Objective To evaluate the blood-saving effect of prophylactic tranexamic acid (TXA) use in the patients undergoing cervical spine surgery.Methods A total of 100 patients of both sexes,aged 55-75 yr,with body mass index of 19.0-25.0 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective cervical laminectomy and instrumentation,were divided into TXA group and normal saline group (group NS) using a random number table,with 50 patients in each group.TXA 15 mg/kg was intravenously injected at 30 min before skin incision in group TXA,and the equal volume of normal saline was given instead in group NS.Hemoglobin was measured before operation and on postoperative days 1,3 and 5.The intraoperative,postoperative,total blood loss,hidden blood loss and requirement for blood (allogeneic and autologous blood) transfusion were recorded.The development of complications such as epidural hematoma,deep vein thrombosis and pulmonary embolism was also recorded.Results Compared with group NS,the postoperative blood loss,total blood loss and blood transfusion rate were significantly decreased,the postoperative hemoglobin was increased (P＜0.05),and no significant change was found in the intraoperative blood loos or hidden blood loss in group TXA (P＞0.05).No patients developed complications such as epidural hematoma,deep vein thrombosis or pulmonary embolism in the two groups.Conclusion Prophylactic TXA use produces blood-saving effect to some extent in the patients undergoing cervical spine surgery.

Objective To measure the volumetric changes precisely during stereotactic ablative radiotherapy for early-stage and oligo-metastatic lung tumors and optimize the treatment plan timely.Methods From October 2011 to October 2014, 66 patients with 71 early-stage or oligo-metastatic lung tumors received SABR.Median age was 66 years.To measure the volume of tumors, the verification images were registered before each treatment fraction with stimulation images by reference to bone structure.Tumors volume was measured by the first verification images, and were defined as the reference when evaluating the trend of tumors volume change during SABR treatment.Generalized estimated equations were used to analyze the trend of the change of tumors volume over time with several possible predictors.The primary plan (P-plan) was modified when the biological effective dose (BED) of a tumor reached 60 Gy and volume change reached 25％.The modified plan was named as M-plan.Paired t-test was used to compare the dose of organs at risk (OAR) between M-plan and P-plan.Results In 71 tumors, 49 (69％) tumors showed volumetric shrinkage, 21 (30％) tumors showed enlargement and 1 tumor showed invariance.Generalized estimated equation showed no statistical significance (P =0.281) for the volumetric shrinkage of lung tumors.M-plan was made in 26 tumors.Of these tumors, 21 tumors decreased over 25 ％ and the result of paired t-test showed V5 of lung, Dmax and D1.2 cm3 of spinal cord, Dmax and D5 cm3 of esophagus and D30 cm3 of chest wall were statistically different between two plans(t =3.139 ～11.939 ,P＜0.05).5 tumors enlarged over 25％ and the result of paired t-test showed V5 and V20 of lung,Dmax and D1.2cm3 of spinal cord, Dmax of esophagus and D30cm3 of chest wall were statistically different between the two plans(t =-10.436--2.518, P ＜ 0.05).Conclusions Size of lung tumors changed dynamically during SABR, but it is unnecessary to modify treatment plans for all tumors.The tumors which showed obvious volumetric change may benefit from modifying treatment plans.

Objective To summarize the clinical features of patients with ovarian tumor associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis,and to explore the influence of operation patterns on the prognosis.Methods The clinical data of ovarian tumors with anti-NMDAR encephalitis in the Third Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2018 were collected,and the clinical characteristics,treatment and prognosis were analyzed.Results A total of 110 patients with ovarian tumors and anti-NMDAR encephalitis were collected.All patients were positive for anti-NMDAR antibodies in serum and/or cerebrospinal fluid.The age of onset ranged from 10 to 35 years (24.6 ±5.7).About 60.9％ patients'initial symptom was psychosis.The main clinical features were psychosis (97.3％),seizures (83.6％),conscious disturbance (72.7％),autonomic dysfunction (64.5％),dyskinesia (64.5％),central hypoventilation (54.5％) and impaired memory (31.8％).Most patients'symptoms were relieved after surgery and immunotherapy.Postoperative pathological results revealed that ovarian teratoma accounted for 97.8％ of the ovarian tumor.The prognosis of patients with surgery was better than the patients without surgery,with statistically significant difference (P ＜ 0.05).The prognosis of patients with adnexectomy was better than the patients with ovarian tumor excision,with statistically significant difference (P ＜ 0.05).Conclusions Anti-NMDAR encephalitis,with psycho-neurological symptoms as dominant manifestation,is usually associated with ovarian tumor.For young female patients with psychosis,clinicians should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor.Patients with adnexectomy and immunotherapy can get a better prognosis.

Liquid biopsies have made a great progress in malignant tumors research.Circulating tumor cells,circulating tumor DNA and exosomes can be regarded as biomarkers to be applied in diagnosis of epithelial ovarian cancer,monitoring progress dynamically,estimating prognosis and drug resistance in chemotherapy,which can help doctors provide patients with individual treatment to realize precision medicine in epithelial ovarian cancer.

ObjectiveTo evaluate the overall demand for rehabilitation services from the perspective of the groups with disabilities, diseases, injuries and older adults, and explore the causes of the supply and demand gap of rehabilitation services. MethodsThe literatures in the field of rehabilitation were collected, summarized and analyzed, including policy documents issued by World Health Organization and relevant departments in China, surveys, and researches. ResultsThe demand for rehabilitation services caused by disabilities, chronic diseases, injuries and population ageing were vast in China, but many were still unmet. The main reasons leading to the gap included those population trend and health situation, the insufficient reserve of rehabilitation resources coming from incomplete development of rehabilitation service system early, and inadequate construction of disability reporting system, which could not efficiently meet rehabilitation demand with supply. ConclusionThe strategies to optimize the rehabilitation services system and promote the quality of the services based on the disability reporting system are warranted.

Under the new situation of rapid development of medical science and technology, how to effectively cultivate medical students’ humanistic spirit and comprehensively improve medical quality is an important responsibility of medical college teachers. Blend-learning can guide students to immersive learning in multiple dimensions and forms. Obstetrics and Gynecology is one of the main compulsory courses for clinical medical students, which is faced more sensitive and vulnerable female patients, and required higher humanistic quality training for medical students. Through the construction of the blend-learning platform, medical humanities can be better integrated into the content and teaching design of medical education, and students can be more appropriately imperceptibly trained in medical humanities in obstetrics and gynecology teaching, so as to enhance medical students’ medical humanities quality in the process of obstetrics and gynecology diagnosis and treatment, and improve doctor-patient relationship.

The investigation of environmental radioactivity level is an important basic work of ecological environment protection. It can provide basic data and scientific basis for the evaluation of radioactive environment quality and the formulation of radiation safety regulations and standards. Based on many years of practical experience of environmental radioactivity level investigation, combined with relevant regulations and standards, this paper summarizes the common investigation methods in the investigation and research of environmental radioactivity level at home and abroad, summarizes a set of environmental radioactivity level investigation scheme with strong applicability, and gives detailed suggestions on the ideas, methods, technical routes and other key points of the investigation scheme. The research results of this paper can provide a reference for the preparation of environmental radioactive level investigation scheme.

As an excellent hosting matrices for enzyme immobilization, metal-organic framework (MOFs) provides superior physical and chemical protection for biocatalytic reactions. In recent years, the hierarchical porous metal-organic frameworks (HP-MOFs) have shown great potential in enzyme immobilization due to their flexible structural advantages. To date, a variety of HP-MOFs with intrinsic or defective porous have been developed for the immobilization of enzymes. The catalytic activity, stability and reusability of enzyme@HP-MOFs composites are significantly enhanced. This review systematically summarized the strategies for developing enzyme@HP-MOFs composites. In addition, the latest applications of enzyme@HP-MOFs composites in catalytic synthesis, biosensing and biomedicine were described. Moreover, the challenges and opportunities in this field were discussed and envisioned.
Metal-Organic Frameworks/chemistry* ; Porosity ; Enzymes, Immobilized/chemistry* ; Biocatalysis ; Catalysis

Objective: To investigate the expression of Tim-3 on the surface of T cells in patients with esophageal cancer, and to explore its clinical significance. Methods: Fresh tumor tissues, paracancerous tissues, and peripheral blood were collected from 25 patients with esophageal cancer at the first affiliated Hospital of Zhengzhou University from September 2016 to April 2018. Peripheral blood from 10 healthy subjects was also collected during the same time period. The expressions of Tim-3, early apoptotic molecules and intrinsic factors in tumor tissues and peripheral blood PBMCs of 25 esophageal cancer patients were determined by flow cytometry. Also, the correlation between Tim-3+ T cell proportion and pathological parameters was investigated. The expression of Tim-3 in tumor tissues and paracancerous tissues was detected by fluorescence quantitative real-time polymerase chain reaction (qPCR). TCGA database was used to further verify the expression of Tim-3 in tumor tissues and paracancerous tissues, as well as its relationship with prognosis. Results: Tim-3 expression on T cells was higher in tumor tissues from esophageal cancer patients (P<0.01). Tim-3+ T cell function was in an exhausted status(P<0.05 or P<0.01), and the expression of Tim-3 on the surface of T cells in esophageal cancer microenvironment was closely related to lymph node metastasis and clinical staging (all P<0.01). Conclusion: Taken together, Tim3 expression on the surface of T cells could induce T cell dysfunction in patients with esophageal cancer, suggesting that Tim-3 may serve as a potential therapeutic target for esophageal cancer.

Objective The radioactivity level survey was carried out in Weizhou Island area of Beihai, to comprehensively master the radiation environment status in the area, understand the natural radioactivity level and its distribution law, and provide basic data for scientific evaluation of radiation environment quality. Methods According to the relevant standards and technical specifications, the air absorbed dose rate of gamma radiation in Weizhou Island area was monitored from April 2020 to March 2021, the concentrations of radionuclides in water, soil and other environmental samples were sampled and analyzed, and the monitoring results were analyzed and discussed in combination with the regional characteristics. Results The results show that the air absorbed dose rate of gamma radiation in Weizhou Island area ranges from 0.2～122 nGy/h; the activity concentrations of ²³⁸U, ²²⁶Ra, ²³²Th, ⁴⁰K and ¹³⁷Cs in solid samples range 17.0～37.3 Bq/kg, < 0.501～29.5 Bq/kg, < 0.766～54.3 Bq/kg, 18.7～369 Bq/kg and < 0.212～1.48 Bq/kg, respectively, the concentrations of U and Th in well water and reservoir water range 0.065～0.25 μg/L, 0.046～0.079 μg/L, the activities of ²²⁶Ra, ⁴⁰K, total α and total β range 1.42～3.08 mBq/L, 0.069～0.231 Bq/L, 0.025～0.163 Bq/L, 0.082～0.572 Bq/L, respectively, the concentrations of U and Th in seawater samples range 1.81～2.25 μg/L, 0.634～0.648 μg/L, and the activities of ²²⁶Ra, ⁴⁰K, ⁹⁰Sr and ¹³⁷Cs range 9.38～19.7 mBq/L, 11.3～11.8 Bq/L、0.193～0.866 mBq/L、1.13～1.42 mBq/L. Conclusion The environmental ionizing radiation level in Weizhou island of Beihai is in the range of background fluctuation and at a relatively low level, indicating that the radiation environmental quality of Weizhou Island and its surrounding areas is good.