OBJECTIVE To evaluate the effictiveness and safety of recombinant human endostatin combined with afatinib and teggio in the treatment of advanced lung squamous cell carcinoma. METHODS A total of 25 patients with driver-negative advanced lung squamous cell carcinoma were included in this single-arm prospective study, and the enrolled patients were treated with recombinant human endostatin combined with afatinib and teggio as scheduled. Progression-free survival(PFS), overall survival(OS), disease control rate(DCR), objective response rate(ORR), and adverse reactions(AR) were observed and analyzed. RESULTS The 25 enrolled patients received at least 2 cycles of second-line treatment, and were followed up as of March 31, 2023. Among them, 4 patients had partial remission, 17 patients had stable disease, and 4 patients experienced progressive disease. The ORR confirmed by the researchers was 16%(95%CI, 4.5%−36.1%), DCR was 84%(95%CI, 63.9%−95.5%), and median PFS was 5.3 months(95%CI, 3.5−6.9 months). The median OS had not yet been achieved. The entire group of patients had good treatment tolerance, and the most common level Ⅲ or Ⅳ adverse events related to treatment were leukopenia(20%) and rash(12%), with no reported treatment-related deaths. CONCLUSION Recombinant human endostatin combined with afatinib and teggio in the second line treatment of advanced lung squamous cell carcinoma can prolong the progression free survival period of patients and is relatively safe, which is worth further exploration and promotion.

Objective:To evaluate the long-term impact of three different outdoor activity intervention strategies on the prevalence of myopia among school-aged children in China.Methods:Cross-sectional data from the Refractive Error Study in Children (RESC) on the baseline prevalence of myopia and 10-year longitudinal data from the Guangzhou Twin Eye Study (GTES) on the baseline incidence of myopia were utilized.The effect size of outdoor activity intervention was derived from longitudinal data of the Guangzhou Outdoor Activity Longitudinal Study (GOALS). Three intervention strategies were proposed: intervention for children in grades 1 to 6 (Strategy A), intervention for children in grades 1 to 3 (Strategy B), and intervention for children from the last year of kindergarten to grade 3 (Strategy C). Outdoor activity interventions across all strategies included an extra 40 minutes of daily outdoor activity time.Simulated analyses assumed that the prevalence of myopia would decrease with declining incidence and increasing school grade, and the degree of myopia among highly myopic children would decrease with delayed myopia onset.This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (No.2006-5).Results:With prolonged intervention time, the overall prevalence of myopia in children showed a significant declining trend.After 5 years of implementation, Strategy A resulted in a decrease in myopia prevalence from 34.67% to 25.71%, which decreased to 24.89% after 10 years, with an average annual reduction of 0.98%.Strategies B and C had similar long-term effects, with myopia prevalence after 10 years being 26.00% and 26.20% respectively, with an average annual reductions of 0.87% and 0.85%.Strategy A yielded the greatest reduction in myopia severity, with a decrease of -5.94 D after 5 years and -5.88 D after 10 years in the initial 15-year-old highly myopic individuals.Strategy B followed with -6.08 D and -6.02 D after 5 and 10 years, respectively.Conclusions:Implementing intensified outdoor activity intervention among children in grades 1 to 6 may be the recommended strategy to reduce the overall prevalence of myopia in regions with high rates of myopia among school-aged children.

Objective:To explore and analyze the changes of miRNA-138 and miRNA-26b before and after transsphenoidal surgery for pituitary tumors and their clinical significance.Methods:86 patients with functional pituitary tumors who underwent transsphenoidal surgery in Linyi People’s Hospital from Apr. 2020 to Apr. 2021 were retrospectively analyzed. The recurrence within 1 year after operation was followed up and the patients were divided into unrecovered group (24 cases) and cured group (62 cases) . Clinical data such as age, gender, tumor pathological type, Knosp grade, first operation, tumor diameter, intraoperative tumor residue, Ki-67 and adjuvant therapy were collected. Fasting venous blood was collected before surgery and the next morning after surgery. Quantitative real-time PCR was used to detect the serum levels of mircoRNA-138 (miRNA-138) and miRNA-26b (mirNA-26B) , and the changes of serum miRNA-138 and miRNA-26b levels before and after surgery. Univariate and multivariate logistic regression were used to analyze the relationship between serum miRNA-138 and miRNA-26b levels and postoperative prognosis, and ROC curve was drawn to analyze their predictive value for postoperative prognosis.Results:Univariate analysis showed that Knosp grade, tumor diameter, intraoperative tumor residual, Ki-67, and adjuvant therapy were associated with the recurrence of body tumor after transsphenoidal surgery ( P<0.05) . After operation, the expression of miRNA-138 in serum was higher than that before operation, and the expression of miRNA-138 in unhealed group (4.13±1.12) was higher than that in cured group (3.56±0.84) ( P<0.05) . The expression of miRNA-26b in serum after operation was lower than that before operation, and the expression of miRNA-26b in the unhealed group (2.34±0.62) was lower than that in the cured group (2.75±0.58) ( P<0.05) . Pituitary tumor hormone increased before operation and returned to normal after operation. Multivariate logistic regression analysis showed that tumor diameter ≥40cm (OR=3.476, 95%CI: 1.267-9.539) , postoperative tumor residual (OR=3.155, 95%CI: 1.236-8.052) , Ki-67≥3% (OR=3.885, 95%CI: 2.038-7.403) , postoperative serum miRNA-138 expression ≤3.62 (OR=2.323, 95%CI: 1.536-3.513) , postoperative serum miRNA-26b expression ≥2.59 (OR0.453, 95 %CI: 0.286-0.717) was an independent risk factor for the recurrence of pituitary tumors after transsphenoidal surgery ( P<0.05) . When the optimal cut-off value of serum miRNA-138 was 3.62, the area under the curve for predicting the recurrence of pituitary tumors after transsphenoidal surgery was 0.78, the sensitivity was 81.35%, and the specificity was 71.46%; the optimal cut-off value of serum miRNA-26b When it was 2.59, the area under the curve for predicting and predicting the recurrence of pituitary tumors after transsphenoidal surgery was 0.75, at this time, the sensitivity was 78.62%, and the specificity was 72.33%. The lower area was 0.83, the sensitivity was 85.47%, and the specificity was 72.38%. Conclusion:The expression of serum miRNA-138 was up-regulated and the expression of miRNA-26b was down-regulated after transsphenoidal surgery for pituitary tumors, and its abnormal expression was associated with postoperative recurrence, which has a good predictive value for predicting postoperative recurrence.

Objective:To explore the safety of transanal re-excision (TAR) after positive-margin local resection for early rectal cancer.Methods:A retrospective analysis was made data of 44 patients with rectal cancer after local excision from Mar 2006 to Oct 2018 at the Department of Colorectal Surgery, Cancer Hospital of Chinese Academy of Medical Sciences. All patients had positive margin or suspicious tumor remains after local excision, and subsequently salvage TAR surgery was performed after informed consent was given.Results:Forty-four patients after local excision were with pathologically showed residual condition, including 26 cases of positive margin and 18 cases of suspicious tumor remaining. The pathological types were all adenocarcinoma. Forty-one (93%) patients with pT1 and 3 (7%) patients with pT2. The median follow-up time after salvage TAR was 100 (11-164) months. During follow-up, 3 patients (7%) developed mild anal incontinence. One patient (2%) had local recurrence, 3 (7%) patients had distant metastases, and 3 patients (7%) died of non-tumor specific deaths. The overall 5-year survival rate and disease-free survival rate were 98% and 93 %, respectively.Conclusions:Transannal full thickness tumor re-excision is safe and reliable for the salvage treatment after non-complete local resection of early rectal cancer. The long-term follow-up results show that the 5-year survival rate is comparable to that of radical surgical resection, and with a good anal function.

Objective: To evaluate the difference and correlation between continuous non-invasive arterial pressure (CNAP) monitor and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in mechanically ventilated critically ill patients, and to assess the feasibility of non-invasive monitoring of hemodynamics with CNAP. Methods: A prospective observation self-control study was conducted.The critically ill patients with mechanical ventilation who needed hemodynamics monitoring, and admitted to the fourth department of intensive care unit (ICU) of Fujian Provincial Hospital from June 2018 to March 2019 were enrolled. PiCCO catheter were inserted immediately after admission, the hemodynamic indexes were measured by thermodilution method, and mean arterial pressure (MAP_PiCCO), cardiac index (CI_PiCCO), pulse pressure variation rate (PPV_PiCCO) and systemic vascular resistance index (SVRI_PiCCO) were obtained at 0 hour and 24 hours respectively. Meanwhile, the above indexes (MAP_CNAP, CI_CNAP, PPV_CNAP and SVRI_CNAP) were measured with CNAP. All measurements were repeated thrice and average values were reported. The differences in above parameters between the two methods were evaluated. Pearson test was used for the correlation analysis and Bland-Altman analysis method was used for consistency test. Results: Thirty-eight patients were enrolled into this study. One patient died within 24 hours was excluded, 2 patients were excluded due to withdrawing treatment within 24 hours, 2 patients were excluded because of atrial fibrillation, and 1 patient's data was lost due to technical problems. Thus, data from 32 patients were available for final analysis. There were 12 females and 20 males, aging 26-84 years old with the mean of (66.8±19.1) years old, body mass index (BMI) of (23.7±3.9) kg/m², acute physiology and chronic health evaluationⅡ (APACHEⅡ) score of 19.5±5.3, sepsis-related organ failure assessment (SOFA) score of 9.7±4.1. There were no significant differences in CI or PPV between CNAP and PiCCO groups [CI (mL·s^-1·m^-2): 59.8±12.6 vs. 58.5±14.2, PPV: (14.7±6.8)% vs. (14.0±6.8)%, both P > 0.05]. MAP and SVRI measured by CNAP were significantly higher than those measured by PiCCO [MAP (mmHg, 1 mmHg = 0.133 kPa): 65.6±9.4 vs. 60.1±9.2, SVRI (kPa·s·L^-1·m^-2): 206.2±53.9 vs. 179.5±57.8, both P < 0.01]. The correlation analysis showed that MAP, CI, PPV and SVRI measured by the two methods were significantly positively correlated (r value was 0.624, 0.864, 0.835 and 0.655 respectively, all P < 0.05). Bland-Altman analysis showed that CNAP and PiCCO had a good consistency for the measurement of CI and PPV, the average differences were 1.2 mL·s^-1·m^-2 and 0.5% respectively, while the 95% confidence interval (95%CI) were -12.8-15.3 mL·s^-1·m^-2 and -7.1%-8.2% respectively. However, the consistency of MAP and SVRI measured by those two methods was poor, the average differences were 5.5 mmHg and 26.8 kPa·s·L^-1·m^-2 respectively, while the 95%CI was -10.4-21.3 mmHg and -64.5-118.0 kPa·s·L^-1·m^-2 respectively. Conclusion CNAP was comparable with PiCCO when monitoring CI and PPV in mechanically ventilated critically ill patients; while the results of MAP and SVRI might be inaccurate, which should be interpreted correctly and carefully.

OBJECTIVE: To evaluate the difference and correlation between continuous non-invasive arterial pressure (CNAP) monitor and pulse indicated continuous cardiac output (PiCCO) monitor on determination of hemodynamic parameters in mechanically ventilated critically ill patients, and to assess the feasibility of non-invasive monitoring of hemodynamics with CNAP. METHODS: A prospective observation self-control study was conducted.The critically ill patients with mechanical ventilation who needed hemodynamics monitoring, and admitted to the fourth department of intensive care unit (ICU) of Fujian Provincial Hospital from June 2018 to March 2019 were enrolled. PiCCO catheter were inserted immediately after admission, the hemodynamic indexes were measured by thermodilution method, and mean arterial pressure (MAP_PiCCO), cardiac index (CI_PiCCO), pulse pressure variation rate (PPV_PiCCO) and systemic vascular resistance index (SVRI_PiCCO) were obtained at 0 hour and 24 hours respectively. Meanwhile, the above indexes (MAP_CNAP, CI_CNAP, PPV_CNAP and SVRI_CNAP) were measured with CNAP. All measurements were repeated thrice and average values were reported. The differences in above parameters between the two methods were evaluated. Pearson test was used for the correlation analysis and Bland-Altman analysis method was used for consistency test. RESULTS: Thirty-eight patients were enrolled into this study. One patient died within 24 hours was excluded, 2 patients were excluded due to withdrawing treatment within 24 hours, 2 patients were excluded because of atrial fibrillation, and 1 patient's data was lost due to technical problems. Thus, data from 32 patients were available for final analysis. There were 12 females and 20 males, aging 26-84 years old with the mean of (66.8±19.1) years old, body mass index (BMI) of (23.7±3.9) kg/m², acute physiology and chronic health evaluation II (APACHE II) score of 19.5±5.3, sepsis-related organ failure assessment (SOFA) score of 9.7±4.1. There were no significant differences in CI or PPV between CNAP and PiCCO groups [CI (mL×s^-1×m^-2): 59.8±12.6 vs. 58.5±14.2, PPV: (14.7±6.8)% vs. (14.0±6.8)%, both P > 0.05]. MAP and SVRI measured by CNAP were significantly higher than those measured by PiCCO [MAP (mmHg, 1 mmHg = 0.133 kPa): 65.6±9.4 vs. 60.1±9.2, SVRI (kPa×s×L^-1×m^-2): 206.2±53.9 vs. 179.5±57.8, both P < 0.01]. The correlation analysis showed that MAP, CI, PPV and SVRI measured by the two methods were significantly positively correlated (r value was 0.624, 0.864, 0.835 and 0.655 respectively, all P < 0.05). Bland-Altman analysis showed that CNAP and PiCCO had a good consistency for the measurement of CI and PPV, the average differences were 1.2 mL×s^-1×m^-2 and 0.5% respectively, while the 95% confidence interval (95%CI) were -12.8-15.3 mL×s^-1×m^-2 and -7.1%-8.2% respectively. However, the consistency of MAP and SVRI measured by those two methods was poor, the average differences were 5.5 mmHg and 26.8 kPa×s×L^-1×m^-2 respectively, while the 95%CI was -10.4-21.3 mmHg and -64.5-118.0 kPa×s×L^-1×m^-2 respectively. CONCLUSIONS CNAP was comparable with PiCCO when monitoring CI and PPV in mechanically ventilated critically ill patients; while the results of MAP and SVRI might be inaccurate, which should be interpreted correctly and carefully.
Adult ; Aged ; Aged, 80 and over ; Arterial Pressure ; Cardiac Output ; Critical Illness ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Prospective Studies ; Respiration, Artificial

Objective: To explore the effect of microRNA-21 (miR-21) on myocardial fibrosis in mice with chronic viral myocarditis (CVMC) and related mechanisms. Methods: Forty 4-week-old Balb/c male mice were randomly divided into 4 groups (n=10 each): phosphate buffer saline (PBS) group, CVMC group, CVMC+miR-21 inhibitor group, CVMC+isotype control group. The first injection of Coxsackie virus B3 (CVB3) or PBS was performed on day 0, and the total study time was 42 days. Each mouse in CVMC group, CVMC+miR-21 inhibitor group and CVMC+isotype control group was intraperitoneally (i.p) injected with 100TCID50 CVB3 0.1, 0.15, and 0.2 ml on day 0, 14, and 28, respectively. The mice in PBS group were i.p injected with the same dose of PBS at the same time point. After the initial infection, each mouse in CVMC+miR-21 inhibitor group and CVMC+isotype control group was intravenously injected with 0.1 ml miR-21 inhibitor or 0.1 ml isotype control, on day 14 and 28. Cardiac function was measured on surviving mice of 4 groups by echocardiography on day 42. Then, the hearts were removed aseptically to observe the expressions of green fluorescence protein (GFP). The myocardial pathological changes were examined with HE, Masson staining and the myocardial pathological scores (PS), the collagen volume fraction (CVF) were calculated respectively. The levels of miR-21, collagen typeⅠ-A1 (COL1-A1) and collagen type Ⅲ-A1 (COL3-A1) mRNA in heart were detected by quantitative real-time polymerase chain reaction (RT-qPCR). Furthermore, the expressions of transforming growth factor-β1 (TGF-β1) and mothers against decapentaplegic homolog 7(Smad7) in heart were determined with Western blot assay. Results: (1) Cardiac function in 4 groups: Compared with PBS group, left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) were markedly increased in CVMC group and CVMC+isotype control group (all P<0.05), whereas the left ventricular ejection fraction (LVEF) was decreased (P<0.05). LVESD and LVEDD were significantly decreased, and LVEF was increased in CVMC+miR-21 inhibitor group compared with those in CVMC group and CVMC+isotype control group (all P<0.05). (2) Myocardial pathological changes: The expressions of GFP in CVMC+miR-21 inhibitor group and CVMC+isotype control group were visible in heart tissues frozen sections. The hearts in CVMC group and CVMC+isotype control group were enlarged and stiff, inflammatory cells were visible and significantly increased myocardial fibrosis was evidenced in mice of these two groups. Higher PS and CVF were evidenced in CVMC group (PS: 1.14±0.69 vs. 0, CVF: (17.86±2.61)% vs. (5.70±1.42)%, all P<0.05) and CVMC+isotype control group(PS: 1.00±0.63 vs. 0, CVF: (16.78±2.58)% vs. (5.70±1.42)%, all P<0.05) compared to PBS group. Compared with CVMC group and CVMC+isotype control group, degree of cardiac fibrosis was reduced in mice of CVMC+miR-21 inhibitor group (CVF: (11.01±2.55)% vs. (17.86±2.61)%, (11.01±2.55)% vs. (16.78±2.58)%, all P<0.05), whereas PS were similar between them (PS: 0.89±0.60 vs. 1.14±0.69, 0.89±0.60 vs. 1.00±0.63, all P>0.05). (3) Cardiac expressions of miR-21, COL1-A1 and COL3-A1 mRNA: The cardiac expressions of miR-21, COL1-A1 mRNA, COL3-A1mRNA in CVMC group and CVMC+isotype control group were markedly higher than those in PBS group (all P<0.05), which were significantly downregulated in CVMC+miR-21 inhibitor group (all P<0.05 vs. CVMC group and CVMC+isotype control group). (4) The cardiac expressions of TGF-β1 and Smad7 protein: The cardiac expressions of TGF-β1 protein in CVMC group and CVMC+isotype control group were markedly higher, whereas the cardiac Smad7 protein expressions were significantly lower (all P<0.05) than those in PBS group (all P<0.05), these changes could be reversed in CVMC+miR-21 inhibitor group (P<0.05 vs. CVMC group and CVMC+isotype control group). Conclusions Our results suggest that miR-21 contributes to the myocardial fibrosis in CVMC mice through modulating TGF-β1/Smad7 signaling pathway.

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius ( AO types B and C ) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67. 9 ± 10. 7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66. 2 ± 11. 5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complica-tions. Results There was no significant difference between the 2 groups in follow-up time ( P > 0. 05 ) . Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85. 0％ while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57. 7％. A significant difference was shown between the 2 groups ( P <0. 05 ) . At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score ( 2. 16 ± 1. 82 ) and complication rate ( 30. 0％, 6/20 ) than the nonoperative group [ 6. 62 ± 3. 78 and 53. 8％( 14/26 ) , respectively ] ( P <0. 05 ) . Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoper-ative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen.

Objective To explore the clinical characteristics of pattern of phlegm heat and bowel excess in acute stage of stroke involving meridian-collateral or involving zang-fu organs from the aspects of severity of neurological impairment, pattern distribution at different time points and duration of bowel excess.Methods The basic information,scores of National Institute of Health Stroke Scale(NIHSS), whether bowel qi being unobstructed or not,duration of bowel excess,and pattern distribution at different time points(onset for 1 d to 3 d,onset for 4 d to 7 d and onset for 8 d to 14 d)were inputted based on structured data by using retrospective analysis of medical records in 204 cases of pattern of phlegm heat and bowel excess of stroke involving meridian-collateral(meridian-collateral group)and 217 cases of pattern of phlegm heat and bowel excess of stroke involving zang-fu organs(zang-fu organ group).The clinical characteristics from the data were compared, analyzed and studied.Results The severity of neurological impairment except of conscious state was significantly higher in zang-fu organ group than that in meridian-collateral group(P<0.01).The average duration of unobstructed bowel qi was significantly longer in zang-fu organ group than that in meridian-collateral group(P<0.01), and the percentage of patients with throughout obstructed bowel qi was significantly higher in zang -fu organ group than that in meridian-collateral group in acute stage of stroke.The pattern of phlegm heat and bowel excess showed a decline trend after stroke onset for 1 d to 14 d in meridian-collateral group, and showed an ascending trend after stroke onset for 1 d to 7 d and a decling trend after stroke onset for 8 d to 14 d in zang-fu organ group.The cases of pattern of qi deficiency with blood stasis or pattern of collaterals blocked by wind -phlegm and static blood were significantly higher in meridian-collateral group at 4-14 d than those at 1-3 d,and cases of pattern of wind stirring due to yin deficiency,pattern of phlegm heat and blood stasis or pattern of wind phlegm and blood stasis were significantly higher in zang-fu organ group at 8 -14 d than those at time point 1.Conclusion The duration of pattern of phlegm heat and bowel excess is posi-tively correlated to the severity of stroke,that is,neurological impairment is more serious and duration is longer in patients with pattern of phlegm heat and bowel excess of stroke involving zang -fu organs.

BACKGROUND:Vertebral compression fractures are the most common vertebral fractures in the elderly patients with osteoporosis, and the correlation between the compression of anterior border of vertebral body and adjacent vertebral refractures is not clear.
OBJECTIVE:To establish a model of different compression of T12vertebral body with finite element method, and analyze the relationship between the compression of T12vertebral body and the stress of adjacent vertebral plate.
METHODS:Based on thoracolumbar CT data of normal adult volunteers, MIMICS/3-matic was imported. Through image segmentation, repair and three-dimensional mesh of accessto thoracic and lumbar T11-L1data, grid assigned material properties was imported to ABAQUS so as to establish ligament, joint and other small features and obtain realistic three-dimensional finite element model. The six degrees of freedom, including anteflexion, posterior extension, left and right flexion, left and right rotation, were loaded, to verify the validity of the normal model. With the frontier of vertebral body compression to 90%, 80%, 70%…10% of the nine states, MISES stressesof the T11andL1segment intervertebral disc endplate were extracted; the relationship curve of compression state and endplate stress was obtained.
RESULTS AND CONCLUSION:(1) The model was highly realistic and could reflect the actual stress state. (2) The stress value of T11vertebral body and L1vertebral body was positively correlated with the compression of T12vertebral body. Increased stress may lead to an increased likelihood of end plate fractures, which increases the risk of fractures in the adjacent vertebralbodies.