OBJECTIVE: To summarize the clinical phenotype and genotypic characteristics of 3 patients with KBG syndrome and epileptic seizure. METHODS: Clinical data of the patients were collected. Family-trio whole exon sequencing (WES) was carried out. Candidate variants were verified by Sanger sequencing. RESULTS: Patients 1 and 2 were boys, and patient 3 was an adult woman. All patients had epileptic seizures and mental deficiency. Their facial features included triangular face, low hair line, hypertelorism, large forward leaning auricles, broad nasal bridge, upturned nostrils, long philtrum, arched upper lip, and macrodontia. The two boys also had bilateral Simian creases. WES revealed that the three patients all harbored heterozygous de novo frameshift variants in exon 9 of the ANKRD11 gene including c.2948delG (p.Ser983Metfs*335), c.5397_c.5398insC (p.Glu1800Argfs*150) and c.1180_c.1184delAATAA (p.Asn394Hisfs*42). So far 291 patients with ANKRD11 gene variants or 16q24.3 microdeletions were reported, with over 75% being de novo mutations. CONCLUSION Above findings have enriched the spectrum of ANKRD11 gene mutations underlying KBG syndrome. WES is helpful for the early diagnosis of KBG, and provided reference for genetic counseling of this disease.
Abnormalities, Multiple/genetics* ; Bone Diseases, Developmental/genetics* ; Epilepsy/genetics* ; Facies ; Humans ; Intellectual Disability/genetics* ; Phenotype ; Repressor Proteins/genetics* ; Seizures/genetics* ; Tooth Abnormalities/genetics*

Objective To explore the expression and significance of serum DKK1 in patients with gastric cancer. Methods We selected 170 gastric cancer patients (gastric cancer group) and 170 subjects with non-gastric cancer during the same period (control group). ELISA was used to detect the DKK1 level. The ROC curve was used to evaluate the diagnostic performance, and we analyzed the relation between DKK1 level and age, gender, family history of gastric cancer, cigarette smoking, alcohol consumption, tumor size, TNM stage, infiltration depth, lymph node metastasis, liver metastasis, vascular invasion, perineural invasion. Results The serum DDK1 level in GC patients was higher than that in control group (P < 0.0001). ROC curve showed that the possible optimal cut-off value of DKK1 for gastric cancer patients was 167.8 pg/ml, AUC was 0.908, sensitivity was 80.59%, and specificity was 84.71%. There was no significant relation between the serum DKK1 level and age, gender, family history of gastric cancer, cigarette smoking, alcohol consumption, tumor size, liver metastasis, vascular invasion or distant metastasis (all P > 0.05). However, DKK1 level was significantly related with TNM stage, infiltration depth, lymph node metastasis and perineural invasion (all P < 0.05). Conclusion Serum DKK1 level is higher in gastric cancer patients than that of control group and related with the severity of lesions, which indicates that serum DKK1 may be a potential biomarker for gastric cancer screening.

Marinesco-Sj?gren syndrome (MSS), also known as hereditary ataxia-dwarf-mental retardation syndrome, is a rare autosomal recessive ataxia syndrome. This article reviews the recent advance in clinic characteristics, pathogenic gene mutation sites, pathogenesis and clinic diagnosis and treatment of MSS, in order to improve clinicians' understanding of the disease and diagnosis and treatment level, and reduce the missed diagnosis and misdiagnosis of the disease.

Sialidosis is a rare lysosomal storage disease caused by NEU1 gene mutation at 6p21.33. It is characterized by myoclonic, ataxia, epilepsy, and decreased vision. A pair of twins with sialidosis type 1 are reported to enrich clinicians ′ understanding of the disease, so as to improve the diagnosis and treatment. The proband was a 16-year-old male. The main symptom was intermittent limb involuntary trembling for 2 years, with paroxysmal loss of consciousness. Fundus examination showed cherry-red spots. His twin brother had similar symptoms, but the overall performance was mild. Whole exome sequencing results showed that both patients carried compound heterozygous mutations of c.239C>T (p.P80L) and c.803A>G (p.Y268C) in NEU1 gene, which were from their normal phenotype mother and father.

The pandemic of Corona Virus Disease 2019 (COVID-19) continues, which shows the concentrated or sporadic cases in multiple places. Current COVID situation is still complex. During the COVID-19, routine diagnosis and treatment of liver cancer patients has been affected in different degrees. Under the premise of following the treatment guidelines, how to reduce the risk of infection of patients and medical staff, utilize limited medical resources to maximally ensure anti-tumor treatment and related emergency treatment, and help patients get through the epidemic period is a problem for liver oncologists. Thus, experts of liver cancer treatment related disciplines of Zhongshan Hospital, Fudan University have written the Expert guidance on overall management of liver cancer during the COVID-19, which aims to provide references for liver oncolo-gists to conduct clinical work safely and effectively under the epidemic prevention and control, and to help patients fight against the epidemic smoothly.

Objective To analyze results of breast cancer screenings in the Cancer Screening Program in Urban China (CanSPUC) during 2012-2013. Methods In 14 cities of 9 provinces (Eastern Region: Beijing, Hebei, Liaoning, Shandong and Guangdong; Central Region: Heilongjiang and Hunan;Western Region: Chongqing and Gansu), 198 097 women aged 40-69 years who had lived in their cities for ≥3 years were surveyed through a cancer risk assessment questionnaire during 2012-2013. The questionnaires identified women considered to be at high risk for breast cancer, of whom 17 104 received screening examinations, for whom complete records of breast cancer screening and other data were available for 12 440 subjects altogether, including breast ultrasound exams for subjects 40-44 years old. Subjects older than 45 years or in whom breast imaging reporting and data system (BI-RADS) ultrasound had found≥3 lesions also underwent mammography. In this cohort, BI-RADS 3 class was defined as suspicious and BI-RADS ≥4 class as positive. Chi-square tests were used to compare breast cancer screening results by groups. Results As of October 2013, breast cancer screening percentages for the 12 440 subjects for whom full data were available were, by region, Eastern: 55.43% (6 895); Central: 21.45% (2 669); and Western:23.12% (2 876); by age, 40-44 years: 5.50% (684); ≥45 years: 94.50% (11 756). Using BI-RADS, 2018 subjects were found to have 3 lesions (detection rate:16.22%), which were distributed regionally as Eastern:19.00% (1 310 women), Central: 13.75% (367) and Western; 11.86% (341); χ2=91.45, P<0.001; and 289 were found to have≥4 lesions (detection rate:2.32%), which were distributed regionally as Eastern:2.41%(166), Central:1.54%(41) and Western;2.85%(82);χ2=11.04, P=0.004. Women aged 50-54 years had the highest detection rate of BI-RADS 3 lesions at 18.74% (561/2 994), and those aged 40-44 years had the highest detection rate of BI-RADS ≥4 at 2.92% (20/684). Conclusion Detection rates of BI-RADS ≥4 lesions were highest in the Western region and in women aged 40-44 years, and lowest in the Central region and in women aged 60-64 years. Detection rates of BI-RADS 3 lesions were highest in the Eastern region and in women aged 50-54 years and the lowest in the Western region and in women aged 60-64 years.

Objective To analyze results of breast cancer screenings in the Cancer Screening Program in Urban China (CanSPUC) during 2012-2013. Methods In 14 cities of 9 provinces (Eastern Region: Beijing, Hebei, Liaoning, Shandong and Guangdong; Central Region: Heilongjiang and Hunan;Western Region: Chongqing and Gansu), 198 097 women aged 40-69 years who had lived in their cities for ≥3 years were surveyed through a cancer risk assessment questionnaire during 2012-2013. The questionnaires identified women considered to be at high risk for breast cancer, of whom 17 104 received screening examinations, for whom complete records of breast cancer screening and other data were available for 12 440 subjects altogether, including breast ultrasound exams for subjects 40-44 years old. Subjects older than 45 years or in whom breast imaging reporting and data system (BI-RADS) ultrasound had found≥3 lesions also underwent mammography. In this cohort, BI-RADS 3 class was defined as suspicious and BI-RADS ≥4 class as positive. Chi-square tests were used to compare breast cancer screening results by groups. Results As of October 2013, breast cancer screening percentages for the 12 440 subjects for whom full data were available were, by region, Eastern: 55.43% (6 895); Central: 21.45% (2 669); and Western:23.12% (2 876); by age, 40-44 years: 5.50% (684); ≥45 years: 94.50% (11 756). Using BI-RADS, 2018 subjects were found to have 3 lesions (detection rate:16.22%), which were distributed regionally as Eastern:19.00% (1 310 women), Central: 13.75% (367) and Western; 11.86% (341); χ2=91.45, P<0.001; and 289 were found to have≥4 lesions (detection rate:2.32%), which were distributed regionally as Eastern:2.41%(166), Central:1.54%(41) and Western;2.85%(82);χ2=11.04, P=0.004. Women aged 50-54 years had the highest detection rate of BI-RADS 3 lesions at 18.74% (561/2 994), and those aged 40-44 years had the highest detection rate of BI-RADS ≥4 at 2.92% (20/684). Conclusion Detection rates of BI-RADS ≥4 lesions were highest in the Western region and in women aged 40-44 years, and lowest in the Central region and in women aged 60-64 years. Detection rates of BI-RADS 3 lesions were highest in the Eastern region and in women aged 50-54 years and the lowest in the Western region and in women aged 60-64 years.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

[摘 要] 目的：探讨四氧化三铁（Fe3O4）纳米粒子（PION）作为药物载体增强二氢卟吩e6（chlorin e6，Ce6）在胶质瘤中的增效作用。方法：采用高温降解法和相转移法制备PEG-Fe3O4@Ce6复合纳米粒子（PION@E6），用水合粒径分析、透射电镜、胶体稳定性分析、紫外可见光吸收光谱等方法对PION@E6进行鉴定。CCK-8法检测胶质瘤U251细胞的增殖活性，流式细胞术检测细胞的凋亡水平，DCFH-DA探针法检测细胞中活性氧（reactive oxygen species，ROS）的水平。构建BALB/c-nu裸鼠胶质瘤U251细胞移植瘤模型，动物活体荧光成像术及磁共振成像（MRI）观察PION@E6及Ce6在移植瘤中的潴留时间，比较PION@E6声动力治疗组及Ce6声动力治疗组的第28天生存情况及肿瘤体积。结果：PION@E6的核心粒径为10 nm、水合粒径为（37.86±12.90）nm，具有良好的水溶性和稳定性；吸收光谱及XRD图谱显示Ce6已经负载到Fe3O4纳米粒子上。与Ce6声动力组比较，PION@E6声动力组U251细胞的增殖活性显著下降（P<0.05），细胞凋亡率显著升高（均P<0.05），细胞中ROS水平显著升高（P<0.05）。荷瘤裸鼠胶质瘤U251细胞移植瘤治疗实验结果显示，与Ce6声动力治疗组比较，PION@E6声动力治疗组裸鼠移植瘤组织中潴留时间显著延长（P<0.05），存活的裸鼠数显著增多，移植瘤体积显著缩小（P<0.01）。结论：Fe3O4纳米粒子对Ce6介导的胶质瘤U251细胞声动力治疗具有明显的增效作用。

OBJECTIVE To study the quality grade stand ard of the premature Forsythia suspensa . METHODS A total of 138 batches of premature F. suspensa were collected from the main producing areas of F. suspensa in China. According to 2020 edition of Chinese Pharmacopoeia ，the contents of impurities ，moisture，ethanol-soluble extract ，volatile oil ，forsythin and forsythoside A in the premature F. suspense were determined ，and the qualified samples were screened. AHP-PCA mixed weighting method was used to give comprehensive weight to the indicators （except for the limit of impurity ）. The comprehensive score of the samples was calculated. The suggestions on the quality grade division of premature F. suspensa were put forward according to cluster analysis of K-mean value. RESULTS & CONCLUSIONS The contents of impurities ，moisture，ethanol-soluble extract ，volatile oil ，forsythin and forsythoside A in the premature F. suspense were 0-7.80％，1.60％-8.18％，13.13％-61.60％，0.21％-3.47％，0.02％-2.15％ and 0.79％-14.04％，respectively；average contents of them were 1.24％，4.97％，34.88％，2.01％，0.42％，6.86％，respectively. Totally 47 batches of 138 batches were qualified in all indexes. It is suggested that the quality grade of the premature F. suspense can be divided into three grades ：in first grade of F. suspense ，the contents of volatile oil ，forsythin，forsythoside A ， ethanol-soluble extract and moisture were ≥2.40％，≥0.59％，≥8.34％，≥38.66％ and ≤4.99％，respectively；in second grade of F. suspense ，the contents of above indicators were ≥2.26％，≥0.41％，≥7.47％，≥32.58％ and ≤5.33％，respectively；in third grade of F. suspense ，the contents of above indicators were ≥2.15％，≥0.32％，≥4.60％，≥31.52％ and≤7.23％，respectively.