Objective To explore the clinical effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) gefitinib combined with platinum-containing chemotherapy and whole brain radiotherapy in the treatment of non-small cell lung cancer (NSCLC) with brain metastasis. Methods One hundred and fifty-six patients of NSCLC with brain metastasis were divided into observation group (82 cases) and control group (74 cases) according to the therapeutic regimens. On basis of whole brain radiotherapy, the patients in control group received platinum-containing chemotherapy (paclitaxel+cis-platinum+pemetrexed), while the patients in observation group received gefitinib. The serum levels of carcino-embryonic antigen (CEA), cytokeratin 19 fragment antigen (CYFRA21-1) and EGFR, short-term effects, progression-free survival (PFS) and incidences of adverse reactions between two groups were evaluated. A subgroup analysis was carried on the 41 cases of patients with EGFR mutant type. The short-term effects and PFS between two groups were compared. Results The levels of CYFRA21-1 and EGFR in observation group were obviously lower than those in control group (P<0.01). The ORR and DCR in observation group was obviously higher than that in control group (81.71％ vs. 36.49％, 93.90％ vs. 82.43％) (P < 0.05 or < 0.01). The median PFS in observation group and control group was 12 months and 6months. There were statistic differences between two groups (P < 0.05). Subgroup analysis showed that the ORR and DCR in observation group was obviously higher than that in control group (72.0％vs. 25.0％, 96.0％vs. 31.25％)(P<0.01). The median PFS in observation group and control group was 13 months and 5 months. There were statistic differences between two groups (P<0.05). There was no statistic difference in incidences of adverse reactions between two groups (P>0.05). Conclusions For patients with NSCLC with brain metastasis, compared with the therapeutic regimen of whole brain radiotherapy + platinum-containing chemotherapy, whole brain radiotherapy + platinum-containing chemotherapy+EGFR-TKIs (gefitinib) could more effectively reduce the levels of EGFR and CYFRA21-1, improve short-term effects, prolong PFS and do not increase the incidence of adverse reactions.

Objective To analysis contraindication detection of radiological workers and explore thevariation trend. Methods Occupational health examination data of radiological workers were selected from 2014 to 2018. Contraindications were identified according to the criteria, and the detection rates and trends were described in each statistical dimension. Results A total of 17197 cases were selected. Among them 74 patients were found contraindication and the detection rate is 0.43%. The major abnormalities were in thyroid gland and crystalline lens; The detection rate of female is higher than that of male (χ² = 25.24，P < 0.01); High age andhigh working age groups showed a higherrate of contraindication detection; The abnormal rate of contraindication increased with the age; The risk of > 30 working years group is 2.541 times that of 1 ～5 working years group (95%CI: 1.32 ～4.88). The abnormal rate of thyroid grand was increased year by year, and the trend test showed statistical significance (χ² = 3.87，P < 0.05). Conclusion Low dose ionizing radiation has a great effect on thyroid gland and crystalline lens of radiation workers, whichhigh age and high working years group should be pay attention to. The contents of occupational health monitoring should be further regulated to safeguard the health of radiation workers so that we can discover the possible health effects and take intervention earlier.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

【Objective】 The amplitude of low-frequency fluctuation (ALFF) resting state functional magnetic resonance imaging (rs-fMRI) was used to investigate the signals image in the brain functional areas of overactive bladder (OAB) patients. 【Methods】 OAB patients treated in 3 participating hospitals during Mar.2021 and Mar.2023 were selected as the OAB group (n=14).Healthy subjects matching the gender, age and years of education of the patients in the OAB group were collected as the control group (NC group, n=14).Changes in the over active bladder symptom score (OABSS), quality of life scale (QoL), self-rating depression scale (SDS), self-rating anxiety scale (SAS) were analyzed.All subjects underwent rs-fMRI to collect blood oxygen level dependent magnetic resonance signals, which were then processed with ALFF.Two-sample t-test was conducted on the results to obtain the different brain regions. 【Results】 The OABSS \[(8.07±0.37) vs. (1.21±0.18)\], QoL \[(4.85±0.21) vs. (0.64±0.13)\], SAS \[(60.14±1.40) vs.(37.64±1.57)\] and SDS \[(52.50±1.29) vs.(36.14±0.34)\] scores of the OAB group were higher than those of the NC group, with significant differences (P<0.05).The brain regions with significant differences in ALFF were located in the left supplementary motor area, left medial superior frontal gyrus and right anterior central gyrus (P<0.000 1). 【Conclusion】 The abnormal spontaneous activity and coordination ability of the brain in resting state may lead to OAB symptoms, which are displayed in the abnormal functions of the left supplementary motor area, left medial superior frontal gyrus and right anterior central gyrus.

Approximately 140 million people worldwide are homozygous carriers of APOE4 (ε4), a strong genetic risk factor for late onset familial and sporadic Alzheimer's disease (AD), 91% of whom will develop AD at earlier age than heterozygous carriers and noncarriers. Susceptibility to AD could be reduced by targeted editing of APOE4, but a technical basis for controlling the off-target effects of base editors is necessary to develop low-risk personalized gene therapies. Here, we first screened eight cytosine base editor variants at four injection stages (from 1- to 8-cell stage), and found that FNLS-YE1 variant in 8-cell embryos achieved the comparable base conversion rate (up to 100%) with the lowest bystander effects. In particular, 80% of AD-susceptible ε4 allele copies were converted to the AD-neutral ε3 allele in human ε4-carrying embryos. Stringent control measures combined with targeted deep sequencing, whole genome sequencing, and RNA sequencing showed no DNA or RNA off-target events in FNLS-YE1-treated human embryos or their derived stem cells. Furthermore, base editing with FNLS-YE1 showed no effects on embryo development to the blastocyst stage. Finally, we also demonstrated FNLS-YE1 could introduce known protective variants in human embryos to potentially reduce human susceptivity to systemic lupus erythematosus and familial hypercholesterolemia. Our study therefore suggests that base editing with FNLS-YE1 can efficiently and safely introduce known preventive variants in 8-cell human embryos, a potential approach for reducing human susceptibility to AD or other genetic diseases.
Humans ; Apolipoprotein E4/genetics* ; Cytosine ; Mutation ; Blastocyst ; Heterozygote ; Gene Editing ; CRISPR-Cas Systems