Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:This study aims to explore the relationship between the single nucleotide polymorphism (SNPs) of Apo liporoteine E (ApoE), GTP cyclohydrolase 1 (GCH1), and J subfamily member of inward rectifier potassium channel-15 (KCNJ15) gene and cognitive dysfunction in Han nationality patients with schizophrenia in Yunan province.Methods:From September 2018 to August 2020, 182 patients with schizophrenia (patient group) and 176 healthy volunteers (control group) were recruited from the Department of Psychiatry and Physical Examination Center respectively, in the First Affiliated Hospital of Kunming Medical University. The Chinese versions of PANSS and the MATRICS Cognitive Battery (MCCB) were used to evaluate psychiatric symptoms and cognitive function respectively. The SNPs of four loci of GCH1 (rs72713460), KCNJ15 (rs928771), and APOE (rs7412 and rs429358) genes were measured by fluorescence in situ hybridization. The differences of genes and genotypes between the two groups were compared. Then multiple linear regression analyses were performed in the patient group. In the regression models, the T scores of each cognitive function test were entered as dependent variables one by one, while the demographic and clinical data and the four SNPs of ApoE, GCH1, and KCNJ15 as independent variables.Results:The T scores of seven cognitive domains of MCCB were lower in the patient group than in the control group ( t=-25.65 to -18.27, all P<0.001). The genotype frequencies of ApoEε3ε4 (55/182 (30.2%) vs. 22/176 (12.5%)) and allele frequencies of ApoEε4 (65/182 (17.9%) vs. 30/176 (8.5%)) were statistically significantly higher in the patient group than in the control group (χ 2=16.64 and 13.55 respectively, both P<0.001). The genotype and allele frequency of GCH1 in patient group were higher than those in control group (χ 2=8.01 to 21.50), and the difference was statistically significant ( P<0.001 or P<0.05). In the patient group, the T scores of 7 cognitive domains were lower in ApoEε4 allele carriers than in non-carriers ( t=4.99 to 17.69), the T scores of 6 cognitive domains were lower in GCH1-T allele carriers than in non-carriers ( t=5.75 to 13.36), and the T scores of 5 cognitive domains were higher in KCNJ15-G allele carriers than in non-carriers ( t=-2.99 to -2.48). In schizophrenia patients, multiple regression analyses showed that the cognitive domains of information processing speed and word learning were related to carrying ApoEε4 and GCH1-T allele. Conclusion:There is pervasive and significant cognitive dysfunction in Han nationality patients with schizophrenia in Yunan province. The polymorphism of ApoE and GCH1 genes may be related to the pathogenesis of cognitive dysfunction in schizophrenia.

Objective:This study aims to explore the relationship between the single nucleotide polymorphism (SNPs) of Apo liporoteine E (ApoE), GTP cyclohydrolase 1 (GCH1), and J subfamily member of inward rectifier potassium channel-15 (KCNJ15) gene and cognitive dysfunction in Han nationality patients with schizophrenia in Yunan province.Methods:From September 2018 to August 2020, 182 patients with schizophrenia (patient group) and 176 healthy volunteers (control group) were recruited from the Department of Psychiatry and Physical Examination Center respectively, in the First Affiliated Hospital of Kunming Medical University. The Chinese versions of PANSS and the MATRICS Cognitive Battery (MCCB) were used to evaluate psychiatric symptoms and cognitive function respectively. The SNPs of four loci of GCH1 (rs72713460), KCNJ15 (rs928771), and APOE (rs7412 and rs429358) genes were measured by fluorescence in situ hybridization. The differences of genes and genotypes between the two groups were compared. Then multiple linear regression analyses were performed in the patient group. In the regression models, the T scores of each cognitive function test were entered as dependent variables one by one, while the demographic and clinical data and the four SNPs of ApoE, GCH1, and KCNJ15 as independent variables.Results:The T scores of seven cognitive domains of MCCB were lower in the patient group than in the control group ( t=-25.65 to -18.27, all P<0.001). The genotype frequencies of ApoEε3ε4 (55/182 (30.2%) vs. 22/176 (12.5%)) and allele frequencies of ApoEε4 (65/182 (17.9%) vs. 30/176 (8.5%)) were statistically significantly higher in the patient group than in the control group (χ 2=16.64 and 13.55 respectively, both P<0.001). The genotype and allele frequency of GCH1 in patient group were higher than those in control group (χ 2=8.01 to 21.50), and the difference was statistically significant ( P<0.001 or P<0.05). In the patient group, the T scores of 7 cognitive domains were lower in ApoEε4 allele carriers than in non-carriers ( t=4.99 to 17.69), the T scores of 6 cognitive domains were lower in GCH1-T allele carriers than in non-carriers ( t=5.75 to 13.36), and the T scores of 5 cognitive domains were higher in KCNJ15-G allele carriers than in non-carriers ( t=-2.99 to -2.48). In schizophrenia patients, multiple regression analyses showed that the cognitive domains of information processing speed and word learning were related to carrying ApoEε4 and GCH1-T allele. Conclusion:There is pervasive and significant cognitive dysfunction in Han nationality patients with schizophrenia in Yunan province. The polymorphism of ApoE and GCH1 genes may be related to the pathogenesis of cognitive dysfunction in schizophrenia.

Objective To explore the teaching effects of Lecture Based Learning (LBL) incorporated with Case Based Learning (CBL) and Problem Based Learning (PBL) methods in the teach-ing of anatomy.Methods 740 students of Grades 2012 and 2013 from clinical medical major were chosen as the subjects,randomly divided into experimental and control groups.LBL was conducted in the control group of 644 students,while LBL+PBL+CBL method was applied in the experimental group of 96 students.After completion of the course,all students were surveyed with the questionnaire and tested with specimen and theoretical examinations.The data was collected and analyzed with SPSS 17.0 and two sample U tests.Results The students' time of learning anatomy in the control group outside classroom teaching was (105 ± 25) minutes per week,while the students' time of learning anatomy in the experimental group was (190 ± 25) minutes per week.The difference was statistically significant (t=31.08,P=0.000).The difference of after-class total learn-ing time was also statistically significant between two groups(t=27.42,P=0.000).Percentages of satisfaction with teaching methods for control group were 87.5％ and 87％,while for the experimental group 98％ and 100％.Kruskal-Wallis test showed there were significant differences in experimental groups of grades 2012(x2=31.19,P=0.000) and 2013 (x2=40.35,P=0.000) compared with control group.Comparison of both groups' results of the examinations was statistically significant concerning multiple choices,essays and case analysis questions (P＜0.05).Conclusion Teaching method of LBL incorporated with PBL and CBL was significantly effective than that of the sole traditional LBL method,which indicated its practice value.

Objective: To investigate the application of therapeutic communication in patients with foreign body in digestive endos?copy. Methods: A total of 31 patients with foreign body undergoing endoscopic treatment from Jun 2014 to Feb 2015 were selected as control group and received conventional education. A total of 31 patients with foreign body undergoing endoscopic treatment from Mar 2015 to Oct 2015 were selected as observation group and received therapeutic communication. The number of mind state, nursing sat?isfaction and adverse events were analyzed. Result: There was significant difference in the number of mind state, nursing satisfaction and adverse events in 2 groups. Conclusion: Therapeutic communication can help to resolve the patient?s sense of fear, improve the mind state, active cooperation, reduce operation risk and adverse events, ensure the treatment effect, improve nursing satisfaction.

BACKGROUND:N-methyl-D-aspartate receptor is an ionic glutamate receptor which is closely related with the neural synaptic plasticity, and also can regulate neural synaptic plasticity. OBJECTIVE:To explore the mechanism by which N-methyl-D-aspartate receptor subunits NR2A and NR2B regulate neural synaptic plasticity after cerebral ischemia. METHODS: 60 Wister rats were randomly and evenly divided into a sham-operated group and a cerebral ischemia group. Rat models of chronic cerebral ischemia were established using the modified bilateral common carotid artery occlusion method in the cerebral ischemia group, while rats in the sham-operated group did not undergo occlusion of the common carotid artery and vagus nerve. RESULTS AND CONCLUSION:At 0-12 hours after chronic cerebral ischemia, NR2A expression in the rat hippocampus was gradualy decreased, while the expression of NR2B reached its peak level at 4 hours after cerebral ischemia. Under the circumstance of cerebral ischemia, neither low frequency nor high frequency induced long-term potentiation. These findings suggest that NR2B exhibit inhibitory effect, while NR2A exhibit promoting effect on long-term potentiation induced by stimulation.