Objective:To examine the oncogenic mutations involved in melanoma in Southern China and to provide a theoretical basis for the development of melanoma molecular targeted therapy strategy. Methods:The Sequenom platform (OncoCarta Panel v1.0 and MassARRAY System) was used to determine the prevalence of oncogene mutations in 28 acral melanoma samples, 28 mucosal mel-anoma samples, and 30 non-chronic sun-induced-damage (no-CSD) melanoma samples from Southern China. Results:At least one mu-tation was detected in 33 of the 86 melanomas (38.4%) with mutations observed in BRAF (16.3%), NRAS (10.5%), KIT (5.8%), EGFR (4.7%), HRAS (2.3%), KRAS (2.3%), MET (2.3%), and PIK3CA (1.2%). In BRAF, the age of patients with mutations was significantly lower than those without BRAF mutation (45.7±15.3 vs. 55.9±12.7, P=0.01). Patients with mutations in NRAS were more likely to have ulceration compared with patients without NRAS mutations (88.9%vs. 48.1%, P=0.049). Conclusions:This study represents a compre-hensive and concurrent analysis of the major recurrent oncogenic mutations involved in melanoma cases from Southern China areas. The data have implications for both clinical trial designs and therapeutic strategies.

Objective: To observe the tolerability of Chinese melanoma patients to four-week high-dose interferon alfa-2b(INTRON A(R)，Schering-Plough)therapy. Methods:A total of 29 patients with high risk melanoma[American Joint Committee on Cancer Staging(AJCC)ⅡB-ⅢC]who received adjuvant interferon therapy in our hospital between September 2007 and May 2009 were retrospectively reviewed.Patients received 4 hours of intravenous infusion of interferon alfa-2b fdose range，22.00 million international unit(MIU)to 33.75 MIU]Ⅳ 5 days/week for 4 weeks.The adverse events were evaluated with National Cancer Institute Common Toxicity Criteria(NCI 2.0 version). Results: The average daily dose was 17.63 MIU/(m~2·d).The therapy was ended in two patients because of poor wound healing or intolerability to severe fatigue.The most common adverse events were myelosuppression.Grade 3/4 neutropenia was observed in 69% (20/29)patients and was rapidly reversed after conventional support interventions.Grade 1/2 abnormal hepatic function occurred in 18 cases(62%).Twenty-six patients were followed up for 3 to 22 months.Five patients developed early progression:one with local recurrence，two with regional lymph node metastasis one with in-transit metastasis in the affected limb,and one with distant metastasis. Conclusion: High-dose interferon alfa-2b regimen can be well tolerated by Chinese patients but cannot effectively inhibit subclinical lesions.

OBJECTIVETo explore the present contamination status and profile of toxaphene in fish, chicken and meat samples in Pearl River Delta area.

METHODSTotally 60 independent samples including fish, chicken, meat were collected from Huizhou,Guangzhou,Dongguan,Jiangmen of Pearl River Delta area in Guangdong by purposive sampling from Oct 2010 to Jun 2011. Toxaphene monomer Parlar26, Parlar50 and Parlar62 levels in three various categories of foods were quantitatively and qualitatively analyzed referencing international authoritative standard methods by utilizing isotope dilution high-resolution gas chromatography/high-resolution double-focusing magnetic mass spectrometry (HRGC-HRMS). The levels of pollution and characteristics were compared.

RESULTSThe concentration of toxaphene median(M) in fish, chicken and meat were 12.87, 5.8 and 1.89 ng/kg (gross weight) , respectively and the difference was significant(H = 14.29, P = 0.001). The toxaphene level in seafish (M = 32.07 ng/kg) was significantly higher than that in freshwater fish (M = 10.63 ng/kg, Z = -2.52, P = 0.012). The profile analysis showed that Parlar50 and Parlar26 were the predominant characteristic monomers in fish, which contributed about 44% (9.91/22.60, ng/kg) and 39% (8.89/22.60, ng/kg) to total concentration, and Parlar62 and Parlar26 were the two predominant congeners in poultry products, the two congeners accounted for 42% (5.03/11.90, ng/kg) and 38% (4.58/11.90, ng/kg). Furthermore Parlar26 and Parlar62 made up about 57% (3.45/6.08, ng/kg) and 26% (1.58/6.08, ng/kg) of total concentration in livestock meat respectively.

CONCLUSIONToxaphene levels in all tested food samples are far lower than the limited standard stipulated by the European Food Safety Authority (EFSA) in 2002, which was 0.1 mg/kg. The congener characteristic difference in the three categories food indicated that the different enrichment ability in Toxaphene in different animal species.

Objective:To compare the therapeutic effect of polysaccharide iron complex capsule and Shengxuening tablet on renal anemia in maintenance hemodialysis (MHD) patients.Methods:Patients who received MHD treatment from April to June 2016 in our dialysis center and met the criteria for iron deficiency anemia were block-randomly divided into two groups: the polysaccharide-iron complex group and the Shengxuening group. Blood routine, iron metabolism biomarkers and biochemical exams were measured before treatment and at the 1st, 2nd and 3rd months after treatment, and the incidence of adverse reactions were recorded. The compliance rate of the two groups was observed and compared, and the block-randomized-statistical methods were used to compare the clinical data of the two groups before and after treatment, and cost-benefit analysis was also conducted.Results:Thirty patients in each group completed follow-up. After three months of treatment, the blood routine and iron metabolism indicators of the two groups were improved. Compared with the Shengxuening group, the polysaccharide iron complex group had higher therapeutic efficiency, and the levels of hemoglobin, transferrin saturation and serum ferritin were higher, and lower use of recombinant human erythropoietin ( P<0.05). The other indexes such as red blood cell (RBC), hematocrit (HCT) levels and the effective rate of anemia correction, the effective rate of iron therapy, the effective rate of iron therapy between the two groups were similar. Cost-benefit analysis suggested that the use of polysaccharide iron complexes to treat anemia has lower costs and higher benefits ( P<0.05). Conclusions:Polysaccharide iron complex capsule can better correct anemia and improve iron metabolism, and has low cost-effectiveness, which can effectively reduce medical insurance expenditure. It is a good iron supplementing method in addition to intravenous iron supplement.

Objective:To investigate the effect of tidal volume (Vt DI) on pulse pressure variation (ΔPP DI) during deep inspiration maneuvers in spontaneously breathing patients with sepsis and to test if adjusting ΔPP DI by Vt DI can further improve its ability in predicting fluid responsiveness (FR). Methods:Spontaneously breathing, nonintubated sepsis or septic shock patients who were admitted to the Intensive Care Unit of the Characteristic Medical Center of Chinese People's Armed Police Force and Nanjing Gaochun People's Hospital were prospectively enrolled from October 2017 to October 2019. Volume expansion (VE) was performed by infusing 500 mL saline over 20 min. Prior to VE, measurements including pulse pressure variation and tidal volume were obtained during quiet spontaneous breathing (ΔPP TB and Vt TB, respectively) and during the deep inspiration maneuver (ΔPP DI and Vt DI, respectively). Patients were classified as responders if stroke volume (SV) increased ≥ 15% after VE, otherwise non-responders. Multiple linear regression analysis was conducted to investigate the correlation of ΔPP DI with Vt DI and VE-induced percentage changes in SV (ΔSV). Receiver operating characteristic (ROC) curve analysis and the gray zone approach were used to assess the ability of each index to predict FR. Changes in gray zone limits according to the cost ratio (R = cost[false positive (FP)]/cost[false negative (FN)]) were also evaluated. Results:Of the included 31 patients, 17 were responders. There was no significant difference in ΔPP TB between fluid responders and non-responders ( P>0.05), whereas ΔPP DI was significantly higher in responders than in non-responders [(19.1±7.4)% vs (11.2±4.5)%; P=0.001]. The area under the ROC curve (AUC) of ΔPP DI predicted FR was 0.832, sensitivity of 76.47% and specificity of 71.43%, which was significantly higher than ΔPP TB (AUC=0.580, sensitivity of 47.06% and specificity of 71.43%; P<0.05). Multiple linear regression analysis showed that both Vt DI and ΔSV were independently associated with ΔPP DI ( P<0.01), the AUC of ΔPP DI adjusted by Vt DI was signigicantly higher than that of ΔPP DI alone ( P=0.03). Among the ΔPP TB, ΔPP DI and ΔPP DI/Vt DI, ΔPP DI/Vt DI had the narrowest gray zone (12.7-14.5) for the normal fluid policy (R=1), which only included 19% of the patients. When applying "restrictive" fluid management (R=2), the gray zone for ΔPP DI/Vt DI was 12.8-14.5 and included only 2 patients (6.5%). Conclusions:In spontaneously breathing, nonintubated patients with sepsis or septic shock, the ΔPP value obtained during the deep inspiration maneuver predicts FR with moderate accuracy. Given the close correlation between Vt DI and ΔPP DI, ΔPP DI adjusted by Vt DI performs better than ΔPP DI alone in predicting FR.

Objective To explore the present contamination status and profile of toxaphene in fish, chicken and meat samples in Pearl River Delta area.Methods Totally 60 independent samples including fish,chicken,meat were collected from Huizhou,Guangzhou,Dongguan,Jiangmen of Pearl River Delta area in Guangdong by purposive sampling from Oct 2010 to Jun 2011.Toxaphene monomer Parlar26,Parlar50 and Parlar62 levels in three various categories of foods were quantitatively and qualitatively analyzed referencing international authoritative standard methods by utilizing isotope dilution high-resolution gas chromatography/high-resolution double-focusing magnetic mass spectrometry ( HRGC-HRMS ) .The levels of pollution and characteristics were compared.Results The concentration of toxaphene median(M) in fish,chicken and meat were 12.87,5.8 and 1.89 ng/kg(gross weight),respectively and the difference was significant(H=14.29,P=0.001).The toxaphene level in seafish(M=32.07 ng/kg)was significantly higher than that in freshwater fish(M=10.63 ng/kg,Z=-2.52,P=0.012).The profile analysis showed that Parlar50 and Parlar26 were the predominant characteristic monomers in fish,which contributed about 44%(9.91/22.60, ng/kg) and 39%(8.89/22.60, ng/kg) to total concentration,and Parlar62 and Parlar26 were the two predominant congeners in poultry products,the two congeners accounted for 42%(5.03/11.90, ng/kg) and 38%(4.58/11.90, ng/kg).Furthermore Parlar26 and Parlar62 made up about 57%(3.45/6.08, ng/kg) and 26% ( 1.58/6.08, ng/kg ) of total concentration in livestock meat respectively.Conclusion Toxaphene levels in all tested food samples are far lower than the limited standard stipulated by the European Food Safety Authority(EFSA) in 2002,which was 0.1 mg/kg.The congener characteristic difference in the three categories food indicated that the different enrichment ability in Toxaphene in different animal species.

Objective To explore the present contamination status and profile of toxaphene in fish, chicken and meat samples in Pearl River Delta area.Methods Totally 60 independent samples including fish,chicken,meat were collected from Huizhou,Guangzhou,Dongguan,Jiangmen of Pearl River Delta area in Guangdong by purposive sampling from Oct 2010 to Jun 2011.Toxaphene monomer Parlar26,Parlar50 and Parlar62 levels in three various categories of foods were quantitatively and qualitatively analyzed referencing international authoritative standard methods by utilizing isotope dilution high-resolution gas chromatography/high-resolution double-focusing magnetic mass spectrometry ( HRGC-HRMS ) .The levels of pollution and characteristics were compared.Results The concentration of toxaphene median(M) in fish,chicken and meat were 12.87,5.8 and 1.89 ng/kg(gross weight),respectively and the difference was significant(H=14.29,P=0.001).The toxaphene level in seafish(M=32.07 ng/kg)was significantly higher than that in freshwater fish(M=10.63 ng/kg,Z=-2.52,P=0.012).The profile analysis showed that Parlar50 and Parlar26 were the predominant characteristic monomers in fish,which contributed about 44%(9.91/22.60, ng/kg) and 39%(8.89/22.60, ng/kg) to total concentration,and Parlar62 and Parlar26 were the two predominant congeners in poultry products,the two congeners accounted for 42%(5.03/11.90, ng/kg) and 38%(4.58/11.90, ng/kg).Furthermore Parlar26 and Parlar62 made up about 57%(3.45/6.08, ng/kg) and 26% ( 1.58/6.08, ng/kg ) of total concentration in livestock meat respectively.Conclusion Toxaphene levels in all tested food samples are far lower than the limited standard stipulated by the European Food Safety Authority(EFSA) in 2002,which was 0.1 mg/kg.The congener characteristic difference in the three categories food indicated that the different enrichment ability in Toxaphene in different animal species.

Objectives:To investigate the early related factors for hepatic insufficiency after hemihepatectomy and to construct and validate a nomogram model.Methods:This is a retrospective cohort study.There were 207 patients with liver tumor who underwent hemihepatectomy in the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to December 2022. Using the random number method, patients were randomly divided into a model group( n=166) and a validation group( n=41) according to an 4∶1 ratio. There were 118 males and 48 females in the modeling group,with an age ( M(IQR)) of 59.0(13.3) years (range: 22.0 to 81.0 years),42 patients in the group with postoperative liver insufficiency and 124 patients in the group without postoperative liver insufficiency. There were 32 males and 9 females in the validation group, with an age of 54.0(19.0) years (range: 25.0 to 81.0 years). The first results of the peripheral blood test of patients within 24 hours after surgery were collected,and the independent related factors for incomplete postoperative liver function were determined by multivariate Logistic regression analysis,and related factors of postoperative incomplete liver function were screened by best subset selection. A nomogram model of the related factors of postoperative hepatic insufficiency after hemihepatectomy was constructed using R software,validated by internal and external validation of the model. Results:Multivariate logistic regression analysis showed that elevated D-dimer level and decreased antithrombin Ⅲ (AT-Ⅲ) activity within 24 hours after surgery were independent related factors for the development of postoperative hepatic insufficiency in hemihepatectomized patients. The results of the best subset selection showed that ALT, D-dimer, and AT-Ⅲ activity levels within 24 hours postoperatively were the most relevant factors for postoperative hepatic insufficiency. The R software was applied to build a nomogram prediction model based on the above three indicators in the model set, and the receiver operating characteristic(ROC) curve of the model showed an area under the curve of 0.803 and the calibration curve showed a U-index of -0.012 for the model( P=0.977). The results of the clinical decision analysis and the clinical impact curve indicated that the model had good clinical utility. The internal validation results of the Bootstrap method suggested that the model had reasonable consistency. The area under the ROC curve of the validation group model was 0.806, suggesting that the model had a good generalization prediction ability. Conclusions:The levels of ALT, D-dimer, and AT-Ⅲ activity within 24 hours after hemihepatectomy are valuable indicators for predicting liver insufficiency after hemihepatectomy. The nomogram model is reliable and can be used as an indicator for close postoperative monitoring.

Objectives:To investigate the early related factors for hepatic insufficiency after hemihepatectomy and to construct and validate a nomogram model.Methods:This is a retrospective cohort study.There were 207 patients with liver tumor who underwent hemihepatectomy in the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to December 2022. Using the random number method, patients were randomly divided into a model group( n=166) and a validation group( n=41) according to an 4∶1 ratio. There were 118 males and 48 females in the modeling group,with an age ( M(IQR)) of 59.0(13.3) years (range: 22.0 to 81.0 years),42 patients in the group with postoperative liver insufficiency and 124 patients in the group without postoperative liver insufficiency. There were 32 males and 9 females in the validation group, with an age of 54.0(19.0) years (range: 25.0 to 81.0 years). The first results of the peripheral blood test of patients within 24 hours after surgery were collected,and the independent related factors for incomplete postoperative liver function were determined by multivariate Logistic regression analysis,and related factors of postoperative incomplete liver function were screened by best subset selection. A nomogram model of the related factors of postoperative hepatic insufficiency after hemihepatectomy was constructed using R software,validated by internal and external validation of the model. Results:Multivariate logistic regression analysis showed that elevated D-dimer level and decreased antithrombin Ⅲ (AT-Ⅲ) activity within 24 hours after surgery were independent related factors for the development of postoperative hepatic insufficiency in hemihepatectomized patients. The results of the best subset selection showed that ALT, D-dimer, and AT-Ⅲ activity levels within 24 hours postoperatively were the most relevant factors for postoperative hepatic insufficiency. The R software was applied to build a nomogram prediction model based on the above three indicators in the model set, and the receiver operating characteristic(ROC) curve of the model showed an area under the curve of 0.803 and the calibration curve showed a U-index of -0.012 for the model( P=0.977). The results of the clinical decision analysis and the clinical impact curve indicated that the model had good clinical utility. The internal validation results of the Bootstrap method suggested that the model had reasonable consistency. The area under the ROC curve of the validation group model was 0.806, suggesting that the model had a good generalization prediction ability. Conclusions:The levels of ALT, D-dimer, and AT-Ⅲ activity within 24 hours after hemihepatectomy are valuable indicators for predicting liver insufficiency after hemihepatectomy. The nomogram model is reliable and can be used as an indicator for close postoperative monitoring.

Objective For more focused prevention and management,this investigation examines the risk factors for multidrug resistant organisms(MDRO)infections in intensive care unit(ICU)patients.Methods Case-control studies and cohort studies of risk factors for MDRO infection in ICU patients were searched in the Embase,Website of Science,Cochrane Library,PubMed,CNKI,WanFang,and VIP databases from their start to October 26,2022.The Meta-analysis was carried out with RevMan 5.3.Results A total of 32 papers were included,with 10 985 cases studied,with the quality of the literature rated as moderate to high.The results of Meta-analysis of this study showed that gender[OR=1.21,95% CI=(1.08,1.36),P=0.002],ICU length of stay[WMD=5.36,95% CI=(3.99,6.73),P<0.000 01],total length of stay[WMD=8.96,95% CI=(6.51,11.41),P<0.000 01],hypertension[OR=1.33,95% CI=(1.10,1.60),P=0.003],abnormal renal function[OR=1.69,95% CI=(1.33,2.16),P<0.000 01],hypoproteinemia[OR=1.87,95% CI=(1.51,2.32),P<0.000 01],mechanical ventilation[OR=2.26,95% CI=(1.18,4.33),P=0.01],duration of mechanical ventilation[WMD=8.83,95% CI=(2.52,15.14),P=0.006],arteriovenous placement[OR=1.46,95% CI=(1.23,1.72),P<0.000 1],placement of urinary catheter[OR=1.71,95% CI=(1.25,2.36),P<0.000 01],gastrointestinal tube placement[OR=0.10,95% CI=(0.03,0.18),P=0.008],antimicrobial drug type≥3[OR=4.27,95% CI=(2.06,8.85),P<0.000 01],use of carbapenem antibiotics[OR=4.09,95% CI=(300,5.58),P<0.000 01],the use of the third-generation cephalosporin[OR=1.63,95% CI=(1.15,2.33),P=0.007],the use of quinolone antibacterials[OR=1.86,95% CI=(1.42,2.44),P<0.000 01],the use of aminoglycoside antibiotics[OR=1.99,95% CI=(1.49,2.67),P<0.000 01],use of piperacillin-tazobactam[OR=2.94,95% CI=(1.56,5.54),P=0.000 9],use of glycopeptide antibiotics[OR=3.78,95% CI=(2.48,5.78),P<0.000 01],use of sedatives[OR=3.25,95% CI=(2.06,5.14),P<0.000 01],and use of acid suppressants[OR=1.51,95% CI=(1.06,2.16),P=0.02]are risk factors for MDRO infection in ICU patients.Conclusion MDRO infections in ICU patients are associated with gender,duration of ICU stay,chronic lung disease,total length of stay,hypertension,abnormal renal function,hypoproteinemia,mechanical ventilation,duration of mechanical ventilation,arteriovenous placement,placement of urinary catheters,gastrointestinal placement,type of antimicrobial drugs≥3,use of carbapenem antibiotics,use of third-generation cephalosporin,use of quinolone antibacterials,use of aminoglycoside antibiotics,use of piperacillin-tazobactam,use of glycopeptide antibiotics,use of sedatives,use of acid suppressants,and other factors.Targeted controls of different factors such as underlying diseases,comorbidities,invasive procedures performed,and the use of antimicrobial medications and other therapeutic pharmaceuticals could limit the risk of infection in MDRO in ICU patients.