Immune checkpoint inhibitor(ICI)associated diabetes mellitus(DM)a rare specific type of diabetes,usually developed after the treatment of programmed cell death protein 1(PD-1)inhibitor or programmed cell death ligand 1(PD-L1)inhibitor.We reported 4 cases of DM after ICI use.These patients had a subacute onset,6 to 17 months after the first use of the drug,with diabetic autoantibodies negative.Pancreas atrophy was observed in one of them.All of the patients received treatment of insulin.

Placental implantation disorders (PAS) have become the main cause of postpartum hemorrhage and perinatal hysterectomy. The risk of placental implantation surgery is high. It is important to conduct screening and diagnosis of high-risk patients with PAS, promptly refer patients with severe PAS, choose appropriate surgical opportunities, form a multidisciplinary team, conduct reliable preoperative evaluation and sufficient preoperative preparation, develop reasonable surgical plans and rescue plans, and have experienced doctors perform the surgery to minimize the risk. Standardized management of clinical diagnosis and treatment for patients will help improve pregnancy outcomes, reduce hysterectomy rates, and reduce severe complications and mortality rates in pregnant and postpartum women.

Objective: Analysis of the effect of triggering receptor-1 expressed on myeloid cells (TREM-1) in nonalcoholic fatty liver disease (NAFLD) and the mechanism. Methods: The oleic acid-treated HepG2 cells were divided into model group, overexpression group, interference group A, interference group B and negative control group. The mouse model of NAFLD was generated and randomly divided into (nuclear factor-κB) NF-κB inhibition group, protein kinase B (AKT) inhibition group, knockout group A, knockout group B and control group. The expression of inflammatory factors and TREM-1 in liver tissue was detected by PCR, and fat accumulation was detected by oil red O staining. Western blotting was used to detect the expression of TREM-1 and signaling pathway proteins, and HE staining was used to detect liver tissue changes. Results: TREM-1 was up-regulated in liver tissue of NAFLD mice [(0.936±0.127) vs. (0.432±0.105)] and in oleic acid-treated HepG2 cells. In oleic acid-treated HepG2 cells, overexpression of TREM-1 increased inflammatory factor expression and increased lipid droplets; inhibition of TREM-1 expression decreased inflammatory factor expression, and lipid droplets decreased. Knockout of TREM-1 and inhibition of NF-κB in NAFLD mice reduced hepatocyte inflammatory factor expression and reduced liver damage; knockout of TREM-1 and inhibition of AKT reduced liver tissue lipids and drops accumulate. Conclusions The overexpression of TREM-1 in NAFLD mice liver tissue can regulate inflammatory factor expression and lipid droplets through NF-κB and AKT signal pathway. TREM-1 might be a potential therapeutic target of NAFLD.

Objective To discuss the clinical effect of perioperative bundle of care for patients with advanced hepatocellular carcinoma (HCC) who are receiving CT-guided percutaneous minimally-invasive argon-helium knife cryoablation.Methods A total of 30 HCC patients,who underwent percutaneous argonhelium knife cryoablation,were enrolled in this study.Perioperative measures based on the concept of bundle of care were implemented,which included training of nursing team members,perfect preoperative psychological nursing,dietary guidance,preoperative routine preparations,effective intraoperative guidance and close observation of the patient's condition,postoperative activity guidance,prevention and observation of complications,etc.Results All 30 advanced HCC patients could actively cooperate with physicians for the performance of percutaneous argon helium cryoablation.After the treatment,two patients developed nausea and vomiting and one patient developed chills and fever,which were improved after symptomatic treatment.All the 30 patients recovered well during the perioperative period and were discharged from hospital smoothly.Conclusion Perioperative bundle of care can help patients restore the surgical damage as soon as possible,reduce the pain and improve the quality of life.

With the increasing incidence of osteoporosis, osteoporotic vertebral compression fracture (OVCF) has become a common disease in the elderly. Relevant researches have indicated that percutaneous vertebroplasty (PVP) has become the main treatment for painful osteoporotic vertebral compression fractures. In aspect of perioperative nursing care for PVP, both domestic and foreign scholars have published a large number of research reports, indicating that perioperative nursing intervention can alleviate the pain, reduce the incidence of complications, improve the quality of life of patients, and promote rehabilitation. This article aims to make a comprehensive review about the perioperative nursing care for patients with osteoporotic vertebral compression fractures who are receiving PVP so as to provide reference for clinical nursing staff in the implementation of nursing intervention. (J Intervent Radiol, 2018, 27:290-293)

Objective:To evaluate the feasibility and therapeutic efficacy of transhepatic arterial embolization with superparamagnetic iron oxide (SPIO) and lipiodol (LIP) for the treatment of VX2 tumor in rabbits.Methods:Twenty-four rabbits with hepatic VX2 tumors by surgical implantation were randomly divided into 4 groups and treated with transhepatic arterial embolization of 4 different agents as follows (n=6 each):doxorubicin (DOX) group,DOX-LIP group,SPIO-DOX group,and SPIO-DOX-LIP group.Liver function (AST and ALT) was measured at 0,1,3,5 and 7 d after transhepatic arterial embolization.The serum DOX level was measured at 0,5,15,30,60,and 120 minutes after transhepatic arterial embolization.MRI was performed at 7 d after the treatment to assess the distribution of SPIO in the SPIO-DOX group and SPIO-DOX-LIP group,while CT was performed to assess the distribution of LIP in the DOX-LIP group and SPIO-DOX-LIP group.All the rabbits were sacrificed and their livers were removed at 7 d after treatment for the detection of tissue DOX level.The histopathologic examinations were performed including HE staining,Prussian blue staining and TUNEL assay,and then the tumor necrosis percentage and apoptosis index were calculated.Results:Compared to the DOX group,the levels of AST and ALT in other 3 groups were significantly elevated at 1 and 3 d after embolization (P＜0.05).The levels of ALT and AST in the DOX group,DOX-LIP group or SPIO-DOX-LIP group returned to the baseline at day 7,there were no significant differences (P＞0.05).The SPIO-DOX-LIP group exhibited the lowest serum DOX level at all time points up to 120 minutes after embolization (P＜0.05).However,the tissue DOX level in the SPIO-DOX-LIP group was the highest among all groups at day 7 (P＜0.05).The SPIO-DOX group and SPIO-DOX-LIP group showed significantly lower MRI signal intensity of tumors in T2 weighted imaging (T2WI) at day 7.Meanwhile DOX-LIP group and SPIO-DOX-LIP group showed that high-density lipiodol was deposited in the tumors in CT images.Histopathologic findings showed an almost complete central necrosis coagulation of tumors in the SPIO-DOX-LIP group,and the tumor necrosis percentage and tumor apoptosis index were significantly increased in the SPIO-DOX-LIP group compared to those in other 3 groups (P＜0.05).Conclusion:This novel drug-delivery system of SPIO nano-drug carrier together with LIP is safe and feasible when it is used for transhepatic arterial embolization for liver tumor.It provides an excellent MR and CT visualization and improves the therapeutic efficacy for the treatment of rabbit VX2 liver tumor.

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10⁹/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10⁹/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10⁹/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10⁹/L) at 4^th week, 8^th week and 12^th week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10⁹/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

Objective To evaluate the effect of discussion-based teaching pattern in clinical noviciate of general surgery. Methods Two hundred and ten students majoring in clinical medicine were randomly divided into the trial group and the control group during clinical noviciate of general surgery.There were 105 students in each group. The discussion-based teaching pattern and traditional teaching pattern were performed in the trial and control groups,respectively. After the clinical novici-ate of general surgery was completed,the teaching effects of both groups were evaluated by the exam-ination performance analyses and the questionnaire-based survey. Student's t-test andχ22 test were used in statistical analysis. Reults The rate of satisfaction with the teaching pattern was 88.6%in the trial group and 70.5%in control group(P<0.05). The mean scores in the trial group and control group were 80.3±9.2 and 74.5±11.3,respectively (P<0.05). The pass rate of examination in the trial group and control group were 97.1% and 88.6%,respectively (P<0.05). The excellence rate in the examination was 24.8%in the trial group and 12.4%in control group (P<0.05). The overwhelming majority of stu-dents in the trial group thought that the discussion-based teaching pattern had more advantages in im-proving students' learning initiative and enthusiasm,ability to analyze and solve problems,etc.,acord-ing to the questionnaire-based survey. Conclusions Discussion-based teaching is an effective teach-ing pattern and superior to the traditional teaching pattern.

Objective To investigate the immunogenicity of mycobacteriophage D29 (phage D 29) in guinea pig models with different delivery routes,and provide information for the application of phages in tuberculosis (TB) therapy.Methods Hartley guinea pigs were administrated with phage D29 through inhalation,intranasal drop or subcutaneous injection for 6 times within 35 days.7H9 broth aerosol inhalation and 0.85 ％ NaCl solution aerosol inhalation were set as solvent and negative controls,respectively.Anti-phage D29 neutralizing antibodies in sera collected weekly were measured by phage reduction neutralizing test (PRNT) and cytokine levels (interleukin-2,interleukin-4 and interferon-γ) were detected at day 35 by enzyme linked immunosorbent assay (ELISA).The data were analyzed by ANOVA and nonparametric test.ResultsNeutralizing antibodies were both negative in two control groups,while low-titer neutralizing antibodies (below 1 ∶ 100) appeared in inhalation and intranasal drop groups only at day 7 and day 14. Nevertheless, neutralizing antibodies were continuously detected in subcutaneous injection group,which increased rapidly and reached 1∶ 16 365.6 at day 35. After 35 days of experiments,serum concentrations of interleukin-2 (x2 =2.7605,P＞0.05),interleukin-4 (F=2.17,P＞0.05) and interferon-γ(F=0.75,P＞0.05) among three treatment groups and two control groups were all not significantly different.ConclusionsThe titer of anti-phage 29 neutralizing antibodies induced by inhalation or intranasal drop administration of phage D29 are both significantly lower than subcutaneous injection.Phage D29 administration doesn’t change the levels of cytokines,which indicates that it may not break the helper T cell (Th)1/Th2 balance.

ObjectiveTo investigate the role of iNOS in the middle and late stage of pulmonary hypertension (PH) and the effect of L-Arginine(L-Arg) on these stage.MethodsThirty healthy male SD rats were randomly divided into five groups.All rats except those in control group were injected intraperitoneally (ip) with a single dose (50 mg/kg) of MCT to induce PH.Then the L3 and L5 groups were injected ip with 500 mg/kg L-Arg daily for 3 weeks and 5weeks respectively,the M3 and M5groups received a daily ip injection of the same amount of saline as L-Arg for 3 weeks and 5 weeks respectively; the same amount of saline was injected ip daily in control group for 5 weeks.Right ventricular systolic pressure(RVSP) was measured before lungs were excised for immunohistochemistry at the end of experiments. ResultsThe expressions of iNOS and elastin in M3 and M5 were higher compared to the control group,but L-Arg partly reduced the expressions of iNOS and elastin both at 3weeks and 5 weeks post-MCT.The reduction of eNOS expression in L3 and L5 groups were lower compared to M3 and M5 groups,but the eNOS expression in L3 and L5 groups were still lower than control group.ConclusionDuring the middle and late stage of PH,the expression of eNOS was decreased.The expression of iNOS was induced,which would produce numerous NO.However,these NO had no benefit on the development of PH.L-Arg could restore the balance of eNOS and iNOS,and could inhibit the development of PH,which may provide a new clues to explore the pathogenesis and treatment of PH.