Multiple primary cancers(MPC)refer to the presence of more than one type of cancer with different histological features and sites in the same individual,and it is relatively rare in clinical practice.This article reports a case of decompensated cirrhosis with MPC and discusses the diagnosis,treatment,and clinical implications of this patient with decompensated cirrhosis and MPC.

Objective To investigate the protective effect of total flavonoids of Salvia divinorum extract against acetaminophen(APAP)-induced acute liver injury(ALI)and its molecular mechanism.Methods The main chemical constituents of total flavonoids of Salvia divinorum were obtained through literature search,and their pharmacological mechanisms were predicted using bioinformatics analysis.In a mouse model of APAP-induced ALI,the protective effects of 100,200 and 400 mg/kg total flavonoids of Salvia miltiorrhiza and 150 mg/kg bifidus were evaluated by observing changes in blood biochemistry and liver histopathology and detecting expressions of the key proteins in the Nrf2/HO-1 signaling pathway.Results Network pharmacology analysis suggested that the main active components in total flavonoids of Salvia divinorum for regulating APAP-induced liver injury included quercetin,lignocerol,caruric acid,and kaempferol,for which GO function enrichment analysis yielded 632 GO entries,including 472 involving biological processes,42 involving cellular composition,and 118 involving molecular function.KEGG enrichment analysis showed that the total flavonoids of Salvia divinorum regulated APAP-induced liver injury mainly through ferroptosis-related signaling pathway.In mice with APAP-induced ALI,treatment with the total flavonoids significantly lowered ALT and AST levels,improved liver histopathology and inflammatory cell infiltration,reduced iron deposition in liver tissues,improved lipid peroxidation-related indexes,promoted the expressions of Nrf2,HO-1,SLC7A11,and GPX-4 proteins,and inhibited the expression of keap1 protein.Conclusion The total flavonoids of Salvia divinorum alleviate APAP-induced ALI in mice possibly by suppressing hepatocyte ferroptosis via activating the Nrf2/SLC7A11/GPX-4 signaling pathway.

Objective To investigate the protective effect of total flavonoids of Salvia divinorum extract against acetaminophen(APAP)-induced acute liver injury(ALI)and its molecular mechanism.Methods The main chemical constituents of total flavonoids of Salvia divinorum were obtained through literature search,and their pharmacological mechanisms were predicted using bioinformatics analysis.In a mouse model of APAP-induced ALI,the protective effects of 100,200 and 400 mg/kg total flavonoids of Salvia miltiorrhiza and 150 mg/kg bifidus were evaluated by observing changes in blood biochemistry and liver histopathology and detecting expressions of the key proteins in the Nrf2/HO-1 signaling pathway.Results Network pharmacology analysis suggested that the main active components in total flavonoids of Salvia divinorum for regulating APAP-induced liver injury included quercetin,lignocerol,caruric acid,and kaempferol,for which GO function enrichment analysis yielded 632 GO entries,including 472 involving biological processes,42 involving cellular composition,and 118 involving molecular function.KEGG enrichment analysis showed that the total flavonoids of Salvia divinorum regulated APAP-induced liver injury mainly through ferroptosis-related signaling pathway.In mice with APAP-induced ALI,treatment with the total flavonoids significantly lowered ALT and AST levels,improved liver histopathology and inflammatory cell infiltration,reduced iron deposition in liver tissues,improved lipid peroxidation-related indexes,promoted the expressions of Nrf2,HO-1,SLC7A11,and GPX-4 proteins,and inhibited the expression of keap1 protein.Conclusion The total flavonoids of Salvia divinorum alleviate APAP-induced ALI in mice possibly by suppressing hepatocyte ferroptosis via activating the Nrf2/SLC7A11/GPX-4 signaling pathway.

Objective:To investigate the method of determining oral implantation sites based on an anatomical model of mandibular premolar area of a Beagle dog.Methods:This study was performed in the Second Affiliated Hospital of Zhejiang Chinese Medical University between January 2019 and October 2020. Mandibular anatomical structure and measurement data were compared between before and after removal of premolar teeth to determine safe implantation areas and oral implantation sites.Results:Among all mandibular premolars, the roots of the 1 st to 4 th premolars (P1-P4) gradually increased. The diameter of the mesial roots of the double root teeth P2, P3, and P4 was (2.72 ± 0.45) mm, (3.22 ± 0.32) mm, (4.16 ± 0.34) mm, respectively, which was significantly shorter than those in the distal roots [P2: (2.98 ± 0.29) mm, P3: (3.48 ± 0.27) mm, P4: (4.58 ± 0.22) mm]. The length of distal roots P2, P3 and P4 was (8.79 ± 0.41) mm, (9.21 ± 0.31) mm, (10.12 ± 0.36) mm), respectively, which was significantly shorter than that of mesial root [P2: (8.91 ± 0.69) mm, P3: (9.48 ± 0.27) mm, P4: (11.58 ± 0.24) mm]. Among all mandibles, the distance (H) from the mental foramen to the first molar and the width (W) of the alveolar crest increased successively [H1: (7.24 ± 0.49) mm, H2: (8.28 ± 0.71) mm, H3: (9.52 ± 0.37) mm, W1: (5.71 ± 0.81) mm, W2: (5.82 ± 0.28) mm, W3: (6.72 ± 0.54) mm]. Conclusion:The mental foramen and the distal part outside the canine apical area are safe implantation areas. In the safe implantation area, the length and diameter of the implant prosthesis do not exceed the root length in the implantation area and the maximum diameter in the buccal lingual direction.

The Brodmann area(BA)-based map is one of the most widely used cortical maps for studies of human brain functions and in clinical practice;however,the molecular architecture of BAs remains unknown.The present study provided a global multiregional proteomic map of the human cerebral cortex by analyzing 29 BAs.These 29 BAs were grouped into 6 clusters based on similarities in proteomic patterns:the motor and sensory cluster,vision cluster,auditory and Broca's area cluster,Wernicke's area cluster,cingulate cortex cluster,and heterogeneous function cluster.We identified 474 cluster-specific and 134 BA-specific signature proteins whose functions are closely associated with specialized functions and disease vulnerability of the corresponding clus-ter or BA.The findings of the present study could provide explanations for the functional connec-tions between the anterior cingulate cortex and sensorimotor cortex and for anxiety-related function in the sensorimotor cortex.The brain transcriptome and proteome comparison indicates that they both could reflect the function of cerebral cortex,but show different characteristics.These pro-teomic data are publicly available at the Human Brain Proteome Atlas(www.brain-omics.com).Our results may enhance our understanding of the molecular basis of brain functions and provide an important resource to support human brain research.

Objective:To explore the current situation and related factors of asphyxia prevention and management for the elderly in elderly care institutions, so as to provide a reference for improving the safety management of elderly care institutions.Methods:This research was a cross-sectional survey. From December 2020 to January 2021, convenience sampling was used to select 43 elderly care institutions from the China Aged Care Alliance. The self-designed questionnaire was used to collect the content related to asphyxia prevention and management for the elderly in institutions, and analyze its current situation and related factors. A total of 43 questionnaires were distributed in this survey, and 43 were recovered, with a recovery rate of 100%.Results:Among the 43 elderly care institutions, and 3 (6.98%) were state-run, and 22 (51.16%) were private, and 18 (41.86%) were public and private. The average occupancy rate was (67.63±20.59) %, and the average proportion of moderate to severe disability among the elderly residents was (80.10±20.25) %. The proportions of elderly care institutions that formulated systems and regulations for monitoring and early warning of asphyxia events, reporting of asphyxia events, analysis and improvement of asphyxia incidents in the elderly were 53.49%, 51.16%, and 51.16%, respectively. The proportions of elderly care institutions that carried out asphyxia risk screening, swallowing function assessment, and swallowing function training for the elderly residents were 65.12%, 51.16%, and 46.51%, respectively.Conclusions:Most elderly care institutions have problems in the prevention and management of asphyxia for the elderly, which needs to be improved. It is recommended that building a complete asphyxia prevention and management system, carrying out risk screening, assessment and training of swallowing function for high-risk groups, strengthening the professional training of agency leaders and caregivers, and seeking continuous external professional support so as to improve the safety management system of elderly care institutions, and ensure the quality of life and personal safety of the elderly.

Objective:To explore the demand for suffocation prevention training for nursing staff in elderly care institutions and analyze its influencing factors to provide reference for improving training strategies.Methods:In this cross-sectional study, from December 2020 to January 2021, the caregivers from 43 elderly nursing institutions under China Geriatric Care Alliance were selected by convenient sampling. Self-made questionnaires were used to collect personal information of caregivers as well as related experience and training needs of suffocation prevention for the elderly. Totally 526 questionnaires were recovered, of which 412 were valid, with an effective rate of 78.33%.Results:Among the 412 caregivers, 53 (12.86%) were registered nurses and 359 (87.14%) were senior caregivers. They had a high demand for suffocation prevention, identification, and emergency treatment training. The top three most demanded are the common causes of suffocation, the risk factors of suffocation for special elderly people, and the identification of abnormal physical signs to detect suffocation in time. There were statistically significant differences in the scores of content requirements for suffocation prevention training between institutions which had and had not experienced suffocation and caregivers who knew or did not know the medication status or suffocation history of the care recipients ( P<0.05) . Conclusions:Caregivers in elderly care institutions have a high demand for suffocation prevention training. It is recommended that elderly care institutions apply pre-prevention to the management of suffocation prevention for the elderly, and guide caregivers to fully understand the medication status, suffocation history, and swallowing function of the care recipients, and provide registered nurses and elderly caregivers with systematic training related to suffocation prevention.

Objective:To investigate the effects of exercise prescription on quality of life in patients with pituitary adenomas after surgery.Methods:A total of 82 patients with pituitary adenomas who met the inclusion criteria from December 2017 to September 2018 were enrolled. The control group received routine nursing care. The intervention group was given exercise prescription on the first day after surgery and 3 months after discharge from hospital. Both groups of patients completed the Health Status Survey(SF-36) before and after the intervention.Results:Before the intervention, there was no significant difference in baseline date of patients between two groups( P>0.05). After intervention, the general health dimension score (53.03±11.30) of the control group was significantly higher than the score within the group before treatment ( Z value was -4.398, P<0.05). The physiological function (86.67±7.46), physical function (66.67±29.28), role-emotional (71.30±22.75), vitality (68.33±8.78), general health dimension (61.39±10.66) of the intervention group were significant higher than the score within the group before treatment ( Z values were -4.809--2.041, P<0.05) . After the intervention, the significant difference were found in role-physical, general health, vitality, social function(77.18±15.71) and physiological health dimensions (73.75±10.00) between the intervention and control group ( Z values were -3.122- -2.467, t value was 3.044, P<0.05). After the intervention, non-function patients′ physiological function (72.06±23.19), general health (60.59±10.75), vitality (69.71±10.23) and social function (81.04±10.22) were significantly higher than the control group ( Z values were -2.832- -2.059, P<0.05). Conclusion:Exercise prescription can improve the quality of life in patients with pituitary adenomas after surgery.

Objective: To explore the correlation between microdamage in white matter and radiotherapy dose at early stage after radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC). Methods: Thirty-three patients who were initially diagnosed with NPC were recruited and received diffusion tensor imaging (DTI) scan and neuro-cognitive scale test within 1 week before RT and the first day after RT. DTI-related characteristic parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ_‖), and radial diffusivity (λ_⊥) were calculated based on whole-brain voxel analysis method. Paired t-test was conducted to evaluate statistical significance between pre-RT and post-RT groups. In the subgroup analysis, all the subjects were divided into 3 groups according to the average dose of temporal lobe, and each group was set with an equal dose interval range. The DTI-related parameters of whole brain pre-RT and post-RT in each group were statistically compared. All the statistical results were corrected by FDR with a threshold of P<0.05 and clusters>100. Results: FA, MD, λ_‖ and λ_⊥in the post-RT group significantly differed compared with those in the pre-RT group (P<0.05). The values of FA, MD, λ_‖ and λ_⊥were 0.455±0.016, (9.893±0.403)×10^-4, (13.441±0.412)×10^-4 and (8.231±0.429)×10^-4, respectively. Subgroup analysis showed that the extent and degree of λ_‖ and λ_⊥ changes were exacerbated with the increase of the average dose of temporal lobe after RT. Particularly in high-dose group, the average dose range was 25-35 Gy and the extent of regions with significant changes was significantly larger than those in the medium-dose (15-25 Gy) and low-dose groups (5-15 Gy)(P<0.05). Conclusions DTI can be utilized to detect" normal" brain tissue microdamage in NPC patients at early stage after RT. The average radiation dose of temporal lobe may be one of the reasons for the severity of cerebral microdamage. In the future, DTI technique may be useful for guiding exposure dose of organs at risk during RT planning and to evaluate the cohort with a high risk of cerebral microdamage at early stage after RT, thereby protecting normal cerebral tissues to the maximum extent.

Objective To observe the ocular manifestations and the titer of aquaporin 4 antibody (AQP-4) in NMO patients,and to evaluate the BCVA prognosis in patients with different titers of AQP-4Ab.Methods A retrospective case study.From September 2009 to March 2014,132 NMO patients diagnosed in Department of Neurology and Ophthalmology in Huashan Hospital of Fudan University were included in the study.Among the patients,74 patients (56.06％) were involved in optic nerve for the first time,among which 63 patients (47.72％) were involved in optic nerve alone,and 11 patients (8.33％) were involved in optic nerve and spinal cord at the same time.The recurrence rate was 62.88％ (twice or more).All patients underwent BCVA,slit lamp microscope,fundus examination,thyroid function,sex hormones,and serum AQP-4Ab detection.BCVA was recorded at admission and before discharge from hospital,and worse BCVA was recorded in binocular patients.The BCVA of patients with different titers of AQP-4Ab were analyzed comparatively.Results Among the 74 patients with optic nerve involved in the first onset,50 patients with BCVA＜0.1 at the initial diagnosis (67.57％);AQP-4Ab positive was found in 56 patients,which including 13,9 and 34 patients of AQP-4Ab titer 5-60,61-100 and ＞ 100 RSRU/ml.After 2 weeks of treatment,BCVA improved in 40 patients (71.42％),including 11 (84.62％),6 (66.67％) and 23 (67.64％) ofAQP-4Ab titer 5-60,61-100 and ＞ 100 RSRU/ml.Among 132 patients,98 patients (74.24％) were AQP-4Ab positive.There were 73 patients (55.30％) with abnormal immune rheumatoid index.Conclusions The optic nerve is involved in 56.06％ patients with NMO for the first time,and 67.57％ of the patients had poor vision with BCVA＜0.1.BCVA prognosis is better in patients with serum AQP-4Ab titer of 5-60 RSRU/ml.