A patient who underwent posterior lumbar interbody fusion was treated with imrecoxib,the patient's liver biochemical examination was abnormal.Follow taking polyene phosphatidylcholine injection combined with glutathione for liver protection,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and alkaline phosphatase(AKP)still increased progressively,with peaks of 404.7,122.8 and 255.1 U·L-1,respectively.With stopping the use of imrecoxib,and adjusting the liver protection treatment of polyene phosphatidylcholine injection combined with compound glycyrrhizin injection,ALT,AST and AKP decreased gradually before discharge and were 54.6,21.2,137.2 U·L-1,respectively.Associations were evaluated by RUCAM rating scale,with an imrecoxib association score of 8,and it may be causing liver damage of this patient.The hepatotoxicity should be vigilant and the liver function should be monitored in application of imrecoxib to ensure the safety of drug in patients.

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.

Objective To study the clinical characteristics and related factors affecting the severity of acute tinnitus in patients.Methods A retrospective analysis was conducted on the data of 319 patients with acute tinni-tus.All patients had detailed case history,including basic patient information,tinnitus location,course of disease,acoustic characteristics of tinnitus,hearing loss,combined headache,dizziness,aural fallness,earache and other symptoms,as well as accompanying clinical diseases.All patients completed the tinnitus handicap inventory(THI),generalized anxiety disorder(GAD-7),patient health questionnaire(PHQ-9),pittsburgh sleep quality index(PSQI),hyperacusis questionnaire(HQ),type D personality scale-14(DS-14),etc.The mild tinnitus group was determined based on a THI score of ≤36.The moderate tinnitus group was determined based on a THI score of 38～56.The severe to extremely severe tinnitus group was determinded based on THI 56～100.THI grouping was used as the dependent variable and the above factors as independent variables.The correlation between each factor and the severity of acute tinnitus was analyzed using ordered multinomial logistic regression.Results Among 319 patients with acute tinnitus,158(49.5％)were in the mild tinnitus group,and 72(22.6％)were in the moderate tinnitus group,and 89(27.9％)were in severe to extremely severe tinnitus group.Ordered multinomial logistic re-gression analysis found that hyperacusis(OR=3.921),anxiety(OR=2.495),depression(OR=2.921),and D-type personality(OR=0.349)were associated with the severity of acute tinnitus(P＜0.05),with more serere tin-nitus in these patients.Conclusion Hyperacusis,anxiety,depression,and D-type personality may be factors that affect the severity of acute tinnitus,so high attention should be paid when treating patients with acute tinnitus.

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective To observe the clinical efficacy of CYP2C19 genotype detection guided an-tiplatelet therapy in patients with ischemic stroke(IS)and its effect on adverse cardiovascular and ce-rebrovascular events(MACCE).Methods A total of 130 IS patients were selected in this study,and were divided into control group(n=65)and observation group(n=65)by random number table method.Patients in the control group were given aspirin and clopidogrel regimen,those in the observa-tion group were firstly tested for CYP2C19 genotypes,and were further divided into fast metabolism(CYP2C19*1/*1)group(n=30),medium metabolism(CYP2C19*1/*2,CYP2C19*1/*3)group(n=20)and slow metabolism(CYP2C19*2/*2,CYP2C19*3/*3,CYP2C19*2/*3)group(n=15)based on the test results.Patients in the fast metabolism group were treated with clopidogrel,those in the middle metabolism were still treated with clopidogrel,and those in the slow metabolism group were given aspirin treatment at the first day of treatment.All patients were followed up for 1 year.According to the occurrence of MACCE,the patients were divided into MACCE group(n=28)and non-MACCE group(n=102).Platelet aggregation was compared between the control group and the observation group.Modified RANKIN Scale(mRS)scores and the incidence of MACCE were compared between control group and observation group.Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group;independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analy-sis.Results After 1 month of treatment,the platelet aggregation rates in the control group and ob-servation group were lower than before treatment,the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group,and the platelet inhi-bition rates in fast metabolism group and middle metabolism group were higher than that in control group(P＜0.05).There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate(P＞0.05).After 1 month of treatment,the mRS scores of both groups were significantly decreased,and the observation group was lower than the control group(P＜0.05).The incidence of MACCE in the observation group was significantly lower than that in control group(P＜0.05).The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group,and the in-cidence of MACCE in the middle metabolism group was the lowest(P＜0.05).Logistic regression model showed that older age,hypertension,diabetes and left ventricular ejection fraction(LVEF)＜50％were independent risk factors for MACCE in IS patients(P＜0.05).Conclusion For patients with IS,CYP2C19 genotype detection and corresponding treatment for patients with different sub-types can effectively improve their platelet aggregation rate and inhibition rate,and reduce the oc-currence of MACEE,especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits.Independent risk factors for MACEE in patients with IS include older age,hypertension,diabetes and LVEF＜50％.Close clinical monitoring should be conducted to improve the prognosis of these patients.

Objective:To investigate the expressions of lysine specific demethylase 1 (LSD1) and podoplanin (PDPN) in tongue squamous cell carcinoma and the correlation between LSD1 or PDPN and clinicopathological characteristics or prognosis.Methods:A total of 67 cases of tongue squamous cell carcinoma and corresponding paracancerous normal tissues in the First Affiliated Hospital of Xinjiang Medical University from January 2011 to January 2016 were selected. The expressions of LSD1 and PDPN in cancer and paracancerous tissues were detected by immunohistochemical method, and the patients were followed up for a long time to analyze the correlation between the expression of LSD1 or PDPN and clinicopathological characteristics or prognosis.Results:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma tissues were higher than those in paracancerous tissues, and the differences were statistically significant ( Z=6.089, P<0.001; Z=5.781, P<0.001). The expression intensities of LSD1 and PDPN were significantly different in patients with different clinical stage ( χ2=11.487, P=0.001; χ2=8.111, P=0.004), lymph node metastasis ( χ2=4.772, P=0.029; χ2=6.206, P=0.013) and tumor size ( χ2=5.985, P=0.014; χ2=4.247, P=0.039). The expression intensity of LSD1 was also significantly different in patients with different degrees of differentiation ( χ2=6.660, P=0.010). In univariate analysis, LSD1 expression intensity was negatively correlated with progression-free survival (PFS) and overall survival (OS) ( χ2=18.930, P<0.001; χ2=16.257, P<0.001), PDPN expression intensity was negatively correlated with PFS and OS ( χ2=31.720, P<0.001; χ2=18.390, P<0.001), and tumor size was negatively correlated with PFS and OS ( χ2=5.326, P=0.021; χ2=8.843, P=0.003). Postoperative radiotherapy and clinical stage were positively and negatively correlated with OS respectively ( χ2=4.197, P=0.040; χ2=6.355, P=0.012). In multivariate analysis, LSD1 was an independent risk factor for PFS and OS ( HR=5.743, 95% CI: 1.012-32.579, P=0.048; HR=17.759, 95% CI: 2.303-136.916, P=0.006), PDPN was an independent risk factor for PFS ( HR=4.380, 95% CI: 1.258-15.254, P=0.020), postoperative radiotherapy was a protective factor for PFS and OS ( HR=0.374, 95% CI: 0.157-0.895, P=0.027; HR=0.218, 95% CI: 0.091-0.521, P=0.001), and clinical stage was an independent risk factor for OS ( HR=2.637, 95% CI: 1.107-6.280, P=0.029). In tongue squamous cell carcinoma tissues, the expression of LSD1 was positively correlated with that of PDPN ( rs=0.655, P<0.001). Conclusion:The expressions of LSD1 and PDPN in tongue squamous cell carcinoma are higher than those in adjacent tissues. LSD1 is an independent risk factor for PFS and OS, PDPN is an independent risk factor for PFS, clinical stage is an independent risk factor for OS, and postoperative radiotherapy is a protective factor for PFS and OS. There is a positive correlation between the expressions of LSD1 and PDPN in tongue squamous cell carcinoma, and they can both be used as independent predictors of prognosis in patients with tongue squamous cell carcinoma.

A male patient, with diagnose of Madelung disease, was admitted in September 2009. He has been a heavy drinker for decades before onset of the disease. This patient was characterized by the large amount of symmetrical deposits of adipose tissue in the subcutaneous layer around neck, and without obesity on other sites. The excessive adipose tissue was surgically removed by three steps. Appearance almost returned to normal. No recurrence happened after 8 years of follow-up.

Objective: To investigate the expressions of histone lysine-specific demethylase 1 (LSD1), O⁶-methylguanine DNA methyltransferase (MGMT) and cell proliferation-associated antigen Ki-67 in high-grade glioma and their influences on prognosis. Methods: Sixty-five cases of grade Ⅲ and Ⅳ glioma confirmed by pathology from January 2011 to June 2017 in the First Affiliated Hospital of Xinjiang Medical University were selected. Immunohistochemistry (SP method) was used to detect the expressions of LSD1, MGMT and Ki-67 in pathological specimens. The therapeutic effect was evaluated by long-term follow-up. The relationships between the three markers and pathological grade, progression-free survival (PFS) and overall survival (OS) were analyzed. Results: The overall positive rates of LSD1, MGMT and Ki-67 in the 65 high-grade glioma specimens were 70.8% (46/65), 60.0% (39/65) and 100.0% (65/65), respectively. There were no significant differences in the expressions of LSD1 and MGMT in grade Ⅲ and Ⅳ glioma (χ²=1.588, P=0.208, χ²=0.013, P=0.908). Ki-67 expression (+ ), (+ + ), (+ + + ) in grade Ⅳ glioma were observed in 18, 19 and 11 cases, respectively. Ki-67 expression (+ ), (+ + ) in grade Ⅲ glioma were observed in 11, 5 cases, and 1 case was (+ + + ), and the difference in expression intensity between the two groups was statistically significant (Z=-2.083, P=0.037). Log-rank test showed that the positive expressions of LSD1, MGMT and Ki-67 were negatively correlated with the PFS of patients with high-grade glioma (χ²=12.217, P=0.007; χ²=4.446, P=0.035; χ²=12.536, P=0.002), also were negatively correlated with OS (χ²=11.708, P=0.008; χ²=6.637, P=0.010; χ²=11.807, P=0.003). Grade Ⅳ patients were more likely to have relapse progression than grade Ⅲ patients (χ²=6.573, P=0.010), and OS was shorter (χ²=3.974, P=0.046). Cox proportional hazards model analysis showed that the expressions of LSD1 (HR=1.361, 95%CI: 1.094-1.694, P=0.006; HR=1.406, 95%CI: 1.117-1.771, P=0.004) and Ki-67 (HR=1.703, 95%CI: 1.175-2.468, P=0.005; HR=1.778, 95%CI: 1.209-2.616, P=0.003) were the independent prognostic risk factors for PFS and OS of patients with high-grade glioma. Correlation analysis results showed that the expression of MGMT was positively correlated with the expression of LSD1 (r=0.406, P=0.001). Conclusion LSD1, MGMT and Ki-67 have higher positive expression rates in high-grade glioma. MGMT is a prognostic factor for high-grade glioma, and LSD1 and Ki-67 can be used as independent predictors of prognosis for high-grade gliomas.

Curriculum integration has become the core content of the current medical education reform.With the rapid development of information technology,how to reflect the teaching and learning effects and to further improve them,is one of the difficulties in the reform of the integrated curriculum.In view of the problems of single form of assessment model,separate classroom teaching and extracurricular teaching evaluation,low utilization of network and electronic teaching resources,we make full use of network methods to carry out reform on the current formative teaching evaluation system.With the purpose of formative assessment and evaluation,the "Blackboard network teaching system" of the curriculum has been built,and the evaluation indexes of classroom teaching and extracurricular teaching have been established.And at the same time,the formative assessment index has been enriched and perfected in a diversified form,and the formative assessment model adapted to the integrated curriculum is preliminarily explored.

Objective To detect the frequency of BRAF/ KRAS and PIK3CA mutations in the small cell lung cancer (SCLC) specimens from a large population of Chinese patients and to analyze the gene mutation and clinical characteristics. Methods A total of 557 samples were collected from SCLC patients from 2009 to 2014.BRAF,KRAS,PIK3CA,NRAS and MEK1 gene mutations were detected by the dideoxy sequencing. Chi-square test was adopted to analyze the correlation between clinical factors and gene mutation. Kaplan-Meier method was utilized for survival analysis. Cox model was used for multivariate prognostic analysis. Results BRAF mutations were detected in 13 out of 557 specimens. The mutation types included V600E (n= 5) ,V600A (n= 2) ,V600M (n= 1) ,D594G (n= 1),G464E (n= 1),K601R (n= 2) and S605N (n= 1).KRAS mutation was detected in 6 cases including G12C (n= 3),G12A (n= 1),G12D (n=1) andG13D (n= 1).PIK3CA mutation was observed in 4 samples including E545G (n= 2) and H1047R (n= 2).Besides,NRAS mutation (Q61R) was detected in 1 case and MEK1 mutation (D61Y) was noted in 1 case. These gene mutations were not significantly correlated with the age, gender, smoking status and clinical staging of the patients. Univariate survival analysis demonstrated the median survival time of patients with gene mutation was (10.30±0. 751) months (95％CI:8. 829-11. 771 months),significantly shorter than (12.80±0. 543) months (95％CI:11. 736-13. 864 months) of their counterparts without gene mutation (P=0. 011). Conclusions BRAF/ KRAS and PIK3CA gene mutation is detected in a small proportion of SCLC patients. These gene mutations are not significantly correlated with the clinical characteristics. Univariate survival analysis demonstrates that negative these gene mutations are negatively correlated with the clinical prognosis of SCLC patients.