ObjectiveTo evaluate the therapeutical effect and toxicity of home-made paclitaxel and cisplatin combination in metastatic breast cancer.Methods Home-made paclitaxel 175 mg/m2,d1 intravenous drip,cisplatin 80 mg/m2,d1-3 intravenous drip,21-28 d was one cycle,all patients continuous course treatment for 2-6 cycles,then the effect was evaluated.ResultsAll the patients received meso-cycle were 4 (2-6) cycles chemotherapy.The total effective rate was 56.60％ (30/53),disease control rate was 81.13％(43/53 ).The rates of internal organ metastasis and non-internal organ metastasis,before menopause and after menopause had no significant difference [56.76％ (21/37) vs.56.25％ (9/16),59.09％ (13/22) vs.54.84％ ( 17/31 ),P ＞ 0.05 ].The median existence time for all the patients was 18.8 ( 12-27 ) months.The survival rate was 56.60％ (30/53) and 30.19％ (16/53) for 1 and 2 years respectively.The major toxieities were gastrointestinal reaction,alopeoia and myelosuppression,the rates of nerve and heart toxicities were less,15.09％ (8/53) and 7.55％ (4/53) respectively.ConclusionThe therapeutic effect of home-made paclitaxel and cisplatin combination in metastatic breast cancer is good,it is to be worth to spread in clinic.

AIM:To investigate the influence of continuous subculturing of human umbilical cord mesenchymal stem cells (hUC-MSCs) on the mRNA expression of all 23 family members of NOD-like receptors (NLRs), and to search for the way of improving the subculture quality of hUC-MSCs and increasing the quantity and safety in the experimental and clinical application .METHODS:Neonatal umbilical cord was collected to isolate and purify the hUC-MSCs with the colla-genase II digestion and adherence screening methods .These cells were continuously subcultured .The hUC-MSCs at pas-sage 3 and passage 28 were identified by flow cytometry and induced differentiation .The mRNA expression of NLRs in the passage 3 and passage 28 hUC-MSCs was detected by RT-qPCR.RESULTS: The cell phenotypes of both passage 3 and passage 28 hUC-MSCs were CD29 +/CD44 +/CD105 +/CD31 -/CD34 -/CD40 -/CD45 -/CD106 -/HLA-DR-, and both of the cells were induced into osteoblasts and adipocytes , which were conformed to the criteria of International Society for Cellular Therapy to define MSCs .All the NLR family members were expressed in passage 3 hUC-MSCs.NOD1, NLRC4, NLRC5, NLRP1, NLRP3, NLRP10, NAIP, NLRX1 and APAF1 at mRNA levels were highly expressed , and the rest were lowly expressed.When hUC-MSCs were subcultured to passage 28, NLRP10 mRNA was increased, NLRC5 mRNA and NLRX1 mRNA were hardly changed , and all of the rest members were decreased .The difference of NLRP1 mRNA expres-sion between passage 3 and passage 28 hUC-MSCs was observed with statistical significance (P<0.05).CONCLU-SION:The effects of subculturing on the expression of NLR family in hUC-MSCs are pleiotropic .It requires further investi-gation to confirm whether these effects are related to the proliferation , differentiation and immunomodulation of MSCs .

Objective To investigate the changes of the immunological factors in subcutaneous exudate and blood components of the rats receiving cutaneous scraping method,and to compare the changes of skin histopathological features before and after cutaneous scraping under microscope.Methods SD rats were randomly divided into two groups,cutaneous-scraping group and non-cutaneous-scraping group.And then each group was divided into three subgroups.The observation indexes included the levels of interleukin (IL)-1β,IL-6 and interferon gamma (IFN-γ) in the blood and the skin,routine blood examination,and skin histopathological features.Results In cutaneous-scraping group,the number of white blood cells in the blood and the levels of IL-1 β and IFN-γ in skin tissues were increased (P ＜ 0.05),the hemolysis rate was increased (P ＜ 0.05).However,the levels of IL-1β,IL-6 and IFN-γin the blood showed no obvious changes.Under the microscope,severe skin edema,vascular congestion and dilatation,and infiltration of inflammatory cells were found in the skin after cutaneous scraping.Conclusion The cutaneous scraping method can activate the immune response rapidly,and the immunological components of the subcutaneous exudate after cutaneous scraping are helpful to the disease treatment.

Objective To evaluate the efficacy of a sustained releasing mosquito larvicide package against larval breeding and its impact on water and plant,in order to provide a scientific evidence for its application in control and prevention of Dengue.Methods Guangzhou Center for Disease Control and Prevention was chosen as the test place.Twenty test sites were set up,2 bags of sustained releasing larvicides package,1 bag of sustained releasing larvicides package,3 g 1％ temephos granules and nothing were put into 4 glass bottles for each test site from July to December in 2014,respectively.The 4 glass bottles were called high dose (H) group,low dose (L)group,positive control (P) group and blank control (B) group,respectively.The 4 groups were observed at intervals of 10 days for 19 times.Environmental air temperature,turbidity of water,number of larvae and damage of plant were recorded.And 5 test sites were selected to collect water specimen.The chemical oxygen demand,ammonia nitrogen concentration and temephos concentration of water specimen were detected.Results The larval breeding rates were 0 (0/380),1.1％ (4/380),0.8％ (3/380) and 63.4％ (241/380),damage rates of plant were 5.0％ (19/380),5.5％ (21/380),4.7％ (18/380),4.7％ (18/380) and turbidty rates of water were 24.5％ (93/380),19.7％ (75/380),33.4％ (127/380) and 20.3％ (77/380) in H,L,P and B groups,respectively.Statistically significant differences were seen in larval breeding rate and turbidity rate of water between different groups (x2 =823.565,24.715,all P ＜ 0.05),but they were not seen in damage rate of plant (x2 =0.332,P ＞ 0.05).The temephos concentrations were 1.24,0.78 and 2.33 mg/L in H,L and P groups,respectively.Statistically significant differences were seen in temephos concentration between different groups (H =35.426,P ＜ 0.01),but they were not seen in chemical oxygen demand and ammonia nitrogen concentration (H =0.239,0.013,all P ＞ 0.05).Conclusions The sustained releasing package of mosquito larvicide makes less pollution to water and has no impact on water turbidity.Moreover,it doesn't damage the aquatic plant.The efficacy of the sustained releasing package of mosquito larvicide could effectively prevent mosquito larval breeding in Dengue epidemic period.

Objective:To investigate the learning curve of laparoscopic transanal total mesorectal excision (taTME) for rectal cancer operated by one or two surgery teams.Methods:The retrospective cross-sectional study was conducted. Based on the concept of real-world research, the clinical data of 1 458 patients undergoing laparoscopic rectal cancer taTME from 44 medical centers who were registered in the Chinese taTME registry collaborative (CTRC) database from May 2010 to May 2020 were collected. The 1 458 patients were divided into cohorts with one surgery team or two surgery teams according to the operation method. Patients with one surgery team underwent taTME by transabdominal operation and then by transanal operation. Patients with two surgery teams underwent taTME by transabdominal and transanal operation simultaneously with duration of the simutaneous operation time ≥30 minutes. The entire surgical process of patients with two surgery teams is not required to be performed by two surgery teams simutaneously. The clinical data were collected from the medical centers with similar operation amount according to the operation time sequence to analyze the difference between different operation stages and explore the learning curve. The operation time was taken as the parameter to carry out cumulative sum analysis and draw the learning curve of laparoscopic rectal cancer taTME in each medical center. The clinicopathological characteristics of patients from two medical centers with the largest difference in learning curves were analyzed. Observation indicators: (1) screening results of clinical data; (2) clinical data collection of patients with one surgery team; (3) surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages; (4) learning curve of the one surgery team; (5) clinical data collection of patients with two surgery teams; (6) surgical situations of laparoscopic rectal cancer taTME from the two surgery teams; (7) learning curve of the two surgery teams. The cumulative sum was calculated by the CUSUM=∑i=1nXi-U, where Xi represented the operation time of each taTME, U represented the average operation time of all cases, and n represented the operation number. Fitting process was conducted on scatter plot of learning curves. Taking the apex of learning curve as the boundary, the learning curve was divided into two stages. The abscissa corresponding to the apex of learning curve was the number of operations that needed to be performed to cross the learning curve. Measurement data with normal distribution were represented as Mean±SD. Comparison between two groups was conducted using the t test and comparison between multiple groups was conducted using the ANOVA. Measurement data with skewed distribution were represented as M( P25,P75), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. Results:(1) Screening results of clinical data:the clinical data of 661 patients from 7 medical centers with one surgery team and two surgery teams were collected. (2) Clinical data collection of patients with one surgery team: the clinical data of 312 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected including 42 cases in the number 2 medical center, 97 cases in the number 20 medical center, 82 cases in the number 33 medical center, 35 cases in the number 37 medical center and 56 cases in the number 39 medical center, respectively. (3) Surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages: three medical centers including the number 2, number 37 and number 39 medical center with close operation volume provided the clinical data of cases distributed in five operation stages. Among the five operation stages, the proportion of high-quality operation of total mesorectal excision (TME) was ≥17/18, the incidence of postoperative complications was ≤13.3%(4/30) and the incidence of anastomotic leakage was ≤10.0%(3/30). There was no significant difference in the TME quality, postoperative complications or anastomotic leakage among the five operation stages ( P>0.05). There was no significant difference in the operation time among the five operation stages ( χ2=6.950, P>0.05). (4) Learning curve of the one surgery team: the number of operations corresponding to the turning point of learning curve in number 2 and number 20 medical center was 22 and 39, respectively. The number of operations corresponding to the turning points of learning curve in number 33 and number 37 medical center was 15, 66 and 10, 28, respectively. The number of operations corresponding to the turning point of learning curve in number 39 medical center was 20. The overall curve of number 20 medical center was in line with the trend of learning curve and 39 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 20 and number 33 medical center. Cases with the gender of male or female, age, body mass index, cases classified as stage 1, stage 2, stage 3 or stage 4 of the American Society of Anesthesiologists (ASA) Classification, cases with neoadjuvant therapy, duration of postoperative hospital stay of the number 20 medical center were 77, 20, (60±10)years, 24 kg/m 2(22 kg/m 2, 26 kg/m 2), 1, 88, 8, 0, 8, 8, 11 days (9 days, 13 days), respectively, versus 51, 31, (64±11)years, 23 kg/m 2(21 kg/m 2, 26 kg/m 2), 0, 35, 43, 1, 31, 16 days (13 day, 21 day) of number 33 medical center, showing significant differences in the above indicators between the two medical centers ( χ2 =6.442, t=-2.265, Z=-2.032, -6.870, χ2 =22.120, Z=-8.408, P<0.05). (5) Clinical data collection of the two surgery teams: the clinical data of 259 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected, including 46 cases in the number 2 medical center, 47 cases in the number 8 medical center, 78 cases in the number 18 medical center, 43 cases in the number 33 medical center and 45 cases in the number 44 medical center, respectively. (6) Surgical situations of laparoscopic rectal cancer taTME from the two surgery teams: four medical centers including the number 2, number 8, number 33 and number 44 medical center with close operation volume provided the clinical data of cases distributed in four operation stages. Among the four operation stages, the proportion of high-quality operation of TME was ≥50.0%(13/26), the incidence of postoperative complications was ≤35.0%(14/40) and the incidence of anastomotic leakage was ≤22.5%(9/40). There was no significant difference in the TME quality, postoperative complications or operation time among the four operation stages ( χ2 =3.252, 4.733, 8.848, P>0.05). There was a significant difference in the incidence of anastomotic leakage among the four operation stages ( P<0.05). (7) Learning curve of the two surgery teams: the number of operations corresponding to the turning point of learning curve in number 2 and number 8 medical center was 28 and 16, respectively. The number of operations corresponding to the turning points of learning curve in number 18, number 33 and number 44 medical center was 12 and 58, 10 and 36, 14 and 36, respectively. The overall curve of number 2 medical center was in line with the trend of learning curve and 28 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 2 and number 33 medical center. The age and cases with tumor in stage T0 and (or) Tis, stage T1, stage T2, stage T3 or stage T4 of the T staging of the number 2 and number 33 medical center were (60±12)years, 3, 1, 9, 11, 20 and (65±10)years, 2, 3, 22, 15, 0, respectively, showing significant differences in the above indicators between the two medical centers ( t=-2.280, Z=-4.033, P<0.05). Conclusion:Thirty-nine cases of operations was the minimum number for the one surgery team to cross the learning curve of laparoscopic rectal cancer taTME and 28 cases of operations was the minimum number for the two surgery teams to cross the learning curve of laparoscopic rectal cancer taTME.

Gastrointestinal neoplasms is the most common digestive tract neoplasms, and its incidence rate is increasing year by year. Compared with other solid tumors, the application of immune checkpoint inhibitors in gastrointestinal neoplasms is still in the stage of continuous exploration. This paper intends to review the relevant research and latest progress of immune checkpoint inhibitors in advanced gastric cancer, mismatch repair function defect/microsatellite high instability and mismatch repair function integrity/microsatellite stability or microsatellite low instability, and further evaluate the effectiveness and safety of immunotherapy combined with relevant studies.

As a general anesthetic,esketamine has the advantages of sedation,analgesia,and slight respiratory depression within the clinical dose range,which is suitable for preoperative sedation in children.Intravenous injection is mostly used in clinical practice,but nasal dropping is not affected by the venous access and has a rapid onset time with no first pass effect.The recommended nasal dose of esket-amine is 1 mg/kg,with reliable sedation effect and few adverse reactions.When combined with dexmedeto-midine or midazolam,sedation onset time of esketamine can be significantly shortened,the respective drug dosage can be reduced,and postoperative pain can be alleviated.Nasal dropping alone or combined with dexmedetomidine can be safely used in children with congenital heart disease complicated by pulmonary hy-pertension,which helps to maintain the stability of hemodynamic.This article summarizes the current situa-tion of clinical application of nasal dropping of esketamine to provide reference for its rational application.

OBJECTIVETo document the investigation and control of an outbreak of gastroenteritis in City G, South China, and provide a reference for preventing future outbreaks.

METHODSAn ambispective cohort study was designed. Attack rate (AR) and relative risks (RR) were calculated to identify the causes of gastroenteritis. Investigations using questionnaires included personal interviews with patients and doctors, reviews of medical records, laboratory examinations of fecal specimens and continuous hygiene monitoring of water samples from the waterworks.

RESULTSOverall, 427/71534 (AR=5.97%) cases were identified between October 31 and November 12 2010. Geographic distribution was highly localized, with 80% of cases occurring in the areas supplied by waterworks-A. Consumption of water provided solely by waterworks-A was found to be associated with illness (RR=8.20, 95 CI%:6.12-10.99) compared with that from waterworks-B. Microbiological analyses confirmed the presence of Norovirus in six of eight fecal samples from symptomatic patients, two water samples from waterworks-A and two sewage samples. After taking effective measures, the hygienic indices of waterworks-A met health criteria again on November 9 and no cases were reported 3 days later.

CONCLUSIONThe outbreak reported here was caused by drinking tap water contaminated with sewage at the source. Early identification of possible contamination sources and awareness of changes that might negatively impact water quality are important preventive measures to protect public health.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Disease Outbreaks ; Female ; Gastroenteritis ; epidemiology ; etiology ; Humans ; Infant ; Male ; Middle Aged ; Water Pollution ; adverse effects ; Young Adult

Objective:To investigate the epidemiological and clinical characteristics of a case infected with avian influenza A (H5N6) virus associated with exposure to aerosol and provide evidence for the prevention and control of human infection with avian influenza virus.Methods:Epidemiological investigation was conducted to identify the history of exposure, infection route, and disease progression. Real-time fluorescent quantitative RT-PCR was used to test the samples collected from the case, close contacts, environment and poultry market.Results:The case had no history of exposure to live poultry and poultry market. But before the onset the case had a history of exposure to the live poultry placed in a car with doors and windows closed. The samples collected from the case’s lower respiratory tract and the remaining frozen chicken meat were all influenza A (H5N6) virus positive.Conclusions:The source of infection was the live poultry, and the infection route might be the exposure to aerosol in a car with doors and windows closed, where the poultry were temporarily stored. It is necessary to promote centralized poultry slaughtering, cold chain distribution and fresh poultry sale, as well as strengthen health education and establish the concept of consuming fresh poultry.

Objectives: The purpose of this study was to compare differences in facial soft tissue thickness in three-dimensional (3D) images before and after orthognathic surgery in patients with skeletal Class III malocclusion and to obtain a better understanding of the relationship between hard and soft tissue changes after surgery.Materials and method: The present retrospective study included 31 patients with skeletal Class III malocclusion with mandibular chin deviation greater than 4 mm who had undergone cone-beam computed tomography before and 6 months after surgery. Seven bilateral points were established. Measurements were taken from software-generated multiplanar reconstructions. The predictor variables were timing (pre- and postoperatively) and side (deviated vs.nondedicated). A regression model and correlation analysis were conducted for statistical analysis. Results: The difference of bilateral facial soft tissue thickness was statistically significantly different between deviated and nondeviated sides (P < 0.05), with lower values observed on the deviated side. The soft tissue thickness has become nearly symmetric at local regions of the lower thirds of the face after orthognathic surgery. However, most measurements showed a negative correlation between changes in soft tissue thickness and changes in bone tissues. Conclusions Skeletal Class III malocclusion with facial asymmetry is accompanied by differences in soft tissue thickness when comparing Dev and N-Dev sides of the posterior region of the mandible, where soft tissues are thinner on the Dev side. Soft tissue thickness can compensate for or camouflage the underlying asymmetric mandible. In addition, the asymmetric soft tissue thickness on the lower third of the face can be partially improved by orthognathic surgery, but the amount of soft tissue thickness change is not consistent with that of hard tissue positional change.