate of all kinds of COVID-19 vaccine in stable inoculation unit was the lowest. It is recommended to distribute 40 vial packaging COVID-19 vaccine for centralized vaccination to reduce the loss of COVID-19 vaccine.分析2020年12月18日至2021年4月30日苏州市10个区（县）新型冠状病毒疫苗（新冠疫苗）的使用及损耗情况。研究结果显示，苏州市新冠疫苗损耗率为0.222‰。预填充包装的损耗率高于西林瓶包装；西林瓶包装的疫苗中40支装损耗率最低；不同类型接种门诊中，固定接种门诊对各种包装的新冠疫苗损耗最低。建议配发西林瓶40支装新型冠状病毒疫苗进行集中接种以减少疫苗损耗。.

The oligometastatic and oligoprogressive state has been a hot issue in cancer research. Its indolent tumor behavior, representing a novel therapeutic opportunity, has been identified as a clinical subtype in several malignancies. However, the clinical implications of the oligometastatic and oligoprogressive state in esophageal squamous cell carcinoma (ESCC) have not been thoroughly elucidated. There are still controversies regarding the existence of the oligometastatic state in ESCC, if the solitary regional lymph node metastasis should be viewed as oligoprogressive disease after esophagectomy, and the role of surgery and radiotherapy in ESCC oligometastatic disease. Despite many exciting contributions to the literature on these, further exploration is warranted. Thus, fostering the advance of research and scientific knowledge on the biological and prognostic characteristics scrupulously would facilitate personalizing treatment strategy for better outcomes.近年来，恶性肿瘤寡转移或寡进展状态逐渐成为癌症领域的研究热点。因其相对惰性的肿瘤生物学特征，以及潜在的局部治疗获益机会，寡转移或寡进展在多个癌种中被列为特殊的临床亚型，然而在食管鳞状细胞癌中尚无深入的研究。食管鳞状细胞癌是否存在寡转移状态，孤立性区域淋巴结转移是否应视为食管鳞状细胞癌术后寡进展，外科治疗在寡转移中的临床价值，以及局部放疗在寡进展中的临床价值，文献报道了一些有价值的成果，但仍需进一步探索。谨慎推进相关研究，明确食管鳞状细胞癌寡转移或寡进展的生物学特点和预后特征，有望为患者制定效果更佳的个性化治疗方案。.

患者青年女性。以阵发性心悸、多汗、头痛、血压升高为表现，检测儿茶酚胺及代谢产物甲氧基肾上腺素类（MNs）水平增高，基因检测为琥珀酸脱氢酶亚基B（SDHB）错义突变，影像学检查发现由冠状动脉左回旋支供血的纵隔肿瘤（40 mm×38 mm），经充分药物准备后在体外循环下行肿瘤手术切除，术后病理确诊为心脏副神经节瘤。患者术后3个月随诊复查血压、MNs正常，并对其家系进行了研究追随。.

The concept of "XingShen"(Body and spirit) and their relationship are important philosophical categories and basic issues in life cognition. The view of "body and spirit" in Chinese medicine is the inheritance and development of the concept of "form and spirit" in ancient Chinese philosophy; the view of body-spirit syncretism is one of the elements of the original thinking mode in traditional Chinese medicine, which reflects the holism of TCM. This article selects interpretations of "body and spirit" form the works of the four great physicians of the Jin and Yuan period as the starting point to find out the internal connection between their academic innovation and their identities of Confucian physician, as well as their classic study, based on the social background of the Jin and Yuan Period.“形神”概念及其关系，是重要的哲学范畴，也是生命认知中的基本问题。中医学的形神观，是对中国古代哲学“形神”思辨的继承与发展；“形神一体”的形神观反映了中医学的整体观念，是中医原创思维模式的要素之一。以金元四大家对于中医“形神观”的阐发为切入点，结合当时社会背景，发现他们的学术创新与其儒医身份及经典研习之间存在重要关联。.

Patients with persistent asthma often show poor adherence to inhaled corticosteroids (ICS). Shared decision-making can improve adherence rates in this population. Patient decision aids (PDAs) are tools to facilitate shared decision-making. To date, only one PDA, developed in a Canadian French-speaking population, exists for patients considering ICS maintenance therapy. This PDA has been culturally adapted in this study to contextualize to the needs of multi-ethnic Asian patients in Singapore. This study explored the views of local clinicians on the content, design and implementation of this newly-adapted PDA.24 clinicians, who were purposively sampled from polyclinics and a tertiary institution, were interviewed on the content, design and implementation of the PDA. The interviews were audio-recorded, transcribed and analyzed via thematic analysis.Clinicians generally accepted the design of the PDA. They suggested for the target users to be patients on Step 2 of GINA guidelines and the number of options to be reduced from four to two (do nothing or start inhaled corticosteroids). Moreover, they supported including a list of values for patients to select from given that Asian patients often do not articulate their values readily. The addition of more visual aids, the production of multilingual Asian editions and the involvement of nurses to administer the PDA was also suggested.The PDA was culturally-adapted with local clinicians' perspectives to target multi-ethnic Asian patients with persistent asthma (Step 2 GINA guidelines). The main changes include a list of values and addition of visual aids.

患儿 男，1岁2月龄，因“阴茎短小、尿道下裂伴反复感染1年”就诊，合并发育迟缓、慢性腹泻、吞咽功能障碍、一过性血小板减少及贫血，结合基因检测，患儿7号染色体92732940位点存在c.2471GA（p.Arg824Gln）的杂合变异，诊断为MIRAGE综合征。儿童MIRAGE综合征罕见。儿童期病死率高达62.5%，常见死因为呼吸衰竭、感染性休克、多脏器功能衰竭、失血性休克等。.

Background Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease with clinical sequelae such as itching, dyspigmentation and scarring. Objectives We applied a previously described modular analysis approach to assess the molecular heterogeneity of patients with CLE. Methods Whole-blood transcriptomes of RNA sequencing data from a racially and ethnically diverse group of patients with CLE (n = 62) were used to calculate gene co-expression module scores. An unsupervised cluster analysis and k-means clustering based on these module scores were then performed. We used Fisher's exact tests and Kruskal-Wallis tests to compare characteristics between patient clusters. Results Six unique clusters of patients with CLE were identified from the cluster analysis. We observed that seven inflammation modules were elevated in two clusters of patients with CLE. Additionally, these clusters were characterized by interferon, neutrophil and cell-death signatures, suggesting that interferon-related proteins, neutrophils and cell-death processes could be driving the inflammatory response in these subgroups. Three different clusters had a predominant T-cell signature, which were supported by lymphocyte counts. Conclusions Our data support a diverse molecular profile in CLE that further adds to the clinical variations of this skin disease, and may affect disease course and treatment selection. Future studies with a larger and diverse cohort of patients with CLE are warranted to confirm these findings.

Colorectal cancer (CRC) is the fourth leading cause of death worldwide and there is a need for more specific therapeutic targets and biomarkers for the disease. Transforming growth factor β1-induced transcript 1 (TGFΒ1I1) was reported to be downregulated in CRC tissues; however, the precise roles of TGFΒ1I1 in CRC remain unclear.The expression of TGFΒ1I1 in CRC cell lines and tissues was assessed by quantitative Polymerase Chain Reaction (qPCR). TGFΒ1I1 was overexpressed in SW620 and RKO cells. Cell viability was analyzed by a CCK-8 assay. The proportion of apoptotic cells was analyzed by flow cytometry. The EdU cell proliferation assay of SW620 and RKO cells after transfection was performed via flow cytometry. The migration potency of SW620 and RKO cells was analyzed using a cell migration assay. A wound healing assay was performed to assess the migration potency of SW620 and RKO cells. The invasion potency of SW620 and RKO cells after TGFΒ1I1 overexpression was analyzed. The protein levels of VEGF, TGF-β, MMP9, p-Smad2/3, N-cadherin, and E-cadherin were analyzed by Western blot.Decreased expression of TGFΒ1I1 was found in CRC tissues and cell lines. Overexpression of TGFΒ1I1 inhibited the proliferation and induced the apoptosis of CRC cells. The overexpression of TGFΒ1I1 inhibited the migration and invasion of CRC cells. We also found that the overexpression of TGFΒ1I1 in CRC cells inhibited the TGF-β pathway and epithelial-mesenchymal transition (EMT) progress.TGFΒ1I1 suppressed cell migration and invasion in CRC by inhibiting the TGF-β pathway and EMT progress.

胃母细胞瘤是发生于胃部的一种罕见、具有独特特征的双向分化肿瘤。该文报道1例发生于胃窦胃体交界处的胃母细胞瘤。患者女，53岁。因上腹部隐痛不适1年，发现胃窦胃体交界处隆起性病变伴溃疡形成，临床拟诊"胃肠道间质瘤"行"胃肠道间质瘤切除术"。大体见附部分胃黏膜灰白灰红色结节样肿物一个，体积5.0 cm×4.2 cm×4.0 cm，切面灰白，半透亮，局部囊性变。镜下观察瘤细胞密度不均，细胞密集区肿瘤细胞呈上皮样形态，排列呈小巢状或条索状，可见腺管形成的趋势，细胞核轻度异型。稀疏区肿瘤细胞核呈卵圆形或短梭形，肿瘤细胞弥漫片状分布于黏液样基质中，部分区黏液聚集呈肺水肿样结构，部分区呈微囊样。免疫标记广谱细胞角蛋白、上皮细胞膜抗原上皮样区域阳性，CD10、波形蛋白梭形细胞区阳性，Ki-67阳性指数小于1%。诊断为胃母细胞瘤。.

烧伤休克与复苏是一个古老却又充满挑战的话题。本文在反思烧伤休克本质及其血流动力学特点的基础上，结合国内外现代休克复苏理念和技术，阐述了以大循环-微循环为复苏目标的烧伤个体化休克复苏策略。同时对烧伤临床休克复苏若干特殊情况和未来方向也做了简要阐述。.

Growing evidence has shown that long non-coding RNAs (lncRNAs) can serve as prospective markers for survival in patients with gastric cancer (GC). In this study, we mainly focused on the potential roles of LINC00511 in the development process of GC.RT-PCR was used to detect the expressions of LINC00511 and miR-124-3p in GC tumor tissues, adjacent tissues and GC cell lines. Furthermore, correlations between LINC00511 with miR-124-3p, and miR-124-3p with EZH2, were analyzed by Correlation analysis. Moreover, the overall survival (OS) of patients was analyzed using Kaplan-Meier method. Additionally, proliferation ability was measured by CCK-8 assay and invasion ability of GC cell line was detected by transwell assay. Besides, Western blot was performed to measure protein levels of GC tissues and GC cell lines. Finally, Dual-Luciferase reporter assay was performed to prove the potential binding sites between LINC00511 and miR-124-3p, miR-124-3p and EZH2.We found that LINC00511 was significantly increased in GC tissues and GC cell lines, which was associated with tumor growth, metastasis and predicted poor diagnosis of GC patients. MiR-124-3p was decreased in GC tissues and GC cell lines, which was negatively correlated with LINC00511 and EZH2. Furthermore, EZH2 was increased in GC tissues and GC cell lines, which was positively correlated with LINC00511. Moreover, LINC00511 inhibition repressed cell proliferation and invasion in MKN28 cells, the protein levels of Cyclin D1, ICAM-1, VCAM-1 and N-cadherin were repressed, while E-cadherin was increased. Besides, Luciferase gene reporter assay indicated that LINC00511 could sponge with miR-124-3p, which could directly target at EZH2, an oncogenic gene. We found that miR-124-3p/EZH2 axis regulated cell proliferation and invasion in MKN28 cells. Finally, the inhibited cell proliferation and invasion abilities were eliminated following with miR-124-3p inhibition in MKN28 cells with LINC00511 knockdown.According to the results, we found that LINC00511 was increased in GC tissues, which was associated with the poor OS in patients with GC. We uncovered a previously unappreciated LINC00511/miR-124-3p/EZH2 signaling axis in promoting cell proliferation and invasion in GC patients and GC cell lines, which suggested that it might be a potential target for treating human GC.

In December 2019, a new type of coronavirus-infected pneumonia broke out in Wuhan and spread rapidly to other parts of the country. The purpose of this study was to investigate the clinical features of coronavirus disease 2019 (COVID-19).A retrospective analysis was performed on the confirmed cases of COVID-19, who were admitted to the North Hospital of Changsha first Hospital (Changsha Public Health treatment Center) from January 17 to February 7, 2020.The median age of COVID-19 patients was 45 years (range 33.5-57). The male patients accounted for 49.7%, 64.6% of the patients had a history of exposure in Wuhan, and 31.7% had family aggregation. The median days of onset were six, and the incidence of severe illness was 18.6%. Compared with the non-severe group, the severe group showed statistical significance in older age, hypertension, bilateral lung plaque shadow, decrease in lymphocyte count, increase in C-reactive protein (CRP), aspartate aminotransferase (AST), lactate dehydrogenase, and creatine kinase.Age, combined hypertension, oxygenation index, double lung patch, decreased lymphocyte count, and elevated levels of C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase can be used as predictors of the disease severity.

Atherosclerosis (AS) is a representative inflammatory vascular disease. This study explored the molecular pathogenesis of AS based on circular RNA (circRNA), the checkpoint with forkhead-associated and ring-finger domains (circ_CHFR).The cell model of AS in vitro was established by stimulating human vascular smooth muscle cells (VSMCs) with oxidized low-density lipoprotein (ox-LDL). The RNA expression was measured by quantitative Real-time polymerase chain reaction (qRT-PCR). Cell viability and colony formation ability were separately evaluated using 3-(4, 5-dimethylthiazol-2-y1)-2, 5-diphenyl tetrazolium bromide (MTT) and colony formation assay. Cell migration was assessed via the transwell assay. The inflammation injury was analyzed by enzyme-linked immunosorbent assay (ELISA). Associated proteins were determined through Western blot. The combination of hypothetic targets was ascertained using Dual-Luciferase reporter assay.Circ_CHFR was up-regulated in AS serums and ox-LDL-stimulated VSMCs. Circ_CHFR depletion weakened the ox-LDL-induced promotion of cell growth, migration and inflammation in VSMCs. Circ_CHFR positively regulated Wnt3 expression and the downregulation of Wnt3 abrogated the ox-LDL-triggered injuries in VSMCs. Circ_CHFR functioned as the sponge of microRNA-214-3p (miR-214-3p) and miR-214-3p targeted Wnt3. Circ_CHFR regulated cell growth, migration and inflammation via regulating the expression of Wnt3 as a competitive endogenous RNA (ceRNA) of miR-214 in ox-LDL-treated VSMCs. Circ_CHFR/miR-214-3p axis mediated the Wnt3/β-catenin signal pathway.Circ_CHFR contributed to the progression of AS through the miR-214-3p/Wnt3/β-catenin signals, which illuminated the molecular mechanism of AS and suggested circ_CHFR might be an index for AS treatment.

This article reported a case with primary cystic echinococcosis in the left femur.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.破伤风分为新生儿破伤风和非新生儿破伤风。我国已于2012年消除了新生儿破伤风，但非新生儿破伤风仍是一个严重的公共卫生问题。非新生儿破伤风重症患者在无医疗干预的情况下，病死率接近100%，即使经过积极的综合治疗，全球范围病死率仍为30%~50%，是一种极为严重的潜在致命性疾病。为规范我国非新生儿破伤风诊疗行为，提高医疗质量，保障医疗安全，特制定本规范。本规范包括了非新生儿破伤风的病原学、流行病学、发病机制、临床表现及实验室检查、诊断、鉴别诊断、分级、治疗等方面内容。.

Purpose To investigate whether computer-aided design (CAD) and 3-dimensional printing technology can assist in accurate completion of ulna-radius proximal rotational osteotomy in congenital radioulnar synostosis (CRUS). Methods We treated 1 right arm and 4 left arms of 4 boys with a mean age of 5.2 years (range, 4.3–6.0 years) between July 2018 and April 2019. Computed tomography (CT) scans of the forearm were performed on the children before surgery. Using the CT data, the pronation angle of the forearm was measured. An individualized dial with a matching forearm diameter was designed before surgery to control the angle of the rotational osteotomy . Ulna and radius models, and individualized dials, were prepared for each patient using 3-dimensional printing technology. Preoperative simulated surgery was performed using the 3-dimensional printed models. During the surgery, 2 Kirschner wires were used as operating levers for rotation, and rotational angle correction was precisely controlled using the dial. The cast and internal fixation were removed after x-ray examination showed that the osteotomy had healed, about 5 weeks after surgery. Results The rotational osteotomies were completed in a single operation, and the correction angle was 60°. No complications occurred after the operation. All patients showed functional improvements in activities of daily living. Conclusions For CRUS patients, models and dials made with CAD and 3-dimensional printing technology can assist in precise rotational osteotomy. Type of study/level of evidence Therapeutic V.

Metabolic disorder is one of the most obvious pathophysiological characteristics of patients with severe burn or trauma, which leads to high mortality of patients with severe burn or trauma. Metabonomics is a newly developed subject which provides new research concepts and ideas for studying the changes of metabolism in a disease condition. Based on the analysis of group indicators, metabonomic technique not only can systematically study the change rules of metabolites, which helps to further clarify the pathophysiological mechanism of burn or trauma, but also is helpful to find some significant biomarkers with important clinical value so as to provide new insight for the therapy of burn or trauma. This paper reviews the research progress of application of metabonomics in the treatment of severe burn or trauma in recent years.代谢紊乱是危重烧创伤患者最明显的病理生理特征之一，也是导致危重烧创伤患者高病死率的重要因素之一。代谢组学是一门新发展起来的学科，为研究机体代谢在疾病状况下的改变提供了新的理念和思路。代谢组学技术以组群指标分析为基础，不仅有助于系统研究代谢产物的变化规律，从而进一步阐明烧创伤的病理生理机制；还可以帮助发现某些具有重要临床价值的生物标志物，从而为烧创伤的治疗提供方向。本文就近年来代谢组学在危重烧创伤救治中的应用研究进展进行综述。.

The aim of this study was to elucidate the potential function of microRNA-488-3p (miRNA-488-3p) in the pathogenesis of acute myocardial infarction (AMI).AMI mice constructed by ligation of the anterior descending coronary artery (LAD) were administrated with miRNA-488-3p mimics or negative control, respectively. Infarct size and risk region of AMI mice were determined by triphenyltetrazolium chloride (TTC) staining. The serum level of lactate dehydrogenase (LDH) release in mice was detected by enzyme-linked immunosorbent assay (ELISA). Subsequently, primary cardiomyocytes were isolated from AMI mice administrated with miRNA-488-3p mimics or negative control. LDH release in both hypoxia-preconditioning primary cardiomyocytes and MCM cells was detected. Dual-Luciferase reporter gene assay was used to verify the potential target of miRNA-488-3p. Furthermore, the regulatory effects of miRNA-488-3p and its target ZNF791 on AMI-induced cardiomyocyte apoptosis were evaluated.MiRNA-488-3p was lowly expressed in AMI mice. Meanwhile, miRNA-488-3p expression decreased in hypoxia-preconditioning primary cardiomyocytes or MCM cells in a time-dependent manner. AMI mice overexpressing miRNA-488-3p showed significantly smaller infarct size and risk region, as well as lower LHD release in serum. Overexpression of miRNA-488-3p markedly down-regulated the protein level of caspase3 in MCM cells. ZNF791 was predicted as the direct target of miRNA-488-3p, which was negatively regulated by miRNA-488-3p. Overexpression of ZNF791 reversed the protective role of miRNA-488-3p in AMI-induced cardiomyocyte apoptosis.MiRNA-488-3p is down-regulated in AMI mice, which alleviates AMI-induced cardiomyocyte apoptosis via down-regulating ZNF791.

To study the correlation between the plasma long non-coding RNA (lncRNA) maternally expressed gene 3 (MEG3) and the levels of inflammatory cytokines in patients with traumatic brain injury (TBI) and to evaluate its prognosis to screen new biological targets for the diagnosis and treatment of TBI.40 patients with TBI (TBI group) and 40 healthy people (control group) were collected and venous blood was drawn. The plasma MEG3 in subjects was quantitatively analyzed via quantitative Polymerase Chain Reaction (qPCR). Moreover, the levels of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-8] in plasma in each group were detected via enzyme-linked immunosorbent assay (ELISA). Finally, the correlation analysis was performed for the MEG3 expression level and inflammatory cytokine levels in patients with TBI. Patients were divided into high-expression MEG3 group and low-expression MEG3 group, high-level inflammatory cytokine group and low-level inflammatory cytokine group according to the median, followed by prognosis evaluation. The MEG3 expression level in TBI group was significantly decreased compared to that in control group, and the levels of inflammatory cytokines in plasma, including TNF-α, IL-1β, IL-6, and IL-8, were significantly higher than in control group.The results of the correlation analysis showed that the expression level of plasma MEG3 had a significantly negative correlation with the level of each inflammatory cytokine. The prognostic analysis revealed that the prognosis of patients with high MEG3 expression level and low inflammatory cytokine levels was good, while it was poor in patients with low MEG3 expression level and high inflammatory cytokine levels; the difference was significant. In patients with TBI, the expression level of plasma MEG3 is decreased, while the inflammatory cytokine levels are increased, and there is a significantly negative correlation between the two items.The prognosis of patients with high MEG3 expression level and low inflammatory cytokine levels is good so MEG3 and inflammatory cytokines can be used as biomarkers for diagnosis and treatment of TBI, improving the prognosis of patients.

Work relative value units (wRVUs) can be used as a compensation model based on the effort required for providing a service and helps to determine adequate compensation for physicians. Thus, more complex surgical procedures that require greater technical skills and time should yield greater compensation. There are limited data comparing wRVUs and operative times within common general surgery procedures such as inguinal hernia repair. This study aims to compare mean operative times and wRVUs per minute between primary and recurrent inguinal hernia repairs, the latter being considered as a more difficult procedure to perform.A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was performed to identify all patients undergoing primary inguinal hernia repair and recurrent inguinal hernia repair by general surgeons over a 6-year period (2012-2017). Calculation and comparison of mean operative times, wRVUs, and wRVU per minute were performed.A total of 134,391 patients were included in the analysis. 121,235 underwent primary inguinal repair and 13,156 patients underwent repair of recurrent inguinal hernia. Patients were distributed within open/reducible, open/incarcerated and laparoscopy groups. Mean operative time and RVUs were greater for recurrent inguinal procedures (p 0.0001). Consistently, RVU per minute was also found to be higher for recurrent procedures within the different groups analyzed.Appropriately, general surgeons are reimbursed at a higher rate per minute in recurrent cases, regardless of the technique used.

To cope with the higher prevalence of asthma and other non-communicable diseases without compromising on quality of care, a Singapore public primary care institution has adopted the Chronic Care Model (CCM). This retrospective cohort study aimed to describe the proportion of patients with well-controlled asthma (based on Asthma Control Test score ≥20) between 2010 and 2016 in association with their management based on the CCM (which covers the polyclinic clinical information system, self-management measures, system re-design and decision support). Data were retrieved from the Singapore National Asthma Programme (SNAP) and institutional clinical quality databases of eight local polyclinics in eastern and southern Singapore. The data were aggregated, analysed and presented in proportions against monthly polyclinic attendances for asthma. From 2010 to 2016, the total asthma attendances increased by 31% from 27,345 to 35,731, with the highest rise among patients aged ≥60 years. The proportion of patients with good asthma control rose from 71.4% to 80.9%; those who received rescue therapy for acute exacerbations fell from 15.8% to 11.7% and those referred to emergency departments after failed rescue therapy decreased from 0.7% to 0.6%. The proportion of patients with updated asthma action plans increased from 66.7% to 73.4% (proxy for self-management). The overall health and process outcomes of asthma seemed to have improved with multiplex of system-based interventions relating to the introduction of CCM in a public primary healthcare institution in Singapore.

Miles procedure is often necessary for patients with low rectal carcinoma. However, this operation often affects the quality of life of patients, to evaluate the advantages of improved operation (anal reconstruction), the quality of life and survival between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection were analyzed. The clinical data of 43 patients with low situated rectal carcinoma were retrospectively analyzed. 23 patients with left lower abdominal stoma after radical resection (Miles procedure) were divided into group A, and 20 patients with reconstruction of the anus in situ after radical resection were in group B. All patients were investigated by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaire, the clinical data are recorded. Independent sample T test was used to analyze the difference in quality of life between group A and group B at 3, 6, and 12 months after surgery, and Kaplan–Meier was used to compare the difference in overall survival between group A and group B. The results of T test showed that there were statistical significance in global health status and physical functioning between group A and group B at 3 and 6 months, but no statistical significance at 12 months (P = 0.024, P = 0.019, P = 0.115 for global health status; P = 0.004, P = 0.006, P = 0.065 for physical functioning, respectively). Emotional functioning and social functioning were also statistically significant between group A and group B at 3, 6, and 12 months (P = 0.041, P = 0.040, P = 0.034 for Emotional functioning; P = 0.020, P = 0.009, P = 0.032 for social functioning, respectively). This study also found that there was no statistical significance in body image and sexual functioning between group A and group B at 3 months, but there was statistical significance at 6 and 12 months(P = 0.098, P = 0.035, P = 0.045 for body image; P = 0.110, P = 0.048, P = 0.047 for sexual functioning, respectively). There were statistically significant about sexual enjoyment and defecation problems at 3, 6, and 12 months (P = 0.023, P = 0.028, P = 0.050 for sexual enjoyment; P = 0.013, P = 0.011, P = 0.050 for defecation problems, respectively).The results of Kaplan–Meier showed that the overall survival (OS) between group A and group B was not statistically significant (χ2 = 0.600, P = 0.439). There was no difference in survival time between group A and group B, but compared with the patients with left lower abdominal stoma(group A), the quality of life was better in patients with reconstruction of the anus in situ (group B). It is significant to improve the traditional lower abdominal stoma operation.

To investigate the expressions of claudin-1 and placental growth factor (PlGF) proteins in retinoblastoma (RB) and their relationships with the differentiation of RB, the infiltration of optic nerve and choroid and clinical stages.Immunohistochemical (IHC) method was used to detect the expressions of claudin-1 and PlGF proteins in 56 cases of RB paraffin-embedded tissue samples. The x2-test and Fisher exact test were used to compare the qualitative variables. The Pearson correlation coefficient was used to detect the correlation of the expression of claudin-1 with that of PlGF in RB tissues.1) Among RB tissues, the positive expression rates of claudin-1 in clinical stage I tumors and clinical stage III tumors were 69.2% and 38.9%, respectively, and claudin-1 was not expressed in all clinical stage II tumors (p=0.002). In case of optic nerve invasion, the lowly positive expression of claudin-1 was detected, and the difference was significant (p=0.001). 2) The positive expression rate of PlGF proteins in RB was 73.8%, which was higher in tumors with optic nerve invasion than in tumors without the invasion; the expression was significantly different (p=0.001). In addition, the positive expression rate of PlGF in tumors with choroidal invasion was 74.1%. 3) The expression of claudin-1 in RB was negatively correlated with the presence of choroidal invasion (r=0.52, p≤0.0001) and optic nerve infiltration (r=0.49, p=0.0003). There was a significant positive correlation between the expression of PlGF and the presence of optic nerve invasion (r=0.30, p=0.009). In addition, there was a significant positive correlation between the expression of claudin-1 and that of PlGF (r=0.41, p=0.006).The expression level of claudin-1 is negatively correlated with the differentiation of RB cells, optic nerve infiltration and clinical stages, while the expression of PlGF was positively correlated with the optic nerve infiltration and clinical stages of RB. The role of claudin-1 may be opposite to that of matrix metalloproteinase-2 (MMP-2) in the development of RB.

To investigate the expression of long non-coding RNA zinc-finger E-box binding homeobox 1-AS1 (lncRNA ZEB1-AS1) in gastric cancer cells and tissues, to study its effect on the gastric cancer cell metastasis capacity, and analyze its clinical significance.The relative expression level of lncRNA ZEB1-AS1 in gastric cancer cells was detected via quantitative reverse transcription polymerase chain reaction (qRT-PCR). Transwell assay was used to detect the effects of lncRNA ZEB1-AS1 on the invasion and metastasis capacities of gastric cancer cells. qRT-PCR was used to detect the relative expression level of lncRNA ZEB1-AS1 in 75 pairs of gastric cancer tissues, and the correlations of its expression with the pathological characteristics and prognosis of patients were statistically analyzed.qRT-PCR showed that compared with that in the normal gastric epithelial cell (GES-1), the expression level of lncRNA ZEB1-AS1 was up-regulated in gastric cancer cells (MKN28, MKN45, BGC823, MGC803, KATOIII, and SGC7901). LncRNA ZEB1-AS1 interfering sequence was transfected into model cells, and Transwell assay showed that the cell invasion and migration capacities were significantly inhibited. qRT-PCR also revealed that the expression of lncRNA ZEB1-AS1 was up-regulated in 55 out of 75 cases of gastric cancer and para-carcinoma tissues (fold change1). Statistical analysis showed that the high expression of lncRNA ZEB1-AS1 was positively correlated with TNM staging (p = 0.002), lymph node metastasis (p = 0.002), and invasion degree (p = 0.004). The survival time of patients with high expression of lncRNA ZEB1-AS1 in gastric cancer tissues was shorter than that of patients with low expression (p = 0.004).LncRNA ZEB1-AS1 is highly expressed in gastric cancer tissues and cells, and it is expected to be a new prognostic marker of gastric cancer used for the clinical diagnosis and prognostic evaluation. After intervention in lncRNA ZEB1-AS1 expression, the cell invasion and migration are inhibited, and lncRNA ZEB1-AS1 may be an important target to reverse the malignant phenotype of gastric cancer.

MicroRNAs have caught more attention for their role in tumor progression. Retinoblastoma (RB) is one of these ordinary malignant tumors. This study aims to identify whether mir-138-5p can regulate the development of RB, and find out its potential mechanism.Mir-138-5p expression in RB cells was monitored by RT-qPCR. Besides, the role of mir-138-5p in RB development was explored through function experiments in vitro. The potential mechanism was further explored by RT-qPCR, luciferase assay, and Western blot assay.In our investigation, mir-138-5p was lower-expressed in RB cells than that in retinal pigment epithelial cells. Moreover, overexpression of mir-138-5p repressed cell viability, migration and invasion, and induced apoptosis of RB cells, while downregulated mir-138-5p increased cell viability, migration and invasion, and reduced apoptosis of RB cells. Furthermore, pyruvate dehydrogenase kinase 1 (PDK1) could be downregulated via overexpression of mir-138-5p, while PDK1 was upregulated via knockdown of mir-138-5p.Our results suggested that mir-138-5p could repress the development of RB via suppressing PDK1, which may offer a new vision for interpreting the mechanism of RB tumorigenesis.

SUMMARYHepatitis C virus (HCV) infection is one of the leading causes of death and morbidity associated with liver disease. Risk factors identified for the transmission of HCV include contaminated blood products, intravenous drug use, body piercing, an infected mother at birth, sexual activity, and dental therapy, among others. However, the exact diversity of the HCV genotype and genetic variation among patients with low-risk factors is still unknown. In this study, we briefly described and analysed the genotype distribution and genetic variation of HCV infections with low-risk factors using molecular biology techniques. The results suggested that genotype 1b was predominant, followed by genotypes 2a and 1a. Genetic variations in the 5′ UTR sequences of HCV were identified, including point mutations, deletions, and insertions. The frequency of genetic variations in 1b was higher than in 2a. This study provides considerable value for the prevention and treatment of liver disease caused by HCV among patients with low-risk factors and for the development of HCV diagnostic reagents and vaccines.