Objective:To investigate the effect of Mini-Clinical Evaluation Exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in ophthalmology practice training in the integrated teaching of sensory system diseases.Methods:The medical students in the five-year program who entered the stage of ophthalmology practice in the integrated teaching of sensory system diseases in The Second Clinical College of Chongqing Medical University, were selected as research group, and the medical students in the five-year program who received training from October 2020 to July 2021 were selected as control group. The two groups were compared in terms of department examination score, progressive evaluation of the research group, and the degree of satisfaction with practice. SPSS 23.0 was used for the t-test. Results:Compared with the control group, the research group had significantly better scores of medical history inquiry, medical record writing, and operational skills ( t=2.47, P=0.016; t=5.26, P<0.001; t=2.20, P=0.031). In progressive training, the Mini-CEX and DOPS scores in the second progressive formative assessment were better than those in the first assessment ( t=-21.06, P<0.001; t=-15.09, P<0.001). The degree of satisfaction with performance among the interns and the degree of satisfaction with interns among the examiners in the second assessment were better than those in the first assessment ( t=-5.53, P<0.001; t=-8.19, P<0.001). Conclusion:Mini-CEX combined with DOPS has a good effect in ophthalmology practice training in the integrated teaching of sensory system diseases and thus holds promise for application.

Objective:To investigate the clinical characteristics of congenital esophageal atresia with gastric perforation, and to improve pediatricians′ understanding of this disease.Methods:The clinical data of five neonates with congenital esophageal atresia and gastric perforation treated in the neonatal intensive care unit of the Affiliated Hospital of Qingdao University from 2012 to 2022 were analyzed retrospectively.Results:Among the five neonates, four were boys and one was girl.The gestational age was 28 + 5 to 37 + 6 weeks, the birth weight was 1 100~2 350 g. All of them had dyspnea and feeding difficulties after birth.Gastric perforation occurred in three cases during invasive mechanical ventilation, one case during non-invasive ventilation, and one case during nasal catheter oxygen inhalation.Emergency primary gastric repair was performed, followed by secondary esophageal anastomosis.All the patients were cured and discharged from hospital. Conclusion:Gastric perforation is a rare complication of congenital esophageal atresia, which is more common in premature infants and low birth weight infants.Mechanical ventilation may promote the occurrence of gastric perforation.If gastric perforation is complicated, repair should be performed as soon as possible, and esophageal anastomosis surgery should be performed early after stability to improve the final outcome.

BACKGROUND: Epidermal growth factor receptor (EGFR) and cellular-mesenchymal to epithelial transition factor (c-Met) are widely expressed on cancer cells. There is a synergistic effect of EGFR and HGF/c-Met pathways on proliferation, downstream activation of signal transduction and an additive effect. Studies show that combination of both signaling pathways could potentially be targeted in a synergistic fashion. Amivantamab, a bispecific monoclonal antibody targeting EGFR and c-Met, yielded robust and durable responses in a variety of clinicals trials. However, few researches have reported its efficacy in Chinese non-small cell lung cancer (NSCLC) patients. This study was conducted to evaluate the effectiveness and tolerance of Amivantamab in NSCLC patients with EGFR/MET gene abnormalities at Peking University Cancer Hospital. METHODS: The study enrolled NSCLC patients who received Amivantamab in our hospital between August 2020 and December 2021, and analyzed the response, survival, and treatment-related adverse events. RESULTS: Fifteen patients were enrolled in this research, and six of them received Amivantamab treatment and the other nine patients received Amivantamab plus Lazertinib treatment. The rates of partial response (PR), stable disease (SD), and progressive disease (PD) were 46.7% (7/15), 46.7% (7/15) and 6.7% (1/15), respectively. The overall response rate (ORR) and disease control rate (DCR) were 28.6% (2/7) and 100.0% (7/7) in seven patients with EGFR exon 20 insertion, respectively. The ORR and DCR were 40.0% (2/5) and 100.0% (5/5) in five post-osimertinib EGFR-mutant patients, respectively. After a median follow-up of 8.7 months, the median progression-free survival and overall survival were not reached. The most common treatment-related adverse events were rash (86.7%), paronychia (80.0%), and infusion-related reactions (60.0%), and most of them were graded as 1 to 2. Grade 3 to 4 adverse events included rash (33.3%), alanine aminotransferase elevation (13.3%), gamma-glutamyl transpeptidase elevation (13.3%), peripheral edema (6.7%), thromboembolism (6.7%), interstitial lung disease (6.7%), and thrombocytopenia (6.7%). CONCLUSIONS Amivantamab was effective in Chinese NSCLC patients with EGFR exon 20 insertion and post-Osimertinib EGFR-mutant patients, similar to the results of clinical trials conducted in western countries. Amivantamab was well tolerated and emphases should be put on adverse events such as rash, paronychia, and infusion-related reactions.
Antibodies, Bispecific ; Carcinoma, Non-Small-Cell Lung/genetics* ; ErbB Receptors/genetics* ; Exanthema/drug therapy* ; Humans ; Lung Neoplasms/genetics* ; Mutation ; Paronychia/drug therapy* ; Protein Kinase Inhibitors/therapeutic use*

Objective:To explore the changes and their clinical significance of plasma d-dimer (D-D) and fibrinogen (Fib) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with hypoxemia.Methods:150 patients with AECOPD admitted to our hospital from September 2017 to October 2018 were selected and divided into simple AECOPD group (75 cases) and AECOPD combined with hypoxemia group (75 cases) according to the arterial blood gas analysis results. In addition, 75 healthy people in the same period were selected as the control group. The D-D, Fib and C-reactive protein (CRP) level were detected in venous blood, and the differences and correlation of these indexes among the groups were statistically analyzed.Results:The D-D and Fib of AECOPD combined with hypoxemia group were significantly higher than those of AECOPD group and healthy control group, and the AECOPD group was higher than the healthy control group ( P<0.001). In AECOPD group, the plasma Fib and D-D were positively correlated with CRP ( r=0.617, P<0.001; r=0.300, P=0.009), but not with platelets (PLT) and white blood cell (WBC) ( P>0.05); in AECOPD combined with hypoxemia group, the plasma Fib was positively correlated with CRP, WBC and PLT ( r=0.854, P<0.001; r=0.345, P=0.002; r=0.272, P=0.018), but there was no correlation between D-D and CRP, WBC and PLT ( P>0.05). Conclusions:The plasma level of D-D and Fib increase with the aggravation of chronic obstructive pulmonary disease (COPD). They could be considered as potential inflammatory markers for the assessment of inflammation in the progression of COPD.

Objective:To explore the serotype distribution and drug resistance of Shigella in stool samples of children under five years old with diarrhea from 2008 to 2017 in Sui County, Henan Province. Methods:A total of 4 721 stool samples of children under five years old with diarrhea were collected from Doufuyuan Clinic of Sui County during 2008 to 2017, and Shigella strains were isolated through bacterial culture. The slide agglutination test was used for serotyping of Shigella strains. Two hundred of seventy-one Shigella strains were selected in proportion, and multiple gradient polymerase chain reaction was used to detect virulence genes and Kirby-Bauer agar method was used for drug sensitivity. Trend chi square test was used to analyze the annual trend of drug resistance. Results:The detection rate of Shigella strains in 4 721 fecal samples was 20.69% (977/4 721). A total of 977 Shigella strains were divided into 13 serotypes in two groups, including 77.79%(760/977) Shigella flexneri strains and 22.21%(217/977) Shigella sonnei strains.The top three serotypes detected alternately every year.The dominant gene pattern of Shigella flexneri was Shigella enterotoxin ( shET)-1+ , shET-2+ , invasion plasmid antigen H ( ipaH)+ , invasion-associated locus ( ial)+ , accounted for 84.04%(179/213) and that of Shigella sonnei was shET-1-, shET-2+ , ipaH+ , ial+ , accounted for 46.55%(27/58). The drug resistance rates of 271 Shigella strains to ampicillin, nalidixic acid and tetracycline were more than 90% and the strains were more sensitive to cefepime and ceftazidime.The drug resistance rates to cefotaxime, cefepime, ciprofloxacin, chloramphenicol and sulfamethoxazole/trimethoprim increased year by year, and all had statistically significant differences ( χ2=24.027, 7.232, 6.039, 4.764 and 6.809, respectively, all P< 0.05). There were 98.52%(267/271) strains resistant to more than three kinds of drugs. The resistance rates of Shigella flexneri to ciprofloxacin, norfloxacin, and chloramphenicol were higher than those of Shigella sonnei, and the resistance rates to gentamicin and sulfamethoxazole/trimethoprim were lower than those of Shigella sonnei. The differences were statistically significant ( χ2=31.866, 14.868, 83.036, 68.534 and 14.738, respectively, all P<0.01). Conclusions:The major serotypes of Shigella in children under five years old in Sui County are constantly changing from 2008 to 2017. The dominant gene patterns of different serotypes are different. Most isolated strains have multiple drug resistances, and different serotypes have different resistance profiles.

Objective To explore the optimal combination of parameters for the maximum spatial cluster size and maximum temporal cluster size of scan statistics. Methods The daily incidence data of hand-foot-and-mouth disease (HFMD) in Jingzhou in 2016 was collected as data source. The maximum spatial cluster sizes were set to 50%, 40%, 30%, 20%, and 10% of the population at risk. The maximum temporal cluster sizes were set to 7d, 14d, 30d, and 60d. A total of 20 parameter setting schemes were formed and spatial-temporal scanning was conducted one by one. The areas where the number of towns covered by the scanning area was less than 25 were selected, and the clustered epidemic of hand-foot-mouth disease can be detected at the same time in Xiejiaping Town of Songzi City and Sanzhou Town of Jianli County. The combination of large LLR and RR values was the optimal parameter setting. Results When the spatial windows were set to 20% of the population at risk, and the temporal windows were set to 30d, a total of 6 aggregation areas were detected. The number of covered townships was less than 25, and the clustered epidemic of Xiejiaping Township and Sanzhou Town were successfully detected. The LLR and RR values of the detected aggregation area were relatively large. This combination was the optimal parameter setting. Conclusion The combination of different parameters has a significant impact on the results of spatial-temporal scan statistics. It is recommended that parameters be optimized before applying this method.

Objective: To analyze the changes of the characteristics of Hemorrhagic fever with renal syndrome (HFRS) in Jingzhou City in different periods. Methods: According to the HFRS epidemic data of Jingzhou City in 2009-2018, based on the incidence rate, the HFRS epidemic situation in Jingzhou City was divided into three periods: 2009-2012 (low), 2013-2016 (middle), and 2017-2018 (high). Descriptive epidemiological methods, standard deviation ellipse and spatio-temporal scanning analysis were used to analyze the time, region, population distribution and temporal and spatial trends of HFRS epidemic in the three periods. Results: The incidence of HFRS in Jingzhou City in the three periods was seasonal and bimodal. The peak incidence included spring and summer peaks (May-July) and autumn-winter peaks (January, November-December). The HFRS cases in Jingzhou City were concentrated in Jianli County, Jiangling County and Honghu City in the three periods. The incidence rates were 0.48/100 000, 1.98/100 000, 0.84/100 000, 0.89/100 000, 1.88/100 000, 1.20/100 000; 4.82/100 000, 13.37/100 000, and 4.58/100 000. The incidence of HFRS in males was higher than that in females in the three periods (χ²=43.38, P < 0.05); the occupations of HFRS in the three periods were mainly farmers, which were 56.26%(69/122), 69.61% (126/181), 74.94% (293/391), respectively. In 116 farmers, growing rice [48.28% (56/116)] and shrimp rice [27.59% (32/116)] were mostly. From the age point of view, the incidence rate in 2009-2017 was 55 to 64 years old; the incidence rate of 2018 was 60 to 69 years old. The results of standard deviation ellipse analysis showed that the expansion trend of HFRS epidemic areas in Jingzhou City was not obvious, and the center of gravity was located in Jianli County or Jiangling County. Spatio-temporal scans revealed that the first-class spatial-temporal clustering areas in the three periods were 2 towns and villages in Jiangling County, and the gathering time was from December 7, 2010 to January 2, 2011; in some townships in Jiangling County and Shacheng District, the gathering time was from December 7, 2016 to February 28, 2017; some townships in Jiangling County and surrounding counties, gathered from April 27, 2018 to July 16, 2018. Conclusions The HFRS epidemic season in Jingzhou City in different periods is basically the same; the high-incidence areas are basically the same, but there are local fluctuations; the population is mainly male farmers, and the age of high-incidence has shifted back. We should adapt to local conditions and formulate scientific and reasonable comprehensive prevention and control measures.

Objective To investigate the spatial correlation and spatial cluster pattern of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou City,Hubei Province from 2013 to 2017.Methods The HFRS surveillance data during 2013-2017 were collected from China Disease Prevention and Control Information System.Software ArcGIS 10.3 was used to analyze the spatial distribution,and global autocorrelation analysis (Moran'sI) and hot spot analysis (Getis-Ord Gi) were used to analyze the spatial autocorrelation.Spatial cluster pattern was explored by trend surface analysis and directional distribution.Results In 2013-2017,the global Moran's I was 0.117 6 (P ＞ 0.05),0.349 8 (P ＜ 0.05),0.102 1 (P ＞ 0.05),0.276 3 (P ＜ 0.05),and 0.394 8 (P ＜ 0.05),respectively.The Getis-Ord Gi analysis showed that there were 7,8,8,8,15 hot areas with high incidence of HFRS during this period,respectively,which were part of townships in Jiangling County,Shashi District,Jianli County,and Honghu City.The cold spot area with low incidence of HFRS was only detected in 2015,and it was part of the township in Shashi District and Jingzhou District.The trend surface analysis showed that the inverted-U type curve could reflect the HFRS distribution from northern to southern,and it was also from eastern to western.The directional distribution showed that the HFRS cases were distributed in the north-central part of Jingzhou in 2013-2017,and they were inconsistent with the distribution of the Yangtze River system.Conclusions The incidence of HFRS has an obvious spatial clustering characteristic,and the areas at high risk are mainly in the north-central part of Jingzhou City.The spatial cluster pattern of HFRS has nothing to do with the Yangtze River system.

Objective To evaluate the effect of over-expression of phosphatase and tensin homolog does on chromosome ten (PTEN) in podocytes on kidney under high fat diet (HFD) in vivo and clarify the mechanism how PTEN regulates scavenger receptor A (SR-A) expression exposed to oxidized low density lipoprotein (ox-LDL) in podocytes in vitro.Methods The podocyte-specific PTEN knockin (PPKI) mice were fed with HFD to establish mouse model of lipid-induced renal injury.Mice were divided into four groups:ND+Ctrl group,ND+PPKI group,HFD+Ctrl group and HFD+PPKI group.After 24 weeks of dietary intervention,all mice were tested for clinical and biochemical parameters,including serum creatinine (Scr) as well as urine albumin excretion rate (UAER);renal lipid content was measured by oil red O staining and cholesterol quantitative analysis;the pathological changes of glomeruli were observed by PAS staining and electron microscope.Podocyte injury was induced by ox-LDL in vitro.Western blotting was used to detect the changes of SR-A expression induced by ox-LDL after YAP-siRNA interfering (si-YAP),as well as YAP phosphorylation induced by ox-LDL after interfering by PTEN-siRNA (si-PTEN) and PTEN phosphatase inhibitor (Bpv-PTEN),and overexpressing by recombinant adenovirus (ad-PTEN).Results Compared with ND+Ctrl group,HFD+ Ctrl group significantly aggravated the levels of Scr and UAER,the expression of SR-A in podocytes,renal lipid content,mesangial matrix expansion,effacement of podocyte foot processes,and incrassation of glomerular basement membrane (all P ＜ 0.05).Conversely,compared with HFD+Ctrl group,HFD+ PPKI group obviously alleviated the above lipid-induced renal damage (all P ＜ 0.05).In vitro,the expression of SR-A in podocytes was up-regulated when stimulated with ox-LDL (P ＜ 0.05),and the knockout of YAP significantly down-regulated the expression of SR-A induced by ox-LDL (P ＜ 0.05).Exposed to ox-LDL,the expression of p-YAP increased in podocytes (P ＜ 0.05);over-expression of PTEN inhibited p-YAP up-regulation induced by ox-LDL (P ＜ 0.05),while either knockdown of PTEN or inhibition of PTEN phosphatase activity displayed opposite effect (all P ＜ 0.05).Conclusions Over-expression of PTEN in podocytes protected the kidney against damage from HFD in vivo and PTEN might suppress SR-A mediated lipid uptake via dephosphorylating p-YAP to prevent podocyte injury from ox-LDL.

Objective To discuss the risk in duo paternity testing. Methods 22 fictitious duo families formed by 22 pairs of unrelated individuals having one or zero inconsistent locus were selected after detected by GoldeneyeTM 20A Kit. The 22 fictitious duo families were further tested with STRtyper-10G kit and/or AGCU 21+1 STR kit until there were more than 3 inconsistent loci and the cumulative paternity index(CPI) value was less than 0.0001. According to the three excluding rules, ① number of inconsistent loci>3; ② CPI ≤ 0.0001; ③ accord with both ① and ② , using multiple STR systems, such as 19 STR loci, 26 STR loci, 39 STR loci and 46 STR loci to test and discuss whether there is difference among the excluding result of unrelated individual. Results Among those 22 fictitious duo families, using three excluding rules, None was excluded by 19 STR loci, and all was excluded by 39 STR loci. Conclusion Duo paternity tests may get a wrong result using only 19 loci system. To reduce the error risk 39 STR-loci systems would be suggested.