Objective To investigate the clinical value and safety of thoracoscopic lung biopsy in the diagnosis of diffuse parenchymal lung diseases. Methods 35 patients with diffuse parenchymal lung disease underwent thoraco-scopic lung biopsy were reviewed in order to obtain clinical and pathological data. Results 31 cases were diagnosed by pathology, and the total positive diagnostic rate was 88.6 % (31/35), 10 cases as usual interstitial pneumonial (UIP), 6 cases as Tuberculosis, 4 cases as alveolar cell carcinoma, 3 cases as nonspecific interstitial pneumonia (NSIP), 3 cases as crypto-genieorganizingpneumonia (COP), 2 cases as pulmonary alveolar proteinosis (PAP), 1 case as Wegener's granulomatosis (WG), 1 case as acute interstitial pneumonia (AIP), 1 case as lymphangioleiomyomatosis (LAM). 3 cases (8.6 %) were occurred with postoperative complications, 2 cases as pulmonary infection combined with respiratory failure, 1 case as idiopathic pulmonary fibrosis with acute exacerbation, and 2 cases (5.7 %) were complicated with death. Conclusions Thoracoscopic lung biopsy is a safe and effective method which helps final di-agnosis of diffuse parenchymal lung disease.

Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.

Objective To compare the differences between endoscopic resection and laparoscopy?assisted surgery or transanal endoscopic resection for rectal neuroendocrinal tumor. Methods Clinical data of patients who underwent endoscopic or surgical resection of neuroendocrinal tumor of less than 2 cm which were confirmed by pathology from December 2010 to November 2013 were retrospectively analyzed. Results Twenty cases of endoscopic treatment, including 17 cases of ESD, 3 cases of EMR,were included in endoscopy group;while 18 cases treated with surgery were included in surgery group, among which 12 ca?ses underwent transanal endoscopic microsurgery and 6 cases laparoscopic resection. The mean lesion sizes were 7 mm(4?18 mm)and 8 mm(3?15 mm),respectively. Pathology showed there were 16 cases of grade G1 neurocrinal tumor and 2 G2 cases in surgical group. There was no lymphvascular invasion with clear margin in the endoscopy group,but three cases of lymphvascular invasion in surgical group. No treatment?related se?vere adverse event occurred in either group. The time for oral food intake was 2?0 d(1?4 d) in endoscopy group, while that in surgery group was 2?4 d(1?7 d)(P=0?295). The hospital stay was(6?80±2?12) d in endoscopy group and(8?59±2?85)d in surgery group, respectively(P=0?034). And the total hospitalization cost was 10 488(4 128?15 296) yuan and 15 590(3 024?40 503) yuan(P=0?031) in the two groups, re?spectively. The follow?up was 25 months(2?48 months)and no recurrence was found. Conclusion Endo?scopic resection, especially ESD, is a new approach to treat colorectal neuroendocrinal tumor,advantageous over surgery in shorter hospitalization time, minimal invasiveness, faster postoperative recovery, less compli? cation, and reduced hospitalization cost.

Objective To investigate the relationship between red blood cell distribution width (RDW) and prognosis in patients with multiple myeloma (MM).Methods The population that studied consisted of 27 patients with multiple myeloma and 30 healthy controls.The RDW was calculated according to the results of blood routine examination and compared between patients and healthy controls.Then,compared the difference between the two groups of RDW.MM patients were treated with international standard staging (ISS),and the differences of RDW in different stages were analyzed.ISS staging was used to draw the receiver operating curve (receiver operating characteristic curve,ROC curve),then take RDW14.65 ％ as the best cut-off point,the MM patients were divided into low RDW group (RDW=14.65 ％) and high RDW group (RDW ＞14.65％).Overall survival (OS) condition were compared between the above two groups.The impacts of RDW on OS were analyzed by Kaplan-Meier and Log-rank test.Results The average RDW value in experimental and controlled were 15.60 ％ ± 2.35 ％ vs 12.72 ％ ±0.61 ％ separately (t=6.201,P＜0.001),with statistical differences.The average RDW value in low ISS(Ⅰ + Ⅱ stage) and high ISS (Ⅲ stage) were 13.99 ％ ± 1.08％ vs 16.55 ％±2.39％ separately (t=3.800,P=0.001).The median survival time of low RDW and high RDW group was 13 months and 8 months respectively,and the difference was statistically significant (x2=6.481,P =0.011).Conclusion RDW increased in patients with MM,the risk stratification higher prognosis is worse.

OBJECTIVETo explore the association of a functional polymorphism Val158Met of COMT gene and attention and executive function in first-episode treatment-naive patients with schizophrenia and healthy controls.

METHODSTrail making test (TMT) and clinical performances were evaluated in 103 first-episode treatment-naive patients with schizophrenia and 99 healthy controls. Polymorphism of COMT Val158Met was analyzed using polymerase chain reaction-restriction fragment length polymorphism method. A general linear model was used to investigate the effect of genotype subgroups on the attention and executive function.

RESULTSThere was a significant difference between control subjects and patients with schizophrenia on the TMT-A and B. However, no significant difference among Val/Val, Val/Met and Met/Met on the TMT-A and B in control subjects and patients with schizophrenia was detected.

CONCLUSIONThe association among COMT Met variant and trail making testing (attention and executive function) has been replicated. However, no association of COMT Met variant with disruption of dopaminergic influence on neurocognitive function was detected. This may be due to the heterogeneity of population.

Adolescent ; Adult ; Amino Acid Substitution ; Attention ; physiology ; Catechol O-Methyltransferase ; genetics ; Executive Function ; physiology ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Schizophrenia ; genetics ; physiopathology ; Schizophrenic Psychology ; Trail Making Test ; Young Adult

Objective:To investigate the efficacy of mFOLFOX7 regimen systemic chemo-therapy combined with camrelizumab and apatinib for hepatocellular carcinoma (HCC) with Vp4 portal vain tumor thrombus (PVTT).Methods:The single-arm, open, exploratory clinical study was conducted. The clinicopathological data of 15 HCC patients with Vp4 PVTT who were admitted to the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2021 to October 2023 were collected. There were 14 males and 1 female, aged 48(range, 33-67)years. All patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. Observa-tion indicators: (1) clinical efficacy; (2) survival of patients. Measurement data with skewed distribution were represented as M(rang), and count data were described as absolute numbers or percentages. Results:(1) Clinical efficacy. All 15 patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. According to the response evaluation criteria in solid tumors version 1.1, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 10/15, 1/15, 9/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. According to the modified response evaluation criteria in solid tumors, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 12/15, 6/15, 6/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. Of the 15 patients, 7 cases were successfully treated with conversion therapy with the surgical conversion rate as 7/15, and all of them achieved R 0 resection. The other 6 cases were failed in conversion therapy, and there were 2 cases still undergoing conversion therapy. Of the 7 patients with successful conver-sion therapy, 5 cases achieved complete pathological remission, 1 case achieved major pathological remission with 90% of tumor tissue necrosis, and 1 case achieved complete remission through imaging examination, but new liver lesions appeared in multiple locations during further observation which were surgically removed. Results of histopathology examination on the patient confirmed multiple liver metastases. The proportion of treatment-associated adverse reactions in 15 patients was 13/15, with 7/15 having ≥grade 3 adverse reactions, including diarrhea (3/15), neutropenia (2/15), thrombo-cytopenia (2/15), and elevated aspartate aminotransferase (2/15). One patient may experience ≥1 adverse reaction. All patients were improved after symptomatic treatment. (2) Survival of patients. All 15 patients were followed up for 13.0(range, 2.0-31.0)months. During the follow-up period, 3 patients died. One case died of upper gastrointestinal bleeding after achieving partial remission, with a survival time of 7.5 months. One case died of multiple liver metastases of tumor, with tumors accounting for over 70% volume of liver and a survival time of 9.5 months. One case with multiple liver tumors and bilateral lung metastasis died due to disease progression after achieving partial remission, with a survival time of 13.5 months. The postoperative follow-up time for 7 patients undergoing surgical treatment was 14.0(range, 2.0-25.0)months. Of the 7 patients, 1 case experien-ced tumor recurrence 20.0 months after surgery, and 6 cases had no recurrence at last time of the follow-up (3 cases completed treatment and entered follow-up observation). The longest survival time was 31.0 months. Conclusion:The mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for HCC with Vp4 PVTT is safe and feasible.

Objective:To explore the effects of estrogen receptor α (ERα) encoded by protein encoding gene ESR1 on the radiation resistance of breast cancer cells and their molecular mechanisms.Methods:The ESR1 overexpression plasmid was transfected into estrogen receptor (ER)-negative breast cancer cells. Then, the shRNA-ESR1 vector was introduced into ER-positive cell to establish models with different phenotype. The ATG5 mRNA level and protein expression levels of LC3B-I, LC3B-II, P62, FIP200, ATG5, ATG7, ATG12, Beclin1, ULK1 were detected using qPCR and Western blot techniques. Cell death was measured using flow cytometry. The radiation sensitivity was determined through the colony formation assay. The mortality of breast cancer cells under the autophagy gene knockdown and overexpression or treated with estrogen receptor inhibitor (TAM) combined with ionizing radiation were detected by trypan blue staining.Results:Under the condition of 8 Gy X-ray irradiation, the knockdown of ESR1 in ER-positive ZR75 breast cancer cells promoted cell death ( t = 3.49, 3.13, P < 0.05), while the overexpression of ESR1 in ER-negative MDA-MB-231 breast cancer cells inhibited cell death ( t = 4.16, 7.48, P < 0.05). Compared to the control group, the treatment with chloroquine increased the number of formed colonies of ESR1 knockdown ZR75 cells ( t = 8.49, P < 0.05), and inhibiting autophagy could reduce the death of ZR75 cells caused by ESR1 silencing. Under the treatment with ionizing radiation, the overexpression of ESR1 in MDA-MB-231 cells promoted protective autophagy, which, however, was reduced after ESR1 knockdown in ZR75 cells. Furthermore, it was observed that the knockdown of ATG5 in ZR75 cells was associated with reduced autophagy and an increase in cell death ( t = 4.19, 6.39, P < 0.05). In contrast, the overexpression of ATG5 in ZR75 cells reversed the increase in cell death caused by ESR1 knockdown ( t = 1.70, 4.65, P < 0.05). After the treatment of ER-positive ZR75 breast cancer cells with TAM, the expressions of ATG5 and ATG12 decreased, suggesting inhibited autophagy and an increase in cell death ( t = 18.70, P < 0.05). Furthermore, these processes were promoted by ionizing radiation ( t = 16.82, P < 0.05). Conclusions:The estrogen receptor encoded by ESR1 promotes protective autophagy of ER-positive breast cancer cells by increasing ATG5, further leading to radiation resistance in ER-positive breast cancer cells. Treatment with tamoxifen combined with ionizing radiation can increase the radiation sensitivity of ER-positive breast cancer cells.

OBJECTIVETo investigate the feasibility of extraction site preservation using injectable calcium phosphate cement (CPC) combine with poly (lactic-co-glycolic acid) (PLGA) microspheres.

METHODSImmediate extraction defects models were created in canine mandibles, and the defects were filled with CPC/PLGA (experimental group, E) , Bio-Oss (positive control, P), non-treatment (blank control, B) respectively. Dogs were sacrificed after 4, 8, 12 weeks post operation. Statistical analysis were conducted using SPSS 19.

RESULTS RESULTSof radiological observation showed that there were not significantly different between groups in 4 and 8 week (P > 0.05). After 12 week,E (114.9 ± 8.4) were not significantly different compared with P (117.4 ± 12.1) (P > 0.05) , both were significantly higher than B (95.0 ± 12.6) (P < 0.05) . Histology examination showed that at 4 week following surgery, the result of newly formed bone was as follow, P[ (87.5 ± 1.5) %] > B[(78.7 ± 2.7)%] > E[(69.2 ± 1.8)%] (P < 0.05). At 8, 12 week, results of P[(94.0 ± 2.3)% and (93.5 ± 1.9) %] and E[ (94.7 ± 1.1) % and (96.0 ± 0.9) %] were better than those of B[ (76.8 ± 3.0)% and (87.0 ± 2.4)%] (P < 0.05).

CONCLUSIONSThe effect of CPC/PLGA repair immediate alveolar ridge defects is the same as that of Bio-Oss, and CPC/PLGA can be used as a material in extraction site preservation.

Animals ; Calcium Phosphates ; Dental Cements ; Dental Models ; Dogs ; Glycolates ; Lactic Acid ; Microspheres ; Minerals ; Polyesters ; Polyglycolic Acid ; Polymers ; Tooth Extraction

OBJECTIVE To explore the value of providing pharmaceutical service related to risdiplam in direct-to-patient （DTP） pharmacies. METHODS The follow-up data of spinal muscular atrophy （SMA） patients who purchased and used risdiplam from Shangyao Yunjiankang Yiyao Pharmacy （Shanghai） Co.， Ltd. from May 2021 to January 2023 were collected. The medication information， therapeutic efficacy and the occurrence of adverse events were retrospectively analyzed. RESULTS A total of 42 prescriptions were checked by pharmacists in the DTP pharmacies， and 7 prescriptions were found to be unreasonable （16.7%， 7/42）， which were corrected after the timely intervention. During the follow-up management， pharmacists replied to 4 patients （9.5%， 4/42） regarding medication consultation about medication requirements and adverse events. Two patients with type Ⅰ SMA experienced adverse events： one of them presented with fever and the other presented with skin dryness with darkening. Both of them were grade Ⅰ toxic reactions and generally did not require clinical treatment. Considering that the patient sustained low-grade fever for a long time， the pharmacist suggested symptomatic treatment under the guidance of the doctor. CONCLUSIONS Pharmacists in DTP pharmacies conducting follow-up management of risdiplam use for rare disease SMA patients can help promote rational， standardized medication for patients.

Objective To understand the epidemic characteristics of different virus types of hand, foot and mouth disease (HFMD) in Zhaotong City, and provide guidance and recommendations for the prevention and control of HFMD, and to analyze seasonal characteristics of different virus types of HFMD in Zhaotong City. Methods The epidemiological characteristics of different virus types of HFMD in Zhaotong City from 2014 to 2017 were analyzed using the concentration and circular distribution methods. Results The main pathogens detected were EV71, Cox A16 and other enteroviruses, which were 216, 182, and 294, respectively, accounting for 57.45%, 73.44%, and 67.11%. M was 0.86, indicating that EV71 had strong seasonality. The Rayleigh test showed statistically significant differences (Z = 99.53, P <0.001). ā = 157 °, the peak day of onset was May 10, similar to untyped (May 16), the peak period was April 21-June 1, and the epidemic period was April 1-June 21. Conclusion According to the incubation period of hand-foot-mouth disease and the period of time during which the vaccine develops protective effects, vaccination of hand-foot-mouth disease vaccine at the peak period has a good guiding significance for the timeliness and pertinence of vaccination.