Progestagen-associated endometrial protein (PAEP) gene mainly expresses in the secretory phase endometrium and decidua in early trimester of pregnancy.In recent years,it is reported that PAEP is abnormally expressed in many kinds of tumors,such as breast cancer,endometrial carcinoma,ovary cancer,stomach cancer and melanoma.PAEP gene plays an important role in tumorigenesis and tumor development.The application of PAEP gene as an indicator for clinical diagnosis,prognostic and therapy needs further studies on the influence of PAEP gene on tumor biological behaviour.

Objective To evaluate the value of DWI in assessing the biological characteristics of breast invasive ductal carcinoma (IDC).Methods Eighty-seven IDC lesions confirmed by postoperative pathology were involved in this retrospective study.The ADC values of IDC were compared among different lymph node status,grades,and molecular subtype.The correlations of ADC value and lymph node status,grades,and molecular subtype were evaluated.Results The ADC value of IDC with positive lymph node was lower than that with negative lymph node (P=0.035),and the ADC value of the high grade IDC was lower than those of medium grade IDC and low grade IDC (P=0.021,0.002).There was no significant difference of ADC value between different molecular subtypes.There was low negative correlation of ADC value with grades (r.s =-0.357,P 0.001) and week negative correlation of ADC value lymph node status and nolecular subtype (rs =-0.227,P=0.034;rs-0.093,P＜0.001).Conclusion DWI can provide useful information in evaluating the biological characteristics of IDC.

Pain is a common and crucial problem in clinical practice, because it has a profound influence on patients in perioperative period. Butorphanol, among plenty of analgesics, is widely used in clinical trials for its various advantages and better analgesic effects. As a typical agonist-antagonist opioid analgesic agent, butorphanol, however, shows different clinical manifestations with different affinity for opioid receptors 25∶4∶1 (κ∶μ∶δ). Besides, butorphanol provides remarkable analgesic and sedative effect in preemptive analgesia, induction and recovery period in general anesthesia, and postoperative analgesia And it could be as a adjuvant to local anaesthesia either. Compared with other opioid drugs, butorphanol is less likely to have side effect on respiratory depression. In addition, its physical dependence is extremely low.

Dexmedetomidine (DEX ) is an α₂ adrenalin-receptor agonist with potent sedation, analgesia, anti-anxiety and anti-sympathetic effect. Moreover, DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect. Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state. Thus, an ideal pediatric anesthetic premedication is getting a lot of attention. DEX is superior to other premedication in sedation with high safety. Compared with others, DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug. The relevant research progress of the effective dose, efficacy and safety will be reviewed.

Objective To investigate the diagnostic values of radiomics model based on ADC map in differentiating benign from malignant lesions in suspicious breast findings with MRI breast imaging reporting and data system (BI-RADS) category 4. Methods Eighty eight patients (36 benign and 52 malignant)with diagnosis of MRI BI-RADS 4 in our hospital from December 2014 to December 2015 were retrospectively enrolled in this study.All the patients were proved by pathology and examined by sequence of T1WI,T2WI,DWI and dynamic contrast enhanced magnetic resonance imaging(DCE-MRI),and then were further sub-categorized into BI-RADS 4A, BI-RADS 4B, or BI-RADS 4C based on DCE-MRI sequence. Thus positive predictive value(PPV)of each sub-category were calculated and ROC were used to describe its efficiency in differential diagnosis.Radiomics features based on ADC map were generated automatically from Analysis-Kinetics(GE Healthcare).Sixty three of the 88 cases randomized-selected by computer were used to establish forecasting models and other 25 cases for validation. Kruskal-Wallis test and Spearman were introduced to reduce radiomics features that were highly correlated with others. Logistic linear regression(LLR)model was constructed based on the selected features by'glm'function in R software and then verified by 10-fold cross validation (repeat 10 times). ROC was curved to determine the diagnostic accuracy of the model.Results The PPV of BI-RADS 4A,4B,4C were 16.7%(2/12),59.6%(28/47),75.9% (22/29)respectively.Area under curve(AUC)of ROC was 0.650,sensitivity and specificity were 76.9% and 45.9% respectively. Three hundred and ninety six radiomics features were extracted automatically by software and 5 features (size zone variability, difference entropy, zone percentage, intensity variability and inverse difference moment)were left after redundancy reduction step.Cross-validation showed the accuracy of Logistic regression model was 80.0%(20/25),AUC was 0.790,sensitivity and specificity were 81.3% and 77.8% when cut-off was 0.45. Conclusion The radiomics model could provide important reference for differentiation between benign and malignant lesions in suspicious BI-RADS 4 findings.

Objective:To investigate the correlation of hepatocellular carcinoma (HCC) classified by contrast-enhanced ultrasound (CEUS) Liver Imaging Data and Report System (LI-RADS) with differentiation degree and Ki-67 index.Methods:A multicenter, retrospective study was conducted.The clinical and CEUS imaging data of 208 patients with 208 HCC lesions from December 2017 to December 2020 in China CEUS database were included and analyzed. According to the CEUS LI-RADS version 2017 proposed by the American College of Radiology, the HCC was classified. The diagnosis and pathological information of all lesions were confirmed by pathology. The differentiation degree of HCC and the distribution of Ki-67 index in different LI-RADS categories were evaluated, and their correlation was analyzed.Results:The degree of differentiation and Ki-67 index among HCC of different CEUS LI-RADS were statistically significant ( P<0.001, P=0.009). LI-RADS M HCC was more likely to be poorly differentiated and showed a higher Ki-67 index. The category of LI-RADS was positively correlated with the degree of tumor differentiation (tau-b=-0.250, P<0.001) and the Ki-67 index (tau-b=0.178, P=0.002), that is, the higher the category of LI-RADS, the lower differentiation degree and the higher the Ki-67. Conclusions:The CEUS LI-RADS classification of HCC is correlating with the degree of differentiation and Ki-67 index.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

[摘 要] 目的：体内外实验探讨木鳖子单体化合物对羟基桂皮醛[Momordica cochinchinensis(Lour.)Spreng.p-hydroxycinnamaldehyde，CMSP]对小鼠黑色素瘤移植瘤生长和转移的影响及其作用机制。方法：建立荷瘤小鼠动物模型，并将18只C57BL/6小鼠随机分成3组（每组6只）：对照组（腹腔注射0.1 ml生理盐水）、CMSP治疗组（分别腹腔注射0.1 ml 1、2 mg/ml CMSP），给药的第5天开始，每次给药前用卡尺分别测量和计算小鼠移植瘤的体积，实验结束后称量移植瘤的质量；H-E染色后光镜观察肝组织的病理学变化；免疫组织化学SP法观察移植瘤组织E-cadherin和vimentin蛋白的表达。采用细胞划痕和Transwell实验分别检测CMSP实验组（10、20 µg/ml）黑色素瘤B16细胞24、48 h的迁移能力，qPCR法检测CMSP处理24 h后B16细胞EMT相关mRNA表达，WB法检测CMSP处理B16细胞48 h后β-catenin、p-β-catenin（Ser675）、vimentin和E-cadherin蛋白的表达水平。结果：CMSP治疗组小鼠移植瘤平均体积和肿瘤质量明显降低（均P<0.05）；对照组小鼠肝脏中转移灶的数量明显多于CMSP（1、2 mg/kg）治疗组（均P<0.05），CMSP（2 mg/kg）处理组小鼠的肝组织内未发现明显转移灶。CMSP治疗组（1、2 mg/kg）移植瘤组织中E-cadherin蛋白表达水平明显高于对照组（均P<0.05），而vimentin蛋白表达显著低于对照组（均P<0.01）。体外实验中，CMSP实验组（10、20 μg/ml）B16细胞24、48 h后划痕愈合率较对照组均明显降低（均P<0.05）。20 μg/ml CMSP处理B16细胞24、48 h后穿过Transwell小室的细胞数较对照组则显著下降（均P<0.01）。CMSP（10、20 μg/ml）处理B16细胞后β-catenin mRNA表达水平较对照组明显降低（均P<0.01），E-cadherin mRNA表达水平则明显升高（均P<0.05），而vimentin mRNA表达水平在10 μg/ml处理组与对照组相比差异无统计学意义（P>0.05），20 μg/ml处理组则明显降低（P<0.01）。与对照组相比，CMSP实验组（10、20 μg/ml）处理B16细胞后β-catenin、p-β-catenin和vimentin蛋白表达均显著降低（均P<0.01），而E-cadherin蛋白表达则明显升高（均P<0.01）。结论：CMSP能够抑制小鼠黑色素瘤移植瘤的生长和转移，其作用机制可能与抑制wnt/β-catenin通路的活性相关。

In July 2023， the National Medical Products Administration issued the Measures for the Administration of Standards for Medicinal Products （hereinafter referred to as the Measures）. This article interprets the main content of the Measures， and analyzes its shortcomings as unclear definition of the drug standard code and the goals of drug standard information construction. It is recommended that the national drug regulatory department promptly apply to the standardization authority for the confirmation of the drug standard code “YB” letter， and the drug standard code and numbering rules would be included in the next round of amendments to the Measures. It is necessary to clarify the construction goals of the information system for drug standards at the same time， and build a national drug standard data-sharing platform based on the basic framework of user interface layer， computing processing layer， and data storage layer. Digital drug standards will be free， and access and download services for the public will be provided.