Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas.Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed.Abdominal ultrasound,computed tomography and tumor markers detection were carried out preoperatively to learn the condition of the patients.No patient received neoadjuvant therapy before operation,and chemotherapy,biotherapy and radiotherapy were applied to all the patients after radical resection.Indicators including the gender,age,onset of back pain,site,diameter and differentiation of tumors,operative procedure,lymph node metastasis,metastatic rate of lymph nodes,extra-and intra-pancreatic neural invasion,splenic artery invasion,splenic vein invasion,retroperitoneal soft tissue infiltration,venulae infiltration and TNM staging were collected.The survival curve was drawn by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Univariate and multivariate analysis were carried out by chi-square test and COX proportional hazards model,respectively.Results All patients received R0 resection,and the mean number of lymph node resected was 15 (range,12-22).There were 5 patients with pancreatic leakage,3 with delayed gastric emptying,1 with peritoneal infection,and 1 with deep venous thrombosis,no perioperative mortality was detected.All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma,and 9 patients were with high differentiated tumor,35 with moderate differentiated tumor and 20 with low differentiated tumor.There were 4 patients with tumor in the TNM IA stage,9 in the TNM IB stage,17 in the TNM Ⅱ A stage and 34 in the TNM Ⅱ B stage.Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis.The 1-,3-,5-year survival rates were 42.2％,17.2％ and 15.6％,respectively,and the median survival time was 19.0 months.The result of univariate analysis showed that back pain,maximum tumor diameter,differentiation,lymph node metastasis,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging were factors affecting prognosis (x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P ＜0.05).The result of multivariate analysis showed that tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion,TNM staging were the independent factors affecting prognosis (RR =2.509,2.107,6.692,5.109,4.784,P ＜ 0.05).Conclusion Tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging are the risk factors affecting the prognosis of carcinoma of the body and tail of the pancreas.

A baseline survey on health knowledge was conducted in Yayuncun (Asian Games Village) Community in 2004 and 2005 respectively. A sample consisting of 1765 residents aged 15 and above from 600 households, who had lived in the community at least 5 years, was randomly taken; the "Beijing Typical Community Resident Questionnaire" was used for survey and the participants were followedup annually from 2006 to 2008. The results showed that the awareness rate of food nutrition and disease prevention increased year by year; however, the participants with educational level lower than junior middle school had the lowest rate of overall health knowledge. The main channels for local residents to acquire health knowledge were activities, lectures and other programs with the title of the Olympic Games; the educational level and the year of survey were independent affecting factors on overall health knowledge among residents.

Objective To explore the value of non-contrast MRI for diagnosing cesarean scar pregnancy(CSP)developed placental implantation(PI)in early pregnancy.Methods Totally 79 pregnant women with CSP in early pregnancy were retrospectively enrolled.According to postoperative pathology,PI was diagnosed when villi tissue or trophoblast cells were found in the scar muscle(PI group,n=23),while single CSP was diagnosed when no villi nor trophoblast cells were detected in the scar muscle(CSP group,n=56).Preoperative non-contrast pelvic MRI parameters were compared between groups,and the efficacy of MRI quantitative parameters for diagnosing CSP developed PI in early pregnancy was evaluated.Results Compared with those in CSP group,the largest area of the pregnancy sac,the length of the pregnancy sac close to the scar were both larger,the thickness of the thinnest scar was smaller,and the proportion of empty blood vessels shadow around the scar was higher in PI group(all P＜0.01).The sensitivity of the largest area of the pregnancy sac,the length of the pregnancy sac close to the scar and the thickness of the thinnest scar for diagnosing CSP developed PI was 78.26％,82.61％and 91.07％,respectively,and the specificity was 67.86％,66.07％and 69.57％,respectively,with area under the receiver operating characteristic curve of 0.76,0.79 and 0.82,respectively.The sensitivity,specificity and accuracy of empty blood vessels shadow around the scar for diagnosing CSP developed PI was 78.26％(18/23),85.71％(48/56)and 83.54％(66/79),respectively.Conclusion Non-contrast MRI had important clinical value for diagnosing CSP developed PI in early pregnancy.

Objective To evaluate the short-term efficacy and safety of percutaneous liver puncture for local management of portal vein thrombosis(PVT).Methods Variations in thrombus,blood flow,and laboratory examination results were observed before and after percutaneous liver puncture in 197 patients with PVT,and the occurrence of comorbidities was recorded and followed up for one year after treatment.Results After treatment,the thrombus in the main portal vein vessels almostly disappeared in 119 patients(60.41％)with PVT,the thrombus had a significant reduction in 57 patients(28.93％),and the thrombus had a smaller change or an increase in 21 patients(10.66％);146 patients(74.11％)had smooth blood flow in the main portal vein vessels,29 patients(14.72％)showed significant improvement in blood flow,and 22 patients(11.17％)showed no significant improvement or worsening of blockage.The mean portal venous pressure was significantly lower than that before treatment(P＜0.001);thrombin time,activated partial thromboplastin time,and prothrombin time were prolonged compared to those before thrombolysis(P＜0.001),and fibrinogen were reduced compared to those before thrombolysis(P＜0.001).A total of 35 patients(17.77％)occured comorbidities during treatment.One year after treatment,196 patients(99.49％)with PVT survived,of which thrombus essentially disappeared in 141(71.94％),thrombus stabilized(or decreased)in 42(21.43％),and thrombus increased in 13(6.63％).Conclusion percutaneous liver puncture for local management of PVT is effective and reliable in the short-term and requires standardized management of the entire process.

ObjectiveTo comprehensively evaluate the clinical value of Feilike mixture and provide a basis for the allocation of medical resources， rational drug use， and hospital procurement and supply of Chinese patent medicines. MethodWith the data from available studies and provided by drug manufacturers， the methods of evidence-based medicine， pharmacoeconomics， and health technology assessment were employed to construct a multi-criteria decision-making analysis framework from the "6+1" dimensions of safety， effectiveness， economy， innovation， suitability， accessibility， and characteristics of traditional Chinese medicine （TCM）. The clinical evidence and value evaluation software of Chinese patent medicine， CSCv2.0， was used to comprehensively evaluate the clinical value of Feilike mixture. ResultBased on the existing clinical evidence， the following results were obtained. ① Safety： Multi-sources of evidence showed that Feilike mixture had little known risk and sufficient evidence， with the safety rated as grade A， which indicated good safety. ② Effectiveness： The systematic review and Meta-analysis showed that Feilike mixture combined with conventional Western medicine in the treatment of bronchitis shortened the time to disappearance of cough compared with conventional Western medicine alone， with the evidence rated as grade B by the Grading of Recommendations Assessment， Development， and Evaluations （GRADE） system， which indicated high effectiveness. ③ Economy： From the perspective of health system， Feilike mixture combined with conventional Western medicine was more economical than conventional Western medicine alone， and the quality evaluation of pharmacoeconomics rated the economy as grade B. ④ Innovation： Feilike mixture combined with conventional Western medicine improved the clinical treatment effect and had innovation advantages compared with similar drugs. From the aspects of cultivation， identification of medicinal materials， and production， the sufficient supply and safety of medicinal materials can be ensured for Feilike mixture. This medicine was rated as grade B in terms of the medicinal material quality， preparation technology， and patents， which indicated good innovation. ⑤ Suitability： According to the results of the questionnaire survey， the usage of Feilike mixture was easy to be mastered and accepted by doctors and nurses， without special administration time， complex personalized treatment， and special technical and management requirements. It is convenient for patients to use， with convenient supply and storage， and weak influences of policy， publicity， and drug information. Therefore， the suitability of Feilike mixture was rated as grade B. ⑥ Accessibility： Among the similar Chinese patent medicines， Feilike mixture had a moderate price， high production capacity， wide sales coverage， wide coverage of hospitals， sustainable supply of medicinal materials， and low costs of treatment for acute bronchitis， with the accessibility rated as grade A. ⑦ TCM characteristics： Feilike mixture is composed of Scutellariae Radix， Peucedani Radix， Stemonae Radix， Gentianae Rhodanthae Herba， Scleromitrion diffusum， Firmiana platanifolia Radix， and Aster ageratoides， with reasonable compatibility. This formula is derived from the medical experience of Miao ethnic group， with rich experience in human use and the TCM characteristics rated as grade B. According to the evaluation results in the "6+1" dimensions， Feilike mixture was evaluated as class B， with a high clinical value. ConclusionAccording to the existing clinical evidence， compared with conventional Western medicine alone， Feilike mixture combined with conventional Western medicine demonstrates a high clinical value and prominent TCM characteristics in the treatment of acute bronchitis with phlegm-heat invading lung. It is suggested that it should be translated into the basic clinical drug management policy results according to the conditions.

ObjectiveTo explore the therapeutic mechanism of Bushen Huoxue prescription from the perspective of bone metabolism by observing the clinical efficacy of this prescription in treating femoral head necrosis （ONFH， syndrome of liver and kidney deficiency） and its influences on bone metabolism indexes： N-terminal propeptide （PINP） and β-collagen degradation product （β-CTX）. MethodSixty-six ONFH patients with the syndrome of liver and kidney deficiency in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics from December 2021 to September 2022 were selected. The patients were randomized into an experimental group and a control group by the parallel control method， with 33 patients in each group. The experimental group received Bushen Huoxue prescription orally， while the control group received Xianlinggubao Capsules orally， with a treatment cycle of 6 months. The visual analogue scale （VAS） score， Harris score， Association Research Circulation Osseous （ARCO） staging， imaging changes， quantitative scores of TCM symptoms， and serum levels of PINP and β-CTX were determined before and after treatment. The occurrence of adverse events and reactions was recorded. ResultThe total response rate in the experimental group was 83.87% （26/31）， which was higher than that （68.75%， 22/32） in the control group （Z=-2.096， P<0.05）. After treatment， the single and total scores of TCM symptoms， VAS score， and β-CTX level decreased in the two groups （P<0.05）. Moreover， the decreases in the scores of hip pain， lower limb mobility， soreness of waist and knees， and lower limb flaccidity， total score of TCM symptoms， VAS score， and β-CTX level in the experimental were larger than those in the control group （P<0.05）. After treatment， the imaging results showed no significant improvement in the two groups. The Harris score and PINP level in both groups increased after treatment （P<0.05）， and the increases were more obvious in the experimental group than in the control group （P<0.05）. No serious adverse event or adverse reaction appeared during the observation period. ConclusionBushen Huoxue prescription can relieve pain and TCM symptoms and improve the hip joint function in treating ONFH patients with the syndrome of liver and kidney deficiency. It can inhibit the development of ONFH， increase PINP， and decrease β-CTX. No obvious side effect appears during the clinical observation period， which shows that Bushen Huoxue prescription has good safety.

【Objective】 To investigate the development of adaptability in children aged 2 - 6, and to explore its influencing factors, so as to provide reference for promoting the development of adaptability in young children. 【Methods】 Data were from the National Nutrition and Health Systematic Survey for Children in China, and 3 319 children aged 2 - 6 and their parents from 28 sites across 14 provinces were recruited in this study.The Development Scale for Children Aged 0 - 6 years (WS/T 580-2017) was used to measure the developmental quotient of children′s adaptive ability, and a survey questionnaire was used to collect relevant information about children and their parents. 【Results】 Among 3 319 children aged 2 - 6, the proportion of slightly low or low level of adaptability, moderate adaptability development, good and excellent adaptability development was 7.68%,66.25% and 26.06%, respectively.The proportion of children aged 5 - 6 with good and excellent adaptability was lower in 3-year-old and 4-year-old groups (χ²=59.29, P<0.05).Multiple stepwise linear regression showed that children′s gender (β=0.06), gestational age of birth (β=-0.05), only child (β=-0.04), left-behind child (β=-0.04), the main caregiver (β=-0.06), and the education level of parents (β=0.09, 0.10), whether parents actively pay attention to children′s emotions (β=-0.06) and whether children play with homemade toys (β=-0.04) were the influencing factors of children′s adaptive development quotient.Girls, full-term children, only children, non-left-behind children, children with parents as main caregivers, parents with a high level of education, parents who often take the initiative to pay attention to children′s emotions, and children who play with homemade toys had a higher level of adaptability development quotient. 【Conclusions】 The development level of adaptability in children aged 2 - 6 in China is mostly above the average level and is related to multiple factors.Targeted intervention work can be carried out on relevant factors in order to promote the development of children′s adaptability.

Bacitracin is a broad-spectrum cyclic peptide antibiotic, and mainly produced by Bacillus. Energy metabolism plays as a critical role in high-level production of target metabolites. In this study, Bacillus licheniformis DW2, an industrial strain for bacitracin production, was served as the original strain. First, our results confirmed that elimination of cytochrome bd oxidase branch via deleting gene cydB benefited bacitracin synthesis. Bacitracin titer and ATP content were increased by 10.97% and 22.96%, compared with those of original strain, respectively. Then, strengthening cytochrome aa3 oxidase branch via overexpressing gene qoxA was conducive to bacitracin production. Bacitracin titer and ATP content were increased by 18.97% and 34.00%, respectively. In addition, strengthening ADP synthesis supply is also proven as an effective strategy to promote intracellular ATP accumulation, overexpression of adenosine kinase DcK and adenylate kinase AdK could all improve bacitracin titers, among which, dck overexpression strain showed the better performance, and bacitracin titer was increased by 16.78%. Based on the above individual methods, a method of combining the deletion of gene cydB and overexpression of genes qoxA, dck were used to enhance ATP content of cells to 39.54 nmol/L, increased by 49.32% compared to original strain, and bacitracin titer produced by the final strain DW2-CQD (DW2ΔcydB::qoxA::dck) was 954.25 U/mL, increased by 21.66%. The bacitracin titer produced per cell was 2.11 U/CFU, increased by 11.05%. Collectively, this study demonstrates that improving ATP content was an efficient strategy to improve bacitracin production, and a promising strain B. licheniformis DW2-CQD was attained for industrial production of bacitracin.
Bacillus licheniformis ; metabolism ; Bacitracin ; biosynthesis ; Energy Metabolism ; genetics ; Industrial Microbiology ; methods