OBJECTIVE:To investigate clinical efficacy and adverse reactions(ADRs)of 4 kinds of the second-generation anti-psychotic drugs in the treatment of acute phase of schizophrenia. METHODS:159 patients with schizophrenia were randomly divid-ed into risperidone group(40 cases),olanzapine group(40 cases),aripiprazole group(39 cases)and ziprasidone group(40 cas-es). All groups were given routine dosage of relevant medicine by routine usage for 6 weeks. Mental status of patients were mea-sured by PANSS before treatment and after 2,4 and 6 weeks of treatment. At the same time,blood glucose,blood lipid,prolac-tion and other metabolic and biological indicators were all detected. RSESE,BARS and UKU were adopted to evaluate ADR. RE-SULTS:A total of 100 patients completed the study. Compared with aripiprazole group and ziprasidone group,risperidone and olan-zapine inhibited symptom more rapidly,with statistical significance (P<0.05). After treatment,body mass index and abdominal circumference of olanzapine group were significantly higher than those of other 3 groups,with statistical significance (P<0.05). Low density lipoprotein of olanzapine group was increased significantly,there was statistical significance compared to ziprasidone group and aripiprazole group(P<0.05). Prolactin level of risperidone group was significantly higher than those of other 3 groups, while that of aripiprazole group was significantly lower than those of other 3 groups,with statistical significance(P<0.05). ADRs of 4 drugs were mild or moderate,most of whom could be alleviated by symptomatic treatment. CONCLUSIONS:In the treatment of acute phase schizophrenia,4 drugs of the second-generation have similar curative effect in symptoms control,among which ris-peridone and olanzapine inhibit positive symptom more rapidly while more ADRs that related to lipid and glucose metabolism and prolactin also show. Aripiprazole and ziprasidone induce less ADRs relatively,and patients show better tolerability. Physicians should consider all kinds of factors in drugs selection,and make individualized treatment plan.

Objective:To investigate the clinical significance of detecting serum 25-hydroxyl-vitamin D [25(OH)D] level and albumin/fibrinogen ratio (AFR) in patients with rheumatoid arthritis (RA).Methods:This retrospective study included 131 patients (95 patients with RA and 36 with arthralgia excluding autoimmune diseases), who were treated in Bozhou People′s Hospital from May 2017 to January 2020. Forty healthy controls underwent health checkups during the same period served as healthy control. RA group was divided into high (>5.1, 25 cases), medium (3.2

Objective:To evaluate the radiosensitivity enhancement effect of FePd@CNTs nanocomposites on human breast cancer MCF-7 cells.Methods:FePd@CNTs nanocomposites were synthesized by chemical reduction method. Transmission electron microscope and energy dispersive spectrometer were utilized to characterize the surface morphology and chemical composition of FePd@CNTs nanocomposites. The compatibility of FePd@CNTs nanocomposites with human normal breast epithelial MCF-10A cells was determined by CCK-8 assay. The radiosensitivity enhancement effect of FePd@CNTs nanocomposites on MCF-7 cells was assessed by CCK-8 assay, flow cytometry and clony formation assay.Results:FePd nanospheres were successfully modified on the surface of CNTs by chemical reduction method. FePd@CNTs nanocomposites showed a low toxicity to MCF-10A cells (IC 50=738.3 μg/m), and effectively enhanced the effect of X-ray radiation on MCF-7 cells (sensibilization ratio=1.22). Conclusion:FePd@CNTs nanocomposites exhibit a promising potential for treating breast cancer and enhancing radiosensitivity effect.

Neuroendocrine tumors(NET) originating in the kidney account for less than 1% of renal epithelial malignancies, and are rarer when combined with horseshoe kidney. This article reported a patient of NET with horseshoe kidneys. The patient was admitted to hospital because of the pain of left waist and back for more than 1 month. Enhanced CT examination showed that horseshoe kidney, left kidney mass, about 5.0 cm × 4.0 cm, and about 2 cm from the gorge. There was a separate blood supply in the gorge. The patient underwent laparoscopic radical left nephrectomy. Intraoperatively the canyon was separated, and the tumor and left kidney were completely removed. The postoperative pathological results was NET. No auxiliary treatment was given after surgery. After 15 months of follow-up, no tumor recurrence and metastasis was seen.

Objective:To investigate the clinical, pathological and genetic features of 3 cases of limb-girdle muscular dystrophy 2A (LGMD2A) caused by non-canonical splice site mutations in the CAPN3 gene. Methods:For the 3 LGMD2A patients admitted to Qilu Hospital of Shandong University from July 2016 to July 2018 were selected as the subjects. Clinical data were collected, whole exome sequencing was conducted, and the candidate variants were verified by Sanger sequencing. Total RNA was extracted from the skeletal muscle tissue of 3 probands and effects of splicing mutations on pre-mRNA splicing in the CAPN3 gene were verified by reverse-transcription polymerase chain reaction. Total protein was extracted from the muscle tissue of the probands and expression level of calpain 3 protein was detected by Western blotting. Results:All the 3 probands presented muscle weakness in upper and lower limbs, and muscle weakness in proximal limbs was more severe. Muscle biopsies all indicated myogenic impairment. Genetic sequencing showed proband 1 carried compound heterozygous c.2185-14T>G and c.2305C>T (p.R769W) mutations in the CAPN3 gene, proband 2 carried compound heterozygous c.1193+30G>A and c.2069_2070delAC (p.H690Rfs *9) mutations, and proband 3 carried homozygous c.1194-9A>G mutations in the CAPN3 gene. Splicing assay showed the c.2185-14T>G mutation located in intron 20 induced retention of the entire intron 20, the c.1193+30G>A mutation in intron 9 induced retention of the first 31 nucleotides of intron 9, and the c.1194-9A>G mutation in intron 9 induced retention of the last eight nucleotides of intron 9. Western blotting revealed deficiency of calpain 3 protein in skeletal muscle of proband 1 and proband 2. Conclusions:The clinical manifestation of LGMD2A is muscle weakness predominantly in proximal limbs, and the muscle pathology is mostly characterized by myogenic impairment.Moreover, aberrant splicing of pre-mRNA caused by non-canonical splice site mutations plays a pathogenic role in this disease.

Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.

Objective To investigate the survival of oral arsenic-containing Qinghuang Powder (QHP) and low intensive chemotherapy (LIC) in the treatment of elderly patients with acute myeloid leukemia (AML).Methods Forty-two AML patients older than 60 years in Xiyuan Hospital from January 2015 to December 2017 were retrospectively analyzed.Of them,20 cases were treated with QHP (QHP group),22 cases were treated with LIC (LIC group).The survivals of the two groups were compared.Results There was no significant difference of median survival time (13 months vs.13.5 months,x2 =0.096,P =0.757),1-year survival rates (59.1％ vs.70.0 ％,x2 =0.543,P =0.461),2-year survival rates (13.6 ％ vs.15.0 ％,x2 =0.016,P ＞ 0.05),and 3-year survival rates (4.6 ％ vs.5.0 ％,x2 =0.005,P ＞ 0.05) between LIC and QHP groups.There was no significant difference of median survival time in age ≥75 year (12 months vs.12.5 months,x2 =1.317,P =0.251),performance status scores ＞ 2 (12 months vs.12 months,x2 =0.834,P =0.361),hematopoietic stem cell transplantation with combined disease index ＞ 2 (12 months vs.13 months,x2 =1.726,P =0.189),secondary AML (10 months vs.14 months,x2 =1.552,P =0.213),and poor cytogenetics (12 months vs.8 months,x2 =0.479,P =0.489) between LIC and QHP group.Conclusion The survival of elderly AML patients is considerable in patients treated with oral QHP and LIC,which suggests that oral QHP may be an equivalent alternative treatment since elderly AML (especially more than 75 years) patients refused to LIC therapy.

Objective:To investigate the clinical efficacy of low-set perforating branch propeller flap of fibular artery for repairing calcaneal soft tissue defects.Methods:A retrospective case series study was conducted on 28 patients with calcaneal soft tissue defects admitted to 920th Hospital of Joint Logistics Support Force of PLA from January 2013 to December 2019. There were 19 males and 9 females，aged 13-69 years［（33.8±13.7）years］. The size of soft tissue defects ranged from 5 cm×2 cm to 18 cm×12 cm，and the size of flaps ranged from 12 cm×4 cm to 24 cm×10 cm. The soft tissue defects were repaired with the low-set fibular artery perforator propeller flap after emergency debridement or flap transplantation at the second stage after debridement according to the wound surface conditions. The survival of the flap，wound healing at the recipient and donor sites and complications were recorded. The function of the affected ankle was assessed according to American Orthopedic Foot and Ankle Society（AOFAS）ankle-hindfoot score before operation and at the final follow-up. The degree of satisfaction of flap appearance was assessed by Thankappan flap appearance satisfaction score at the final follow-up.Results:All patients were followed up for 2-40 months［（17.4±5.9）months］. All flaps survived and wounds at both donor and recipient sites were healed well，with satisfactory color and texture of the flaps，without thinning operation performed. Three patients experienced numbness on both sides of the incision at donor sites within 1 week after operation and returned to normal on their own about 2 months after operation，with all flaps restoring partial light pain sensation 1 year after operation. No complications occurred such as blood flow disorder of the affected limb or compartment syndrome. The AOFAS ankle-hindfoot score was 56-95 points［（82.3±15.2）points］at the final follow-up，significantly higher than the preoperative score of 17-68 points［（35.7±13.4）points］（ P<0.01）. The results were excellent in 21 patients，good in 5 and fair in 2，with excellent and good rate of 93%.The appearance satisfaction score was 4-10 points［（7.6±2.9）points］according to Thankappan flap appearance satisfaction score. The results were excellent in 6 patients，good in 15 and fair in 7，with the excellent and good rate of 75%. Conclusions:The low-set perforating branch propeller flap of fibular artery for reconstruction of calcaneal soft tissue defects has advantages of reliable blood supply and high survival rate of the flap as well as good restoration of the appearance and function of the affected limb.

The existing regulations and systems of the Swedish Medical Products Agency (MPA) have clear provisions on the definition, classification and listed on the market procecure of pharmaceutical products, and the supervision strictly follows the EU standards. Traditional Chinese Medicine (TCM) products belong to the category of Swedish Herbal Medicine Products (HMP) or Traditional Herbal Medicine Products (THMP) and are under the supervision of Swedish Pharmaceutical Products Administration (MPA). This paper analyzes the classification, relevant regulations and registration procecures of TCM products in Sweden. It is suggests that TCM enterprises should fully understand the EU regulations and guidance regulations before listed on the market of TCM products. They should also clarify the product category, and provide sufficient and accurate evidence. In the application process, they should pay attention to strengthening communication with the drug administration units of Sweden.

Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.