After the occurrence of acute rejection following solid organ transplantation, high-dose glucocorticoid (steroid) pulse therapy is commonly used. However, high-dose steroid pulse therapy is ineffective for some patients, leading to steroid resistant acute rejection, which may easily result in graft loss and severely affect patient prognosis. It is currently believed that both cell-mediated rejection and antibody-mediated rejection are involved in the occurrence and development of steroid resistant acute rejection. The diagnosis and treatment of steroid resistant acute rejection after kidney transplantation have become relatively mature, while the focus on steroid resistant acute rejection after liver transplantation has been relatively low in the past in China, and a unified standardized treatment plan has not yet been formed. Therefore, this article reviews the pathogenesis, diagnosis, and treatment of steroid resistant acute rejection after liver transplantation, in order to provide a reference for the diagnosis and treatment of steroid resistant acute rejection after liver transplantation.

ObjectiveTo investigate and analyze the public health status of escape room-style venues in Yangpu District， Shanghai. MethodsReferring to the hygiene standards and testing methods for public places， an investigation of the current situation and environmental monitoring were conducted in 15 escape room-style venues in Yangpu District， which involved exploring the changes in physical， chemical， and microbial indicators before and after the game. ResultsThe hygiene condition of escape room-style venues in Yangpu District was generally good， with all 19 monitoring indicators not exceeding the indoor standards. The indoor carbon dioxide （CO₂） and formaldehyde concentrations increased significantly after the game but did not exceed the standards. ConclusionThe hygiene condition of escape room-style venues in Yangpu District is good. However， potential public health risks were identified in four aspects： site selection and design， length of the game， cross-contamination， and training and management.

Schizophrenia is a serious mental disease. The diagnosis of schizophrenia so far relies heavily on subjective evidence, including self-reported experiences by patients, manifestations described by relatives, and abnormal behaviors assessed by psychiatrists. The diagnosis, monitoring of the disease progression and therapy efficacy assessment are challenging due to the lack of established laboratory biomarkers. Based on the current literature, clinical consensus, guidelines, and expert recommendations, this review highlighted evidence-based potential laboratory biomarkers for the diagnosis of schizophrenia, including genetic biomarkers, neurotransmitters, neurodevelopmental-related proteins, and intestinal flora, and discussed the potential future directions for the application of these biomarkers in this field, aiming to provide an objective basis for the use of these biomarkers in the early and accurate diagnosis, treatment, and prognosis and rehabilitation assessment of schizophrenia.

Objective:To investigate the epidemiological characteristics and relevant factors among individuals characterized by their longevity in multiple regions of Guangxi Zhuang Autonomous Region, and provide a valuable scientific perspective for the research in health and longevity of the elderly in Guangxi.Methods:Registration and face-to-face questionnaire on a door-to-door basis were adopted to collect the demographic characteristics of the long-lived individuals (≥90 years old) in Bama of Hechi city, Yongfu of Guilin city, Dongxing of Fangchenggang city, Guangxi. Then, among the local general population, individuals within the age group between 40 and 85 years old were selected randomly as controls. Correlations were then analyzed between the relative health and longevity of the subjects and their gender, ethnicity, family history, disease history, marital status, the number of family generations, the number of children, smoking, drinking, outdoor activities, sleep and other health-related factors, then the result was subject to further analysis by comparing the long-lived population and the control population respectively.Results:Among 691 500 of the permanent residents of Bama, Yongfu and Dongxing city, 1 005 cases were 90 years old and over with a ratio of 145.34 out of 100 000 persons; within the 1 005 cases, 944 were aged between 90 and 100 (longevity rate: 136.51/100 000) with an average age of (93.28±2.57); 61 cases were aged 100 or over, arriving at a centenarian rate of 8.82/100 000 with an average age of (102.00±3.05) years. Significant differences were found just among three particular factors — regional distribution ( P=0.014), history of disease ( P=0.002), four generations of family ( P=0.008) between nonagenarians and centenarians ( P<0.05), while the other 15 indicators did not show anything noteworthy. The result indicated that longevity and centenarians might be the same group and then we combined both groups into one. By cross-comparison between the longevity-plus- centenarians and the control group in the region, factors listed below exhibited significant correlation with health and longevity: marital status ( OR=26.469, 95% CI: 13.208-53.045), number of generations within the family ( OR=5.419, 95% CI: 3.418-8.592), number of male offspring ( OR=2.013, 95% CI: 1.555-2.607), number of female offspring ( OR=1.380, 95% CI: 1.122-1.696), and the frequency of outdoor activities ( OR=10.226, 95% CI: 3.164-33.045). Conclusions:The longevity rate is higher in the general natural population in Bama, Yongfu and Dongxing of Guangxi. The phenomenon may owe to favorable family structure, atmosphere within or out of the family or other elements related with social surrounding. Among them all, mentality, inclination to physical exercise and regular rhythm of life may all exert tremendous contributory influence here.

Objective:To explore the epidemiologic characteristics of long-lived population and influencing factors in Shanglin county of Guangxi and provide scientific basis for the study of health and longevity in Guangxi.Methods:We collected and analyzed the general demographic cross-sectional data of the long-lived individuals (≥90 years old) in 11 villages and towns by multi-source registration and face-to-face interview. The age group control design was adopted to conduct a comparison among the longevity group (90-100 years old), centenarian group (≥100 years old), the longevity plus centenarian group and control group (local population aged 40-85 years), and identify the factors related to longevity.Results:Among the 496 007 people registered in Shanglin, 1 533 were aged ≥90 years, including 1 453 in the longevity group, with an average age of (92.84±2.46) years, and 80 in the centenarian group, with an average age of (102.67±2.60) years. The spatial distribution of long-lived individuals and centenarians was mainly in the north and central areas, and sparse in southwest area. Analysis on factors related to health and longevity indicated that old people with Zhuang ethnic ( OR=1.551,95% CI:1.308-1.838), married ( OR=55.507,95% CI:36.087-85.377) and moderately high waist-to-hip ratio ( OR=258.056,95% CI:27.775-2 397.569), and SBP ( OR=1.019,95% CI:1.013-1.026) tended to live longer. Conclusions:We found that the rate of longevity in Shanglin was higher than the average level in Guangxi and China. Longevity in Shanglin country had unique spatial and population distribution characterics of female longevity more than male longevity, mainly Zhuang ethnic and so on. Being women, married, family history of longevity, appropriate high waist-to-hip ratio, SBP and blood sugar level might be positive factors for longevity in Shanglin, but the impacts of other factors on longevity need further study.

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
Adult ; Asian Continental Ancestry Group ; Biomarkers ; China ; Consensus ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Eosinophils ; Epidemiology ; Epigenomics ; Genetics ; Humans ; Hypersensitivity ; Inflammation ; International Agencies ; Medical Staff ; Neck ; Phenotype ; Precision Medicine

Objective: To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer. Methods: A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. Exclusion criteria were as follows: (1) malignancies of early stage; (2) suspicious adverse mental states which might lead to poor administration compliance; (3) hypersensitivity or allergic reactions to opioids. Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected. The patients were divided into the stoma group and the non-stoma group. The clinical findings of two groups were analyzed, including age, sex, ostomy status, pain location, presence or absence of intestinal obstruction, pain characteristics, selection of opioid analgesic agents, treatment of side effects of analgesics. Pain was assessed using brief pain inventory(BPI) table and NRS score. Strong opioids were prescribed for patients of NRS ≥4. Patients who were intolerant to opioids required opioid titration. The titration drugs included oral or IV morphine and oxycodone. After achievement of adequate pain control, long-acting opioids were administered, which included sustained-release morphine tablets, controlled release oxycodone and transdermal fentanyl. Criteria for pain relief included NRS≤3, breakthrough pain <3 times/day and duration of adequate pain control >3 days. The χ² test and the Wilcoxon signed rank sum test (nonparametric test) were used to analyze the clinical features of patients in the stoma and non-stomach groups. In order to find the factors associated with maintenance therapy and the use of laxatives, the variables were compared as well as in multivariate analysis with multiple regression models. For all the statistical tests, a value of P<0.05 in a two-tailed test was established as the alpha significance level. Result: A total of 123 patients were enrolled in this study, including 79 males (64.2%) and 44 females (35.8%) with a median age of 51 years. Fifty-two patients were in stoma group, including 30 (24.4%) of ileostomy and 22 (17.9%) of colostomy, and 71 patients were in non-stoma group. Pain of 40 (76.9%) patients in stoma group located in abdomenopelvic site while the pain of 44 (62.0%) patients in non-stoma group located in other sites. Compared with non-stoma group, cases in stoma group complained more abdominopelvic pain (73% vs. 62.0%, P<0.001).The median NRS pain score before treatment in the stoma group and the non-stoma group was 5.7 and 5.6, respectively, without statistically significant difference (P=0.741). After analgesic management, the above scores reduced to 2.1 and 2.3, respectively, without statistically significant difference as well (P=0.092). Analgesic treatment was effective in 111 cases (90.2%), including 49 cases (94.2%) in the stoma group, and 62 cases (87.3%) in the non-stoma group, and there was no statistically significant difference between the two groups (P=0.202). There was more application of fentanyl transdermal patch [34.6%(18/52) vs. 9.8%(7/71)] in the stoma group, while more application of lactulose laxative [78.9%(56/71) vs. 61.5%(32/52)](χ²=10.023, P=0.002) in the non-stoma group. Multivariate analysis revealed that ostomy (OR=0.290, 95%CI: 0.102-0.824, P=0.009) and pain site (OR=5.691, 95%CI:1.709-18.948, P=0.005) were independent factors affecting the choice of the first line opioid sustained release agent. Of the 123 patients with maintaining analgesia, 98 had available data of laxative use, of whom 46 used laxatives to prevent or treat constipation, and the proportion of laxatives in stoma group (21.2%, 11/52) was significantly lower than that in non-stoma group (49.3%, 35/71) (χ²=6.957, P=0.008). Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P=0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P=0.045) were independent factors affecting the use of lactulose laxatives. Conclusions Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.

OBJECTIVETo evaluate the safety and preliminary efficacy of dose-modified regimen of 5-fluorouracil plus oxaliplatin and irinotecan (mFOLFOXIRI) for patients with advanced colorectal cancer (CRC).

METHODSData of 312 CRC patients confirmed by pathology receiving triplet drug alone or combined with target therapy between October 2012 and December 2016 at the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. CRC patients who had previously completed adjuvant therapy (or neoadjuvant therapy) within 6 months or palliative chemotherapy were excluded, meanwhile those with poor general condition (ECOG score > 2) or grade 2 neuropathy and allergy to oxaliplatin were excluded as well. Regimen of mFOLFOXIRI: oxaliplatin 85 mg/m² dissolved in 5% glucose solution 500 ml by intravenous infusion for 2 h; irinotecan 150 to 165 mg/m² dissolved in 0.9% sodium chloride 250 ml by intravenous infusion for 90 min; following intravenous infusion of leucovorin 400 mg/m² for 2 h, day 1; 5-FU 2800 mg/m², 48-h continuous intravenous infusion; once every 2 weeks. Therapy could be combined with a targeted drug, bevacizumab 5 mg/kg every two weeks; cetuximab 500 mg/m² every two weeks. Side effect was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE 4.0.3). The objective response rate was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) after administering at least four cycles of chemotherapy.

RESULTSThe median age was 52 years (range 16-73) in the whole group; 113 patients (36.2%) had locally advanced CRC, and 199 (63.8%) had metastatic CRC. Most patients (274/312, 87.8%) did not receive any treatment earlier. There were a total of 1651 chemotherapy cycles in the whole group, with a median of 6(1-19) cycles. Of these 1651 cycles, 124 cycles of chemotherapy(7.5%) were dose-adjusted; 176 cycles of chemotherapy(10.7%) were delayed for median 5(3-13) days; 124 cycles(7.5%) required dose decrease. The overall relative dose intensity was >90%; the specific drug dose intensity was 93.6%(2620 mg×m⁻²×d⁻¹) for fluorouracil, 97.8%(83 mg×m⁻²×d⁻¹) for oxaliplatin, and 94.2%(155 mg×m⁻²×d⁻¹) for irinotecan. Twenty-three patients (7 of intestinal perforation, 7 of intestinal obstruction, 1 of grade 4 hematologic toxicity, and 8 of grade 3 fatigue) refused subsequent chemotherapy due to intolerable toxicity. Main grade 3 or 4 adverse events in patients were neutropenia in 69 cases (22.1%), fatigue in 35 cases (11.2%), and anemia in 28 cases (8.9%). Twenty serious adverse events (6.4%) occurred, including 13 patients of febrile neutropenia (4.2%), 7 patients of intestinal perforation (2.2%, 4 patients in upper rectum, 2 in sigmoid colon, and 1 in transverse colon cancer), and 9 of them had subsequent sepsis (2.9%). All the patients with intestinal perforation underwent emergency operation. No treatment-related deaths occurred. In 199 patients with metastatic CRC, because 22 patients did not receive image evaluation, the preliminary efficacy of 177 patients was actually evaluated. A total of 113 objective response events were observed. The overall response rate was 63.8%(113/177), partial response rate was 61.6%(109/177), clinically complete response rate was 2.3%(4/177), stable disease was 29.9% (53/177), progressive disease was 6.2%(11/177), and the disease control rate was 93.8%(166/177). In 127 patients receiving triplet drug, objective response rate was 40.9% for those with less than four cycles and 81.1% for those with more than four cycles (P<0.001).

CONCLUSIONThe mFOLFOXIRI regimen with reduced dose can be safely used in advanced CRC and has achieved promising results in terms of short-term efficacy.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Camptothecin ; administration & dosage ; analogs & derivatives ; Colorectal Neoplasms ; drug therapy ; Fluorouracil ; administration & dosage ; Humans ; Leucovorin ; administration & dosage ; Middle Aged ; Organoplatinum Compounds ; administration & dosage ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To investigate the effect of arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage. Methods 156 cases diagnosed with moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage were collected from October 2011 to October 2014. Lysholm knee score and preoperative examinations such as anteroposterior, lateral, axial radiographs, the standing full leg length X-ray film and MRI scan of the knee were recommended to definitively understand the osteoarthritis staging and meniscus injury grading. All patients were treated with arthroscopic debridement and meniscectomy. After operation, physical rehabilitation exercises and regular clinical follow-up were carried out as planned. The Lysholm knee score data from preoperation and terminal follow-up was statistical analyzed. Results No patient experienced any perioperative and postoperative complications. Statistical analysis showed that the Lysholm knee score of postoperation was significantly higher than that of preoperation [(87.3 ± 7.9) vs (67.5 ± 4.9), P < 0.05). Conclusion Arthroscopic debridement and meniscectomy in treatment of moderate or severe meniscus injury combined with knee osteoarthritis in early or middle stage, gains beneficial effects for its minimal invasion and quick recovery.

OBJECTIVETo evaluate the expression and possible modulation of heme oxygenase-1 (HO-1) in nasal polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODSNasal polyps and uncinate process tissues were collected from 25 CRSwNP patients and 19 healthy controls with nasal septal deviation. HO-1 expression was examined using qRT-PCR, immunohistochemistric staining and Western blot analysis. Moreover, additional uncinate process mucosal samples of 15 healthy controls with nasal septal deviation were harvested for nasal explant culture experiments. HO-1 expression was measured in cultured nasal explant in response to specific inflammatory and glucocorticoid stimulation. SPSS 20.0 software was used to analyze the data.

RESULTSThe mRNA and protein expression of HO-1 was significantly increased in polyp tissues, 1.220±0.397 in mRNA and 1.409±0.701 in protein, compared with healthy controls 0.464±0.318 in mRNA and 0.017±0.1147 in protein (U=22.00 in mRNA and U=1.00 in protein, both P< 0.05). The immunohistochemical results showed that HO-1 was mainly distributed in the epithelial layer, submucosal glands and inflammatory cells in nasal tissues. Nasal explant culture experiments demonstrated that HO-1 mRNA was upregulated by IL-17A. The HO-1 mRNA level before the stimulation was 1.000, and 17.264±4.275 after the stimulation of 1 ng/ml IL-17A (U=0, P<0.05), 19.128±4.605 after the stimulation of 10 ng/ml IL-17A (U=0, P<0.05), but was significantly suppressed after stimulation with glucocorticoids (dexamethasone, DEX). The mRNA level after the glucocorticoids stimulation was 0.370±0.101 (U=0, P<0.05) and 0.316±0.167 (U=0, P<0.05) respectively. Furthermore, the HO-1 mRNA was inhibited by TGF-β1, the mRNA level was 0.217±0.322 (U=0, P<0.05), 0.070±0.070 (U=0, P<0.05), respectively.

CONCLUSIONIncreased HO-1 expression may play a role in the pathogenesis of CRSwNP, which may be considered as the therapeutic target.

Blotting, Western ; Case-Control Studies ; Chronic Disease ; Dexamethasone ; pharmacology ; Glucocorticoids ; pharmacology ; Heme Oxygenase-1 ; metabolism ; Humans ; Interleukin-17 ; pharmacology ; Nasal Polyps ; complications ; metabolism ; RNA, Messenger ; metabolism ; Rhinitis ; complications ; metabolism ; Sinusitis ; complications ; metabolism ; Tissue Culture Techniques ; Transforming Growth Factor beta1 ; metabolism