Objective To evaluate the curative effects of intravenous methylprednisolone (IVMP) during the conservative management for patients with indirect optic nerve injury (ONI),and to analyze the benefits of visual evoked potential (VEP) monitoring in prognosis assessment.Methods Among the 253 patients with cranial-facial injury,108 sufferred from optic nerve injury including 89 cases without optic nerve decompression treatment.These 89 patients were randomly divided into:group A,in which patients were given methylprednisolone intravenously for 7 days; and group B,in which patients without methylprednisolone treatment.The extent of and time required for eyesight recovery were recorded.VEP measurement was carried out in all cases.Results No differences in gender,age and BMI (Body Mass Index,all P ＞ 0.05) were observed.The incidence of ONI was higher in patients with motorcycle accident than that in those with car accident (P ＜0.01).In the motorcycle accidents,casualties wearing a helmet had lower incidence of ONI (P ＜ 0.01).Patients treated with methylprednisolone had a shorter recovery time (P ＜ 0.01) from blindness,however there was no difference in long-term outcome between group A and B.In patients with visual improvement in the “ non-extinguished” group,the amplitude and latency of the P wave of VEP were markedly ameliorated after the treatments (P ＜ 0.01).Conclusions Most of the ONI casualties in our study were resulted from motorcycle accidents,and wearing a helmet is an effective protection measure.The intravenous methylprednisolone (IVMP) showed no effect on improving the prognosis in patients with conservative treatment.The IVMP shortened the recovery time at the expense of increase in risk of complications.VEP examination is beneficial in prognosis assessment for non-operative ONI patients.The improvement of the amplitude and latency of P wave has close correlations with patients'visual recovery.

Promoting equity and access to medicine is important to guarantee health equity. The international communities commonly guarantee equity and access to medicine through free pharmaceutical policy. In most coun-tries, free pharmaceutical policy covers patients who cannot afford, children under 5, pregnant women and elderly people. The free medicines include essential medicines, medicines for chronic and infectious diseases, vaccines, etc. Financing of free medicines comes from health insurance, direct government investment and international aid, and the medicine delivery mainly depends on the public medical institutions. Free pharmaceutical policy in China mainly refers to medicines for infectious diseases and vaccines, and the coverage is narrow. This paper argues that since China has been becoming one of the middle income countries, the amount of free medicines should be in-creased, especially for chronic diseases, such as diabetes, hypertension, etc. The equity and access to medicine in China should be further promoted by providing all essential medicines for free.

Objective:To improve the centralized bidding procurement practice of essential medicine in China. Methods:By using literature review, comparative analysis and field investigation, implementation plans and regula-tions of the centralized bidding procurement of essential medicines in 30 provinces were collected and analyzed. Re-sults:There are differences in the operating organization, scope of implementation, purchasing cycle, bidding pro-curement mode, judgment criteria and other aspects among provinces. Conclusion: The progress of the implementa-tion of the centralized bidding procurement practice of essential medicine under the request of Document No. 56 of the State Council differed greatly among the provinces. The government should adhere to the centralized bidding procure-ment practice of essential medicine, give full play to the advantages of group purchasing, explore approaches of medi-cal insurance institutions participating in the centralized bidding procurement practice, and perfect the assessment of drug quality to assure the quality of essential medicine.

Objective:To evaluate the expression of CXCR4 and the migration rate of bone marrow stromal CD34+cells in differ-ent risk groups with myelodysplastic syndromes (MDS) using correlation analysis. Methods: Forty MDS patients were divided into low-and high-risk groups based on the International Prognosis Scoring System (IPSS). The former was composed of 20 patients with IPSS<1.5, whereas the latter was composed of 20 patients with IPSS≥1.5. Bone marrow (BM) samples of these patients and 10 nor-mal controls were collected. CD34+cells were separated and purified. The expression of CXCR4 was determined by flow cytometry. The migration rate of CD34+cells on the chemotactic effect of SDF-1αand on the effect of bone marrow stromal cells were measured. Results:The expression rate of CXCR4 was higher in the high-risk MDS group than in the low-risk and control groups (P<0.000 1). No significant differences existed between the low-risk and the control groups (P>0.05). The migration rate of CD34+cells on the ef-fects of SDF-1αand marrow stromal cells were significantly increased in the high-risk MDS group compared with those in the low-risk and control groups (P<0.000 1). Migration rate of CD34+cells on the effect of marrow stromal cells was positively correlated with CX-CR4 expression (P=0.000 1). Conclusion:The CXCR4 expression and migration rates of CD34+cells on the effect of marrow stromal cells are significantly higher in the high-risk MDS group than in the low-risk group. Migration rate has a positive correlation with the CXCR4 expression, which further indicates that MDS is a heterogeneous group of hematopoietic stem cell malignancies. The expres-sion and function of SDF-1 and its receptor CXCR4 differ within each group with various risks. SDF-1 and CXCR4 may be involved in MDS pathogenesis.

Objective: To detect the mutation of epidermal growth factor receptor (EGFR) gene in peripheral blood of non-small cell lung cancer (NSCLC) patients in Yunnan area with Super-ARMS, and to explore its correlation with clinicopathological characteristics. Methods: A total of 222 blood samples from patients with NSCLC were collected between January 2017 to December 2018 in the Molecular Diagnostic Center of Yunnan Cancer Hospital. The EGFR gene mutation in peripheral blood samples was detected by SuperARMS, and the relationship between EGFR gene mutation and clinicopathological features was analyzed. Meanwhile, the independent risk factors influencing EFGR mutation were also analyzed. Results: In the peripheral blood of 222 NSCLC patients, there were 81 cases (36.5%) with EGFR gene mutation. Among them, exon 19 deletion and L858R gene point mutation were the most common (75.3% of total mutation); female patients had a higher mutation rate than male patients (45.9% vs 27.0%); patients <60 years old had a higher incidence of mutation than patients≥60 years old (43.2% vs 28.8%) (P<0.05 or P<0.01); moreover, patients with no history of smoking, no history of radical surgery, adenocarcinoma, advanced stage and no history of chemotherapy had higher incidence of EGFR mutation (43.9% vs 21.6%, 39.2% vs 21.2%, 43.9% vs 4.8%, 39.7% vs 23.3% and 44.0% vs 23.5%) (P<0.05 or P<0.01). Multivariate logistic analysis showed that young, no smoking history, adenocarcinoma and no surgical history were independent risk factors for EGFR gene mutation (all P<0.01). Conclusion: In the peripheral blood of patients with NSCLC in Yunnan, the mutation rate of EGFR gene is higher in patients with age<60 years old, adenocarcinoma and non-smoking. Super-ARMS method is more sensitive in the detection of EGFR mutation in peripheral blood of lung cancer patients.

Background:Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS).Increased duodenal eosinophil counts have been observed in patients with FD,and the density of chromogranin A (CgA)-positive cells was reduced in duodenum in patients with IBS.Aims:To investigate the alterations and significance of duodenal eosinophils and CgA-positive cells in patients with FD and FD-diarrhea-predominant IBS (IBS-D) overlap.Methods:Outpatients with FD and FD-IBS-D overlap who fulfilled Rome Ⅲ criteria from Aug.2014 to Mar.2015 at the First Affiliated Hospital of Fujian Medical University were enrolled.Biopsy specimens were collected from the duodenal bulb for HE staining and CgA immunohistochemical staining.Eosinophils and CgA-positive cells were counted,and their associations with clinical symptoms were analyzed.Results:Twenty-eight FD patients and twelve FD-IBS-D overlap patients were enrolled in this study.Duodenal bulb eosinophil counts were significantly higher in FD-IBS-D overlap patients than in FD patients [(43.83 ± 7.34)/5HPF vs.(22.90 ± 8.93)/5HPF,P ＜ 0.05],while the density of duodenal bulb CgA-positive cells were significantly lower in FD-IBS-D overlap patients than in FD patients [(13.03 ±5.87)/HPF vs.(19.85 ± 9.18)/HPF,P ＜ 0.05].Spearman correlation coefficient analysis revealed that duodenal eosinophil counts were positively correlated with lower gastrointestinal symptoms such as abdominal pain/discomfort and diarrhea,whereas no correlations were found between density of duodenal CgA-positive cells and both upper and lower gastrointestinal symptoms.Conclusions:Duodenal bulb eosinophil counts are increased and CgA-positive cells are reduced in FD-IBS-D overlap patients than in non-overlap FD patients,which may implicate the difference in clinical symptoms between these two functional gastrointestinal disorders.

Objective To analyze the epidemiological characteristics and risk factors of gastric cancer after eradication of ( Helicobacter pylori , Hp) in Fuzhou area, to provide a theoretical basis for reducing the incidence and mortality of gastric cancer after eradication of Hp, and to provide effective suggestions for the prevention of gastric cancer in residents in Fuzhou. Methods A total of 699 patients with Hp eradication admitted to our hospital from January 2020 to December 2020 were selected. According to whether the patients had gastric cancer after eradication, they were divided into control group (no gastric cancer) and observation group (gastric cancer). The serum levels of tumor markers including CEA, CA125 and CA199 were detected and compared between the two groups. Clinical data of the two groups, including age, sex, family history of gastric cancer, course of Hp infection, open atrophy, severe atrophy of gastric mucosa, presence of intestinal metaplasia (IM) of gastric mucosa, xanxoma of gastric mucosa, and long-term use of proton pump inhibitors (PPIs), were analyzed using the self-made survey scale in our hospital. Univariate analysis and logistic regression were used to analyze the risk factors for gastric cancer after Hp eradication. Results Among of 699 patients with Hp eradication, 48 cases (6.96%) developed gastric cancer, including 29 male cases and 19 female cases. The incidence rate of males was significantly higher than that of females (P<0.05). The incidence rate of elderly patients was significantly higher than that of non-elderly patients (P<0.05). Serum CEA, CA125 and CA199 levels in the observation group were significantly higher than those in the control group (P<0.05). There were statistically significant differences in open atrophy, severe atrophy of gastric mucosa, presence of IM, xanxoma of stomach and PPIs use time >3 years between the two groups (P<0.05). The presence of IM (OR=4.874), severe atrophy of gastric mucosa (OR=4.412) and the time using PPIs >3 years (OR=3.631) were independent risk factors for gastric cancer after Hp eradication (P<0.05). Conclusion There is a high risk of gastric cancer after HP eradication in Fuzhou, mainly in elderly male patients, especially in patients with IM, severe atrophy of gastric mucosa and long-term use of PPIs, often accompanied by elevated levels of tumor markers. Close gastroscopy follow-up examination must be conducted within 4 to 5 years after Hp eradication, which is helpful for screening high-risk groups of gastric cancer, preventing gastric cancer and treating gastric cancer as early as possible after Hp eradication.

[摘 要] 目的：采用基于中国人群单核苷酸多态性位点开发的同源重组缺陷（HRD）检测工具评估云南地区卵巢癌患者的HRD状态和BRCA1/2基因突变频率并探讨其临床意义。方法：共纳入2021年1月至2023年5月间在云南省肿瘤医院收治的卵巢癌患者248例，HRD状态采用基因组瘢痕评分法（GSS）（主要依据拷贝数的长度、类型、位置及基因组断片）或HRD评分法（杂合性缺失、端粒等位基因失衡及大片段移位等基因组不稳定事件的总和）进行评估，当组织样本的GSS≥50分或HRD评分≥42分者或检测到有害的BRCA1/2基因突变时HRD被定义为阳性。分析患者HRD状态与临床病理特征的关系。结果：248名卵巢癌患者中70.97%的患者HRD呈阳性，其中BRCA1/2基因突变率为30.65%。Ⅲ~Ⅵ期、高级别浆液腺癌的卵巢癌患者具有更高的HRD阳性率（均P<0.01），HRD评分更高的患者其合并其他基因突变的频率也越高（P<0.05）。HRD状态与卵巢癌的病理类型、临床分期和其他基因突变均有关联（均P<0.01）。结论：云南地区卵巢癌患者HRD阳性率较高，HRD阳性的卵巢癌患者可以从聚ADP核糖聚合酶（PARP）抑制剂治疗中获得更大的收益。