Objective To explore the clinical efficacy and safety of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitor(ICI)and molecular targeted therapy for Child-Pugh grade B hepatocellular carcinoma(HCC).Methods The patients with Child-Pugh grade B HCC,who received TACE combined with ICI and molecular targeted therapy(combination group)or TACE monotherapy(monotherapy group)at the three medical centers including the Affiliated Zhongda Hospital of Southeast University of China between January 2018 and May 2021,were enrolled in this study.The primary outcome was overall survival(OS),and the secondary outcomes included progression-free survival(PFS),objective response rate(ORR),and clinical safety.Results A total of 126 patients were enrolled in this study,including 64 patients in the combination group and 62 patients in the monotherapy group.No statistically significant difference in median OS existed between the combination group and the monotherapy group[17.7 months(95％CI:11.9-29.9 months)vs.13.2 months(95％CI:7.8-19.9 months);P=0.160].In the combination group,the patients having a Child-Pugh score of 7 points obtained a significantly better OS[19.0months(95％CI:13.6-NR)vs.13.2 months(95％CI:8.0-NR),P=0.024].The differences in the median PFS and ORR between the two groups were not statistically significant(P=0.720 and P=0.960 respectively).Grade Ⅲ/Ⅳ adverse events occurred in 19 patients(14.1％)of the combination group and in 6 patients(9.7％)of the monotherapy group.Conclusion In treating patients with Child-Pugh grade B HCC,TACE combined with ICI and molecular targeted therapy does not show a better prognosis than TACE monotherapy,however,the patients having a Child-Pugh score of 7 points in the combination group can have a much better OS.

Preventing bioweapons is an important component of biosecurity,and the Biosecurity Law of the People's Republic of China has a chapter devoted to"Preventing Biological Terrorism and the Threat of Bioweapons".A good knowledge of the history plays a positive role in effective protection against bioweapons.This article analyzes history of bioweapons based on books and literature that have been published in order to provide reference for professionals in the sphere of biosecurity.

Objective:To observe whether hair follicle cells from mice of different species can integrate to generate new pigmented hair follicles, and to explore the role of different melanocyte populations in pigmented hair follicle reconstruction in mice.Methods:The epidermal cell population, hair follicle epithelial cell population and dermal cell population were isolated from the skin of fetal or neonatal C57BL/6J and BALB/C mice, and epidermal melanocytes were obtained by culture and purification of the epidermal cell population. The experiments were divided into 3 parts: (1) hair follicle reconstruction experiment in neonatal C57BL/6J mice, which included 2 groups: epidermal cells + hair follicle epithelial cells group and dermal cells group; (2) chimeric hair follicle reconstruction experiment, which included 4 groups: dermal cells of neonatal C57BL/6J mice group, dermal cells of neonatal BALB/C mice group, dermal cells of neonatal BALB/C mice + dermal cells of neonatal C57BL/6J mice group, and dermal cells of fetal BALB/C mice + dermal cells of fetal C57BL/6J mice group; (3) pigmented hair follicle reconstruction experiment, which included 3 groups: dermal cells of neonatal BALB/C mice + epidermal cells of neonatal C57BL/6J mice group, dermal cells of neonatal BALB/C mice + hair follicle epithelial cells of neonatal C57BL/6J mice group, and dermal cells of neonatal BALB/C mice + cultured C57BL/6J epidermal melanocytes group. Different cells were implanted into dorsal skin fold chambers of the nude mice, and there were 4 mice in each group. At weeks 4 and 8 after inoculation, hair follicle reconstruction was assessed by gross observation, histological examination and immunofluorescence assay.Results:Among the 8 BALB/C nude mice in the 2 groups in the hair follicle reconstruction experiment, 7 survived and 1 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, no hair growth was observed in the epidermal cells + hair follicle epithelial cells group (3 mice) , while normal hair grew out in the dermal cells group (4 mice) mixed with epithelial components. Among the 16 BALB/C nude mice in the 4 groups in the chimeric hair follicle reconstruction experiment, 14 survived and 2 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, brown-grey hair grew well in the dermal cells of neonatal BALB/C mice + dermal cells of neonatal C57BL/6J mice group (4 mice) , and dermal cells of fetal BALB/C mice + dermal cells of fetal C57BL/6J mice group (3 mice) . Among the 12 BALB/C nude mice in the 3 groups in the pigmented hair follicle reconstruction experiment, 10 survived and 2 died of wound infections on week 4 after inoculation; at weeks 4 and 8 after inoculation, only white hair grew out in the dermal cells of neonatal BALB/C mice + cultured C57BL/6J epidermal melanocytes group (3 mice) , and no hair follicle melanocytes were observed by immunofluorescence assay, while brown-grey hair grew well in the dermal cells of neonatal BALB/C mice + epidermal cells of neonatal C57BL/6J mice group (4 mice) , and dermal cells of neonatal BALB/C mice + hair follicle epithelial cells of neonatal C57BL/6J mice group (3 mice) .Conclusions:The interaction between mesenchymal cells and hair follicle epithelial cells is a necessary condition for hair follicle reconstruction. The hair follicle cells from different species of mice can integrate to generate new pigmented hair follicles. Both hair follicle melanocytes and epidermal melanocytes can participate in the formation of pigmented hair follicles, but differentiated melanocytes have no such ability.

Objective:To explore the application effect of case-based learning (CBL) combined with problem-based learning (PBL) teaching model in refresher training of medical imaging technologists.Methods:The study recruited 46 imaging technologists trained in radiology department in the Batch 2017 and Batch 2018 of West China Hospital of Sichuan University. They were divided into 2 groups: experimental group (23 persons) and control group (23 persons). CBL combined with PBL teaching method was used in the experimental group, and traditional lecture-based learning (LBL) method was used in the control group. The results of attitude evaluation, staged exminations, graduation assessment and operational skill tests were compared between the two groups, and the questionnaire survey was performed to test the affirmation of self-worth of the two groups of interns. SPSS 17.0 was used for chi-square test, independent t test, and Mann-Whitney U test. Results:Theoretical examination results at the second stage, the third stage, completion and operational examination results in the experimental group were significantly higher than those in the control group [(91.17±2.59) vs. (85.26±3.03), (92.00±1.86) vs. (87.43±3.23), (92.39±2.08) vs. (87.04±2.93), (85.70±5.48) vs. (80.87±5.57), P<0.05]. The questionnaire survey showed that such 7 aspects as the stimulation of subject interest, the cultivation of exploration spirit, the exercise of self-learning ability, the establishment of clinical ideas, the analysis of difficult problems, the mastering of practical operations, and the affirmation of self-worth in the experimental group were better than those in the control group, with significant difference ( P<0.05), while the consolidation of theoretical knowledge of the experimental group was not statistically different from the control group ( P>0.05). Conclusion:The reasonable application of CBL combined with PBL teaching model in refresher training of medical imaging technologists is helpful to improve their learning enthusiasm, self-learning ability, clinical analysis ability, practical operation ability, and long-term consolidation of theoretical knowledge.

Objective:To explore the application effect of case-based learning combined with problem-based learning teaching model in refresher training of medical imaging technologists.Methods:The study recruited 46 imaging technologists trained in radiology department in the Batch 2017 and Batch 2018 of West China Hospital of Sichuan University. They were divided into 2 groups: experimental group (23 persons) and control group (23 persons). Case-based learning combined with problem-based learning teaching method was used in the experimental group, and traditional lecture-based learning method was used in the control group. 2 test was used for sex distribution comparisons between the two groups, and independent t test was conducted to compare the differences in age, working years, entrance examination results, attitude rating scores, stage examination scores, completion examination scores, and operational examination scores between the two groups. Mann-Whitney U test was used for comparisons of non-parametric variables between the two groups, such as qualifications, occupation title, and questionnaire results.Results:Theoretical examination results at the second stage, the third stage, completion and operational examination results in the experimental group were higher than those in the control group [(91.17±2.59) vs. (85.26±3.03), (92.00±1.86) vs. (87.43±3.23), (92.39±2.08) vs. (87.04±2.93), (85.70±5.48) vs. (80.87±5.57), P<0.05]. The questionnaire survey showed that the stimulation of subject interest, the cultivation of exploration spirit, the exercise of self-learning ability, the establishment of clinical ideas, the analysis of difficult problems, the mastering of practical operations, and the affirmation of self-worth in the experimental group were better than those in the control group, with significant difference [4(3, 4) scores vs. 3(2, 3) scores, 4(3, 4) scores vs. 2(2, 3) scores, 3(3, 4) scores vs. 2(2, 3) scores, 3(3, 4) scores vs. 3(2, 3) scores, 3(3, 4) scores vs. 2(2, 3) scores, 4(3, 4) scores vs. 3(2, 3) scores, 4(3, 4) scores vs. 3(2, 3) scores, P<0.05], while the consolidation of theoretical knowledge of the experimental group was not different from the control group [3(2, 3) scores vs. 3(2, 3) scores, P>0.05]. Conclusions:The reasonable application of case-based learning combined with problem-based learning teaching model in refresher training of medical imaging technologists is helpful to improve their learning enthusiasm, self-learning ability, clinical analysis ability, practical operation ability, and long-term consolidation of theoretical knowledge, and it also can contribute to affirmation of self-worth.

Objective To investigate the relationship between frailty and serum biomarkers in the elderly. Methods A total of 371 elderly individuals aged 60 years and above with complete medical data were recruited during health examinations. Frailty phenotype assessment and comprehensive geriatric assessment were conducted.Serum levels of interleukin-6 (IL-6 ) ,high sensitivity C-reactive protein(hs-CRP) ,tumor necrosis factor-α(TNF-α) ,homocysteine(Hcy) ,insulin-like growth factor-1(IGF-1) ,25-hydroxyvitamin D[25(OH)D] ,folic acid and vitamin B12(VitB12) were detected by enzyme-linked immunosorbent assays ( ELISA ) and chemiluminescence immunoassays. Associations between frailty and the above factors were analyzed. Results Serum levels of IL-6 ,TNF-α ,Hcy and IGF-1 were significantly elevated along with progressive increase in frailty severity(all P＜0.05).There were a downward trend in serum 25(OH)D levels and an upward trend in serum hs-CRP ,folic acid and VitB12 levels as frailty severity increased ,but the changes did not amount to any statistical significance(all P＞0.05).Logistic regression analysis showed that ,after adjusting for age ,gender ,body mass index (BMI)and some clinical aspects (hearing loss ,urinary incontinence ,pain ,malnutrition ,cognitive dysfunction ,decreased activities of daily living ,depression , insomnia ,and anemia) ,serum levels of IL-6(OR=1.012 ,95% CI=1.005-2.041 ,P=0.033) ,IGF-1 (OR= 1.017 ,95% CI = 1.011-1.118 ,P= 0.021)and Hcy (OR= 1.007 ,95% CI :1.002-1.073 ,P=0.047)were significantly associated with frailty status. Conclusions Serum levels of IL-6 ,Hcy and IGF-1 are related to frailty status and may be used as potential biomarkers for the assessment of frailty in older adults.

Objective To perform a methodological evaluation study of 4 HPLC based systems and a capillary electrophoresis based system , with the International Federation of Clinical Chemistry and Laboratory Medicine ( IFCC) glycated hemoglobin reference method as a comparative method .Methods 40 hemolysis samples of variety concentrations were prepared .The samples were measured by IFCC reference method and 5 glycated hemoglobin testing systems , respectively and trueness verification was performed according to the Clinical &Laboratory Standards Institute (CLSI) guideline EP9-A3.Whole blood samples were used to test the systems'precision, linearity and analytical interferences .Results The average CV of IFCC reference method results of 40 hemolysis samples was 1.4％( range from 0.2％to 2.5％).No outlier was found in the results of the 5 testing system.The slopes ranged from 0.9902 to 1.0267, and intercepts from -0.1526 mmol/mol to +0.1512 mmol/mol, squared correlation coefficient from 0.9962-0.9971, biases at two medical decision level were less than 0.3％HbA1c.Within-laboratory precisions were less than 2％ (NGSP unit).Bias between all test results and predicted results were less than 5％.High concentration of glucose showed certain interference to glycated Hemoglobin tests but had little influence in clinical practice.Conclusions The results of the 5 testing system are comparable to the IFCC reference method , the results of precision and linearity evaluation meet the requirements of related guidelines .

OBJECTIVETo preliminarily discuss the anatomical ideas on infrapyloric lymphadenectomy in the sagittal view of laparoscopic radical gastrectomy for gastric cancer.

METHODSA retrospective review was performed on the clinical data of 98 patients of lower-middle stomach cancer who underwent D2 radical gastrectomy in Department of Gastrointestinal Surgery of The First Hospital of Jilin University from June 2015 to December 2016. There were 56 males and 42 females with an average age of 59 years. TNM staging of gastric cancer revealed 22 cases of stage I, 37 cases of stage II, and 39 cases of stage III. All the patients underwent standardized No.6 lymph node dissection. Patients in stage II and above also received dissection of No.14v lymph nodes. During operation, sub-regional lymph node dissection was performed in the infrapyloric region according to sagittal anatomy. The dissection of each sub-region was to expose the corresponding anatomical landmarks as quality control standards. The region under the stomach pylorus was divided into the upper and lower parts by the pancreatic anterior plane and the gastroduodenal artery. The lower part was 6v region, and the upper part was 6a and 6i region. The lower part was further divided into front region and rear region by right vein of gastric omentum. The upper part was further divided into front, middle and posterior parts by right vein of gastric omentum and inferior pyloric artery. A total of 5 regions were established. Lymph node dissection in the lower pyloric region was performed at these five regions. Photographs were taken during operation and statistics was carried out in operation time and harvested lymph nodes from infrapyloric lymphadenectomy.

RESULTSThe time to complete No.6 lymph node dissection was (38±6) minutes for the 22 patients with stage I gastric cancer, and to finish No.6 and No.14v lymph node dissection was (49±8) minutes for the 76 patients with stage II and stage III gastric cancer. The mean number of harvested No.6 lymph nodes was 5.4±2.9, including 2.9±1.8 in No.6a,1.3±0.9 in No.6v, and 1.2±0.7 in No.6i. No.6 lymph node metastasis was found in 29 cases (29.6%), and No.14v lymph node metastasis in 19 patients (9.2%).

CONCLUSIONSub-regional lymphadenectomy for infrapyloric region based on embryology and membrane anatomy may achieve complete dissection of No.6 lymph nodes.

Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery

Purpose Sustained attention dysfunction is a common symptom of patient with attention-deficit/hyperactivity disorder (ADHD).To reveal the neural mechanism of the abnormality of sustained attention of patients with ADHD,the cerebral blood flow (CBF) abnormalities in patients were studied by perfusion imaging.Materials and Methods Sixteen children with ADHD and twenty normal controls treated at the 401st Hospital of PLA from June 2013 to September 2015 underwent 3D arterial spin labeling (3D-ASL)scanning with GE 3.0T MRI scanner.The participants were performed four continuous sections of sustained attention to response task (SART) for 20 minutes in the scanner.Using SPM 8 toolkit,the local CBF values of both groups were compared in a voxel-wise manner,and their correlations with response time and target accuracy of SART were analyzed.Results When performing the SART,the patients with ADHD showed significantly inhibited trend of increasing CBF in the anterior cortex like dorsal cortex,medial prefrontal cortex,and motor area;however,they presented enhanced trend of increasing CBF in the posterior cortex such as posterior cingulate cortex and parietooccipital sulcus (P＜0.01);the change of CBF in the dorsal prefrontal cortex and that in the precentral and postcentral gyrus had significant correlation with response time of SART task and targeting ratio (dorsal prefrontal cortex:r=0.745,P＜0.001;r=0.591,P＜0.001;r=-0.521,P＜0.001.Precentral and postcentral gyrus:r=0.579,P＜0.001).Conclusion Patients with ADHD show different CBF redistribution between anterior and posterior cerebral cortex in performing SART,and the abnormal CBF shows significant correlations with behavioral metrics,which reflects the mechanism of sustained attention dysfunction of patients with ADHD.

OBJECTIVETo investigate the effect of omega-3 polyunsaturated fatty acids (PUFA) on postoperative inflammatory response and clinical efficacy in gastric cancer patients with nutritional risk.

METHODSAll patients with gastric cancer in our department from June 2013 to January 2014 undergoing radical gastrectomy were prospectively enrolled in the study. Patients who matched the selection criteria were randomly divided into two groups: trial group (with omega-3 PUFA in parenteral nutrition) and control group (without omega-3 PUFA in parenteral nutrition). Levels of inflammatory factors (serum CRP, TNF-α, IL-1, IL-6, IL-10) and nutrition-related proteins (prealbumin, retinol conjugated protein and transferrin) were compared between the two groups before operation and 2, 4 and 6 days after operation. Incidence of postoperative systemic inflammatory response syndrome (SIRS) and other indicators associated with efficacy were compared between the two groups as well.

RESULTSForty-seven patients were finally included in this study with 21 patients in the trial group and other 26 in the control group. There were no significant differences of inflammatory factors and nutrition-related proteins between the two groups before operation (all P>0.05). In the 6th days after operation, the levels of proinflammatory cytokines, including CRP, IL-1 and IL-6 were significantly lower in the trial group as compared to the control group, while the level of IL-10 (inhibiting inflammatory cytokine) was higher in the trial group, as well as levels of nutrition proteins(all P<0.05). The trial group had significantly lower rate of SIRS than the control group [57.1%(12/21) vs. 84.6% (22/26), P=0.036]. Compared with the control group, patients in the trial group had shorter bowel sound recovery time [(12.3±1.1) d vs. (3.1±1.3) d, P=0.025], earlier passage of flatus [(3.1±1.0) d vs. (3.9±1.2) d, P=0.025] and shorter hospital stay [(9.4±2.1) d vs. (10.9±2.5) d, P=0.038], but there was no difference in postoperative complication rate between the two groups (P=0.678).

CONCLUSIONSOmega-3 PUFA can reduce the release of inflammatory promoters, promote the release of inhibiting inflammatory cytokine IL-10, decrease the incidence of SIRS, improve patients' nutritional state, expedite the recovery of gastrointestinal function and shorten patients' recovery time.

Fatty Acids, Omega-3 ; Gastrectomy ; Humans ; Nutritional Status ; Parenteral Nutrition ; Postoperative Complications ; Postoperative Period ; Stomach Neoplasms ; Systemic Inflammatory Response Syndrome