Postoperative lower limb lymphedema following gynecological malignancies can be categorized under TCM concepts of"edema"and"meridian obstruction".Professor Jia Liqun believes that the underlying deficiency lies in yang and blood deficiency,while the excess is characterized by dampness and blood stasis obstructing the meridians.Consequently,the treatment strategies include warming yang and nourishing blood to unblock the meridians,dispelling dampness and promoting diuresis to unblock the meridians,and transforming stasis and promoting diuresis to unblock the meridians.Clinical practice requires dynamic syndrome differentiation and treatment according to the disease progression.Additionally,Professor Jia often employs the external application of Wenjing Tongluo Powder to directly target the affected area,combining internal and external treatments to enhance the effect of unblocking the meridians and reducing swelling.

Postoperative lower limb lymphedema following gynecological malignancies can be categorized under TCM concepts of"edema"and"meridian obstruction".Professor Jia Liqun believes that the underlying deficiency lies in yang and blood deficiency,while the excess is characterized by dampness and blood stasis obstructing the meridians.Consequently,the treatment strategies include warming yang and nourishing blood to unblock the meridians,dispelling dampness and promoting diuresis to unblock the meridians,and transforming stasis and promoting diuresis to unblock the meridians.Clinical practice requires dynamic syndrome differentiation and treatment according to the disease progression.Additionally,Professor Jia often employs the external application of Wenjing Tongluo Powder to directly target the affected area,combining internal and external treatments to enhance the effect of unblocking the meridians and reducing swelling.

Objective:To investigate the clinical characteristics of patients with malignant tumors and immune checkpoint inhibitors (ICI) related multisystem adverse events as well as therapeutic efficacy of ICI.Methods:The general data, immune-related adverse events (irAE) type, onset time, severity and ICI efficacy of patients with malignant tumors who developed irAE after receiving ICI in China-Japan Friendship Hospital between January 2019 and November 2021 were retrospectively analyzed. All patients were divided into multisystem irAE group and single system irAE group according to whether patients with more than 1 organ or system developed irAE for once. The occurrence of irAE was summarized, and the clinical characteristics of patients were compared. Progression-free survival analysis was not performed owing to the pause of immunotherapy caused by some irAE, so the efficacy of ICI was evaluated by using ICI treatment duration (TD).Results:A total of 47 patients with malignant tumors and irAE were included in this study, with 70 times of irAE in total. The median onset time was 90 d (35 d, 196 d). Among them, 12 patients (25.53%) developed multisystem irAE (32 times of irAE in total); the other 35 patients (74.47%) developed single system irAE (38 times of irAE in total). Cutaneous toxicity for 7 times, thyroid toxicity for 7 times and pulmonary toxicity for 5 times were the most frequent among multisystem irAE group; pulmonary toxicity for 13 times, thyroid toxicity for 12 times and cutaneous toxicity for 5 times were the most frequent among single system irAE group. There were no statistically significant differences in the proportion of patients stratified by age, gender, the combination of other treatments and different body mass between the two groups (all P > 0.05). The median follow-up time was 20 months (9-40 months). The median TD of ICI was 16.00 months (95% CI 3.62-31.22 months) in multisystem irAE group and 4.60 months (95% CI 4.12-11.30 months) in single system irAE group; TD in multisystem irAE group was longer than that in single system irAE group, and the difference was statistically significant ( HR = 0.413, 95% CI 0.202-0.844, P = 0.038). Conclusions:The efficacy of ICI in patients with malignant tumors and multisystem irAE is better than that in those with single system irAE. It suggests that the better efficacy of ICI may be associated with greater risk of irAE. There is no significant difference in the clinical features between multisystem irAE and single system irAE.

Objective:To explore the effect of breast feeding versus mixed feeding on fecal metabolites of infants delivered by cesarean section.Methods:This was a cross-sectional study.Fecal samples were collected from 23 healthy 1-month-old infants delivered by cesarean section from autumn 2021 and winter 2022 in two maternal and infant care facilities in the North and South of Xi′an city.The samples were divided into the breast feeding group (11 cases) and mixed feeding group (12 cases). Fecal metabolites were analyzed by the non-targeted metabolomic approach and gas chromatography-mass spectrometry coupling, and differentially expressed fecal metabolites between groups were screened using the non-parametric Mann- Whitney U test.Metabolic pathways enriched in them were further analyzed. Results:A total of 155 metabolites were characterized, including 57 sugars and sugar derivatives, 34 fatty acids, 25 organic acids, 22 amino acids, 8 esters, 4 nucleosides, 3 vitamins and 2 other substances.The relative contents of the differentially expressed fecal metabolites were measured, and it was found that some types of sugars and sugar derivatives were highly expressed in the fecal samples of breast feeding group, while amino acids, organic acids and fatty acids were highly expressed in those of the mixed feeding group.A total of 28 metabolic pathways enriched in differentially expressed fecal metabolites were obtained.Among them, alanine, aspartic acid and glutamic acid metabolism, valine, leucine and isoleucine metabolism, arginine metabolism and the tricarboxylic acid (TCA) cycle influenced infant health.Conclusions:Feeding methods have an effect on the fecal metabolites in infants delivered by cesarean section born infants, and mixed feeding may speed up the process of TCA cycle and amino acid metabolism in the intestine of infants delivered by cesarean section to a certain extent.

T cell infiltration and proliferation in tumor tissues are the main factors that significantly affect the therapeutic outcomes of cancer immunotherapy. Emerging evidence has shown that interferon-gamma (IFNγ) could enhance CXCL9 secretion from macrophages to recruit T cells, but Siglec15 expressed on TAMs can attenuate T cell proliferation. Therefore, targeted regulation of macrophage function could be a promising strategy to enhance cancer immunotherapy via concurrently promoting the infiltration and proliferation of T cells in tumor tissues. We herein developed reduction-responsive nanoparticles (NPs) made with poly (disulfide amide) (PDSA) and lipid-poly (ethylene glycol) (lipid-PEG) for systemic delivery of Siglec15 siRNA (siSiglec15) and IFNγ for enhanced cancer immunotherapy. After intravenous administration, these cargo-loaded could highly accumulate in the tumor tissues and be efficiently internalized by tumor-associated macrophages (TAMs). With the highly concentrated glutathione (GSH) in the cytoplasm to destroy the nanostructure, the loaded IFNγ and siSiglec15 could be rapidly released, which could respectively repolarize macrophage phenotype to enhance CXCL9 secretion for T cell infiltration and silence Siglec15 expression to promote T cell proliferation, leading to significant inhibition of hepatocellular carcinoma (HCC) growth when combining with the immune checkpoint inhibitor. The strategy developed herein could be used as an effective tool to enhance cancer immunotherapy.

Objective:To investigate the clinical characteristics and changing trends of primary liver cancer in Yunnan province from 2005 to 2014, in order to provide theoretical basis for the prevention and treatment of liver cancer in this region.Methods:A retrospective survey was used to select inpatient cases of liver cancer who were initially diagnosed and treated in our hospital from 2005 to 2014 with simple random sampling. Patients socio-demographic and clinicopathological characteristics were extracted by a unified and standardized questionnaire, and the data were statistically analyzed.Results:A total of 1000 cases with liver cancer were included, aged (53.2±11.2) years, with a male-to-female ratio of 5.99/1.00. There was no significant change in the gender and age composition ratio of patients in the past 10 years. The proportion of patients with lower education level (primary or junior high school) were increased from 21.8% to 23.4%, and the proportion of patients with relatively higher education level were decreased from 58% to 38.2% ( P<0.001). Smokers and non-smokers patients were decreased and increased from 58.8% to 44.4%, and 41.2% to 55.6% ( P<0.001). The proportion of drinker patients were decreased from 46.4% to 35.2%. The proportion of patients with advanced liver cancer (stage C and D) were increased, while the proportion of patients with stage A and B showed a downward trend ( P<0.001). The proportion of HBsAg-positive patients showed an upward trend, that is, rising from 69% in 2005 to 82% in 2014 ( P=0.043). The proportion of HBeAg-positive patients showed a steady trend ( P=0.008). The use rate of ultrasound examination in patients with liver cancer were decreased from 91.0% to 58.0% ( P=0.001), while the use rate of computed tomography (CT), MRI, and PET/CT examinations were increased from 81.0% to 84.0% ( P=0.05), 0 to 22% ( P<0.001), and 0 to 3% ( P=0.026) between 2005 to 2014. The proportion of surgical patients were increased ( P=0.005), but the proportion of interventional patients did not change significantly ( P=0.590). Surgery and interventional therapy were the most common treatment methods, and the proportion of patients treated with surgery over the past 10 years showed an upward trend ( P=0.005), while the proportion of interventional therapy remained at a high level with no significant change ( P=0.590). Conclusion:In Yunnan province, the incidence of liver cancer increases with age, and the proportion of male with liver cancer is almost six times that of women. Moreover, the low positive rate of alpha-fetoprotein levels and advanced clinical stage in this region are presently the main challenges against the liver cancer prevention and treatment. The application scope of CT, magnetic resonance imaging, PET-CT and other examination methods has gradually expanded, but the treatment methods are still mainly surgery and interventional therapy.

Objective:To analyze the clinical and chest CT features in a family with interstitial lung disease(ILD), and assess the probable causative gene mutations for the family.Methods:In order to identify the etiology of the proband′s ILD, the pedigree was investigated.The clinical data of five proband′s pedigree members were collected, and the chest HRCT examination was performed on four proband′s pedigree members with respiratory symptoms.The human whole exon sequencing was performed on the proband′s blood samples, then its deleterious effects were assessed.Subsequently, the strong pathogenic mutation was validated by Sanger sequencing.Results:According to the family survey, there were five patients with ILD in the family, including three males and two females.One of them died.The surfactant protein C(SFTPC)gene(exon4, c.342G>T, p.K114N)was found in all four surviving patients.The mutation was considered to be originated from the father of the proband, and the pathogenic mutation was considered, which was not included in the databases and was a noval mutation.In addition, the clinical manifestations of different patients in the family were significantly different.Conclusion:The novel mutation of p. k114n in SFTPC gene can lead to ILD in children, and the mutation has incomplete exons in family members.Chest CT and whole exon sequencing play an important role in the diagnosis of ILD in children.

Objective:To analized brain function monitoring results with amplitude- integrated electroencephalogram (aEEG) in neonatal ward.Methods:The clinical data of 1 370 newborns received aEEG monitoring in Neonatal Department of our hospital from September 2017 to August 2019 were retrospectively analyzed.Results:Among 1 370 neonates undergoing aEEG examination,abnormalities were demonstrated in 308 cases with an overall abnormal rate of 22.5%. The abnormal rate in critical neonates was 27.7% (240/868),while that in non-critical neonates was 13.6% (68/502) (χ2=36.304, P<0.01). Neonates with convulsion had the highest aEEG abnormal rate (57.1%, 16/28), followed by small for gestational age (SGA) (48.8%, 20/41), asphyxia (41.5%, 49/118), premature (31.1%, 92/296)and erythrocytosis (29.7%, 11/37). Among 308 cases of abnormal aEEG, the main types of abnormalities were abnormal background activity in 229 cases (74.4%),insignificant sleep-wake cycles in 139 cases (45.1%) and abnormal original EEG in 117 cases (40.0%). Among 308 cases of abnormal aEEG, 38.0%(117 cases) had corresponding clinical manifestations and 62.0%(191 cases) had no clinical manifestations. The sensitivity of aEEG monitoring is 73.6%(117/159), and the specificity is 84.2%(1 020/1 211). Conclusions:The abnormal rate of aEEG is high in hospitalized neonates,especially in critically ill neonates. It is necessary to carry out routine aEEG examination for hospitalized neonates in order to early detect brain function damage.

Objective:To screen the common low-frequency mutation sites in primary biliary cholangitis (PBC) by whole exome sequencing (WES), in order to find PBC-related new susceptibility genes.Methods:From January 2000 to December 2017, the clinical data of seven patients with PBC of three PBC families diagnosed at General Hospital of Tianjin Medical University and two healthy controls were collected. The DNA blood samples were extracted and analyzed by WES. SAMtools 1.3 software was used to detect gene single nucleotide polymorphism (SNP) and indel sites, and gene mutation sites were screened from known databases of 1000 Genome, ExAC, ESP6500 and Novo-Zhonghua gene database. Pymol V2.3.2 software was performed to simulate the three-dimensional structure of major histocompatibility complex-Ⅱ (MHC-Ⅱ), and the amino acid position corresponding to the common mutation sites among families were observed.Results:The age of first diagnosis of seven PBC patients was (61.2±10.2) years. The results of serum test of seven patients indicated that alkaline phosphatase (ALP) level was (306.9±242.5) U/L, γ-glutamyltranspeptidase (GGT) level was (121.7±85.9) U/L, alanine aminotransferase (ALT) level was (47.6±33.1) U/L, aspartate aminotransferase (AST) level was (55.7±34.1) U/L and immunoglobulin G level was (14.9±3.1) g/L. The antinuclear antibody were all cytoplasmic granule types and anti-mitochondrial antibody were all positive. Five PBC patients developed intra-abdominal lymphadenopathy; two patients had extrahepatic autoimmune diseases and the pathological results of liver biopsy of two patients both showed interface hepatitis and small bile duct lesions. Eighteen SNPs were common in three PBC families, which were located in the gene of OTOA, OBSCN and human leucocyte antigen- DRB1( HLA- DRB1). rs200988634 located in OTOA gene was a common polymorphic locus among the three families. rs746424683, rs545316651, rs553144914, rs533059830 and rs56087721 located in OBSCN caused the changes of nine amino acids of different location. There were 12 SNP variations located in HLA- DRB1 gene, which leaded to the changes of 12 amino acids of different location, among them rs16822698, rs112796209 and rs11554463 mutation induced G154A, Y152C and Y107X amino acid variation of MHC-Ⅱ beta chain, and Y107X amino acid was located in the groove region of MHC-Ⅱ binding with peptide. Conclusions:WES in PBC families is a good strategy to elucidate the candidate deleterious mutation genes OBSCN and OTOA. HLA- DRB1 which is a susceptible gene of PBC may affect MHC-Ⅱ mediated antigen presentation process by the changing amino acid sequence.

Objective: To explore the association between middle school students health literacy and bully victimization and associated sex difference, and to provide guidance for bully prevention in adolescents. Methods: During November 2017 to January 2018, 18 900 junior and senior high school students were enrolled from Hefei of Anhui Province, Shenyang of Liaoning Province, Yangjiang of Guangdong Province and Chongqing by multistage cluster sampling. A self rated questionnaires were used to collect demographic information, health literacy, and bully victimization. Group differences by different characteristics and the association between health literacy and bully victimization were analyzed. Results: The detection rates of campus and cyber bullying victimization were 15.8% (2 992/18 900) and 9.1% (1 723/18 900). Boys, junior high school students, students with poor family financial status and few close friends had a detection rate of 28.0%, 18.8%, 23.3%, and 33.6% of school bullying, which are higher than those of the control group ( χ 2=225.64, 148.07, 141.13, 143.49, P <0.01); boys, students with poor household income and few close friends, the detection rates of cyber bullying were 10.9%, 14.4%, and 20.1%, respectively, are higher than the control group ( χ 2=62.96, 112.82, 88.49, P <0.01). Multivariate Logistic regression analysis indicated that students with low overall and dimensions scores of health literacy were more likely to suffer from campus and cyber bullying, except for the dimension of physical activity. In addition, at all levels of health literacy, males are more likely to be bullied than females ( P <0.05). Conclusion Health literacy of middle school students is related to bully victimization, which is sex specific. Intervention programs of bullying should focus on health literacy enhancement.