Objective:To investigate the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) by meta-analysis.Methods:Studies published from January 1, 1980 to August 30, 2021 were searched systematically in PubMed, Embase, Cochrane Systematic Review database and China National Knowledge Infrastructure Database. The searching keywords included "non-small cell lung cancer", "randomized controlled trial", "prophylactic cranial irradiation" and "clinical trial". The data extracted from the above studies were analyzed using Review Manager 5.3 and Stata 12.0 software. Outcomes included the development of brain metastases (BM), overall survival (OS), disease-free survival (DFS), toxicity, and quality of life (QoL).Results:Ten trials, including 2005 NSCLC patients, met the inclusion criteria. Patients who underwent PCI had a significantly lower risk of BM than those who did not ( OR=0.29, 95% CI: 0.22-0.40, P<0.001). Compared with non-PCI group, DFS in PCI group was significantly increased ( HR=0.75, 95% CI: 0.63-0.89, P=0.001). However, there was no significant difference in OS ( OR=0.90, 95% CI: 0.69-1.18, P=0.45). In addition, the incidence of fatigue was significantly increased in the PCI group ( OR=2.64, 95% CI: 1.58-4.40, P<0.001). There was no significant difference in cognitive impairment between the PCI and non-PCI groups ( OR=3.60, 95% CI: 0.97-13.32, P=0.06). Conclusions:PCI is the standard treatment for NSCLC. Compared with non-PCI, PCI significantly reduces the incidence of BM and prolongs the DFS of NSCLC patients. The effect of PCI-related toxicity on the QoL and long-term OS needs further study.

SGLT2 inhibitors currently have clear benefits in the treatment of heart failure whether combined with diabetes or not. Ventricular remodeling after myocardial infarction leads to the occurrence and development of heart failure, and eventually leads to death. There are relatively few studies on SGLT2 inhibitors in patients with myocardial infarction. The purpose of this article is to review the research progress of SGLT2 inhibitors application before and after myocardial infarction.

OBJECTIVE: To assess the association of genomic instability of epithelial cadherin 1 (CDH1) gene and clinicopathological characteristics of gastric cancer. METHODS: In total 120 paraffin-embedded gastric cancer tissue specimen were prepared, and genomic DNA was extracted. The genomic instability of the CDH1 gene was analyzed by immunohistochemistry and silver staining PCR-single-strand conformation polymorphism. RESULTS: The number of information individuals (heterozygotes) was 98 for the D16S752 locus. The detection rates for microsatellite instability (MSI) and loss of heterozygosity (LOH) at the D16S752 locus and the positive rate of CDH1 protein were 19.39%, 16.33% and 51.02%, respectively. The detection rate of MSI in TNM stages I or II was significantly higher than that in stages III or IV (P<0.05) while the detection rate of LOH was significantly lower than that in stages III or IV (P<0.05). The positive rate of CDH1 protein in TNM stages III or IV was significantly lower than that in stages I or II (P<0.05). The detection rate of MSI of cases with lymph node metastasis was significantly lower than that of without lymph node metastasis (P<0.05) while the detection rate of LOH was significantly higher than that without lymph node metastasis (P<0.05). The positive rate of CDH1 protein in patients with lymph node metastasis was significantly lower than that in patients without lymph node metastasis (P<0.05). The positive rate of CDH1 protein in MSI-positive group was significantly higher than that in MSI-negative group (P<0.05), and the positive rate of CDH1 protein in the LOH-positive group was significantly lower than that the LOH-negative group (P<0.05). CONCLUSION The genomic instability of the CDH1 gene is associated with the progression of gastric cancer. MSI at the D16S752 locus may be used as a molecular marker for early gastric cancer, while LOH at this locus mostly occurs in advanced gastric cancer and can be regarded as an effective indicators for malignancy evaluation and prognosis.
Humans ; Stomach Neoplasms/pathology* ; Lymphatic Metastasis ; Cdh1 Proteins/genetics* ; Microsatellite Instability ; Loss of Heterozygosity ; Genomic Instability ; Microsatellite Repeats ; Antigens, CD/genetics* ; Cadherins/genetics*

Since the coronavirus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management and protection of medical staff in the cesarean section is significantly different from that in ordinary surgical operation. This paper reports a case of cesarean section for a woman with COVID-19, which was successfully performed in the First Affiliated Hospital of Zhejiang University School of Medicine on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the pregnant woman during the operation were discussed. Importance has been attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For moderate patients, intraspinal anesthesia is preferred in cesarean section, and try to reduce its influence in respiration and circulation in both maternal and infant; general anesthesia with endotracheal intubation should be adopted for severe or critically ill patients. Ensure the safety of medical environment, and anesthetists should carry out level-Ⅲ standard protection. Special attention and support should be paid to maternal psychology: fully explanation before operation to reduce anxiety; relieve the discomfort during operation, so as to reduce tension; avoid the bad mood due to pain after operation.
Anesthesia ; Betacoronavirus ; isolation & purification ; Cesarean Section ; methods ; Coronavirus Infections ; complications ; Female ; Humans ; Infant ; Injections, Spinal ; Pandemics ; Pneumonia, Viral ; complications ; Pregnancy

Since the corona virus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management in the cesarean section for the patients, as well as the protection for medical staff is significantly different from that in ordinary surgical operation. This paper reports a pregnant woman with COVID-19, for whom a cesarean section was successfully performed in our hospital on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the patients during the operation are discussed. Importance should be attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For ordinary COVID-19 patients intraspinal anesthesia is preferred in cesarean section, and the influence on respiration and circulation in both maternal and infant should be reduced; while for severe or critically ill patients general anesthesia with endotracheal intubation should be adopted. The safety of medical environment should be ensured, and level-Ⅲ standard protection should be taken for anesthetists. Special attention and support should be given to maternal psychology. It is important to give full explanation before operation to reduce anxiety; to relieve the discomfort during operation to reduce tension; to avoid the bad mood of patients due to pain after operation.
Anesthesia ; Betacoronavirus ; Cesarean Section ; Coronavirus Infections ; complications ; surgery ; Female ; Humans ; Infant ; Injections, Spinal ; Pneumonia, Viral ; complications ; diagnosis ; surgery ; Pregnancy ; Pregnancy Complications, Infectious ; surgery ; Pregnancy Outcome ; Preoperative Care

Objective: To observe the impact of cardiac contractility modulation (CCM) on myocardial remodeling in rabbit model of chronic heart failure (CHF) with its possible mechanism. Methods: Rabbit HF model was established by ascending aortic root ligation; the animals were divided into 3 groups: Sham group, the animals received thoracotomy without aortic ligation, HF group and HF+CCM group, the HF animals received CCM treatment for 4 weeks. n=10 in each group. Cardiac function was measured by echocardiography at 12 and 16 weeks in each group respectively; myocardial tissue fibrosis and pathological changes were examined by Masson staining; plasma BNP level was assessed by ELISA; protein expressions of collagen I, collagen II, MMP2,MMP9, TIMP1 and galectin-3 in myocardial tissue were determined by Western blot analysis. Results: ① By echocardiography: with 12 weeks treatment, compared with Sham group, HF group and HF+CCM group had increased LVESD, LVEDD and decreased LVFS, LVEF, all P<0.05; with 16 weeks treatment, compared with HF group, HF+CCM group had improved LVESD, LVEDD, LVEF and LVFS, all P<0.05. ② Pathological changes:compared with Sham group, HF group showed increased collagen content in myocardial tissue, P<0.05; CCM treatment could partially decrease collagen accumulation, P<0.05. ③ After 12 weeks treatment, compared with Sham group, HF group and HF+CCM group presented elevated plasma BNP level, P<0.05; after 16 weeks treatment, compared with HF group, HF+CCM group presented reduced plasma BNP, while it was still higher than that in Sham group, P<0.05. ④ By Western blot analysis: compared with Sham group, HF group demonstrated increased protein expressions of collagen I, collagen II, MMP2, MMP9, TIMP1 and galectin-3 in myocardial tissue; the above indexes were much lower in HF+CCM group while still higher than those in Sham group, all P<0.05. Conclusion: CCM could improve myocardial remodeling in rabbit model of CHF which might be related to down-regulated protein expressions of collagen I, collagen III, MMP2, MMP9, TIMP1 and galectin3 in myocardial tissue.

Objective To explore application of our self-designed U-shaped transdermal surgical navigator based on three-dimensional reverse design in cannulated screwing for femoral neck fracture Methods A retrospective study was done of 5 patients with femoral neck fracture who had been treated from August 2016 to March 2017.They were 3 men and 2 women,aged from 33 to 60 years (average,46.5 years).Thin layer CT scanning was conducted on the patients' affected hip (at the left side in 2 cases and at the right side in 3).Based on their CT data,3D design software and 3D printing technique were used to manufacture the U-shaped transdermal surgical navigator and a real-sized model of the fracture.Operations were simulated using the U-shaped transdermal surgical navigator on the fracture model to determine the angle,depth and location of the screwing.Fixation of the fracture with cannulated screws was conducted after confirmation of satisfactory surgical parameters.The postoperative X-ray films of the patients were reviewed.Evaluations were conducted of the screw position,operating time,volume of operative bleeding,and number of intraoperative X-ray shots.Results The screw positions in the 5 patients were consistent with their preoperative design.Four patients had only one shot of fluoroscopy and one patient 3 shots.Their operating time ranged from 15 to 30 minutes,averaging 22.5 minutes;their bleeding ranged from 5 to 10 mL,averaging 7.5 mL.The 5 patients were followed up for an average of 4.5 months (from 3 to 6 months).By the Harris scoring at their final follow-ups,one was excellent,3 good and one fair.No complications like pain,functional impairment of the joint,or collapse or necrosis of the femoral head occurred during the follow-up.Conclusions Our self-designed U-shaped transdermal surgical navigator based on three-dimensional reverse design can significandy improve the accuracy and safety of the cannulated screwing for femoral neck fractures.The operation is minimally invasive,reducing operating time and intraoperative blood loss.

Objective: To evaluate the testing level of the relevant items in food inspection agency laboratory objectively, analyze the existing problems and help them enhance the ability of detection.Methods: The blind sample assessment of sodium saccharin in drinks was organized and performed.The test samples at high and low concentrations were prepared and studied by the tests of homogeneity and stability.Those met the requirements of blind sample assessment were randomly distributed to 193 laboratories and the returned data were analyzed statistically.Results: Totally 182 valid data were collected.Among the reported results, those from 85 laboratories were satisfied in the low concentration group with the satisfaction rate of 87.6% , those from 12 laboratories were not satisfied, and no results were suspicious;as for the high concentration group, the above data was 67(78.8%), 12 and 6, respectively.The overall satisfaction rate was 83.5%.The results, especially the dissatisfied and suspicious data, were analyzed by the original records of each participating laboratory, the analysis focused on 8 aspects including detection method, instrument brand, control product variety, pretreatment method, recovery rate, column selection and the other influencing factors, and suggestions were given to every laboratory to improve its own situation.Conclusion: The statistical data reflect that our food testing laboratory has strong detection ability in the determination of saccharin sodium in beverages, and can provide powerful technical support for the regulatory authorities.

Objective Aim to explore how severe chyle blood serum effects on the End-point method of colorimetry,velocity method,immunological transmission turbidimetry(TIA)three types of common biochemical tests and their different influ-ences.Methods Collected 20 normal appearance serums,divided each pooled serum into A,B,C,D,E,F and G 7 experimen-tal groups and one control group.Each group contented for 1ml serum.Added intralipid 10,20,40,80,160μl and 320μl to the experimental groups from A to G in turn to prepare into different concentrations of simulate chylous samples.Tested each group by the End-point method of colorimetry,velocity method and TIA which represented by Glucose (Glu),uric acid (UA),Total bilirubin (TBil),aspartate aminotransferase (AST),gamma-glutamyl transpeptidase (GGT),lactate dehydro-genase (LDH),hypersensitive C reactive protein (hs-CRP),Apolipoprotein A1 (apoA1 )andβ2-microglobulin (β2-MG). Used pair T test for both experimental group and their control group.Results In terms of TIA,there were statistical differ-ences between all the experimental groups and their control groups in the three projects (t=-2.842~29.465,P<0.05).In terms of the End-point method of colorimetry,there were statistical differences between all the experimental groups and their control groups (t=-34.942~13.884,P<0.05)except for A group in Glu experiment (t=1.875,P=0.068>0.05).In terms of velocity method,there were no statistical differences between all the experimental groups and their control groups (t=-1.532~1.619,P>0.05)except for the B and C groups in GGT experiment (t=2.234&5.006,P<0.05).Conclusion Severe chyle blood serum had significant influence on the End-point method of colorimetry and TIA,as well as less influ-ence on velocity method.

Objective To discuss the mid?to long?term results and possible prognostic factors of Bernese periacetabu?lar osteotomy for adolescents and young adults with developmental dysplasia of the hip. Methods Bernese periacetabular os?teotomy was performed on 162 patients (171 hips) with hip dysplasia from August 1997 to July 2009. Follow?up data was ac?quirable completely in 123 cases (137 hips), including 30 males (33 hips) and 93 females (104 hips). Age of surgery was 12-48 years (average 27.1 years). The X?ray radiographs and Harris scores were recorded preoperatively and at the last follow?up. The lateral center?edge angle (LCE), acetabular incline angle (AI), continuity of Shenton's line were also recorded. The grades of the hip osteoarthritis were classified by T?nnis classification. Insufficient corrections of osteotomy, excessive corrections of osteotomy, nonunion of the pubis, nerve injuries, and vascular injuries were recorded as complications. Results All the con?tactable cases was followed up again in June and July in 2014. Follow?up duration was 5-17 years (mean, 8.1 years). The LCE angle improved from 7.13° ± 8.86° preoperatively to 30.17° ± 14.98° at the final follow?up. The T?nnis acetabular incline angle decreased from 27.84° ± 12.85° preoperatively to 7.06° ± 10.58° at the final follow?up. The continuity of Shenton's line was in?tact in 106 cases postoperatively, compared with 87 cases preoperatively. Harris score improved from 83.34±9.82 preoperative?ly to 92.79±7.05 at the last follow?up. There was significant correlation between preoperative Harris score and Harris score at the last follow?up. Early complications were observed in 15 cases (15 hips), along with 17 cases (17 hips) of progressions of hip osteoarthritis. Survival rate of the hip at the last follow?up was 97.8%. Conclusion Bernese periacetabular osteotomies can significantly improve bone coverage and joint function of hip dysplasia patients with low rate of short?term complications. Further?more, there was little osteoarthritis progression observed, with good survival rate of the joint in mid?to long?term follow?up. Lower pre?operative Harris scores and higher pre?operative T?nnis classifications are important prognostic factors for post?operative pain.