OBJECTIVE: To evaluate the treatment effect, quality of life and side-effect of transcatheter arterial chemoembolization (TACE) and traditional Chinese medicine (TCM) in treating metastatic liver cancer. METHODS: Thirty-nine cases of colon metastatic liver cancer were randomly divided into two groups. Both TACE and TCM were used in the treatment group, while only TACE was used in the control group. The drug used in TACE included floxuridine, pirarubicin, cisplatin, and the herbs for strengthening the spleen and regulating Qi were used in TCM. RESULTS: The response rate in the treatment group was 30% (45% including minor remission patients), and the median survival time was 18.6 months. While in the control group the response rate was 15.8% (36.8% including minor remission patients), and the median survival time was 14.3 months. The 1-, 2-, 3- year survival rates of treatment group and the control group were 70.2%, 40.3%, 13.0% and 68.7%, 29.5%, 10.3% respectively. There were fewer other organ metastases in the treatment group. The score from the EORTC quality of life questionnaire QLQ-C30 in treatment group was higher than that in the control group. CONCLUSION: Integration of TACE and TCM in treating colon metastatic liver cancer has better results.

Objective To evaluate food intolerance sensitivity among 2962 health check-up receivers from the First Hospital of China Medical University.Methods Serum samples of 2962 adults were collected from January 2008 to June 2010.Serum allergen-specific IgG antibodies of 14 kinds of food were detected by ELISA.The data were analyzed by using One-way analysis of variance.Results In this study,the rate of food intolerance was 0.4%(mushrooms) to 38.0%(eggs).Higher rates of food intolerance were found in egg,crab,shrimp,milk,and cod fish(Eggs 32.5%,crabs 26.0%,shrimps 19.8%,milk 13.8%,and cod fish 12.0% respectively).However,wheat,pork,and mushroom showed relatively lower rates of food intolerance(Wheat 0.8%,pork 0.4%,and mushrooms1.4% respectively).Positive reaction to food intolerance was even stronger in women(9.4% versus 8.2%).Conclusion It is discovered by study that in general population,the diversity of intolerance among different food is associated with 4 factors: gender; age; feature of food; individual diversity.It is recommended that the status of intolerance to food in the general population be investigated by health management.

ObjectiveTo explore the relationship among 14 kinds of intolerant food by using association rules to provide evidence for more reasonable diet intake.Methods A total of 2962 adults who received medical examination at the First Affiliated Hospital of China Medical University during January 2008 and June 2010 were enrolled in this investigation.ELISA was used to detect allergen-specific IgG antibody of 14 kinds of food.An association rules model was established by SPSS Clementinel2.0.In order to find positive intolerance association rules,food frequency was recorded with SPSS 16.0.Results Five most commonly seen food intolerance were eggs,crabs,shrimp,milk,and cod (positive rates were 32.5％,26.0％,19.8％,13.8％ and 12.0％,respectively).Positive association rules were found in crab and shrimp,or milk and eggs.Single order association was found in female,while multi-order association was identified in male.Conclusions Our data show a strong positive association among animal foods.Female may be affected by milk,eggs and seafood,while male may be affected by a variety of foods.

Type 2 diabetes macrovascular disease is the main cause of death in type 2 diabetes mellitus. In recent years, the modern medical research and treatment of type 2 diabetes macrovascular disease has made some progress, but the international clinical trials suggest that the current treatment can not effectively reduce the incidence of this disease. Many clinical practices show that the effect of traditional Chinese medicine on this disease is exact, so that the clinical workers on the treatment of type 2 diabetes mellitus macrovascular disease of the status quo, now from the etiology and pathogenesis,clinical research, experimental research on the literature published in recent years, to provide reference for clinical treatment.

Objective:To improve the rate of successful rescue through analyzing the clinical features and treating processes of septic shock caused by lymphocyst infection after lymph node dissection in diabetic patients.Methods:A total of 462 cases of diabetic patients with bladder, prostate, renal cancers, cervical, endometrial and ovarian were retrospectively analyzed, all of whom underwent standard surgical treatments including pelvic lymph node dissection, hospitalized in department of urology surgery and gynecology of Sun Yat-sen Memorial Hospital from Jan 2015 to Jan 2020. Lymphocytes were confirmed in 148 cases, of which 89 cases were complicated by infection, and 13 cases developed septic shock. Patients with lymphocyst infection were divided into shock and non-shock groups, and age, sex, duration of diabetes, BMI, glycosylated hemoglobin at admission, number of lymph nodes surgically removed, retention time of drainage tube after operation, maximum diameter of lymphocyst and time between infection and previous chemotherapy were compared. The initial symptoms, blood routine in the first time after the onset of the infection, the time from onset to drainage puncture and catheterization and the final outcomes were analyzed in 13 patients with septic shock. The results of pathogen culture and drug sensitivity of infected lymphocyst fluid were also analyzed.Results:Categorical variable test showed that: in diabetic patients with lymphocyst infection, there were significant differences in glycosylated hemoglobin ( P=0.018) , adjuvant chemotherapy ( P=0.014) and lymphocyst size ( P<0.001) between shock group and non-shock group. Among the 13 cases of septic shock, 11 caseshad mild to moderate fever or abdominal pain. The total leukocyte count of all cases in the first hemogram were less than 20×10 9/L. The average time from onset to drainage was 33 hours. Among the 13 patients, 5 developed MODS and 1 died. There were 2 patients whose conditions were complex with frequent fluctuations. In the 12 patients who recovered from septic shock, only 1 underwent a residual lymphocyst pretreatment, 4 had recurrent cyst infection for 1-2 times, 2 had septic shock again, and 1 died. Gram negative bacteria were the most common pathogens, and the main was Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Piperacillin / tazobactam, carbapenems and tigecycline were commonly sensitive, while the drug resistance rates of ceftazidime, ceftriaxone and levofloxacin were more than 50%. Conclusions:Poor glycemic control, adjuvant chemotherapy and big lymphocyst size(d≥5 cm) are the high risk factors of septic shock. Most of shock patients' initial symptoms and total white blood cell count have no warning significance, leading to longer time from infection to drainage, and delayed treatment. Early diagnosis, timely drainage and active anti-infection treatment are the key to a successful treatment. The possibility of connection between lymphocyst and surrounding organ should be considered when the treatment effect is not good. After septic shock of postoperative lymphocyst infection in patients with diabetes, the larger esidual lymphocyst should be intervened actively to avoid serious infection again.

Taking the Department of Obstetrics and Gynecology as an example, this paper expounds a series of practices of online education, in the process from pre-course training, platform selection, curriculum design, to student evaluation, etc. From that, we can provide a reference for carrying out online teaching in response to the epidemic for clinical medical colleges which have not been exposed to the online course. Furthermore, it is a new attempt to explore a way to make a change of the traditional teaching method and deepen the reform of clinical teaching in our hospital after the epidemic, not only in professional medical education, but also in the popularization of medical knowledge.

Objective: To investigate the application of mycophenolate mofetil (MMF) in oral mucosal pemphigoid and provide a clinical reference. Methods: One case of glucocorticoids combined with MMF in the treatment of oral mucosal pemphigoid was reported, and the clinical application of MMF in oral mucosa-related bullous diseases was discussed. Results: One patient with a clinical diagnosis of “oral mucosal pemphigoid” was treated with methylprednisolone (36 mg, qd, morning dose) or combined hydroxychloroquine sulfate (0.1 g/time, bid) and thalidomide capsules (50 mg, qd, bedtime) and other drugs. The patient’s disease was slowly controlled but prone to recurrence. The treatment regimen was immediately adjusted, i.e., methylprednisolone (36 mg, qd, morning dose) was combined with MMF (0.5 g/time, bid) for 2 weeks, which resulted in ideal lesion healing control. After 8 weeks of methylprednisolone combined with MMF, the dose of methylprednisolone was gradually reduced to 12 mg, qd, and MMF was reduced to 0.5 g, qd, the patient’s symptoms improved significantly, and no obvious lesions were found in the mouth. The dose was then reduced and maintained according to the principle of pemphigoid treatment. Methylprednisolone (8 mg, qd, morning dose) and MMF (0.5 g, qd) have been used for 6 months of maintenance treatment, and they are still being followed up. As yet, the patient’s condition is stable without obvious lesions and new blisters, and no obvious side effects have been observed. A review of the literature shows that MMF is widely used in the field of dermatology to treat a variety of immune diseases, such as connective tissue diseases and autoimmune blistering diseases. According to the reports of adverse reactions to MMF, digestive system reactions are the most common adverse reactions; therefore, patients with active gastrointestinal diseases should be treated with caution, followed by bone marrow suppression, and it is recommended to monitor liver function and blood routine in patients using MMF. The safety and efficacy of MMF for treating pemphigoid involving the skin have been reported in the literature, but oral mucosal doctors still lack experience for treating mucous membrane pemphigoid. Conclusions As a new immunosuppressant, MMF has high safety and no obvious side effects and can be considered as a combination adjuvant drug for patients with severe clinical disease and refractory oral mucosal pemphigoid.

BACKGROUNDTo evaluate and compare the effects and toxicity of the domestic product of nrhTNF combined with chemotherapy in the trial group and chemotherapy alone in the control group in the treatment of patients with non-small cell lung cancer (NSCLC).

METHODSNinety patients with NSCLC in multicenter were randomly devided into trial group and control group. Each group had 45 patients. Chemotherapy with CAP regimen was given for the patients in the trial group. Meanwhile, nrhTNF injection of 4×10⁶U/m ² was also given from the 1st to 7th days, the 11th to 17th days on the chemotherapy course. Twenty-one days were as a cycle, 2 cycles were given each patients. Chemotherapy alone with CAP regimen was given in the control group. The chemothepeutic effects and toxicity were observed and compared between the two groups after the therapy.

RESULTSOf the 90 patients, 3 cases in each group were out of the trial because of economy. The other 84 cases (each group had 42 patients) could be used to analyze and evaluate the clinical effects and toxicity. The response rate of chemotherapy was 47.62% (20/42) in the trial group and 19.05% (8/42) in the control group (P=0.002) respectively. The KPS was 85.02±10.74 in the trial group, and 81.35±9.63 in the control group (P=0.038). No significant difference of degree III+IV toxicity was observed between the trial group and control group (P > 0.05). The side effects related to nrhTNF included slight fever, cold like symptoms, pain, and red and swelling in injection site. All of them were mild and didn't need any treatment and disappeared after the therapy.

CONCLUSIONSThe results demonstrate that the effects of domestic nrhTNF combined with chemotherapy can remarkably higher than that of chemotherapy alone in the treatment of NSCLC. It is able to increase the sensitivity to chemotherapy and improve the quality of life of the patients. The toxicity is also slight and is worth to expand clinical use, so as to further evaluate its effect and toxicity.

Objective: To detect the expression of vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) in oral lichen planus (OLP). Methods : Thirty OLP patients and fifteen healthy subjects were enrolled in the study. Serum were collected from 15 healthy volunteers as controls. Normal tissues were collected from surgical department as immunohistochemical analysis. The levels of VEGF, ICAM-1, VCAM-1 in serum were measured by ELISA. Immunohistochemical analysis of VEGF, ICAM-1, VCAM-1 were carried out by the means of primary antibodies and anti-VEGF, anti-CD106 antigen (VCAM-1) and anti-CD54 antigen (ICAM-1). Results: ELISA results showed no expression differences for VEGF between the two groups. Whereas, the levels of ICAM-1, VCAM-1 in OLP group were significantly higher than those in control group (P < 0.05). Immunohistochemical results reveal the presence of a significant angiogenesis in OLP patients through the immunoexpression of VEGF, ICAM-1, VCAM-1 according to the percentage of stained cells (P < 0.05). Conclusion Regarding the results, it seems that high expression of VCAM-1 and ICAM-1 are related to oral lichen planus.

Objective: To analyze the clinical characteristics and treatment experience of Vitamin B12 (VB12) deficient patients with recurrent aphthous ulcers (RAU) to improve the clinical efficacy. Methods: A retrospective analysis was performed on 15 cases of recurrent oral ulcers from January 2016 to September 2018. The causes were analyzed according to the patients’ clinical characteristics. Results: In total, 15 patients with RAU had no remission after routine immunotherapy. Further clinical examination suggested that vitamin B12 levels were reduced. The erythrocyte mean corpuscular volume (MCV) was significantly increased, and the average number of red blood cells (RBC) and hemoglobin (Hb) levels were decreased. RAU disappeared after vitamin B12 supplementation. Routine blood work showed that the MCV returned to the normal range, which was statistically significant compared with the pretreatment MCV (P < 0.001). Vitamin B12 serum levels were significantly higher (P < 0.001) than those before treatment. Conclusion When the main manifestation of vitamin B12 deficiency is recurrent oral ulcer symptoms, dentists should examine the lesions carefully, inquire about the medical history in detail, and perform further serological tests when necessary to avoid the overuse of immunosuppressive drugs for treatment.