Objective To summarize the experience of integrative palliative care at Peking Union Medi-cal College Hospital and provide a reference for promoting the integrative palliative care model.Methods Twenty cases receiving integrative palliative care at Peking Union Medical College Hospital were collected.The clinical characteristics,reasons for initiating integrative palliative care,the process of integrative palliative care,and feedback from these cases were summarized.Results Insomnia(11 cases,55％)and pain(9 cases,45％)were the most common symptoms requiring control in the 20 cases.The integrative palliative care team assisted in medical decision-making for 17 cases(85％),prepared end-of-life for 9 cases(45％),assisted in the transfer for 3 cases(15％),and provided comfort care for all the 20 cases(100％).Conclusions The integrative palliative care model can help alleviate suffering in end-of-life patients and provide support to patients'families and the original medical teams.This model is worth further promotion within class A tertiary hospitals.

BACKGROUND: In light of the significant clinical benefits of antibody-drug conjugates in clinical trials, the human epidermal growth factor receptor 2 (HER2)-low category in breast cancers has gained increasing attention. Therefore, we studied the clinicopathological characteristics of Chinese patients with hormone receptor (HR)-positive/HER2-low early-stage breast cancer and developed a recurrence risk prediction model. METHODS: Female patients with HR-positive/HER2-low early-stage breast cancer treated in 29 hospitals of the Chinese Society of Breast Surgery (CSBrS) from Jan 2015 to Dec 2016 were enrolled. Their clinicopathological data and prognostic information were collected, and machine learning methods were used to analyze the prognostic factors. RESULTS: In total, 25,096 patients were diagnosed with breast cancer in 29 hospitals of CSBrS from Jan 2015 to Dec 2016, and clinicopathological data for 6486 patients with HER2-low early-stage breast cancer were collected. Among them, 5629 patients (86.79%) were HR-positive. The median follow-up time was 57 months (4, 76 months); the 5-year disease-free survival (DFS) rate was 92.7%, and the 5-year overall survival (OS) rate was 97.7%. In total, 412 cases (7.31%) of metastasis were observed, and 124 (2.20%) patients died. Multivariate Cox regression analysis revealed that T stage, N stage, lymphovascular thrombosis, Ki-67 index, and prognostic stage were associated with recurrence and metastasis ( P <0.05). A recurrence risk prediction model was established using the random forest method and exhibited a sensitivity of 81.1%, specificity of 71.7%, positive predictive value of 74.1%, and negative predictive value of 79.2%. CONCLUSION: Most of patients with HER2-low early-stage breast cancer were HR-positive, and patients had favorable outcome; tumor N stage, lymphovascular thrombosis, Ki-67 index, and tumor prognostic stage were prognostic factors. The HR-positive/HER2-low early-stage breast cancer recurrence prediction model established based on the random forest method has a good reference value for predicting 5-year recurrence events. REGISTRITATION ChiCTR.org.cn, ChiCTR2100046766.
Humans ; Female ; Breast Neoplasms/diagnosis* ; Ki-67 Antigen ; Receptor, ErbB-2 ; Prognosis ; Thrombosis ; Receptors, Progesterone

Objective:To investigate the dynamic changes of routine laboratory parameters during the course of hemorrhagic fever with renal syndrome (HFRS) and estimate the predictive value for the severity of the disease.Methods:A retrospective cohort study was conducted, which enrolled 394 HFRS patients admitted to the Second Affiliated Hospital of Air Force Medical University (374 cases) and the Second Affiliated Hospital of Xi′an Jiaotong University (20 cases) from January 2019 to January 2022. The patients were divided into mild (mild and moderate) and severe (severe and critical) groups.The basic information, personal history, past history, treatment, complications and other clinical data of patients were collected and the results of the laboratory examinations in the morning at day 1, 2, 3, 4, 5, 7, 10, 15, 20 and 25 of hospitalization and before discharge were recorded. The dynamic changes of the patients′ routine laboratory indicators and the dynamic predictive values of each indicator for severe condition were analyzed. Mann-Whitney U test and chi-square test were used for comparison, and receiver operator characteristic (ROC) curve was used for predictive value evaluation. Results:The age of 212 patients in the mild group was 38(27, 61) years, and that of 182 patients in the severe group was 49(32, 64) years, the difference was statistically significant ( Z=-2.24, P=0.025). The incidences of acute pancreatitis, acute respiratory distress syndrome, multiple organ dysfunction syndrome, the utilization rates of blood purification and mechanical ventilation in the severe group were 6.0%(11/182), 12.6%(23/182), 19.8%(36/182), 89.6%(163/182) and 22.5%(41/182), respectively, and those in the mild group were 0(0/212), 0(0/212), 0(0/212), 15.6%(33/212) and 0.5%(1/212) respectively, and the differences were all statistically significant ( χ2=13.18, 28.45, 46.15, 214.48 and 50.02, respectively, all P<0.05). The levels of white blood cell count, lymphocyte count, monocyte count and neutrophil count were all increased rapidly after onset and peaked at days 4 to 6 of illness, with the counts of 14.2(9.7, 20.7)×10 9/L, 4.2(2.3, 6.2)×10 9/L, 1.5 (0.8, 3.3)×10 9/L and 8.3(4.3, 11.4)×10 9/L, respectively. Aspartate aminotransferase peaked (102(66, 178) U/L) within three days after onset and then decreased rapidly, returned to normal level by day 12. Blood urea nitrogen and creatinine both increased steadily after onset, peaked at day 9 to 10, with the levels of 13.2(7.7, 19.1) mmol/L and 255.4(122.9, 400.9) μmol/L, respectively. Prothrombin time, activated partial thromboplastin time, fibrinogen degradation products and D-dimer levels at day 3 after onset were 12.7(12.0, 13.2) s, 38.7(33.5, 51.9) s, 12.6(6.9, 32.0) mg/L and 4.9(2.2, 13.7) mg/L, respectively.Platelet count at day 4, neutrophil count at day 5, creatinine at day 11 and blood urea nitrogen at day 14 after onset had decent predictive values for estimating severity, of which the area under curve (AUC) values were 0.801(95% confidence interval (95% CI) 0.727 to 0.875), 0.824(95% CI 0.770 to 0.878), 0.862(95% CI 0.805 to 0.919) and 0.810(95% CI 0.722 to 0.897), respectively. Conclusions:Routine blood count, liver function and coagulation are important reference indicators for early warning of severe disease of HFRS, while with the progress of the disease, renal function indicators are effective in differentiating the severity of the disease. The platelet count at day 4, neutrophil count at day 5, creatinine at day 11 and blood urea nitrogen at day 14 after onset have predictive values for severe HFRS.

Objective Aiming at the problems of many items and long time to fill in the Constitution in Chinese Medicine Questionnaire(CCMQ)when evaluating individual constitution,the research uses artificial intelligence technology to select attributes,and to help construct a short version of the CCMQ.Methods Analyzing the constitution data provided by the Physical Examination Department of Jiangsu Province Hospital of Traditional Chinese Medicine,there are specific target variables as the classification of constitution types.Feature selection of genetic algorithm,cross-validation and KNN classification algorithm are used as filters to select problems,and the effect is evaluated by problem subset size,KNN classification accuracy and filling time.Results The method selected a short version of the CCMQ with 31 problems,and the average classification accuracy in the model was 86.16%,and the time was improved by 47.7%.Conclusion The algorithm can effectively find a better problem subset,achieve dimensionality reduction and have certain accuracy,thus helping to simplify the CCMQ.

BACKGROUND: : Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors. METHODS: : Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed. RESULTS: : Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4-76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750-0.880). CONCLUSIONS: : Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years. TRIAL REGISTRATION : ChiCTR.org.cn, ChiCTR2100046766.
Breast Neoplasms/metabolism* ; Female ; Humans ; Ki-67 Antigen ; Mastectomy ; Receptor, ErbB-2/metabolism*

Objective:To explore the expression of long non-coding RNA (lncRNA) CDK5RAP3 in gastric cancer tissue and its regulatory effect on gastric cancer cell proliferation and invasion.Methods:The expression differences of CDK5RAP3 in gastric cancer tissues and adjacent tissues were analyzed by TCGA database. By transfecting the pcDNA3.1-CDK5RAP3 plasmid into Hs-746T cells, a gastric cancer cell line overexpressing CDK5RAP3 (CDK5RAP3 group) was constructed, and the pcDNA3.1 plasmid was transfected into Hs-746T cells as a control group. The changes of CDK5RAP3 expression in the two groups of cells were detected by real-time quantitative PCR (qRT-PCR). The effects of overexpression of CDK5RAP3 on the proliferation and invasion of Hs-746T cells were detected by CCK-8 assay and Transwell assay, respectively. The binding sites of CDK5RAP3 and miR-223-3p were predicted by the starBase v2.0 database. The direct binding of CDK5RAP3 and miR-223-3p was verified by dual-luciferase reporter gene experiment. The expression levels of miR-223-3p in Hs-746T cells in each group were detected by qRT-PCR. Western blot was used to detect the expression levels of proliferation proteins and invasion proteins in Hs-746T cells in each group. The experimental data were analyzed by SPSS 17.0 software, and the measurement data conforming to the normal distribution were expressed as Mean±SD. The t-test was used to compare between two groups, and the one-way analysis of variance was used to compare the means of multiple groups. Results:Compared with adjacent tissues, the expression level of CDK5RAP3 in gastric cancer tissues was significantly lower ( P<0.01). The expressions of CDK5RAP3 in Hs-746T cells in the control group and CDK5RAP3 group were (1.08±0.77) and (10.63±2.14), respectively, and the difference was statistically significant ( P<0.01). Up-regulation of CDK5RAP3 significantly decreased the proliferation activity of Hs-746T cells ( P<0.05). The number of invasive cells in the control group and CDK5RAP3 group were (137.80±28.72) and (57.76±24.95), respectively, and the difference was statistically significant ( P<0.01). CDK5RAP3 could directly bind miR-223-3p ( P<0.01). The expression of miR-223-3p in Hs-746T cells in control group and CDK5RAP3 group were (6.22±1.20) and (1.01±0.98), respectively, and the difference was statistically significant ( P<0.01). Compared with the control group, up-regulation of CDK5RAP3 significantly reduced the expression levels of proliferation and invasive proteins. Conclusion:The expression of CDK5RAP3 is low in gastric cancer tissue, and CDK5RAP3 inhibits the proliferation and invasion of gastric cancer Hs-746T cells by targeting miR-223-3p.

Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound . Methods Ninety-five fetuses with a little or mild tricuspid regurgitation ( control group) and 60 fetuses with moderate and severe tricuspid regurgitation (observation group) were included . The degree ,velocity ,and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared . As for the follow -up on observation group ,the pressure of fetus with high pulmonary systolic pressure ( > 20 mmHg) was repeatedly measured every 4 weeks until it return to normal . Results There were significant differences in terms of gestational weeks ,velocity and pressure of tricuspid regurgitation ,as well as pulmonary systolic pressure between the two groups ( P < 0 .001) . Pulmonary systolic pressure was positively correlated with gestational weeks , velocity and pressure of tricuspid regurgitation ( r = 0 .442 ,0 .998 ,0 .999 ;all P < 0 .001 ) ,but had no correlations with the age of pregnant women ( r = - 0 .001 , P = 0 .674) . The follow-up revealed that ,in observation group , 47 cases ( 78 .3％ , systolic pressure < 50 mmHg ) presented with the decreased pulmonary systolic pressure ,the disappeared or the slight appeared regurgitation before birth ,meanwhile , 13 ( 21 .7％ ,systolic pressure ≥ 50 mmHg) exhibited severe tricuspid regurgitation and persistent pulmonary elevation ,with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure . Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia ( oxygen saturation <45％ ) . The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth ,with normal heart function . Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid regurgitation is reversible functional alteration , which can restore normality in most cases before or after birth .

Objective To investigate serum levels of interleukin(IL)-22 in typeⅠhypersensitivity disease patients with monosensitization and polysensitization,inhaled allergens and food allergens,and explore the correlation between IL-22 levels and allergens.Methods A total of 100 patients with typeⅠhypersensitivity disease and 30 normal controls were recruited in this study.Western blot and enzyme-linked immuno sorbent assay were used to detect 19 types of allergens′ specific IgE antibody and IL-22 concentrations,respectively.Results Serum level of IL-22 was positive correlated with the number of sensitized allergens(r=0.318,P=0.001).The levels of IL-22 in polysensitization patients,monosensitization patients and normal controls were 24.52(20.41,29.27),22.02(15.25,25.59),18.06(16.02,23.04)pg/mL respectively.IL-22 in polysensitization patients(n=42) were higher than those in monosensitization patients(n=58) and normal controls(U=867.500 and 229.000,P<0.05,respectively).Compared with the normal controls,the IL-22 level was also higher in monosensitization patients(U=608.000),the difference was significant(P<0.05).However,there was no significant difference on IL-22 between inhaled allergens patients(n=34) and food allergens patients(n=24)(t=0.082,P>0.05).Conclusion Serum level of IL-22 increases in type Ⅰhypersensitivity disease patients,was is positive correlated with the number of sensitized allergens.

Objective To establish and evaluate the CaV1?1?R528H gene knock?in mouse model of thyrotoxic hy?pokalemic periodic paralysis. Methods Thirty?six 8?week?old male CaV1?1?R528H gene knock?in mice and thirty?six 8?week?old wild?type male C57BL/6J mice were used in this study. Using three?factor two?level 2 × 2 × 2 factorial design ( the three factors including mutation, thyroxine and insulin, and two levels were with or without) , the mice were divided into 8 groups. The thyroxine groups were intraperitoneally injected with levothyroxine in a dose of 350 μg/kg once per day for 12 consecutive days to produce thyrotoxicosis. The insulin groups were intraperitoneally injected with short?acting insulin in a dose of 0?8 U/kg after the last administration of levothyroxine, and the potassium levels of different groups were meas?ured and recorded before (0 min) and after insulin injection (30 min, 60 min). Results (1) Compared with the control group, the following phenomena including irritability, dull coat, increased diet and water intake, and slow body weight gain, were observed in the thyrotoxic mice. Thyroid function tests showed that the levels of T3 and T4 in the thyrotoxic mice were significantly higher than those in the corresponding control mice (P<0?05), and the TSH level was significantly low?er than that of the corresponding control mice (P<0?05 ). (2) After administration of insulin or thyroxine alone, the po?tassium levels in the mutant and wild?type mice were not significantly different. However, after combined administration of thyroxine and insulin, the potassium levels in the mutant group were significantly lower than those in the wild?type mice at 30 min and 60 min ( P<0?05 for both). (3) The main effects and interactions:Mutation factor or thyroxine factor alone did not influence on the potassium level, only insulin showed hypokalemic effect (P<0?05). There were interactions be?tween thyroxine and mutation, and between insulin and mutation (P<0?05), but no interaction between thyroxine and in?sulin. Conclusions (1) A thyrotoxicosis state in mice is successfully developed in this study. (2) An CaV1?1?R528H gene knock?in mouse model of thyrotoxic hypokalemic periodic paralysis is successfully established.

Objective To evaluate the clinical value of the real-time three-dimensional ultrasound in the diagnosis of the fistula-in-ano.Methods One hundred and eighteen fistula-in-ano patients were examined using conventional and three-dimensional ultrasound,the stereotaxis of interal opening and the shape of the fistula-in-ano were analyzed.Then the diagnosis results of ultrasound were compared with the surgery and pathology.Results In 1 1 8 patients,the accuracy of preoperative identifying internal opening by two-dimensional ultrasound was 85%,and 95% for three-dimensional ultrasound with statistically significant difference (χ2 =6.679,P <0.05).For complex anal fistula,the diagnostic accuracy rates of main fistula tract by three-dimensional ultrasound (100%,82/82 )was higher than that by two-dimensional ultrasound(95%,78/82),the difference was statistically significant (χ2 =4.100,P <0.05 ).In 82 cases of complex anal fistula,the diagnostic accuracy of branch fistula tract by two-dimensional ultrasound was 70%(57/82 ),the accuracy using three-dimensional ultrasound was 89% (73/82 ),there was statistically significance (χ2 =9.499,P < 0.05 ).Conclusions Three-dimensional ultrasound can accurately locate the interal opening of fistula-in-ano and determine the shape of fistula-in-ano,which provided the most intuitive information for clinical treatment and had high practical value.