Objective To analyze the clinical manifestations of primary Sj(o)gren's syndrome (pSS)with peripheral neuropathies.Methods Eighty-six patients who fulfilled the 2002 American-European Consensus Group criteria for pSS were enrolled in the study.For each patient,medical data,including clinical,laboratory,immunologic and electromyography data were collected and analyzed.The clinical manifestations of primary Sj(o)gren's syndrome were compared between patients with and without peripheral neuropathy.Statistical methods used were t-test,chi-square test and Logistic regression.Results Eighty-six patients were analyzed,and neurological involvement was noted in 26％ (22/86) patients.The clinical spectrum of peripheral neuropathies encountered in Sj(o)gren's syndrome patients was wide,with sensory neuropathies being the most common.Median nerve,peroneal nerve and sural nerve were the most likely involved,and lower limb involvement accounted for 73％ (16/22).Peripheral neuropathy was diagnosed during the Sj(o)gren's syndrome course in all patients,and about 45％ patients' neurological involvement were diagnosed early in the course of the disease.The frequency of Raynaud's phenomenon was significantly higher (32％ vs 5％,P=0.002) as well as acroanesthesia (68％ vs 5％,P＜0.01) in pSS with peripheral neurological involvement than in pSS without peripheral neuropathy.The median values of EULAR Sj(o)gren's syndrome disease activity index (ESSDAI) were 5.3 (range 2.8-7.8) and 3.4 (range 1.5-5.3) in the PNS and non-PNS groups respectively (P＜0.01).We found a significant rise of peripheral neuropathy risk associated with Raynaud's phenomenon (relative risk 9.489,95％CI 2.191-41.093,P=0.003) and ESSDAI (relative risk 1.528,95％CI 1.179-1.979,P=0.001).Elevated titers of rheumatoid factor (P=0.023) and ANA (P=0.003) were common in patients with peripheral neuropathy.Conclusion Peripheral neuropathy is not a rare manifestation of pSS.Neurological involvement can be diagnosed early in the course of the disease.Raynaud's phenomenon and high disease activity may be the risk factors for peripheral neuropathy.

Objective To investigate the current status of treatment on traumatic ruptured spleen in a regional medical center in Tianjin,China.Method Logistic analysis of 16 impact ffactors of treatment decision on 147 patients with traumatic ruptured spleen.Results The type of trauma,pulse rate at admission,result of abdominal puncture and CT grade were related to treatment decision making.Splenectomy was carried out in 89 patients (60.54％) which accounted for 89.90％ of all surgical procedures.Splenectomy was carried out in 50.85％ of patients with CT grade 1 or 2 (or 85.71％ of grade 1 and 2 surgery),and 100％ of CT grade 3 or 4.Spleen preservation surgery was carried out in 7 patients with CT grade 1 or 2.Conclusion Splenectomy was carried out in most cases in this study.It is necessary to investigate the treatment of splenic trauma in regional medical centers,and to develop more reliable surgical techniques to carry out more spleen-preservation surgery ffor CT grade 1 or 2 ruptured spleen.

Speaking lesson is an effective way and teaching skill to prepare lessons for the teaching of anatomy. Taking the speaking lesson design of lecture teaching of the neck as an example, this article shows the teaching of topographic anatomy for "5+3" integrated clinical medical students. Adhering to the teaching concept of "student-centered", we have launched the theoretical teaching of "problem-centered discussion" and the experimental teaching of "operator responsibility system" in groups, with the "thanksgiving" humanistic education running through the whole process of theoretical and experimental courses. The teaching is a good way to cultivate the students' gratitude consciousness and humanistic quality, self-learning ability, critical thinking ability, communication and expression ability, hands-on operation ability and teamwork spirit, which has laid a solid foundation for training medical professionals in the new era.

Objective:Standardized sample resources and high-quality clinical big data are important resources for medical research, only through resource sharing can maximize its utilization.Which can be utilized to the max only through resource sharing.Methods:This paper attempts to explore the sharing mechanism of the resource sharing platform and proposes some aspects such as the platform construction background, management regulations, legal ethical system, data sharing principles, benefit distribution, etc.This article attempts to explore the sharing mechanism based on the resource sharing platform of the respiratory disease biobank, proposes the contents that should be included in the sharing mode.Detailed information including the platform construction background, management procedures, legal and ethical system, data sharing principles and benefit distribution should take into consideration in the operating mechanism of the platform.Results:Establishing a resource sharing platform matches the development of clinical research in China.The tailored sharing model which is suitable for the field of respiratory diseases will also guide the rapid development of clinical research.Conclusions:The construction of a respiratory disease biobank sharing platform is conducive to promoting the opening and sharing of biological samples and information resources in the context of big data.

Immunogenic cell death (ICD) plays a major role in cancer immunotherapy by stimulating specific T cell responses and restoring the antitumor immune system. However, effective type II ICD inducers without biotoxicity are still very limited. Herein, a tentative drug- or photosensitizer-free strategy was developed by employing enzymatic self-assembly of the peptide F-pY-T to induce mitochondrial oxidative stress in cancer cells. Upon dephosphorylation catalyzed by alkaline phosphatase overexpressed on cancer cells, the peptide F-pY-T self-assembled to form nanoparticles, which were subsequently internalized. These affected the morphology of mitochondria and induced serious reactive oxygen species production, causing the ICD characterized by the release of danger-associated molecular patterns (DAMPs). DAMPs enhanced specific immune responses by promoting the maturation of DCs and the intratumoral infiltration of tumor-specific T cells to eradicate tumor cells. The dramatic immunotherapeutic capacity could be enhanced further by combination therapy of F-pY-T and anti-PD-L1 agents without visible biotoxicity in the main organs. Thus, our results revealed an alternative strategy to induce efficient ICD by physically promoting mitochondrial oxidative stress.