OBJECTIVE: To optimize the component compatibility of Naomaitong for anti-cerebral ischemia treatment based on artificial neural network. METHODS: The five effective parts in Naomaitong were divided into ten groups by uniform design. Except the rats in the sham groups, all rats were subject to right middle cerebral artery occlusion (MCAO) with the suture-occluded method by Longa. The effect of Naomaitong was evaluated based on the bulk density of necrotic zone and infarction area percentage. The artificial neural network model was established for pharmacodynamic prediction. RESULTS: The model established in this study could predict the actions of different drug combinations. The best effect was obtained by the following formula: total anthraquinones of rhubarb (TAR) 180 mg·kg-1, total saponins of Ginseng (TSG) 70 mg·kg-1, total flavonoids of Pueraria (TFP) 450 mg·kg-1, total phenolic acid of Ligusticum wallichii (TPLW) 27 mg·kg-1, rhizome oil (RO) 110 μL·kg-1. CONCLUSION: Different compatibilities of Naomaitong are all effective for the treatment of ischemia in rats. Uniform design combined with ANN can be a more efficient method to realize dose optimization for Naomaitong prescription.

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Objective To explore motivation alteration influencing factors of internet addiction disorder (IAD) undergraduates.Methods The study sampled randomly 793 undergraduates from China University.According to CIAS-R and Young's internet addiction diagnostic criteria,a total of 37 internet addicts were selected.Internet addiction survey was used to study the motivation alteration influencing factors of IAD undergraduates.Results (1) The negative effect of internet using on academy,personal relationship etc.(damage from internet using) had a significant positive correlation with motivation alteration (r =0.672,0.699,0.658,P ＜ 0.01 ; r =0.653,0.673,0.628,P ＜ 0.01 ; r =0.604,0.681,0.703,P ＜ 0.01).(2) Benefit from psychological satisfactory level of internet using had no significant difference with motivation alteration.(3) Self-efficiency of behavioral control on using internet had a significant negative correlation with motivation alteration (r =-0.397,-0.370,P ＜0.05).Conclusion The motivation alteration of IAD undergraduates is influenced by the factors of damage from internet using,sense of achievement,self-efficiency of behavioral control on using internet and so on.

Objective: To investigate an optimal chemotherapy regimen for patients diagnosed with lung adenocarcinoma harboring common EGFR mutations. Methods: Clinical data of 4,021 patients diagnosed with advanced primary lung adenocarcinoma who were admitted to Guangdong Lung Cancer Institute from June 2007 to June 2014 were retrospectively collected. The efficacy of the standard chemotherapy regimen in patients diagnosed with luny adenocarcinoma harboring common EGFR mutations was analyzed. Results: In total, 205 patients were included in the study, and 119, 60 and 81 patients received gemcitabine plus platinum, pemetrexed plus platinum, and paclitaxel plus platinum regimens, respectively. Statistical difference was not observed in the objective response rate (ORR,25.2%, 25.0%, 30.8%, respectively) and progression free survival (PFS, 5.5, 5.2, 6.2 months, respectively) between these three treatment regimens (P=0.979, P=0.811). Conclusions: Platinum-based chemotherapy regimens based on gemcitabine, pemetrexed, and paclitaxel have similar efficacy in patients diagnosed with advanced primary lung adenocarcinoma harboring common EGFR mutations.

BACKGROUNDPercutaneous balloon pulmonary valvuloplasty (PBPV) is the preferred therapy for pulmonary valve stenosis (PVS). This study retrospectively reviewed recent PBPV outcomes in infants with PVS. The aim of this study was to evaluate factors associated with immediate therapeutic outcomes and restenosis during medium-term follow-up.

METHODSThe study included 158 infants with PVS who underwent PBPV from January 2009 to July 2015. Demographic characteristics and patient records were reviewed, including detailed hospitalization parameters, hemodynamic data before and immediately after balloon dilation, cineangiograms, and echocardiograms before PBPV and at each follow-up. All procedures were performed by more than two experienced operators.

RESULTSImmediately after balloon dilation, the pressure gradient across the pulmonary valve decreased from 73.09 ± 21.89 mmHg (range: 43-151 mmHg) to 24.49 ± 17.00 mmHg (range: 3-92 mmHg; P < 0.001) and the right ventricular systolic pressure decreased from 95.34 ± 23.44 mmHg (range: 60-174 mmHg) to 52.07 ± 18.89 mmHg (range: 22-134 mmHg; P < 0.001). Residual transvalvular pressure gradients of 67.31 ± 15.19 mmHg (range: 50-92 mmHg) were found in 8.2% of patients, indicating poor therapeutic effects; 6.4% of patients had variable-staged restenosis at follow-up and 3.8% underwent reintervention by balloon dilation or surgical repairs. Further analysis demonstrated that the balloon/annulus ratio showed statistically significant differences (P < 0.05) among groups with different therapeutic effects and between the restenosis and no-stenosis groups. Binary logistic regression analysis further revealed that higher balloon/annulus ratio (odds ratio: 0.005, 95% confidence interval: 0-0.39) was an independent protective factor for restenosis. The rate of severe complications was 1.9%.

CONCLUSIONSPBPV is a definitive therapy for infants with PVS based on its effectiveness, feasibility, and safety. Restenosis upon medium-term follow-up is relatively rare.

AIM:To describe the clinical characteristics of 20 patients with acute acquired comitant esotropia(AACE).

METHODS: This retrospective, observational case series study enrolled patients with AACE examined from June 2018 to May 2021 in Guangdong Jiangmen Central Hospital. The age when attacked, the duration of excessive near work before illness, symptom, refraction, AC/A, deviation and near stereopsis were analyzed. All 20 patients had unremarkable neurological finding by imageological test.

RESULTS: Most patients whose mean age was 24.25±5.78 years immersed in near work for more than 6h a day before illness. All patients seeked for medical help because diplopia with normal ocular motility in all directions of gaze and meaningless finding in routine ophthalmologic examinations. They were all nearsightedness whose mean spherical equivalent was -5.73±5.09D, while mean AC/A was 2.65±1.16 within the upper limit. There was no different between the distant and near deviations(P>0.05). Deviations might be correlated with near stereopsis(P<0.05), however the duration from onset to treatment was irrelevant(P>0.05).

CONCLUSION: The clinical features of AACE in older children and adults who immersed excessive near work are medium myopia, diplopia, normal ocular motility, no neurological finding and limited AC/A. Moreover, it is approximate between distant and near deviations. The deviations affect near stereopsisd more, while the influence of duration from onset to treatment may be less.

BACKGROUNDDrug resistance to targeted therapies occurs in lung cancer, and resistance mechanisms related to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are continuously being discovered. We aimed to establish a novel method for highly parallel multiplexed detection of genetic mutations related to EGFR TKI-resistant lung cancer using Agena iPLEX chemistry and matrix-assisted laser desorption ionization time-of-flight analysis on the MassARRAY mass spectrometry platform.

METHODSA review of the literature revealed 60 mutation hotspots in seven target genes (EGFR, KRAS, PIK3CA, BRAF, ERBB2, NRAS, and BIM) that are closely related to EGFR TKI resistance to lung cancer. A total of 183 primers comprised 61 paired forward and reverse amplification primers, and 61 matched extension primers were designed using Assay Design Software. The detection method was established by analyzing nine cell lines, and by comparison with LungCarta™ kit in ten lung cancer specimens. EGFR, KRAS, and BIM genes in all cell lines and clinical samples were subjected to Sanger sequencing for confirming reproducibility.

RESULTSOur data showed that designed panel was a high-throughput and robust tool, allowing genotyping for sixty hotspots in the same run. Moreover, it made efficient use of patient diagnostic samples for a more accurate EGFR TKIs resistance analysis. The proposed method could accurately detect mutations in lung cancer cell lines and clinical specimens, consistent with those obtained by the LungCarta™ kit and Sanger sequencing. We also established a method for detection of large-fragment deletions based on single-base extension technology of MassARRAY platform.

CONCLUSIONSWe established an effective method for high-throughput detection of genetic mutations related to EGFR TKI resistance based on the MassARRAY platform, which could provide more accurate information for overcoming cancers with de novo or acquired resistance to EGFR-targeted therapies.

Intervention therapy for congenital heart diseases has made great progress over the past 50 years, and fetal cardiac intervention therapy, which has saved lives and improved the postnatal prognosis, has thrived with the rapid development of the fetal echocardiography. The safety and effectiveness of fetal cardiac intervention have been acknowledged.

Objective    To investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP). Methods    Thirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients  were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and

Objective To analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization. Methods From June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed. Results Totally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis. Conclusion Overall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.