Objective To investigate the synergic ratio of sorafenib (SO) and sulforaphane (SF) against the hepatocellu‐lar carcinoma cell line HepG2 in vitro .Methods The synergic effect of SO combined with SF against HepG2 cells was deter‐mined by the CCK8 assay (the synergic effect was determined by combination index (CI) value:CI>1 .1 ,antagonistic;0 .91 .1) ,whereas 20∶1 ,5∶1 and 1∶5 ratio resul‐ted in synergistic activity (CI<0 .9) .Furthermore ,10∶1 ratio acted as an additive effective (0 .9

Objective To compare the diagnostic efficiency of the thyroid imaging reporting and data system (TIRADS), the Bethesda system for reporting thyroid cytopathology(BSRTC) and BRAFV600E detection, and their combined use in the differentiation between benign and malignant thyroid nodules. Methods One hundred and twenty eight patients with 128 thyroid nodules who were scheduled for ultrasound-guided fine-needle aspiration biopsy (FNAB) were recruited for the study. All of them underwent ultrasound, fine-needle aspiration cytology(FNAC) examination, and BRAFV600E detection. TIRADS and BSRTC systems were adopted to judge the ultrasound and FNAC results. The receiver operating characteristic curve was established to assess the diagnostic value of each method. Results The sensitivity, specificity, and AUC of TIRADS were 74. 3%, 84. 5%, and 0. 794, respectively. BSRTC had higher specificity(98. 3%) and equal sensitivity compared to TIRADS. The sensitivity, specificity, and AUC of BRAFV600E detection were the highest ones among the three methods. Combinations of different methods could increase the diagnostic sensitivity and accuracy. The combination of FNAC and BRAFV600E detection significantly increased the diagnostic efficiency(AUC=0. 984), with sensitivity 98. 6% and specificity 98. 3%. Conclusions The diagnostic value of BRAFV600E detection in the differentiation of benign and malignant thyroid nodules is better than both TIRADS and BSRTC, and the combination of FNAC and BRAFV600E detection reaches the best diagnostic efficiency.

Objective:To explore the value of octreotide suppression test(OST) in predicting the efficacy of somatostatin receptor ligands(SRLs) in the treatment of active acromegaly.Methods:The clinical data of 76 patients with active acromegaly from 2011 to 2020 was retrospectively analyzed. OST was carried out as follows: After an overnight fasting and baseline sampling of growth hormone(GH), 100 μg octreotide was subcutaneously injected, and sampling for GH was obtained every 2 hours for 8 hours. All patients were treated with SRLs for at least 3 months. A good GH response is defined as a post-treatment random GH<1 μg/L or >80% fall compared with the baseline GH. A good insulin-like growth factor Ⅰ(IGF-Ⅰ) response is defined as IGF-Ⅰ<1.3 upper limit of normal(ULN) or >50% reduction compared with the baseline. If both GH and IGF-Ⅰ fulfill the criteria of a good response, it is defined as a good GH and IGF-Ⅰ response.Results:The baseline level of GH during OST was 15.00(6.38, 34.20) μg/L, the median time to reach the nadir GH was(3.65±1.65) hours, and the nadir GH level was 1.47(0.50, 4.19) μg/L. The median GH suppression rate was 89.12%(72.71%, 95.09%). When the cutoff value of GH suppression rate in predicting a good GH response was 89.32%, the area under the curve(AUC) was 0.74, with a sensitivity of 81.80% and specificity of 66.00%. When the cutoff value of GH suppression rate in predicting a good IGF-Ⅰ response was 93.14%, the AUC was 0.64, with a sensitivity of 50.00% and specificity of 75.60%. When the GH suppression rate was 90.71%, the AUC was 0.78, with the sensitivity of 83.30% and specificity of 70.00% in predicting a good GH and IGF-Ⅰ response. Compared with GH/IGF-Ⅰ non-responders, GH/IGF-Ⅰ responders displayed lower nadir GH during OST, higher GH suppression rate and IGF-Ⅰ reduction rate, and lower ratio of IGF-1 to ULN( P<0.05). Conclusion:GH suppression rate during the OST is a valuable predictor to evaluate the efficacy of SRLs in patients with acromegaly, with the highest sensitivity and specificity when the cutoff value is 90.71%.

Objective:To explore the value of linaclotide combined with compound polyethylene glycol electrolytes powder (PEG) for bowel preparation for colonoscopy.Methods:A randomized and single blind prospective clinical study was conducted in patients who intended to receive colonoscopy at the Department of Gastroenterology in Shenzhen Hospital, Southern Medical University from June 2021 to August 2021. One hundred and fifty-two patients in the experimental group were treated with 580 μg linaclotide + 2 L PEG, and 152 patients in the control group were treated with 3 L PEG. The bowel preparation effects including Boston bowel preparation scale (BBPS) score, bubble score and lesion detection rate, and safety (adverse events) were compared between the two groups.Results:The total BBPS scores were 9 (8, 9) in the experimental group, and 9 (9, 9) in the control group with no significant difference ( Z=0.141, P=0.888). The bubble scores were 1 (1, 2) in the experimental group, and 1 (1, 1) in the control group with no significant difference ( Z=1.788, P=0.074). There was no significant difference in detection rate of lesions between the experimental group and the control group [37.50% (57/152) VS 33.55% (51/152), χ2=0.517, P=0.472]. There was no significant difference in safety including incidence of nausea [7.24% (11/152) VS 13.16% (20/152), χ2=2.910, P=0.088], vomiting [2.63% (4/152) VS 7.24% (11/152), χ2=3.436, P=0.064], abdominal distension [7.89% (12/152) VS 11.84% (18/152), χ2=1.331, P=0.249] and abdominal pain [2.63% (4/152) VS 4.61% (7/152), χ2=0.849, P=0.357] between the experimental group and the control group. Conclusion:Linaclotide combined with PEG for colonoscopic bowel preparation reduces drinking water volume. The cleaning effect and safety are comparable to using 3 L PEG. It can be recommended for bowel preparation for colonoscopy.

ObjectiveThe monitoring of fluoride in drinking water in Qingpu District was conducted to evaluate the external exposure of residents through drinking water， and to provide data support for the continuous improvement of drinking water quality in the area and the health level of residents. MethodsFrom 2016 to 2021， the pipe network water was collected from 42 monitoring points in Qingpu District， every month， and the fluoride concentration in the pipe network water was detected by ion chromatography. ResultsThe fluctuation range of fluoride concentration in drinking water in Qingpu District from 2016 to 2021 was between 0.10 and 0.96 mg·L^-1. The fluoride in drinking water did not exceed the standard， which was lower than the lower limit of the WHO recommended range. The median fluoride concentration in drinking water in the Qingcaosha water source area was 0.20 mg·L^-1， and the median fluoride concentration in drinking water in the Dianshan lake water source area was 0.44 mg·L^-1， and the difference between the two was statistically significant （Z=20.260， P<0.001）. The fluoride concentration in drinking water had a decreasing trend year by year， especially in the water supply area of Dianshan lake water system. The fluoride concentration in drinking water in Qingcaosha water source water supply area decreased relatively gently， from 0.25 mg·L^-1 in 2017 to 0.20 mg·L^-1 gradually. According to the "Chinese Residents' Dietary Nutrient Reference Intake 2013 Edition"， the requirement of 1.5 mg·d^-1 of suitable fluoride intake （AI） for adults. About 50% of the residents in the water supply area of Dianshan lake would consume less than0.75 mg·d^-1， fluoride through drinking water， which was lower than 1/2 of the AI value. The fluoride content in the water supply area of Qingcaosha water source was relatively low， and 75% of the residents ingested fluoride through drinking water was lower than 0.37 mg·d^-1， which was lower than the 1/4 of the AI value. ConclusionThe concentration of fluoride in drinking water in Qingpu District is lower than the sanitary standard of drinking water in China，and the risk of excessive fluoride exposure is very low. However， the fluoride concentration in drinking water has a decreasing trend year by year， and intervention measures should be used rationally to reduce the health risks caused by insufficient fluoride intake.

Objective:To report the clinical characteristics, diagnosis, and treatment of 2 cases of X-linked acrogigantism(X-LAG).Methods:The clinical information of two patients were retrospectively reported, and peripheral blood DNA was collected for copy number variations detection.Results:Both patients had onset at age of two, with common clinical characteristics including linear growth acceleration, mild facial coarsening, enlargement of hands and feet, increased appetite, and snoring, etc. The heights Z scores of the two patients before treatment were + 6.86 and + 6.53, respectively. Growth hormone(GH) glucose inhibition test showed that GH nadir values were over 1 ng/mL and insulin-like growth factor-Ⅰ(IGF-Ⅰ) were 586.0 ng/mL and 1 042.0 ng/mL, respectively. Patient 1 received three cycles of octreotide microspheres therapy followed by surgery, and achieved clinical and biochemical remission. Patient 2 had lanreotide for 5.5 years but failed biochemical remission. Microduplication of Xq26.3, which contained pathogenic gene G-protein coupled receptor 101(GPR101), was found in germline DNA of two patients through copy number variation detection, leading to the diagnosis of X-LAG.Conclusion:It should be cautious of X-LAG when children below 2 years old presents symptoms such as overgrowth and so on. Medication combined with surgery is effective.

BACKGROUNDSubdural hematoma (SDH) is a common complication of spontaneous intracranial hypotension (SIH). To date, the management of SDH caused by SIH remains controversial. In this paper, we reviewed the clinical course of SDH in patients with SIH, and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch (EBP) surgery.

METHODSWe retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center. Patients who received early CT/MRI follow-up after EBP operation were included.

RESULTSA series of four cases of SIH complicated with SDHs were evaluated. Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.

CONCLUSIONTargeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

Adult ; Blood Patch, Epidural ; Female ; Hematoma, Subdural ; therapy ; Humans ; Intracranial Hypotension ; therapy ; Male ; Middle Aged ; Retrospective Studies