OBJECTIVE: To evaluate the efficacy and safety of Chinese medicine (CM) improving pregnancy outcomes after surgery for endometriosis-associated infertility. METHODS: A multicenter, randomized, double-blind placebo parallel controlled clinical trial was designed. A total of 202 patients who had laparoscopy for endometriosis-associated infertility with qi stagnation and blood stasis syndrome were included and randomly divided into the CM treatment group and placebo control group at a ratio of 1:1 using a central block randomization from May 2014 to September 2017, 101 patients in each group. The two groups received continuous intervention at 1-5 days after surgery, for 6 menstrual cycles. Before ovulation, the CM group was treated Huoxue Xiaoyi Granule (); after ovulation, Bushen Zhuyun Granule ( was involved. The control group was treated with placebo. Transvaginal ultrasonography was performed every menstrual cycle during the treatment, and female hormone levels in the follicular and luteal phases were measured during the 1st, 3rd and 6th menstrual cycles. The analysis was continued until pregnancy. The primary outcomes were clinical pregnancy rate and pregnancy outcome, and the secondary outcomes were follicular development and endometrial receptivity. Safety evaluations were performed before and after treatment. RESULTS: (1) Clinical pregnancy and live birth rates: the clinical pregnancy and live birth rates of the CM group were significantly higher than those of the placebo group [44.6% (45/101) vs. 29.7% (30/101), 34.7% (35/101) vs. 20.8% (21/101), both P<0.05]. (2) Follicle development: the incidence of dominant follicles, rate of cumulative cycle ovulation, and rate of cumulative cycle mature follicle ovulation were significantly higher in the CM group than those in the placebo group [93.8% (350/373) vs. 89.5% (341/381), 80.4% (275/342) vs. 69.1% (253/366), 65.8% (181/275) vs 56.1% (142/253), P<0.05 or P<0.01]). The incidence of cumulative cycle luteinized unruptured follicle syndrome was significantly lower in the CM group than in the placebo group [11.7% (40/342) vs. 17.8% (65/366), P<0.05). (3) Endometrial receptivity: after treatment, both endometrial types and endometrial blood flow types in the CM group were mainly types A and B, while those in the placebo group were mainly types B and C, with a significant difference between the two groups (both P<0.05). (4) Adverse events: the incidence of adverse events between the two groups was not significantly different (P>0.05). CONCLUSION Strategies for activating blood circulation-regulating Gan (Liver)-tonifying Shen (Kidney) sequential therapy can effectively improve the clinical pregnancy rate and live birth rate of endometriosis-associated infertility with qi stagnation and blood stasis after laparoscopy, improve follicular development, promote ovulation, improve endometrial receptivity, while being a safe treatment option. (Trial registration No. NCT02676713).

Bombyx mori is a lepidopteran insect with important economic value. Bombyx mori nucleopolyhedrovirus (BmNPV) causes huge economic loss to silkworm industry in China every year. The objective of this study is to determine the anti-BmNPV mechanism of Bombyx mori strain NC99R, and to provide a basis for understanding the molecular mechanism of the silkworm resistance strain. The normal control Dazao (DZ) strain and the NC99R resistant strain were fed with occlusion bodies (OB). The median lethal dose (LD50) analysis of the DZ and NC99R showed that the LD50 of DZ was 1.2×10⁵ OBs/larva, while NC99R was 1.8×10⁶ OBs/larva. The LD50 of the NC99R was about 15 times higher than the DZ. The mortality of DZ and NC99R were analyzed, which were fed with 1×10⁶ OBs/larva and injection with 1×10⁶ BVs/larva. The results showed that the death peak of DZ was concentrated in the 4th to 6th day. And the death peak of NC99R was concentrated in the 6th to 8th day, with a delay of 1-2 days compared with the control. The BmNPV DNA copy number showed that the BmNPV genome in DZ proliferated rapidly. The copy number of BmNPV DNA in NC99R were increased slowly after oral infection and body injection. HE staining showed that midgut tissue has no significant difference between DZ and NC99R in the early stage of oral infection. At 96 h p.i., the nucleus of DZ midgut became larger and shedding. The NC99R had enlarged nuclei, but the cells were still arranged neatly. Finally, the expression of virus genes in different periods were analyzed by RT-PCR. The results indicated that the immediate early gene ie-1 expression levels began to down-regulate after 24 h p.i.. The early, late, and extremely late genes were also down-regulated, and finally maintained at a lower expression level.

Objective: To analyze the role of thyroid imaging reporting and data system(TI-RADS), contrast-enhanced ultrasound(CEUS), fine needle aspiration cytology (FNAC) and tumor proliferation related genes in the early diagnosis of thyroid micro-papillary carcinoma(PTMC) and risk assessment of early metastasis. Methods: From May 2018 to May 2019, a total of 140 patients with Thyroid micronodules for surgical resection and pathological diagnosis of benign or malignant into the Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine for the retrospective study.There were 90 cases in benign group and 50 cases in malignant group.The levels of TI-RADS, CEUS enhancement mode, peak intensity (PI) and cyclin D1 (CCND1), cell nuclear Proliferating Antigen (PCNA) and vascular endothelial growth factor (VEGF) were compared between malignant and benign groups, VEGF) mRNA expression level.The positive rate of FNAC, TNM stage, capsule invasion and lymph node metastasis were evaluated. Results: The percentage of class four and more by TI-RADS grade in malignant group was significantly more than benign group((92.0% (46/50) vs.5.6% (5/90), χ²=103.718, P<0.001), more early low enhancement by CEUS(86.0%(43/50) VS.6.7%(6/90), χ²=91.328, P<0.001) and PI value higher than benign group, too((6.79±1.88) VS.(5.32±1.46), t=4.968, P=0.008). The positive rate of FNAC in malignant group was 92.0% (46/50). FNAC was positive in 42 cases of TNM stage, 9 cases of capsule invasion and 6 cases of lymph node metastasis.The pathological positive rate after resection was 50 cases of TNM stage, 10 cases of capsule invasion and 6 cases of lymph node metastasis.The expression of CCND1, PCNA and VEGF mRNA in malignant group was significantly higher than that in benign group((0.5624±0.134) VS.(0.213±0.097), t=15.639, P<0.001; (0.453±0.126) VS.(0.186±0.056), t=20.253, P<0.001; (0.633±0.159) VS.(0.252±0.097), t=31.265, P<0.001). Conclusion Ultrasound-guided FNAC is used to determine TNM staging, capsule invasion and lymph node metastasis, CCND1, PCNA and VEGF expression level, contrast-enhanced mode and peak intensity value measured by quantitative evaluation software have good accuracy for early diagnosis of PTMC, and are consistent with the pathological results of hand surgery.

Objective Small cell neuroendocrine carcinoma of the ovary is a kind of ovarian cancer with a very low incidence.Its clinical manifestations are not obvious.The diagnosis should be based on the pathology and neuroendocrine indicators, and its primary nature should be determined.The main treatment is operation combined with platinum based chemotherapy.The survival period is related to clinical stage and treatment plan.The patient was hospitalized for 2 days because of the aggravation of abdominal distention and pain for half a year.The diagnosis of adnexal mass was confirmed by pathology.After three cycles of neoadjuvant chemotherapy (etoposide+ cisplatin), the patients underwent abdominal " total hysterectomy+ greater omentum resection+ appendectomy+ right pelvic wall peritoneal biopsy+ mesenteric biopsy" . After the operation, the patients received three cycles of EP chemotherapy, and they have been followed up for 15 months.

Objective: To analyze the clinical , immunological and genetic features of a child with BCL11B mutation induced neurodevelopmental disorder. Methods: The clinical data and genetic test of a child with BCL11B mutation hospitalized in the Department of Rheumatology and Immunology in Children′s Hospital of Chongqing Medical University in December 2018 were extracted and analyzed. The literature was searched with "BCL11B mutation" and "immunodeficiency 49" as key words in Chinese databases and Pubmed until January 2019 was reviewed. Results: A male patient aged 3 years and 11 months with facial dysmorphisms and delayed language and motor development was admitted due to neurodevelopmental retardation over two years. Laboratory tests showed normal human immunoglobulin (IgG 12.90 g/L, IgA 1.02 g/L, IgM 1.15 g/L, IgE 532 000 U/L), Trec (228) and proliferation of T and B cells. The lymphocyte subsets revealeda reduced percentage of B cells (0.108) but normal absolute numbers (0.574×10^-3/L), and an increased percentage (0.828) as well as absolute numbers (4.415×10^-3/L) of T cells. A heterozygous BCL11B mutation was detected by sanger sequencing, showing a de novo frameshift mutation c.1887_c.1893delCGGCGGG in exon 4. Two papers were found which were all in English, with total of 14 patients(13 patients with complete information). Thirteen mutations were reposed, including 7 frameshift, 2 nonsense, 2 missense, and 2 chromosomal rearrangements; Thirteen patients had heterozygous mutations. All patients had delayed language and motor development and facial dysplasia which were mainly hypertelorism, thin eyebrows and small palpebral fissures. Some patients had dental anomalies, ametropia and allergy, and a few were combined with immune impairment, but without overt signs of immunodeficiency. Only one patient had multisystem anomalies and profound immune deficiency. Conclusions BCL11B is essential for development of the nervous and the immune system. In this study, the de novo mutation of BCL11B gene resulted in neurodevelopmental and immunological disorders.

Objective To investigate the prevalence and associated risk factors of diabetes and prediabetes in Blang ethnic adults in Menghai county. Methods A cross-sectional survey including 3 365 Blang ethnic adults (aged 18 and above from 5 administrative villages) was conducted from February 2017 to March 2017 in Menghai county. A questionnaire, physical examination, and blood assays were included in the survey. Finally,a total of 3 237 adults with complete data were selected into this analysis. Results The standardized prevalence of diabetes and prediabetes in Blang ethnic adults were estimated based on the sixth national census in 2010. According to the 1999 WHO criteria, the overall standardized prevalence of diabetes and prediabetes were 8.5% (men: 10.2%, women: 6.8%) and 16.1% (men: 18.0%, women: 14.1%), in which the standardized prevalence of newly diagnosed diabetes among the total population was 7.3% (men: 8.7%, women: 5.8%). Multivariable multinominal logistic regression analyses showed that age, hypertension, hypertriglyceridemia, and central obesity were significantly positively associated with both diabetes and prediabetes, with the corresponding odds ratios of 1.74 and 1.37, 2.39 and 2.02, 2.30 and 1.34, 2.55 and 1.73, respectively. Conclusion The prevalence of diabetes is relatively high in Blang ethnic adults in Menghai county. Improving knowledge of diabetes among the local population is one of key steps in the prevention of diabetes.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To summarize the clinical and the molecular genetic characteristics of type DYT11 dystonia by analyzing the clinical data and pathogenic gene mutation of type DYT11 dystonia of a myoclonus-dystonia syndrome (MDS) family.Methods A MDS family enrolled in the General Hospital of the People's Liberation Army Rocket Force in January 2018 was retrospectively analyzed.The clinical data of 11 affected family members were collected and genetic testing of four affected family members (including the proband) of the MDS family was conducted using a panel of dystonia-associated genes.Results The affected family members showed great differences in clinical characteristics and obvious clinical heterogeneity.Four affected family members had myoclonus and dystonia,two affected family members only had myoclonus and five affected family members only had dystonia.The results of genetic testing showed that the proband,his father and his grandfather had a mutation (c.835_839delACAAA) in SGCE gene,which is autosomal dominant and belongs to type DYT11 dystonia.Conclusions MDS shows clinical heterogeneity.Gene screening is of great importance for the diagnosis and treatment of dystonia with myoclonus.

OBJECTIVE: To analyze the detection rate of the inferior pyloric artery (IPA) in patients with gastric cancer by computed tomography arteriography (CTA). MATERIALS AND METHODS: Fifty-four patients (48 males and 6 females; mean age, 59.0 ± 1.5 years) who had undergone radical gastrectomy for gastric cancer from September 2016 to July 2017 at our institution were recruited prospectively. Patients underwent abdominal contrast-enhanced CT scans and CTA imaging reconstruction before the operation. The origin of the IPA in all cases was determined by a radiologist based on CTA images and verified by the surgeon. The accuracy of CTA in diagnosing the origin of the IPA was calculated. Dominant vessels of the origin were analyzed. RESULTS: IPAs were detected by CTA in 51 patients (94.4%). Among these, IPAs originated from the right gastroepiploic artery (RGEA) (24 cases), the gastroduodenal artery (GDA) (4 cases), and the anterior superior pancreaticoduodenal artery (ASPDA) (20 cases). In the remaining 3 cases, the IPAs contained two branches originating from the RGEA and ASPDA, respectively. During surgery, in 2 (3.7%) of the 54 cases of gastric cancer, IPAs could not be detected; the IPAs originated from the RGEA (22 cases), GDA (5 cases), and ASPDA (24 cases). One case had an IPA originating from both the RGEA and the GDA. Finally, the accuracy of CTA in diagnosing the origin artery of the IPA was 85.2% (46/54). CONCLUSION: CTA can detect the origin of the IPA accurately, which can aid surgeons while performing pylorus-preserving operations.
Angiography ; Arteries ; Female ; Gastrectomy ; Gastroepiploic Artery ; Humans ; Male ; Prospective Studies ; Stomach Neoplasms ; Surgeons ; Tomography, X-Ray Computed

Objective To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.Methods Between December 2012 and April 2015,a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town,Banzhuang Town and Tashan Town,Ganyu District,and 9 urban communities in Xinpu District and Haizhou District,Lianyungang City using epidemiological survey method of cluster sampling.Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack,6 592 people at high risk of stroke were finally screened out.Ultrasound was used to detect carotid plaques.The subjects were divided into plaque-free group and plaque group.The latter was further divided into stable plaque group and unstable plaque group.Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability.The odds ratio (OR) and 95％ confidence interval (CI) were calculated.Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.Results Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques,while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques.Using the lowest quintile (Q1) of LHR as a reference,carotid plaque risk increased significantly with the increasing LHR (Q2:OR 1.448,95％ CI 1.082-1.937,P =0.013;Q3:OR 2.414,95％ CI 1.754-3.322,P＜0.001;Q4:OR 2.939,95％ CI 1.945-4.441,P＜0.001;Q5:OR 4.884,95％ CI 3.143-7.115,P＜0.001).ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95％ CI 0.792-0.807;P＜ 0.001),and the optimal cut-off value was 3.00 (sensitivity 68.37％,specificity 75.65％).LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915,95％ CI 2.104-4.040;P＜0.001).The AUC of the LHR predicting unstable carotid plaques was 0.658 (95％ CI 0.633-0.684;P＜0.001).Conclusions LHR was an independent predictor of carotid plaques in high-risk stroke patients.It had higher predictive value for carotid plaques,and its conversion threshold for promoting plaque formation was 3.00.When LHR was ≥3.92,there was a significant increase in the risk of unstable carotid plaques.