Objective To retrospectively analyze multicenter data from domestic sources, aiming to explore the link between intrahepatic cholangiocarcinoma (ICC) tumor size and prognosis, establishing a classification system based on tumor size. Methods Between December 2011 and September 2018, 280 ICC patients from 13 hospitals were included. The tumor size prognosis cutoff was identified by the minimum P-value method, and the classification's overall survival related effectiveness was assessed by Kaplan-Meier analysis. Results All 280 patients were divided into the group of tumor maximum diameter ≤4 cm and >4 cm. Tumor size was confirmed as an independent prognosis factor by multivariate COX regression analysis (HR=2.110, 95% CI: 1.358-3.280). Conclusions The tumor size dichotomy classification system based on the Chinese patient group can expediently predict ICC prognosis and offers an important basis for selecting post-operative individualized adjuvant therapy and follow up plans.

Objective To construct a prognostic model of centrosome amplification-related genes(CARGs)by machine learning and evaluate its prediction performance for the prognosis of esophageal squamous cell carcinoma(ESCC).Methods CARGs were obtained from Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)datasets.The RNA-sequencing(RNA-seq)transcriptome datasets of ESCC were retrieved from The Cancer Genome Atlas(TCGA)and Gene Expression Omnibus(GEO),and assigned into training and validation sets,respectively.Subsequently,single-sample gene set enrichment analysis(ssGSEA)and weighted gene co-expression network analysis(WGCNA)were employed to screen CARGs.A prognostic model of CARGs was constructed by incorporating 12 machine learning algorithms,and univariate and multivariate Cox regression analyses were applied to evaluate whether the 12 models as an independent prognostic factor or not.Eventually,15 paired ESCC and adjacent non-tumor tissue samples were collected from the Department of Gastroenterology of the Second Affiliated Hospital of Army Medical University,and real-time quantitative PCR(RT-qPCR)and immunohistochemistry staining were performed to detect the expression of these genes ESCC samples.Results Our 9-CARGs prediction model for ESCC prognosis was constructed.RT-qPCR confirmed that the mRNA expression levels of DENR,TRIP13,BRCA2,TTF2,TCFL5 and NUP188 were significantly higher in ESCC tissues than normal tissues(P<0.05),and the protein levels of DENR,TRIP13,TTF2 and TCFL5 were also elevated when compared to normal tissues.Conclusion DENR,TRIP13,TTF2 and TCFL5 are highly expressed and closely associated with poor prognosis of ESCC,suggesting their potential roles in the pathogenesis and progression of this malignancy.

Myotonic dystrophy type 1(DM1)is a multisystem trinucleotide repeat expansion disorder usually referred to the department of neurology with complaints of progressive muscle weakness and myotonia.This article reported a 33-year-old female patient with DM1 presenting with acute respiratory failure.Muscle bi-opsy in vastus lateralis showed significantly increased internal nuclei.Genetic test show CTG repeat expansions with the size of(847±76)in dystrophia myotonica protein kinase(DMPK)gene on chromosome 19.This case report broadens the clinician's understanding of the atypical clinical manifestations of DM1,so as to avoid missed diagnosis and misdiagnosis.

Objective To establish and validate a Nomogram model for predicting the overall survival(OS)of the patients with intrahepatic cholangiocarcinoma(ICC)based on domestic multicenter data,and screen the beneficiaries of adjuvant chemotherapy based on the prediction model.Methods From December 2011 to December 2017,the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model.This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy.Results A total of 278 patients were enrolled,and 23 cases(8.3%)received adjuvant chemotherapy.COX multivariate analysis showed that drinking history,ECOG score,method of hepatectomy,lymph node status,number of tumors,and tumor differentiation were independent risk factors for postoperative OS.The Nomogram model had a C-index of 0.690(95%CI:0.646-0.734)in the training cohort and 0.740(95%CI:0.863-0.617)in the validation cohort.According to risk stratification by Nomogram model,in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy(P=0.033),whereas in the low-risk group,there was no significant difference in survival(P=0.59).Conclusions Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen,and identify the patients with ICC who benefit from adjuvant chemotherapy.

Background Tinnitus is a common symptom in workers exposed to noise, and no specific treatment is available yet. Paying attention to the influencing factors of tinnitus is very important to prevent tinnitus. Objective To investigate the situation of tinnitus among noise-exposed workers and its influencing factors. Methods Using a cross-sectional study design, 1011 noise-exposed male workers in Hangzhou were studied. Tinnitus status, age, education, personal protection, smoking history, drinking history, and family history of the participants were surveyed by questionnaires. Binaural pure tone hearing threshold test was performed on all study subjects. The environmental noise in the workplace was measured. The relationships of tinnitus with noise exposure intensity, noise exposure time, noise exposure category, cumulative noise exposure, and wearing hearing protectors among the noise-exposed workers were analyzed by logistic regression. Results The prevalence of tinnitus among the noise-exposed workers was 36.1%. The mean hearing thresholds at 500, 3000, 4000, and 6000 Hz in the right and left ears were higher in the tinnitus group than in the non-tinnitus group (P<0.05); the hearing threshold at 2000 Hz in the right ear was higher in the tinnitus group than in the non-tinnitus group (P<0.05). There was no statistically significant difference between the two groups in the prevalence of monaural speech-frequency hearing loss or monaural high-frequency hearing loss (P>0.05). The on-site noise intensity was divided into three groups: ＜85, 85-＜95, and ≥95 dB(A); the prevalence of tinnitus in the three groups was 19.6%, 40.5%, and 66.7% respectively. The years of noise exposure was divided into three groups: ＜1, 1-＜5, and ≥5 years; the prevalence of tinnitus in the three groups was 17.9%, 34.0%, and 45.4% respectively. The cumulative noise exposure was divided into six groups: ＜80, 80-＜85, 85-＜90, 90-＜95, 95-＜100, and ≥100 dB(A)·year; the prevalence of tinnitus in the six groups was 6.8%, 25.0%, 31.0%, 39.6%, 43.1%, and 46.7% respectively. The prevalence of tinnitus was higher in the non-stationary noise group (42.5%) than in the stationary noise group (26.8%) (χ²=26.18, P<0.01), and the prevalence in the group without or with hearing protection was 39.7% and 35.5% respectively. The results of logistic regression showed that workers exposed to higher intensity, longer noise exposure, higher cumulative noise exposure, and non-stationary noise (reference: stationary noise) resulted in a higher risk of tinnitus (P_trend<0.01 or P<0.01); workers wearing of hearing protection device versus those not showed a lower risk of tinnitus (P<0.05). Conclusion Higher intensity, longer exposure to noise, and more cumulative noise exposure associate with a higher risk of tinnitus. Wearing hearing protective device can reduce the risk of tinnitus. Tinnitus in noise-exposed workers can precede the presentation of abnormal hearing loss.

【Objective:】 To understand the current situation and influencing factors of ethical knowledge, attitude, and practice (KAP) among clinical researchers, enhance their ethical awareness, and improve the quality of clinical researches. 【Methods:】 A self-designed questionnaire was used to conduct a convenient sampling survey of medical staff who have participated in clinical study. 【Results:】 A total of 6,021 subjects were investigated, with males accounting for 28.46% and females accounting for 71.53%. The average age of them was (37.47±11.46) years old. The total score of ethics and the mean scores of the three dimensions of knowledge, attitude and practice were (70.62±12.99), (59.63±12.50), (79.55±19.62) and (74.92±18.29), respectively. Multiple linear regression analysis showed that researchers with male, tertiary hospitals, doctors, ethics-related part-time jobs, postgraduate education, associate senior title or above, and training experience scored higher (P<0.05). 【Conclusion:】 Ethical attitudes have a significant mediating effect between knowledge and practice, accounting for 62.72% of the total effect. Researchers recognize the importance of ethics, but it is urgent to strengthen their knowledge learning and practical application.

A 54-year-old, non-smoking woman was diagnosed as stage ⅣB adenocarcinoma with widespread bone metastasis (cT4N2M1c) in the First Affiliated Hospital, Zhejiang University School of Medicine. Immunohistochemistry result showed the presence of anaplastic lymphoma kinase (ALK) gene rearrangement; next-generation sequencing (NGS) indicated EML4-ALK fusion (E6:A20) with concurrent CCDC148-ALK (C1:A20), PKDCC-ALK (Pintergenic:A20)and VIT-ALK (V15:A20) fusions. After 32 weeks of alectinib treatment, the patient complained cough and exertional chest distress but had no sign of infection. Computed tomography (CT) showed bilateral diffuse ground glass opacities, suggesting a diagnosis of alectinib-related interstitial lung disease (ILD). Following corticosteroid treatment and discontinuation of alectinib, clinical presentations and CT scan gradually improved, but the primary lung lesions enlarged during the regular follow-up. The administration of crizotinib was then initiated and the disease was stable for 25 months without recurrence of primary lung lesions and ILD.
Female ; Humans ; Middle Aged ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Crizotinib/therapeutic use* ; Lung Neoplasms/drug therapy* ; Anaplastic Lymphoma Kinase/therapeutic use* ; Lung Diseases, Interstitial/diagnosis*

Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.

Objective:To study the neuroprotective effect of Chuanjin Jieyu decoction on a chronic unpredictable stress (CUMS) induced depression rat model.Methods:A total of 48 adult male healthy Sprague-Dawley (SD) rats were randomly selected, with 12 rats as the control group, and the remaining rats were used to establish a CUMS depression model. After successful modeling, the rats were randomly divided into three groups: CUMS group, fluoxetine group, and Chuanjin Jieyu decoction group; 0.9% sodium chloride solution fluoxetine and Chuanjin Jieyu decoction were respectively administered for intervention for 4 weeks. After modeling and intervention, depression levels in rats were measured through open field experiments and sugar water preference experiments; After intervention, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression levels of brain-derived neurotrophic factor (BDNF), tyrosine protein kinase receptor B (TrkB), and cyclic adenosine monophosphate responsive element binding protein (CREB) mRNA in the dentate gyrus of the hippocampus. Immunofluorescence was used to detect the expression levels of BDNF and NeuN. Western blot was used to detect the level of glial fibrillary acidic protein (GFAP).Results:After modeling, the sugar consumption, sugar preference, vertical and horizontal movement results of the CUMS group, fluoxetine group, and Chuanjin Jieyu decoction group were significantly lower than those of the control group (all P<0.01); After intervention, the above indicators in the CUMS group were lower than those in the control group (all P<0.01). The above indicators in the fluoxetine group and the Chuanjin Jieyu decoction group were higher than those in the CUMS group ( P<0.01 or P<0.05), but lower than those in the control group ( P<0.01 or P<0.05). The qRT-PCR results showed that the mRNA expression levels of BDNF, TrkB, and CREB in the CUMS group, the fluoxetine group, and the Chuanjin Jieyu decoction group were significantly lower than those in the control group (all P<0.01); The above indicators in the fluoxetine group and the Chuanjin Jieyu decoction group were significantly higher than those in the CUMS group (all P<0.01). The immunofluorescence results showed that the expression levels of BDNF and NeuN in the CUMS group were significantly lower than those in the control group (all P<0.01); The above indicators in the fluoxetine group and the Chuanjin Jieyu decoction group were higher than those in the CUMS group ( P<0.01 or P<0.05), and all indicators in the Chuanjin Jieyu decoction group and the NeuN expression level in the fluoxetine group were lower than those in the control group ( P<0.01 or P<0.05). Western blot results showed that the expression of GFAP protein in the CUMS group was lower than that in the control group ( P<0.01); The expression of GFAP protein in the fluoxetine group was higher than that in the CUMS group ( P<0.05). Conclusions:Chuanjin Jieyu decoction can improve the behavioral indicators of depression in rats, increase the expression of BDNF, TrkB, CREB, and NeuN in the hippocampal dentate gyrus, suggesting that Chuanjin Jieyu decoction may exert neuroprotective effects through the BDNF/TrkB/CREB pathway.

Objective:To explore the necessity and feasibility of introducing the courses of dental practice management in the undergraduate education of stomatology under the background of the undergraduate entrepreneurship education reform.Methods:In the School of Stomatology of Zhejiang Chinese Medical University, the entrepreneurial course dental practice management was set-up for the junior undergraduate students. CBL, PBL, teacher's lecture, student's lecture on the stage and PPT demonstration, role-play, and team cooperation were taken in the course. And the questionnaires were used to investigate the course setting, necessity, teaching forms and satisfaction from multiple groups. SPSS was performed for data analysis, and the teaching effect was evaluated through the data results.Results:The scores of 108 students in the study [(75.99±5.76) points] were roughly distributed as normal functions. The results of the survey showed that the number of students who planned to have their own private clinics after the course increased by 41 (37.96%) compared with that before the course. All instructors and 33 (78.57%) active dentists thought that the course was reasonable in the undergraduate courses.Conclusion:It is necessary and feasible to introduce the dental practice management course in undergraduate education of stomatology, which will have a certain guiding effect on the long-term development of dentists, and is also beneficial to the reform of innovation and entrepreneurship courses in medical universities.