It is proposed that the disease mechanism evolution of systemic lupus erythematosus can be summarized into four stages： initial invasion and latency， the pathogenesis remains concealing； latent toxin accumulation， the disease gradually becomes apparent； active toxin begins damaging， the disease manifests aggressively； damage resulting to deficiency， the disease course prolonged. Based on the stages of latent toxin evolution， the syndrome differentiation and treatment of systemic lupus erythematosus can be summarized as follows： during the initial latent stage， characterized by latent dampness and heat stagnation， modified Sanren Decoction （三仁汤） should be used； in the toxin outbreak stage， marked by intense heat toxin， modified Xijiao Dihuang Decoction （犀角地黄汤） combined with modified Qingwen Baidu Decoction （清瘟败毒饮） should be used； during the toxin damage stage， which presents as latent toxin damaging zang-fu organs， modified Qinghao Biejia Decoction （青蒿鳖甲汤） should be used； in the healthy qi deficiency stage， characterized by deficiencies of qi， blood， yin， and yang， modified Xieli Shiquan Ointment （燮理十全膏） should be used.

AIM:To explore the effect and mechanism of the interfering Gal-1 on epithelial-mesenchymal transition(EMT),migration and proliferation in MDA-MB-231 cells via transforming growth factor-β(TGF-β)pathway.METHODS:The stable cell lines(shGal-1)which Gal-1 expression were inhibited completely and their control cell lines were used as experimental cells.Western blot assay was used to detect the effects of shGal-1 on EMT process of MDA-MB-231 cells after TGF-β treatment;The effect of shGal-1 on cell migration and invasion after TGF-β treatment was verified by cell scratch and transwell test;The effect of shGal-1 on the TGF-β pathway related proteins were detected by western blot;Finally,the effect of shGal-1 on cell proliferation was detected by MTT and western blot.RESULTS:shGal-1 inhib-ited TGF-β-mediated EMT in MDA-MB-231 cells and regulated phosphorylation of pathway signaling molecules(ERK,AKT and GSK3β);shGal-1 could inhibit the proliferation of MDA-MB-231 cells.CONCLUSION:shGal-1 can inhibit the TGF-β-mediated EMT,migration and proliferation of MDA-MB-231 cells.

Pre-rheumatoid arthritis （Pre-RA） is the asymptomatic state of rheumatoid arthritis （RA）， and its progression showed complexity， dynamics and significant individual differences. The dynamic prediction model is valuable in identifying individual risks and taking timely preventive and control measures. It is believed that applying the dynamic prediction model to traditional Chinese medicine （TCM） clinical studies of Pre-RA is expected to predict the critical state of Pre-RA to RA， reveal the evolution of Pre-RA， reflect the external authenticity of the TCM clinical studies， and complement the clinical efficacy evaluation method. Accordingly， it is envisioned to construct a dynamic prediction model for Pre-RA progression based on TCM clinical trial data through the dynamic prediction model algorithm， and to apply long-term follow-up cohort data for external validation， thereby providing a basis for scientific warning and clinical decision-making on the evolution of Pre-RA.

Based on the latest results of international researches, combining with the experiences of our team in the simulation of acute dyspnea, Xiangya Hospital Central South University has summarized 7 characteristics, procedures and methods of debriefing, including that immediate feedback happens after simulation; feedback is provided by a trained instructor with clinical experience; feedback time is at least longer than the simulation time; various international methods of feedback can be used; the content of feedback is the learning objective; oral feedback is preferred; video can be used to review the details. The study aims to provide a theoretical basis for debriefing in domestic scenario stimulation teaching, and finally improve the effectiveness of the scenario stimulation teaching.

Objective:To analyze the effects of multidisciplinary cooperative nutrition management model in acute stroke patients with dysphagia.Methods:From February 2019 to February 2020, 69 acute stroke patients with dysphagia were enrolled in this study. After exclusion of those unable to complete the trial, patients were randomized into control group ( n=30) and experimental group ( n=30). Patients in the control group were given routine nutrition management, while patients in the experimental group were treated under multidisciplinary cooperative nutrition management model. Nutritional indicators were compared between the two groups on Day 1, 7 and 14 after admission, including levels of albumin (ALB), pre-albumin (PALB), hemoglobin (HB), triceps skin-fold (TSF) thickness on the uninjured side, upper arm muscle circumference etc. Incidence of gastrointestinal complications and infectious complications was also recorded. Results:There was no difference between two groups in the levels of HB, TSF thickness and upper arm muscle circumference on the uninjured side (all P>0.05). However, the serum levels of ALB and PALB on Day 7 and 14 in the experimental group were higher than that in the control group(all P<0.05), The incidence of gastrointestinal complications ( P=0.015)and infectious complications ( P=0.016) in the experimental group was lower than that in the control group. Conclusion:Multidisciplinary collaborative nutrition management improved nutritional indicators, reduced the incidence of gastrointestinal complications and infectious complications in acute stroke patients with dysphagia, making multidisciplinary collaborative nutrition management model worthy of clinical promotion and application.

Objective:To investigate the effect of blue light combined with albumin treatment on heart, liver and nerve damage in neonatal jaundice.Methods:A total of 120 cases with neonatal jaundice in the Department of Pediatrics of Women's and Children's Hospital of Zhoushan from April 2017 to April 2018 were selected and divided into control group and observation group accorded to the random number method, with 60 cases in each group.The control group received blue light therapy.The observation group was given albumin treatment on the basis of the control group.The serum total bilirubin, bile acid, aspartate aminotransferase(AST), alanine aminotransferase(ALT), glutamyl transpeptidase(GGT), troponin(cTnT), creatine kinase isozyme(CK-MB), -hydroxybutyrate dehydrogenase(HBDH), myoglobin(MYO), S100B, neuron-specific enolase(NSE) and glial fibrillary acidic protein(GFAP) levels were determined.Results:Before treatment, there were no statistically significant differences in serum total bilirubin, bile acid, AST, ALT, GGT, cTnT, CK-MB, HBDH, MYO, S100B, NSE and GFAP levels between the two groups(all P>0.05). After treatment, the serum levels of total bilirubin[(142.67±13.02)μmol/L, (118.62±11.68)μmol/L], bile acid[(15.34±2.42)μmol/L, (7.83±2.07)μmol/L], AST[(32.17±6.34)U/L, (21.04±5.58)U/L], ALT[(25.83±4.16)U/L, (18.37±4.05)U/L], GGT[(55.24±6.37)U/L, (36.17±5.86)U/L], cTnT[(0.16±0.03)×10 -6μg/L, (0.09±0.02)×10 -6μg/L], CK-MB[(4.32±0.85)×10 -6U/L, (2.01±0.72)×10 -6U/L], HBDH[(213.04±43.61)U/L, (137.26±41.61)U/L], MYO[(22.15±3.64)×10 -6μg/L, (14.26±3.27)×10 -6μg/L], S100B[(1.41±0.28)×10 -9μg/L, (0.87±0.22)×10 -9μg/L], NSE[(15.29±2.12)×10 -9μg/L, (15.29±2.12)×10 -9μg/L] and GFAP[(19.34±0.96)×10 -9μg/L, (14.36±0.92)×10 -9μg/L] in the two groups were lower than those before treatment( t=5.214, 8.261; 7.216, 11.524; 4.027, 6.843; 3.248, 5.764; 7.129, 13.654; 6.524, 9.751; 6.854, 9.031; 4.026, 6.204; 4.521, 7.026; 4.276, 5.846; 4.812, 7.023; 7.062, 13.524, all P<0.05). The levels of serum total bilirubin, bile acid, AST, ALT, GGT, cTnT, CK-MB, HBDH, MYO, S100B, NSE and GFAP in the observation group were lower than those in the control group( t=10.651, 18.267, 10.208, 9.953, 17.066, 15.038, 16.063, 9.738, 12.490, 11.747, 17.157, 29.011, all P<0.05). Conclusion:Blue light combined with albumin treatment can alleviate heart, liver and nerve damage in neonatal jaundice.

BACKGROUND: Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS: We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS: Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.

Objective: To investigate the characteristics and drug resistance of pathogenic bacteria of refractory mycoplasma pneumonia in children and the changes of serum interleukin-18 (IL-18) and interleukin-33 (IL-33) levels. Methods: From January 2016 to December 2017, 103 children with refractory mycoplasma infection admitted to the Maternal and Child Health Hospital of Zhoushan were selected in the study.Another 60 healthy subjects in our Hospital from January 2016 to December 2017 were selected as control group.The oropharyngeal secretions were collected in all children with refractory mycoplasma pneumonia, isolated and cultured pathogenic bacteria.Disk diffusion (K-B method) was used to detect the drug resistance of the main pathogens.Enzyme-linked immunosorbent assay was used to determine serum IL-18 and IL-33 levels. Results: The 117 strains of pathogenic bacteria were isolated from 103 children with refractory mycoplasma infection, of which 68 strains (58.12%) were Gram-negative bacilli, 39 strains (33.33%) were Gram-positive cocci, and 10 strains (8.55%) were fungi.Klebsiella pneumoniae was more resistant to cefuroxime than Acinetobacter baumannii to cefuroxime and ceftriaxone.Staphylococcus aureus and Staphylococcus epidermidis were more resistant to erythromycin and penicillin G than other Gram-positive cocci.The levels of serum IL-18 and IL-33 in the study group were higher than those in the control group (all P<0.05). Conclusion Gram-negative bacilli are the main pathogens of refractory mycoplasma pneumonia in children.The resistant rate of main Gram-negative bacilli to cephalosporins is higher.The resistant rate of main Gram-positive cocci to penicillin G and erythromycin is higher.The levels of serum IL-18 and IL-33 are significantly higher in patients with refractory mycoplasma pneumonia.

Objective To investigate the effect of TGF-β1 on the proliferation of lymphoma cells induced by M2 macrophages. Methods TGF-β1 was used to treat Jiyoye lymphoma cells, and MTT was used to determine the cell proliferation. Lymphoma cells were treated with M2 macrophage culture liquid supernatant and TGF-β1. MTT assay was used to assess the lymphoma cell proliferation, Transwell assay was used to assess the cell migration and invasion, and Western blot was perfomed to determine the levels of MMP-2, MMP-9, PCNA and Ki-67 proteins. Results The lymphoma cells after TGF-α treatment showed that the proliferation ability, the number of invaded cells and the number of migrated cells, and the levels of MMP-2, MMP-9, PCNA and Ki-67 were significantly decreased, compared with the untreated lymphoma cells (P＜ 0. 05). After treated with the supernatant of M2 type macrophage culture supernatant, the proliferation ability of lymphoma cells, the number of invaded cells and migrated cells, the levels of MMP-2, MMP-9, PCNA and Ki-67 proteins were significantly increased, compared with the untreated lymphoma cells (P ＜ 0. 05 ). Compared with the lymphoma cells treated with culture medium supernatant of M2 macrophages alone, the lymphoma cells treated with TGF-β1 and M2 macrophage culture medium supernatant showed that the proliferation ability, number of invaded and migrated cells, and the protein levels of MMP-2, MMP-9, PCNA and Ki-67 were significantly increased (P＜0. 05). Conclusions TGF-β1 can reduce the proliferation, invasion and migration of lymphoma cells induced by macrophages. The mechanism of action is related to the expression of MMP-2, MMP-9, PCNA and Ki-67 proteins.

BACKGROUND: Lung cancer is the leading cause of cancer-related death in China. The results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. The aim of tihs study is to establish the China National lung cancer screening guidelines for clinical practice. METHODS: The China lung cancer early detection and treatment expert group (CLCEDTEG) established the China National Lung Cancer Screening Guideline with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 2 medical oncologists, 2 pulmonologists, 2 pathologist, and 2 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with at risk for lung cancer. The expert group reviewed the literature, including screening trials in the United States and Europe and China, and discussed local best clinical practices in the China. A consensus-based guidelines, China National Lung Cancer Screening Guideline (CNLCSG), was recommended by CLCEDTEG appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. RESULTS: Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50-74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. CONCLUSIONS A lung cancer screening guideline is recommended for the high-risk population in China. Additional research , including LDCT combined with biomarkers, is needed to optimize the approach to low-dose CT screening in the future.
Aged ; China ; epidemiology ; Early Detection of Cancer ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; epidemiology ; Male ; Mass Screening ; Middle Aged ; Patient Selection ; Practice Guidelines as Topic ; Radiation Dosage ; Risk ; Rural Population ; statistics & numerical data ; Tomography, Spiral Computed