Objective:To explore the safety and efficacy of camrelizumab salvage therapy for extrahepatic recurrent hepatocellular carcinoma with PD-L1 negativity in transplanted liver tissue.Methods:From May 2020 to December 2020, retrospective analysis was performed for 3 cases of camrelizumab salvage therapy for extrahepatic recurrent hepatocellular carcinoma recipients with PD-L1 negative in transplanted liver tissue.Three recipients with extrahepatic recurrence progressed after first/second-line targeted drug therapy.Camrelizumab was given as salvage therapy after normal tissue of ransplanted liver was confirmed as negative for PD-L1 by immunohistochemistry.The safety and efficacy of treatment were observed by monitoring the changes in the levels of alanine aminotransferase, aspartate aminotransferase and bilirubin, the occurrence of complications and the outcome of treatment before and after dosing.Results:During a follow-up period of 1.5 to 15.5 months, no recipients showed acute rejection symptoms such as sharp elevations of transaminase and bilirubin.Headache ( n=1), vomiting ( n=1) and fatigue & hypertension ( n=1) became relieved after treatment.As of February 28, 2022, there were one survivor and two deaths.The fatal causes were tumor progression ( n=1) and thoracic aortic rupture due to esophageal perforation ( n=1). The survival time of recipients was (11-15.5) months and the progression-free survival time (4-6) months. Conclusions:For extrahepatic recurrent hepatocellular carcinoma with PD-L1-negative liver transplantation in normal liver tissue, camrelizumab salvage therapy can control tumor progression to a certain extent and prolong the survival time of recipients.

Objective: To study the current situation of sleep quality of senior high school students and analyze the influencing factors, so as to provide a reference for targeted sleep quality improvement of high school students. Methods: A total of 4 793 senior high school students of different grades were recruited from four different regions (Shanghai, Qinghai, Macao, Henan) in 2020. The information of demographic, sleep status, mental factors, living habits and other information were collected by questionnaire. Descriptive statistics and Logistic regression were used to analyze sleep quality and its influencing factors of the senior high school students. Results: About 24.2% of senior high school students reported sleep problems and 71.4% slept less than 7 hours at night. Interpersonal sensitivity, depression, anxiety symptoms, learning, family and interpersonal stress had significant effects on sleep problems in senior high school students( χ 2=1 147.98, 1 228.35, 1 032.54, 371.05, 497.61, 475.39, P <0.01). Drinking coffee and tea, drinking alcohol, smoking (including secondhand smoke), long term use of electronic products, late sleep, bedtime diet, poor sleep environment, parents with sleep problems were the risk factors for sleep disorders of senior high school students, regular exercise was the protective factors for sleep disorders of senior high school students, the influence was significant ( χ 2=160.28, 127.73 , 108.02, 113.27, 470.91, 340.95, 72.02, 155.53, 116.30, 76.96, 28.75, 12.89, P <0.05). Conclusion The sleep quality of senior high school students needs to be improved. Schools and parents should pay attention to the mental health and living habits of senior high school students to help them improve their sleep quality and grow up smoothly.

Objective By comparing biomechanical properties of two-screw rod and three-screw rod for fixing pelvic fracture, the difference in mechanical effects of different screw rod fixation positions in pelvic minimally invasive surgery was studied.Methods The mechanical models of pelvis fixed by two-screw rod and three-screw rod were established, and biomechanical characteristics of the pelvis during standing on both legs, during single-legged standing on healthy side or affected side, as well as in sitting posture were compared and analyzed by finite element simulation, and the fixation effect of three-screw rod was verified by clinical experiments.Results Both fixation methods could restore mechanical transmission of the pelvis. But for three-screw rod fixation, the stress on both sides of the pelvis was more balanced, and the displacement of the whole body and fracture surface was also lower during single-legged standing.Conclusions The three-screw rod fixation has an excellent effect in stability, which is more beneficial for fracture recovery.

Objective:To develop an innovational hybrid simulation-based education of bone traction with co-Debriefer for medical students and to evaluate its effectiveness.Methods:This study was designed as a cross-controlled study. From June 2018 to June 2019, 28 medical students were randomized into two groups. The two groups adopted simulation-based education and traditional teaching method respectively. In the second week of internship, the teaching methods of the two groups exchanged. Scores rating of the skill were used to assess the students' performance in the end of each teaching methods. SPSS 23.0 software was used to analyze the collected data.Results:In the first weekend of orthopedic-internship, students in the experimental group scored significantly higher than the control group, with an average score of 85.07 points versus 67.92 points. In the second weekend of practice, there was no obvious change in the skill score of the experimental group, but the score of the control group was significantly improved, and there was no obvious difference with the experimental group.Conclusion:The hybrid simulation-based education with co-debriefing is a reliable teaching method for medical interns to learn skills of bone traction, which can effectively help improve students' skills, reduce their errors, and ensure patient's safety.

Objective To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation. Methods Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model. Results The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001)and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients. Conclusions The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C.

We explored the status of Bartonella infection in rodents and the sequence characteristics of Bartonella in Fujian Province.Rodents in Fujian Province were captured by the night trapping method during 2014-2016.Information of the captured rodents on capturing dates and geographic locations,species,gender and ages were recorded.Heart blood samples were collected,from which the fragments of ghA gene and16S-23S rRNA gene of Bartonella were amplified by polymerase chain reaction (PCR).The PCR products were sequenced and the phylogenetic tree was constructed for homology analysis by biological analysis software.Data on infection rate were analyzed with Chi-square or Fisher exact test to indicate statistical significance.Results showed that 5 917 cages were laid and 381 rodents were captured,density of rodent was 6.44％.The overall Bartonella infection rate in rodents was 12.34 ％,while infection rate in domesticated rodents was 10.61％,with 11.30 ％ in Rattus norvebicus and 10.00％ in R.flavipectus.And the infection rate in wide rodents was 13.86％,with a rate of 22.86％ in Rattus losea and 18.00％ in R.fulvescens,respectively.The infection rate was higher in wild rodents than in domesticated rodents,however,no significant difference was found.The Western Fujian and Northern Fujian region had the higher infection rates of 20.00％ and 25.33％,and no infection was found in Southern Fujian region.The statistical analysis result revealed that a significant difference in infection rate among different region and habitats,but no significant difference in infection rate between male and female rodents,or among different ages.The BLAST results revealed the species to be B.tribocorum,B.elizabethae and B.grahamii.In conclusion,Bartonella infection is found in the rodents in Fujian Province and more attention should be paid on its impact on public health in the province.

BACKGROUND:It is wel-known that vitamin E holds antioxidant capacity, but whether other growth factors have the same effect on endplate chondrocytes has not yet been reported. OBJECTIVE:To observe the effect of different growth factors on the antioxidant ability of endplate chondrocytes in the intervertebral disc. METHODS:Endplate chondrocytes were primary cultured, and then divided into four groups, including blank control, serum deprivation, hydrogen peroxide stimulation and hydrogen peroxide stimulation combined with different growth factors groups. The 4th group was subdivided into insulin-like growth factor-1, basic fibroblast growth factor, transforming growth factorβ, forskolin and vitamin E groups. The expression levels of caspase-3, matrix metal oproteinase 13 and 3, inhibitor of metal oproteinase 1 as wel as thrombin 4 and 5 were detected by real-time PCR. Cel apoptosis was analyzed through apoptosis kit and flow cytometry. Cel synthesis and secretion were detected by western blot assay. The total antioxidant capacity and the hydrogen peroxide content were determined by kit, and then statistical y analyzed. RESULTS AND CONCLUSION:Different growth factors had significant differences in the endplate chondrocyte apoptosis, secretion and antioxidant capacity. To conclude, transforming growth factorβand forskolin do further damage to the cel s stimulated by hydrogen peroxide, while insulin-like growth factor-1 and vitamin E expose protective effect on the injured cel s.

Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.

Objective To evaluate the clinical efficacy of application of hepatitis B surface antigen (HBsAg)-positive donor liver in adult liver transplantation. Methods Clinical efficacy of 28 recipients with liver diseases induced by virus B hepatitis (hepatitis B) undergoing liver transplantation using HBsAg-positive donor liver from July 2012 to October 2015 was retrospectively analyzed. Clinical prognosis and postoperative complications of the recipients were summarized. The changing features of serum levels of HBsAg and hepatitis B virus (HBV) DNA was investigated. Results After liver transplantation, 28 recipients were orally administered with entecavir to prevent the recurrence of hepatitis B. During perioperative period, 2 recipients died from sepsis and acute heart failure. During postoperative follow-up, 2 cases died from the recurrence of hepatocellular carcinoma (liver cancer). The remaining 24 patients were followed up for 12-26 months. Throughout the follow-up, 24 recipients were positive for serum HBsAg. After treatment, the titre of HBV DNA was significantly declined to <1×102 copies/mL at postoperative 12 months. No graft dysfunction induced by hepatitis B recurrence occurred in 24 recipients alive. Conclusions As a marginal donor liver, HBsAg-positive liver graft is safe for liver transplantation in the recipients with hepatitis B-related liver diseases. Postoperatively, anti-HBV treatment should be strengthened and intimate follow-up should be delivered.

Objective To evaluate the clinical outcome of anterior subcutaneous internal fixator (ASIF) system with triple pedicle screws in stabilizing Tile type B pelvic fractures.Methods From August 2013 to April 2015,38 cases of pelvic fractures were stabilized with the ASIF system using triple pedicle screws.There were 24 male and 14 female cases,with the age range of 16-74 years [(41.5 ±5.5) years].Causes of injury were traffic accidents (n =28),crushing injury (n =6) and fall from height (n =4).All cases had Tile type B fractures,including 5 cases of type B1,29 type B2 and 4 type B3.Intraoperative blood loss,operation time,length of hospitalization and complications were detected.Postoperative function evaluation was done using the Majeed score.Results All cases were available for follow-up of 6.5-13.5 months (mean,10.5 months).Intraoperative blood loss was (30.8 ± 7.1)ml,operation time was (51.5 ± 9.2) minutes,and length of hospitalization was (5.0 ± 3.1) days.Among them,34 cases showed bilateral hip flexion over 95 degrees after operation,and 24 cases were able to squat fully 1.5 months after operation.No cases experienced nonunion,delayed union,superficial or deep surgical wound infection,urethral injury and dysuresia.Two cases developed temporary lateral femoral cutaneous nerve numbness.According to the Majeed score,excellent results were found in 32 cases (84％) and good results in 6 cases (16％).Conclusion ASIF system with triple pedicle screws results in high healing rate and few complications in the treatment of Tile type B pelvic fractures,and hence deserves popularization in clinic.