BACKGROUND: Electromagnetic navigation bronchoscopy is a tool that can accurately navigation peripheral lung lesions. Because of electromagnetic navigation bronchoscopy (ENB) is too expensive, it has not been widely used in China. It is urgent for us to summarize experience in clinical application, especially in the diagnosis of pulmonary nodules. METHODS: The clinical data of patients with pulmonary peripheral lesions (PPLs) in our department undergoing ENB biopsy between July 2017 and December 2018 were retrospectively analyzed. RESULTS: There were 18 patients with 21 PPLs (10 males and 8 females). Among them, 11 patients got the final pathological diagnosis, 8 cases were diagnosed with adenocarcinoma lung cancer, 1 case was diagnosed with tuberculosis and 2 cases were diagnosed with small cell lung cancer. The positive rate of diagnosis was 61.1%. The sensitivity was 73.3%. The positive diagnosis rate is related to the size of the lesion, the positive diagnosis rate for lesions >2 cm is 100.0% (P=0.04). CONCLUSIONS Electromagnetic navigation bronchoscope is safe and effective in clinic. It has a high positive rate for the diagnosis of peripheral lung lesions larger than 2 cm, ENB has broad clinical application prospects.

N-methyladenosine (mA), a ubiquitous RNA modification, is installed by METTL3-METTL14 complex. The structure of the heterodimeric complex between the methyltransferase domains (MTDs) of METTL3 and METTL14 has been previously determined. However, the MTDs alone possess no enzymatic activity. Here we present the solution structure for the zinc finger domain (ZFD) of METTL3, the inclusion of which fulfills the methyltransferase activity of METTL3-METTL14. We show that the ZFD specifically binds to an RNA containing 5'-GGACU-3' consensus sequence, but does not to one without. The ZFD thus serves as the target recognition domain, a structural feature previously shown for DNA methyltransferases, and cooperates with the MTDs of METTL3-METTL14 for catalysis. However, the interaction between the ZFD and the specific RNA is extremely weak, with the binding affinity at several hundred micromolar under physiological conditions. The ZFD contains two CCCH-type zinc fingers connected by an anti-parallel β-sheet. Mutational analysis and NMR titrations have mapped the functional interface to a contiguous surface. As a division of labor, the RNA-binding interface comprises basic residues from zinc finger 1 and hydrophobic residues from β-sheet and zinc finger 2. Further we show that the linker between the ZFD and MTD of METTL3 is flexible but partially folded, which may permit the cooperation between the two domains during catalysis. Together, the structural characterization of METTL3 ZFD paves the way to elucidate the atomic details of the entire process of RNA mA modification.

Objective: To analyze the clinical characteristics and long-term outcomes with multicenter study for acute lymphoblastic leukemia (ALL) in children over 10 years old and adolescents. Method: Newly diagnosed ALL patients aged from 10 to 18 years old in three hospitals were included in the study from May 1^st 2005 to April 30^th 2015. They were received ALL-2005/2009 protocol following up to December 31^st 2016. The clinical characteristics, outcomes and the prognostic analysis were evaluated between the two protocols. Results: Totally, 237 patients were involved in the study, 76 cases for ALL-2005 and 161 cases for ALL-2009 protocol. Complete remission (CR) after induction therapy was 94.5%. 64 (28.6%) patients relapsed with a median time of 14.5 months and 70 (29.5%) patients passed away during the following time. In long-term follow-up, the 5-year event-free survival (EFS) and 5-year overall survival (OS) of ALL patients were (63.1±3.3)% and (68.4±3.2)%. The 7-year EFS and OS were (61.0±3.5)% and (67.6±3.3)%.The 5-year EFS of intermediate risk group in ALL-2005 and ALL-2009 protocol were (73.6±6.1)% and (71.7±4.3)% with no difference (χ²=0.064, P=0.801). The 5-year EFS of high risk group in two protocols were (27.6±9.6)% and (33.9±9.3)%, showing no significant difference (χ²=0.296, P=0.586). Five years relapsed rate of two protocols were (33.8±5.7)% and (32.6±4.1)% with no difference (χ²=0.055, P=0.815). The mortalities were 36.8% and 29.8% separately (χ²=2.869, P=0.090). Univariate analysis indicated that age, male, risk, BCR/ABL translocation/t(9;22) and resistant to induction were risk prognostic factors in long-term survival (χ²=4.764, 4.796, 46.410, 9.560, 25.450; P=0.029, 0.029, <0.001, 0.049, <0.001). Cox multivariate analysis showed male, risk and resistant to induction were independent risk prognostic factors (RR=1.790, 2.727, 2.719; P=0.021, 0.000, 0.012). Conclusion Protocol ALL-2009 enhanced the chemotherapy intensity in intermediate risk group with no benefit of survival. BCR-ABL fusion or t(9;22) translocation was still the risk factor of prognosis. TKI inhibitor used in these patients could improve survival. EFS rate was increased a little and death rate was decreased in ALL-2009 protocol with no significant lower relapsed rate comparing with ALL-2005 protocol.

OBJECTIVETo explore the efficacy and safety of deferasirox in aplastic anemia (AA)patients with iron overload.

METHODSA single arm, multi- center, prospective, open- label study was conducted to evaluate absolute change in serum ferritin (SF)from baseline to 12 months of deferasirox administration, initially at a dose of 20 mg·kg(-1)·d(-1), and the safety in 64 AA patients with iron overload.

RESULTSAll patients started their deferasirox treatment with a daily dose of 20 mg · kg(-1) ·d(-1). The mean actual dose was (18.6±3.60) mg · kg(-1)·d(-1). The median SF decreased from 4 924 (2 718- 6 765)μg/L at baseline (n=64) to 3 036 (1 474- 5 551)μg/L at 12 months (n=23) with the percentage change from baseline as 38%. A median SF decrease of 651 (126-2 125)μg/L was observed at the end of study in 23 patients who completed 12 months' treatment, the median SF level decreased by 1 167(580-4 806)μg/L [5 271(3 420-8 278)μg/L at baseline; 3 036(1 474-5 551)μg/L after 12 months' treatment; the percentage change from baseline as 42% ] after 12 months of deferasirox treatment. The most common adverse events (AEs) were increased serum creatinine levels (40.98%), gastrointestinal discomfort (40.98%), elevated liver transaminase (ALT: 21.31%; AST: 13.11%)and proteinuria (24.59%). The increased serum creatinine levels were reversible and non-progressive. Of 38 patients with concomitant cyclosporine use, 12(31.8%)patients had two consecutive values >ULN, 10(26.3%)patients had two consecutive values >1.33 baseline values, but only 1(2.6%)patient's serum creatinine increased more than 1.33 baseline values and exceeded ULN. For both AST and ALT, no patients experienced two post- baseline values >5 ×ULN or >10 × ULN during the whole study. In AA patients with low baseline PLT count (less than 50 × 10(9)/L), there was no decrease for median PLT level during 12 months' treatment period.

CONCLUSIONSAA patients with iron overload could achieve satisfactory efficacy of iron chelation by deferasirox treatment. The drug was well tolerated with a clinically manageable safety profile and no major adverse events.

Anemia, Aplastic ; drug therapy ; Benzoates ; therapeutic use ; Blood Transfusion ; China ; Ferritins ; blood ; Humans ; Iron ; blood ; Iron Chelating Agents ; therapeutic use ; Iron Overload ; drug therapy ; Liver ; Prospective Studies ; Triazoles ; therapeutic use

Objective To establish a simple ,rapid,highly specific and sensitive molecular detection of carbapenem-resistance acinetobacter baumannii(CRAB)OXA-23 genes,and this method is used to detect the multiple drug-resistant acinetobacter bau-mannii in our hospital,and the purpose is to know the antibiotic resistance of CRAB OXA-23 genes .Methods The loop-mediated isothermal amplification(LAMP)was established for detection of the CRAB OXA-23 genes,and a set of specific primers were de-signed by special software,PrimerExplorer version 4.The LAMP assay was developed on using SYBR Green Ⅰ for fluorescent chromogenic reaction substances,improved through a series of optimization tests,and through macroscopic observation and electro-phoresis test comparison results.At the same time,the application of LAMP was used to test 41 multiple drug-resistant acineto-bacter baumanniis which were collected from December 2013 to March 2014 in our hospitalized patients.Results The ladder ban-ding was produced in CRAB OXA-23 genes strains by the LAMP detection through electrophoresis test,however,no ladder ban-ding was observed in the others .The color of the amplification product in genes strain CRAB OXA-23 changed from orange to green by adding 1 μL SYBR Green Ⅰ,however it was still orange in others.The sensitivity of the LAMP detection in pure cultrue was 5 cfu/μL of the CRAB OXA-23 genes cells.Application of LAMP was used to separate multiple drug-resistant acinetobacter baumanniis from hospitalized patients ,32 strains were tested in 41 strains,the positive rate was 78.04%.Conclusion Separation of the CRAB OXA-23 genes carry rate is higher in our hospital ,and they have very high resistance of commonly used antibacterial drugs.The LAMP method to test OXA-23 gene of CRAB was established in this research was simple ,fast,sensitive and specific. Therefore,it is especially suitable wider use at the grass-roots unit,and it is of great significance for selecting reasonable choice of antibiotics by clinical doctor.

Objective To investigate the length changes of scapholunate interossous ligament (SLIL) at wrist full extension and forearm rotation and the related significance.Methods Eighteen healthy volunteers (12 males and 6 females) aged at 20-38 years (mean,28 years) were divided into forearm rotation group,wrist hyperextension group and wrist hyperextension-rotation group according to the random number table,with 6 cases per group.CT images of the wrist were analyzed and reconstructed in three-dimensions.Length of SLIL in dorsal,proximal and palmar segments was measured in different settings and compared.Results Conpared with the neutral position,lengths of palmar SLIL in distal,middle and proximal parts increased by (1.4 ±0.5)mm,(1.4 ±0.4)mm and (1.3 ±0.4)mm respectively in wrist hyperextension and increased by (0.3 ± 0.1) mm,(0.2 ± 0.1)mm and (0.3 ± 0.1)mm respectively in forearm maximal pronation.At the positions of wrist full extension,hyperextension with radial deviation or forearm maximal rotation,the palmar and part of proximal SLIL were elongated significantly (P ＜ 0.05).At forearm maximal pronation,palmar and part of proximal SLIL were elongated (P ＜ 0.05).Conclusions At wrist full extension,strain is greater in the palmar and proximal components of the SLIL.SLIL is inclined to injury at wrist hyperextension and forearm rotation.

Objective To investigate changes of ligament lengths with the wrist at the neutral and hyperextended positions in vivo. Methods Six volunteers were enrolled in this study.Their wrists were held in 3 controlled positions:the neutral position of the carpus,hyperextension with radial deviation of 0° and hyperextension with radial deviation of 10°.We obtained computed tomography scans of the wrists at the 3 positions for each subject for 3-dimensional reconstruction of the carpal and distal radioulnar joint with customized softvare (Mimics 10.0).A total of 9 palmar and dorsal wrist ligaments were measured for the length changes. Results Lengths of the radioscaphocapitate (RSC),long radiolunate (LRL),radioscapholunate (RSL),ulnocapitate (UC),ulnolunate (UL),ulnotriquetral (UT) ligaments,and the dorsal intercarpal (DIC) inserting on the scaphoid ligament at the position of hyperextension with radial deviation of 0° were significantly longer than those at the neutral position ( P ＜ 0.05) while lengths of the dorsal-radiocarpal (DRC) ligament and the DIG ligament inserting on the trapezoid decreased significantly ( P ＜0.05).From 0°to 10° of wrist radial deviation in hyperextension,the UL,RSC,LRL,DIG inserting on the scaphoid and the trapezoid ligaments decreased significantly in length ( P ＜ 0.05),while UT,UC,RSL and DRC ligaments lengthened significantly (P ＜0.05). Conclusions The RSL,UC and UT ligaments are subjected to higher strain at the position of hyperextension with wrist radial deviation of 10°; the RSC,LRL,UL ligaments and dorsal DIC ligament inserting on the scaphoid are subjected to higher strains at the position of hyperextension; the DRC ligament at the neutral position and the DIC ligament inserting on the trapezoid when the wrist is extended are subjected to less tension.Thses findings will help understand the mechanism and range of the injury to the wrist ligaments.

Objective To evaluate the functional outcome after repair of zone V flexor tendon and to identify the relevant factors affecting the outcome.Methods A total of 52 patients ( 163 fingers) with wrist lacerations involving zone V flexor tendon from September 2003 to July 2009 were retrospectively studied.The average follow-up period was 32 months.The lacerated tendons were repaired by using three suture methods of different strands.Functional outcome was assessed by determining the active range of motion (AROM),and grip and pinch strength of the injured fingers,testing the independent flexor digitorum superficialis (FDS) action and employing the disability of arm,shoulder,and hand (DASH) questionnaire.Influencing factors for function of the repaired tendon including laceration section levels,repair methods,surgeons' experience,and injury severity were analyzed statistically.Results Functionally,146 out of 163 fingers (89.6％) achieved excellent or good range of motion and 103 out of 147 fingers with FDS injury (70.1％ ) obtained independent FDS action.Grip and pinch strength recovered to about two-thirds of the uninjured level.The mean DASH score was 11.9.Patients had adverse functional outcorme in tendons repaired with the 2-strand Kessler,in the tendons repaired by the surgeons with low level of expertise,or in the wrists with Spaghetti injuries,but levels of laceration section had no significant influence on the outcomes.ConclusionsFunctional recovery of zone V flexor tendon injuries is generally good,but repair methods,levels of expertise of surgeons,and injury severity have significant influences on the outcome.Thereby,advanced levels of expertise of surgeons can effectively improve the postoperative function.

Objective Through the statistical analysis of the student assessment on curriculum quality,through the observation of the current curriculum teaching situation and its cheracteristics to promote the curriculum construction effectively and improve the medical teaching quality.Methods The current study is carried out among 2 841 undergraduates who study in varied majors and different grades in a medical university.A table of Student Evaluation of Course Teaching Quality developed by the researcher is applied to the questionnaire survey and statistical analysis including comparation means test and correlation tests are adopted in the present study to analyze the course teaching quality.Results Initially.the National Selected Model Courses show no significant difference from the common courses;secondly,three variables including teaching content adopting the course syllabus,good professional qualification and teaching capability of teachers and advanced teaching methods and techniques ale highly scored among ten variables;thirdly,the correlation coefficient of the variable of improving self-learning ability and total score is statistically significant and it can be observed higher than that of other variables and total score.Conclusion Establishing student-centered curriculum evaluation and construction of long-effect mechanism,and developing the students'ability of autonomous learning ale important to improve the quality ofthe course.

Objective To investigate changes in lengths of the wrist ligaments during wrist radioulnar deviation. Methods Six volunteers were included in the study. CT scans was used to detect the changes under different positions of the wrist in the volunteers. The wrists were scanned from the position of radial deviation of 20° to the one of ulnar deviation of 40° at an interval of 20°. The 3-dimensional carpal and distal radioulnar joint structures were reconstructed with customized software and chauges in length of the palmar and dorsal wrist ligaments in radioulnar deviation were computed. Results From wrist radial deviation to neutral position, the lengths of the radioscaphocapitate ligament, the long radiolunate ligament and the dorsal intercarpal ligament increased significantly (P ＜ 0.05), they increased (2.4±0.3) mm, (2.3±0.8) mm,(1.2±0.6) mm, (1.2±1.2)mm and (2.6±1.0) mm respectively. While from wrist ulnar deviation to neutral position, ulnocapitate ligament and the dorsal radiocarpal ligament increased significantly (P ＜ 0.05), they increased (0.8 ±0.6) nm and (1.0±0.5) mm respectively. Conclusion At wrist radial deviation, the radioscaphocapitate, long radiolunate and dorsal intercarpal ligaments are slack. At wrist ulnar deviation, the ulnocapitate ligament and the dorsal radiocarpal ligament are slack. These positions may be favorable to healing of these ligaments.