ween WHO histological subtype and Masaoka clinical stage, and their combination is valuable for guiding postoperative treatment in thymoma.

Objective To evaluate the therapeutic efficacy and treatment-related toxicity of stereotactic body radiation therapy(SBRT)in patients with medically inoperable stage Ⅰ/Ⅱ non-small cell lung cancer(NSCLC). Methods SBRT was applied to 30 patients, including clinically staged T1 ,T2(≤5cm)or T3(chest wall primary tumors only), N0, M0 ,biopsy-confirmed NSCLC. All patients were precluded from lobotomy because of physical condition or comorbidity. No patients developed tumors of any T-stage in the proximal zone. SBRT was performed with the total dose of 50 Gy to 70 Gy in 10 - 11 fractions during 12 - 15 days. prescription line was set onthe edge of the PTV. Results The follow-up rate was 100%. The number of patients who completed the 1-, and 2-year follow-up were 15, and 10, respectively. All 30 patients completed therapy as planned. The complete response(CR), partial response(PR)and stable disease(SD)rates were 37%, 53% and 3%, respectively. With a median follow-up of 16 months(range,4-36 months), Kaplan-Meier local control at 2 years was 94%. The 2-year overall survival was 84% and the 2-year cancer specific survival was 90%. Seven patients(23%)developed Grade 2 pneumonitis, no grade ＞ 2 acute or late lung toxicity was observed. No one developed chest wall pain. Conclusions It is feasible to deliver 50 Gy to 70 Gy of SBRT in 10 - 11 fractions for medically inoperable patients with stage Ⅰ / Ⅱ NSCLC. It was associated with low incidence of toxicities and provided sustained local tumor control.The preliminary investigation indicated the cancer specific survival probability of SBRT was high. It is necessary to perform similar investigation in a larger number of patients with long-term follow-up.

microRNAs (miRNAs) are an extensive class of -22-nucleotide (nt) endogenous noncoding RNAs regulating life activities ofmetazoans through binding to 3'-untranslated regions (3'-UTRs) of their target genes. This work aimed to identify yan gene in the silkworm, reveal its expression profile and confirm if it is one target of bmo-miR-7 and, as such, have potential for contributing to better understanding of the molecular mechanisms involved in the metamorphosis of silkworm. Based on homolog searching and PCR amplification, we cloned the coding sequence (CDS) of Bmyan, which encodes 476 amino acid residues and contains SAM-PNT and ETs domains. Quantitative PCR (q-PCR), RT-PCR and microarray data revealed high expression of Bmyan in the head, body wall and ovary of day-3 fifth instar larval silkworm, low or no expression in other tissues. It was lowly expressed in the early larval stages, but highly expressed from late spinning to day 4 pupa. The 3'-UTR of Bmyan was obtained by rapid-amplification of cDNA ends (3'RACE) and predicted to contain two potential recognition sites of bmo-miR-7. The luciferase reporter vector containing the 3'-UTR of Bmyan was constructed and co-transfected into BmE cell line with the mimic of bmo-miR-7 and the decreased relative activity of luciferase showed that Bmyan is one target of bmo-miR-7. This work helps further functional analysis of bmo-miR-7 and Bmyan in the silkworm.
3' Untranslated Regions ; Animals ; Bombyx ; genetics ; Cell Line ; Cloning, Molecular ; Female ; Genetic Vectors ; Insect Proteins ; genetics ; Larva ; Metamorphosis, Biological ; MicroRNAs ; genetics ; Pupa

It is the intent of this paper to locate the activation point in Transcranial Magnetic Stimulation (TMS) efficiently. The schemes of coil array in torus shape is presented to get the electromagnetic field distribution with ideal focusing capability. Then an improved adaptive genetic algorithm (AGA) is applied to the optimization of both value and phase of the current infused in each coil. Based on the calculated results of the optimized current configurations, ideal focusing capability is drawn as contour lines and 3-D mesh charts of magnitude of both magnetic and electric field within the calculation area. It is shown that the coil array has good capability to establish focused shape of electromagnetic distribution. In addition, it is also demonstrated that the coil array has the capability to focus on two or more targets simultaneously.
Algorithms ; Brain ; physiology ; Electric Stimulation ; instrumentation ; Electromagnetic Fields ; Equipment Design ; Evoked Potentials, Motor ; physiology ; Humans ; Neurons ; physiology ; Transcranial Magnetic Stimulation

Objective:To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule (pGGN).Methods:The clinical, pathological and imaging data of 316 patients (320 pGGNs) confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. All pGGNs were divided into preinvasive group (148 pGGNs) and invasive group (172 pGGNs) according to histopathology. Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN, and the ROC curve analysis was performed on each risk factor.Results:Crescent sign was found in 24 cases (16.2%) in the preinvasive group and 49 (28.5%) in the invasive group, and the difference between the two groups was statistically significant (χ2=6.804 ,P=0.009).There were statistically significant differences in patient′s age, lesion size, shape, lobulation sign, and vascular stretch sign between the two groups ( P<0.05). The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value, the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%, the specificity was 61.5%, and the area under the curve was 0.666. Logistic regression analysis showed that maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN, and the OR value (95%CI) were 3.192 (1.981-5.144), 3.672 (1.545-8.725), 1.972 (1.104-3.521), and 2.026 (1.087-3.777), respectively. A logistic model was established based on the above four independent risk factors, and the area under curve was 0.711 (95%CI 0.655-0.768). Conclusion:Crescent sign can effectively reflect the invasiveness of pGGN. Maximum diameter of the lesion ≥10.5 mm, irregular shape, crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.

UK has initiated since 2014 a new round of healthcare reform of its National Healthcare System(NHS), featuring more resources to the primary level, and made supportive reform method reforms for a variety of innovative mods of diagnosis and treatment. These efforts aim at promoting further refined management and ensure smooth progress of healthcare sector reforms. The authors introduced the historical evolution and latest trends of payment methods reform in the UK, and analyzed the review and update of the Quality and Outcomes Framework of basic medical service contracts for GP practices, which can hopefully provide useful references for the reform of payment methods in China.

Optimizing the drug price management mechanism and improving the availability and affordability of drugs are important in deepening the medical and health reform. The price of drugs in the United States has always been higher than the world average. The price of drugs, the total expenditure on drugs and the personal burden of patients have shown an increasing trend. By exploring the causes of high drug prices in the United States, the author found that there were four main reasons for the current situation of drug prices in the United States, including the interests of enterprises, the limited competition mechanism of the US drug market, relatively insufficient market bargaining power of the US payers, and opaque mechanism of price formation.Firstly, pharmaceutical companies try to achieve their interests by raising drug prices. Secondly, the price formation mechanism of the United States drug market is affected by the price strategy of pharmaceutical companies, and government policies also indirectly affect the role of the market. Thirdly, the payers in the United States are relatively scattered, so that the market bargaining power is relatively insufficient.Fourthly, due to the numerous drug circulation links and stakeholders, the drug price formation mechanism is opaque and lacks supervision. Therefore, when strengthening drug price management in China, we should build a coordination mechanism between the government and the market on the basis of the existing basic economic system and drug management mechanism, establish the strategic purchase and negotiation position of medical insurance for drugs, enhance the transparency of drug circulation and trading, and establish a scientific pricing system. It is also important to promote drug innovation and ensure drug quality.

OBJECTIVETo investigate whether DRD4 exon III48 bp variant number tandem repeat(VNTR) polymorphism is associated with tic disorder.

METHODSOne hundred and twenty-two nucleus families were collected using Structured clinical interview for genetic study of Tourette syndrome and related disorders for family-based association analysis of tic disorder and DRD4 exon III 48bp VNTR polymorphism. One hundred and twenty-two trios were divided into two groups: tic disorder group (82 trios of Tourette syndrome or chronic tic disorder, TS&CT) and tic disorder accompanied with attention deficit and hyperactivity disorder (ADHD) group (40 trios of Tourette syndrome or chronic tic disorder accompanied with ADHD, TS&ADHD). Transmission disequilibrium test (TDT), in addition to polymerase chain reaction and VNTR technique were conducted in 122 trios.

RESULTSThere exist 5 alleles at this polymorphic locus in this sample including DRD4 exon III 48bp 2-6 repeats. No transmission disequilibrium was found between DRD4 exon III 48 bp VNTR and tic disorder (chi square=7.44, P 0.12); however, when the sample was divided into two groups, transmission disequilibrium was noticed between the cases of TS&ADHD and this locus by overall allele-wise analysis (chi square=11.74, P 0.02), and there exists transmission disequilibrium exclusively between 5 or 6 repeats of 48bp VNTR(longer alleles) by allele-wise analysis (chi square=10.57, P 0.032, chi square=6.13, P 0.01). No transmission disequilibrium was seen between TS&CT and DRD4 exon III 48bp VNTR(chi square=3.38, P 0.50).

CONCLUSIONThe results of this study have revealed an association between the longer alleles of DRD4 exon III 48bp VNTR polymorphism and tic disorder accompanied with ADHD, thus suggesting a possible genetic risk factor of tic disorder accompanied with ADHD in Chinese.

Adolescent ; Adult ; Alleles ; Attention Deficit Disorder with Hyperactivity ; complications ; genetics ; Child ; Child, Preschool ; DNA ; genetics ; Exons ; genetics ; Family Health ; Female ; Gene Frequency ; Genotype ; Humans ; Linkage Disequilibrium ; Male ; Minisatellite Repeats ; genetics ; Polymorphism, Genetic ; Receptors, Dopamine D2 ; genetics ; Receptors, Dopamine D4 ; Tic Disorders ; complications ; genetics

Objective:To analyze the differences in information needs of doctors, middle managers, and hospital leaders in tertiary public hospitals in the process of new technology access.Methods:From January to October 2018, 1 200 doctors and hospital administrators from 30 tertiary public hospitals in 8 provinces were selected. The importance scores of different positions for decision-making information demand of new technology introduction were collected through questionnaire survey, and the scores were analyzed by SPSS 25.0 software. Descriptive statistical analysis was performed.Results:1 032 valid questionnaires were obtained. Hospital-level leaders, middle-level managers, and doctors scored higher on the clinical application, safety, and effectiveness of technology at home and abroad(more than 4 points, maximum 5 points). Hospital-level leaders and middle-level managers had higher scores on effectiveness, evidence quality, possibility of being covered by medical insurance, ethics and relevant indicators of strategic level, while doctors had higher scores on health economics and organizational indicators.Conclusions:There are some differences in the information demand for new technology access among different positions in tertiary public hospitals. Understanding the decision-making needs of different positions is conducive to promoting the actual implementation of hospital-based health technology assessment standards in China′s public hospitals.

Objective:To analyze and compare the clinical efficacy of robot-assisted and conventional navigation-assisted percutaneous minimally invasive pedicle screw placement in the treatment of thoracolumbar fractures and to provide reference for clinical treatment decisions.Methods:A literature search was performed in China National Knowledge Infrastructure(CNKI),VIP,Wanfang and English databases PubMed and Web of science by using the keywords"vertebral pedicle screws,"and"robot"in Chinese and"robot"and"pedicle screws"in English.The search time in both Chinese and English was from the establishment of the database to December 2022.The relevant clinical studies on robot-assisted and traditional navigation-assisted percutaneous minimally invasive pedicle screw placement for the treatment of thoracolumbar cone fractures were collected.Cochrane Scale and Newcastle-Ottawa Scale(NOS)were used to evaluate the quality of literatures and meta-analysis was carried out.The clinical effects of robot-assisted and traditional navigation-assisted surgery was compared.Results:A total of 15 articles were included in the study.Compared with traditional navigation-assisted percutaneous minimally invasive pedicle screw placement,robotic-assisted surgery resulted in shorter operative time[WMD=-11.45,95% CI(-18.94～-3.95),P＜0.05],less intraoperative bleeding[WMD=-19.11,95% CI(-27.51～-10.70),P<0.001],higher screw placement accuracy[number of grade A nails:RR=1.20,95% CI(1.16～1.25),P<0.001;number of grade A+B nails:RR=1.09,95% CI(1.07～1.11),P<0.001],and fewer complications[RR=0.35,95% CI(0.13～0.93),P＜0.05].The difference in hospitalization time was not statistically significant(P>0.05).Conclusion:In percutaneous minimally invasive pedicle screw placement for the treatment of thoracolumbar fractures,robot-assisted surgery has advantages over navigation-assisted surgery in terms of operative time,intraoperative bleeding,placement accuracy and complications.