Objective:To systematically evaluate the efficacy of different kinds of smoking cessation drugs by network Meta-analysis.Methods:Literature was retrieved from PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, VIP, Wan fang database, from the establishment of the database to November 2022, and randomized controlled trials (RCT) about bupropion, varenicline, nicotine replacement therapy (NRT) versus placebo in the treatment of smoking patients were collected. After data extraction from included literature which met inclusion criteria, and quality evaluation with Cochrane 5.1 risk bias evaluation tool, network Meta-analysis was performed by Stata15.1 software.Results:A total of 19 RCTs, involving 6106 patients and three interventions measures (bupropion, varenicline, NRT) and one control measure (placebo) were included. The results of network Meta-analysis showed that in terms of short-term abstinence rate, varenicline [ OR=4.21, 95% CI (2.32, 7.63)], bupropion [ OR=2.81, 95% CI(1.05, 7.54)] were better than placebo ( P<0.05). The surface under the cumulative ranking area (SUCRA): varenicline (90.2%)>bupropion (64.8%)>NRT (41.7%)>placebo (3.2%). In terms of the long-term abstinence rate, varenicline [ OR=3.06, 95% CI (1.59, 5.90)], NRT [ OR=3.39, 95% CI (2.20, 5.21)] were better than placebo ( P<0.05). SUCRA: varenicline (83.8%)>NRT (73.9%)>bupropion (37.2%)>placebo (5.2%). Conclusion:The existing evidence shows that compared with bupropion, NRT, varenicline has the best effect on quitting smoking, but more high-quality randomized trial evidence is needed for verification.

Objective:To retrospectively summarize the clinical experiences of managing renal artery stenosis after donor kidney transplantation in children.Methods:From January 2018 to October 2021, 114 pediatric kidney transplants(donor/recipient aged <18 years)were performed.According to the findings of color Doppler ultrasonography, they were divided into two groups of normal( n=80)and rapid flow( n=34). Rapid flow group were assigned into symptomatic( n=13)and asymptomatic( n=21)sub-groups based upon clinical features of hypertension and renal instability. Results:Among them, there were 65 males and 49 females.A significant inter-gender difference existed in the proportion of higher arterial flow rate of transplanted kidney(38.5% and 18.4%, P=0.02). No significant difference existed in age or body weight of transplant recipients among all groups( P>0.05). The mean age(10.4 months)and body weight(9 kg)of donors were significantly lower in symptomatic group than those in normal group(65.3 months, 21 kg)and asymptomatic group(64.4 months, 21.2 kg). The mean velocity of symptomatic group was significantly higher than that of asymptomatic group(363.5 vs 228.8 cm/s)( P<0.001). In symptomatic group, 6 cases received medications and their clinical manifestations were completely relieved.Among 7 patients invasively treated, one percutaneous transluminal angioplasty(PTA)was offer once( n=2), twice( n=2)and triple( n=1)with clinical relief and stable renal function.One case of bleeding at puncture site during PTA had treatment failure with a gradual loss of graft function.One ineffective case of PTA was subsequently placed with an endovascular stent.However, repeated stent dilation failed due to restenosis.After surgical exploration, vascular stent removal and transplantation of renal artery clipping, clinical symptoms were relieved. Conclusions:Male recipient, low body weight or young donor may be risk factors for transplant renal artery stenosis(TRAS)during pediatric donor renal transplantation.A higher flow rate of transplanted renal artery on ultrasonography could not confirm the diagnosis of TRAS.Greater arterial flow and associated clinical manifestations often hint at a strong possibility of TRAS, requiring drug or invasive treatment interventions.If PTA efficacy is not satisfactory, multiple treatments should be performed.Nevertheless, stenting should be avoided as far as possible to prevent in-stent restenosis.

OBJECTIVE：To systematically e valuate the efficacy and safety of expectorant/antioxidants in the treatment of chronic obstructive pulmonary disease （COPD），and to provide evidence-based reference for clinical use. METHODS ：Retrieved from PubMed ，Embase，Cochrane Library ，Web of Science ，CBM，CNKI，VIP，Wanfang database ，etc.，randomized controlled trials（RCTs）about expectorant/antioxidants （trial group ）versus placebo （control group ）in the treatment of COPD were collected during the inception to May 2021. After literature screening and data extraction ，the quality of included literatures were evaluated with risk bias evaluation tool recommended by Cochrane systematic evaluator manual 5.1.0. The consistency check was performed by using Gemtc 14.3 software；network Meta-analysis ，clustering and hierarchical sorting were performed with Stata 15.1 software. The publication bias was analyzed by inverted funnel plot. RESULTS ：A total of 12 RCTs，involving 4 637 patients，were included. Five interventions measures were involved ，such as low-dose N-acetylcysteine （NAC），high-dose NAC ，carbo- cisteine， erdosteine and placebo. The results of network Meta-analysis showed that in terms of annual acute aggrava- tion rate ，the patients receiving high-do se NAC [MD ＝－0.45， 163.com 95％CI（－0.74，－0.17），P＜0.05]，carbocisteine [MD ＝－0.59，95％CI（－0.86，－0.32），P＜0.05] and erdosteine [MD ＝－0.26，95％CI（－0.51，－0.01），P＜0.05] in trial group were significantly lower than those in control group ；the annual acute aggravation rate of patients receiving high-dose NAC[MD ＝－0.55， 95％CI（－0.98，－0.11），P＜0.05] and carbocisteine [MD ＝－0.69，95％CI（－1.11，－0.26），P＜0.05] in trial group were significantly lower than those receiving low-dose of NAC ，there was no statistical significance among other groups （P＞0.05）； probability cumulative ranking results （calculated by the area under the curve ）of its network Meta-analysis was carbocisteine ＞ high-dose NAC ＞erdosteine＞placebo＞low-dose NAC. In terms of the incidence of ADR ，there was no statistical significance among groups （P＞0.05）；probability cumulative ranking results （calculated by the area under the curve ） of its network Meta-analysis was erdosteine ＞high-dose NAC ＞low-dose NAC ＞placebo＞carbocisteine. The results of clustering and hierarchical ranking showed that the efficacy and safety of the five interventions could be grouped into three categories ，including placebo and low-dose NAC with low efficacy and safety ，carbocisteine with good efficacy but low safety ，and high-dose NAC and erdosteine with good efficacy and safety. The results of publication bias showed that taking the annual acute exacerbation rate as the index ， there was a greater possibility of publication bias in this study ；taking the incidence of adverse event as index ，there was little possibility of publication bias in this study. CONCLUSIONS ：NAC，carbocisteine and erdosteine all can reduce the annual acute aggravation rate and have low incidence of ADR. Carbocisteine is the best in terms of annual acute aggravation rate ，erdosteine is the best in terms of safety. High-dose NAC and erdosteine are both better in term of efficacy and safety.

Objective To evaluate the necessity of arc by arc setup verification in patients with brain metastases receiving stereotactic radiotherapy (SRT) by analyzing the inter-and intra-fraction setup errors and residual errors collected from the ExacTrac X-ray portal image.Methods Clinical data of brain metastases patients treated with SRT in the previous two years were retrospectively analyzed.The ExacTrac X-ray setup images were collected after the normal setup procedure.Setup errors were calculated by registering the cranial bony structures of the ExacTrac X-ray setup images to that of the digitally reconstructed setup images.The inter-and intra-fraction setup errors and residual errors were statistically analyzed.Results Seventy-five patients from 116 lesions received 337 cycles of SRT of the head.The inter-and intra-fraction translational setup errors in the x,y and z directions were (0.93±0.86) mm and (0.15±0.59) mm;(1.83± 1.27) mm and (0.25±0.73) mm;(0.96±0.80) mm and (0.14±0.56) mm,respectively.The inter-and intra-fraction rotational setup errors in the x,y,z directions were (0.65°± 0.62°) and (0.19°± 0.40°);(0.97°±0.94°) and (0.13°± 0.25°);(0.92°± 0.71°) and (0.10°± 0.29°),respectively.The residual translational setup errors in the x,y,z directions were (0.06±0.23) mm,(0.08±0.24) mm and (0.08±0.22)mm,and (0.12°± 0.27°),(0.09°± 0.18°) and (0.06°± 0.19°) for the residual rotational setup errors,respectively.For a reference setup error threshold of 0.7 mm/0.7°,99.1％ of the SRT exceeded the threshold and required setup correction.For 1 006 non-coplanar arcs,rotating the treatment couch from 0° to the treatment angle made 66.4％ of arcs exceed the threshold and require at least once setup correction.Conclusions During SRT for brain metastasis,the inter-and intra-fraction setup errors should be emphasized.It is necessary to perform arc by arc setup error verification.

Objective To retrospectively analyze the setup error in radiotherapy of somal tumors and body metastases using the ExacTrac X-ray portal image,and to evaluate the feasibility and effectiveness of 6D setup error correction in body radiotherapy.Methods The translational and rotational setup errors were calculated by registering the bony structures on the ExacTrac X-setup images to that of the digitally reconstructed setup images,and the corresponding residual errors were calculated together.Results The translational and rotational setup errors in the x (left-right),y (superior-inferior),z (anterior-posterior) and Rx (sagittal),Ry (transverse),Rz (coronal) directions were(2.27±2.02) mm,(4.49±2.52) mm,(2.27± 1.37) mm and (1.02 ± 0.73) °,(0.67 ± 0.68) °,(0.76 ± 0.84) °,respectively.The residual translational and rotational setup errors in the x(r),y(r),z(r) and Rx(r),Ry(r),Rz(r) directions were(0.27±0.48)mm,(0.37±0.45)mm,(0.22±0.30)mm and (0.17±0.33)°,(0.14±0.34)°,(0.16± 0.28) ° respectively.Conclusions Besides the translational setup errors,a certain amount of rotational setup errors exist in radiotherapy of somal tumors and body metastases.By using the 6D setup error correction of the ExacTrac system,a translational less than 0.4 mm and rotational setup errors less than 0.2° could be achieved.

Objective A self-made tiltable treatment couch was adopted for CT simulation positioning and radiotherapy to evaluate the feasibility and effectiveness to minimize the setup errors. Methods Twenty-two patients with thoracic and abdominal tumors receiving radiotherapy in Department of Radiation Oncology,Peking Union Medical College between March and September 2016 were recruited in this study. All patients were randomly divided into the experimental(n=11)and control groups(n=11).In the study group,the tiltable treatment couch was adopted to switch the patients from the standing position to the supine position,and conventional supine position was utilized in the control group. All patients received CT positioning under spontaneous breathing. Image registration was performed according to the standard recommendations of IGRT group. The image registration data for the translational and rotation errors of CBCT were recorded and analyzed. The setup errors were calculated by four-parameter model between two groups. Results In the experimental group,the translational error of the x direction was(-0.012±0.128)cm with a variation range of(0.29-0.70 cm),(0.272±0.123)cm for the y direction(0.23-0.70 cm)and(0.089± 0.105)cm for the z direction(0.14-0.53 cm),respectively. In the control group,the translational error of the x direction was(0.006±0.198)cm(0.27-0.75 cm),(-0.108±0.396)cm for the y direction(0.56-2.08 cm)and(- 0.096± 0.176)cm for the z direction(0.34-0.89 cm), respectively. Conclusions Application of the self-made tiltable treatment couch can enhance the setup reproducibility and reduce the setup errors,especially in the y direction during radiotherapy for the thoracic and abdominal tumors.

Objective To investigate the influence of fear of hypoglycemia on the compliance of diabetes patients.Methods A total of 201 diabetes inpatients with hypoglycemia in four first-class hospital of grade three in Ji'nan were selected by convenience sampling method and investigated by General Information Questionnaire,Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale and Diabetes Treatment Compliance Scale.And carrid on the correlation analysis and the multiple linear regression analysis.Results The scores of fear of hypoglycemia was 3-33 points,the median score was 12 points(interquartile range,10-15 points).The score of treatment compliance was 23-55(35.90±5.84)points.Spearman correlation analysis showed that fear of hypoglycemia score were negative correlated with treatment compliance score,drug,diet,exercise dimensions(r=-0.467-0.288),and it was positively correlated with self monitoring dimension(r=0.259),the difference was statistically significant(P＜0.01),it was not associated with periodic inspection dimension.Multiple linear regression analysis showed that the economic income,occupation,whether to participate in health education of diabetes mellitus,glycosylated hemoglobin,fear of hypoglycemia were the influence factors of treatment compliance.Conclusions Diabetes patients'fear of hypoglycemia can influence treatment compliance.medical staff should pay attention to and take effective measures to reduce their fear of hypoglycemia and improve treatment compliance.

Objective To investigate the distribution of circadian typology of patients with type 2 diabetes mellitus (T2DM) and to analyze its consequent impact on glycemic control. Methods From January 2016 to June 2016, a total of 283 T2DM patients were interviewed in this study. Self designed questionnaire, Morningness-Eveningness Questionnaire (MEQ), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Survey-Depression Scale (CES-D) were used to collect information on diabetes history, circadian typology, sleep quality and depression. HbA1c and other biochemical indicators were determined. The glycemic control target was<7%. The 283 T2DM patients were divided into three groups:morning type group, evening type group and neither type group according to MEQ score. Results Of the 283 subjects, 97 (34.3%) were classified as morning type, 42 (14.8%) as evening type, and 144 (50.9%) as neither. Participants with evening type were younger, shorter diabetes duration, more depressive symptoms, higher perceived sleep debt, higher FBG and higher HbA1c than those with morning type. The binary Logistic regression analysis showed that HbAlc≥7%was associated with higher FBG, higher PSQI score, higher sleep debt, lower HDL-C, and lower MEQ scores (OR=0.189-2.904, all P<0.05). Conclusions Evening type was associated with higher HbA1c and poorer glycemic control in T2DM patients compared with morning type and may be one of the risk factors affecting glycemic control.

Objective To examine the impact of diabetic foot patients′ negative emotion on the caregiver′quality of life. Methods Totally 100 pairs of diabetic foot patients and their caregivers were investigated using convenience sampling method. Results The incidence of anxiety, depression of hospitalized patients with diabetic foot was 41.5% (23/200), 44.0% (88/200) respectively. Pearson correlation analysis showed that anxiety score were negatively correlated with caregivers′ quality of life except for mental health dimension, physical pain dimension and the total score of physical health, mental health and the MOS item Short from Health Survey (SF-36) (r=-0.471--0.117, P<0.05), and depression score were negatively correlated with caregivers′ quality of life except for physical pain dimension and the total score of physical health, mental health and SF-36(r=-0.519--0.220, P<0.05). Multiple regression analysis indicated that caregivers educational level, provided support, social support , relationship with patients, self-evaluation of health, live together time with patient, patient care burden, caregivers gender, depression score, patient age, diabetic foot Wagner grade were the influence factors of the caregiver′ quality of life. Conclusions Diabetic foot patients′ negative emotion has an important impact on caregiver′quality of life, we can improve the quality of life of patients and their caregivers by reducing the negative mood of patients with diabetic foot.

Objective To compare coagulation data measured with domestic produced and imported coagulation testing solutions on SD rat and human by testing prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time(TT), fibrinogen(FIB).Methods Blood samples were obtained from SPF SD rat and human .Domestic produced and imported coagulation testing solutions were applied to test PT , APTT, TT, and FIB.Results Compared to rat data measured with imported coagulation testing solution , data measured with domestic produced coagulation testing solution of PT, APTT, FIB was significantly higher (P<0.05), while, data of TT was statistically lower(P<0.05), and there was no obvious difference in human blood coagulation .Conclusion The data measured with different coagulation testing solution varies on SD rat , so the laboratories are required to establish reference data according to different products .