Migraine is a common neurological disease,and its pathogenesis is complex.So far,it has not been fully elucidated,nor has it obtained clinically accepted serum biomarkers.Accumulating evidence shows that microRNAs(miRNA),as a class of non-coding regulatory RNAs,not only participate in the pathophysiological mechanism of migraine but also are expected to be a potential biomarker of migraine and play an important role in the pathogenesis of migraine.This article reviews the research on migraine and miRNA,and provides new research ideas for further elucidating the pathogenesis of headache,marker screening,treatment response prediction,and future development of new prevention and treatment drugs.

Hepatolithiasis is one of the most difficult benign diseases in hepatobiliary surgery due to its diverse causes, complex pathogenesis, and high difficulty in therapy. The authors discuss controversial issues in epidemiology, etiology, pathogenesis, and surgical treatment of hepatolithiasis, aiming to explore the research progress and controversial issues, and improve the understanding, diagnosis, and therapy of hepatolithiasis among clinical physicians.

A 57-year-old female patient was treated with secukinumab injection for psoriasis.After the eighth administration,large area of reticular streaks with hyperemia and erosion appeared on the dorsum of the tongue and left buccal mucosa,which improved after three weeks of corticosteroids treatment.The symptoms worsened after re-administration and a diagnosis of an oral lichenoid drug reaction(OLDR)was made,which improved after eight weeks of corticosteroids treatment.There was no recurrence four months after secukinumab injection withdrawal.By correlation analysis,the causal relationship between OLDR and Secukinumab injection was evaluated as"be sure",which had not been reported in China.The clinical manifestations of oral lichenoid drug reactions were unilateral buccal mucosa with hyperemia and erosion.Discontinuation of suspected drugs and topical application of corticosteroids were the most effective treatments.

Background and objective Pembrolizumab(PEM)has been shown to be effective in clinical trials for the treatment of advanced non-small cell lung cancer(NSCLC),but clinical trials were based on cohorts of patients selected on specific criteria,and whether the findings are consistent with real-world patients is debatable.The aim of this study is to evaluate the efficacy and safety of PEM in the treatment of advanced NSCLC based on real-world data.Methods A retro-spective collection of real-world data from patients with advanced NSCLC receiving PEM was conducted.Propensity score matching was used to eliminate inter-group differences and assess the efficacy and safety of PEM compared to chemotherapy.Results Among 450 matched patients,the incidence rates of any-grade adverse events were 79.87％in the PEM group and86.71％inthe chemotherapy group,while the incidence rates of grade＞3 adverse events were 4.03％and 7.31％,respectively.The objective response rates were 48.63％for PEM and 36.00％for chemotherapy(P=0.011).The median progression-free survival was 15.5 months for PEM and 8.8 months for chemotherapy(P＜0.001),and the median overall survival was not reached for PEM and 26.2 months for chemotherapy(P＜0.001).Conclusion PEM treatment for advanced NSCLC demonstrates favorable survival outcomes and acceptable safety in real-world clinical practice.

Migraine is a common type of primary headache worldwide,and its high morbidity and disability rates have brought heavy burden to individuals and society,thereby requiring preventive and acute treatment.Previous thera-peutic strategies for migraine include traditional analgesics and triptans,which are mainly used to relieve pain and reduce accompanying symptoms,but long-term administration of such drugs may lead to medication overuse headache.In recent years,new drugs targeting calcitonin gene-related peptide(CGRP)and its receptors have shown a promising future in the preventive treatment of migraine and the treatment of migraine in the acute stage,such as monoclonal antibodies and small-molecular receptor antagonists,and in addition,they also can be used in patients who have no response to various pharma-cotherapies.This article reviews the recent advances in CGRP drugs in the treatment of migraine.

Objective:To construct the nursing sensitive quality index system for interventional treatment of trigeminal neuralgia, so as to provide reference for the nursing quality evaluation and management of interventional treatment of trigeminal neuralgia.Methods:From June to December 2022, using the "Structure-Process-Results" quality evaluation model as the theoretical framework, an expert inquiry questionnaire was developed based on literature review. The indicator system was established using the Delphi method, and the weights of the indicators were determined using the analytic hierarchy process.Results:The recovery rates of the two rounds of expert correspondence questionnaires were 92.6% (25/27) and 100.0% (25/25), the expert authority coefficients were 0.860 and 0.888, the Kendall's coordination coefficients were 0.073 and 0.058 ( P<0.05), and the coefficient of variation were 0-0.330 and 0-0.191, respectively. Finally, the nursing sensitive quality index system for interventional treatment of trigeminal neuralgia was formed, which included three primary indexes, 14 secondary indexes and 54 tertiary indexes. Conclusions:The index system has strong scientific and clinical applicability, which can provide reference for nursing quality evaluation and management of interventional treatment of trigeminal neuralgia.

Objective:To analyze the clinical and laboratory characteristics of acute myeloid leukemia (AML) patients with NPM1 mutation, and to explore the prognostic factors.Methods:A total of 77 AML patients with NPM1 gene mutation admitted to Hebei Yanda Ludaopei Hospital from May 1st 2012 to December 31st 2021 were enrolled in the study, including 34 male and 43 female patients. The median age was 40 (3, 68) years old. Patients were selected and divided into 4 groups according to the morphological FAB classification. There were 29 cases (37.7%) of M1 type, 13 cases (16.9%) of M2 type, 23 cases (29.9%) of M4 type, and 12 cases (15.5%) of M5 type. The clinical characteristics, bone marrow/peripheral blood cell morphology, immunophenotype, cytogenetics, molecular biology and overall survival of different groups were retrospectively analyzed, and the risk factors affecting the prognosis of AML were also explored. Cox multivariate regression was used to analyze the clinical influencing factors of survival and prognosis.Results:The white blood cell counts were highest in M4 and M5 patients and lowest in M2 patients, while no significant difference in the red blood cell, hemoglobin, and platelet counts( P>0.05). Morphologically, there were significant differences in the percentage of blasts and blasts with cup-like nuclei on bone marrow (BM) and peripheral blood (PB). The proportion of blasts in BM and PB was the highest in M1 and the lowest in M2 ( P<0.001). The positive rate of blasts with cup-like nuclei was the highest in M1 and the lowest in M5 of BM ( P<0.001), while the highest in M2 and the lowest in M5 of PB ( P=0.006). The scores of myeloperoxidase and chloroacetate esterase were all the highest in M1 and the lowest in M5 ( P<0.001, 0.001, respectively). In terms of molecular biology, the occurence rate of blasts combined with DNMT3A mutation was the highest in M4 and the lowest in M2 ( P=0.044), while those combined with FLT3-ITD mutation was the highest in M4 and the lowest in M5 ( P=0.002). In immunophenotype, there were significant differences in the expression positivities of seven antigens including HLA-DR, CD56, CD11c, CD15, CD14, CD96 and cMPO ( P<0.05). Multivariate COX regression analysis showed that no recurrence after treatment ( P<0.001), complete remission after treatment ( P=0.015) and transplantation ( P<0.001) were correlated with overall survival (OS). No recurrence after treatment ( P=0.033), transplantation ( P=0.027), no mutation of FLT3-ITD ( P=0.040), and hemoglobin concentration ( P=0.023) were associated with relapse-free survival (RFS). Survival analysis by Kaplan-Meier curve showed that there was no significant difference in survival time between the M1, M2, M4 and M5 groups in OS and RFS. Conclusion:There were significant differences in the white blood count, the percentage of blasts and blasts with cup-like nuclear morphology, cytochemical staining (MPO integration, CE integration and percentage of NAS-DCE), gene mutation (DNMT3A and FLT3-ITD) and immunophenotypes (HLA-DR, CD56, CD11c, CD15, CD14, CD96 and cMPO) between the four groups. The multivariate analysis revealed that no recurrence after treatment and transplantation were independent prognostic factors in NPM1 mut AML patients. On the other hand, FLT3-ITD mutation and hemoglobin concentration were associated with RFS and complete remission after treatment was associated with OS in the entire NPM1 mut cohort.

Objective:To evaluate the standardized residency training of obstetrics and gynaecology in Shengjing Hospital of China Medical University with Milestones evaluation system of obstetrics and gynecology, and to evaluate the feedback effect of the system.Methods:An improved Milestones evaluation form was developed to evaluate the self-evaluation and clinical tutor's scores, collect the results and make a statistical analysis of the 1-3 years standardized training residents of the Shengjing Hospital of China Medical University in September 2019. GraphPad Prism 8 software was used for data collection and statistical analysis, and Box-Plots software was used for drawing analysist. Descriptive statistics method was used for the general situation of the research objects. After the students' self-evaluation and tutor's scores passed the normal distribution and variance homogeneity test, paired t test was performed, and the scores of residents from different sources were analyzed by variance analysis. Results:A total of 164 residents of obstetrics and gynaecology were evaluated, and there were significant differences between self-evaluation and teacher's evaluation in medical knowledge, learning ability and system work ( P<0.05). The competency scores of the first year residents ranged from 3.003 to 4.556, and at the end of the course they increased to 4.921 to 5.974, showing statistically significant differences in each item compared with the first year ( P<0.001). After three years of training, residents from different sources showed significant improvement ( P<0.001). Conclusion:The Milestones evaluation system of the obstetrics and gynecology can be used for the training assessment and feedback of the residents in obstetrics and gynecology specialty. The self-assessment of residents helps to understand the level of self-assessment, and the teacher's evaluation helps to correct the bias generated by self-assessment. The systematic and staged Milestones evaluation system can instruct the clinical tutors to instruct the residents in accordance with their aptitude, and give feedback on the training effect of the residency training base.

Antibodies, Antinuclear ; Autoantibodies ; China ; Cohort Studies ; Humans ; Scleroderma, Systemic

Objective:To investigate the efficacy of venlafaxine combined with transcranial direct current stimulation in the treatment of postpartum depression and its effects on neurological function.Methods:A total of 135 patients with postpartum depression who were admitted to Wenzhou Seventh People's Hospital from November 2019 to October 2021 were included in this study. They were randomly divided into observation ( n = 70) and control ( n = 65) groups. The control group was treated with venlafaxine alone, and the observation group was treated with an IS200 intelligent electrical stimulator based on the treatment used in the control group. The two groups were treated for 4 weeks. Clinical efficacy and neurological function were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group (98.57% vs. 89.23%, χ2 = 7.61, P < 0.05). After treatment, the scores of Edinburgh Postnatal Depression Scale and Hamilton Depression Scale in the observation group were (8.03 ± 0.79) points and (9.03 ± 3.98) points, respectively, which were significantly lower than (11.74 ± 0.98) points and (14.68 ± 3.79) points in the control group ( t = 3.28, 4.65, both P < 0.05). Standard deviation of heart rate variability, root mean square of successive differences between adjacent NN intervals, ratio of low frequency to high frequency, activity of the autonomic nervous system in the observation group were (32.38 ± 0.93) ms, (27.86 ± 0.78) ms, 1.79 ± 0.19, (86.65 ± 1.21) points, respectively, which were significantly higher than (27.84 ± 0.88) ms, (25.79 ± 0.81) ms, 1.38 ± 0.14, (82.94 ± 1.19) points in the control group ( t = 4.09, 3.72, 2.98, 4.09, all P < 0.05). Conclusion:Venlafaxine combined with transcranial direct current stimulation for treatment of postpartum depression can enhance clinical efficacy and remarkably improve patient's neurological function.