Hepatocellular carcinoma has a high morbidity and mortality, which has seriously harmed human health. Several targeted therapies have been approved for the first- and second-line treatment of advanced hepatocellular carcinoma. The emergence of immunotherapy has brought the treatment of hepatocellular carcinoma into a new era. Targeted and immunotherapeutic agents have synergistic effects in mechanism, also the combination of these two therapies has been clinically beneficial to patients with advanced hepatocellular carcinoma. At the same time, in addition to the systemic therapy of targeted combined immunological, applying appropriate local therapy can provide a longer survival period or even a chance of cure for that some patients. The authors introduce the diagnosis and treatment of a case of advanced hepatocellular carcinoma who achieved pathological complete remission by first-line immunotherapy combined with anti-angiogenesis targeted therapy.

The craniospinal radiotherapy method was studied by using the whole body positioning frame and base dose plan compensation (BDPC) technique.11 patients with central nervous system malignancies in our hospital were studied. Use whole body positioning frame with the head - neck shoulder and body membrane to immobilize posture, then use BDPC for the intensity-modulated radiotherapy. Target area conformability index(CI), homogeneity index (HI), dose of endangerment organ (OAR) and beam connecting dose distribution are evaluated. The use of base-dose-compensation intensity-modulated plan combined with whole-body positioning technology improves the target area conformability and target uniformity, simplifies the design of craniospinal radiotherapy, improves the placement accuracy and ensure good placement repeatability. We measure beam connecting dose distribution. Cold and hot spots do not appear, and calculated values are basically identical. The application of whole-body positioning technique combined with BDPC optimization method in the treatment of the craniospinal radiotherapy meets the clinical requirements of dosimetry. Moreover, it is simple and can improve the treatment planning efficiency.

OBJECTIVETo analyze the phenotypes and proline-rich transmenbrane protein 2 (PRRT2) gene mutations in patients of infantile convulsions with paroxysmal choreoathetosis (ICCA).

METHODSClinical data were collected from ICCA patients and their family members. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations of PRRT2 were screened using PCR amplification and Sanger sequencing.

RESULTSEleven families and one sporadic case with ICCA were recruited in this study. In 11 ICCA families, 49 family members were affected, of which 15 individuals had benign infantile convulsions (BIC) alone, 18 individuals had only paroxysmal kinesigenic dyskinesia(PKD), and 16 individuals had BIC followed by PKD. The seizure onset age of infantile convulsions was between 3 and 12 months. The onset age of PKD was ranging from 5 to 17 years old. Four affected members in two ICCA families had PKD or ICCA co-existing with migraine. The one sporadic ICCA case had afebrile seizures between 3.5 and 4 months, and developed paroxysmal twists of limbs after 3 years and 9 months of age. He had good response to treatment with oxcarbazepine at the age of 4 years and 10 months. PRRT2 mutations were identified in all 11 ICCA families. The most common mutation, c.649_650insC (p.R217PfsX8), was detected in 6 of the 11 families (54.5%). PRRT2 mutation (c.649_650insC) was also found in the sporadic ICCA case, and was identified as de novo mutation.

CONCLUSIONThe phenotype of PKD in ICCA families occurred in childhood or adolescence. Few affected members in some ICCA families may have migraine. PRRT2 is the causative gene of ICCA and the mutation c.649_650insC was the hotspot of PRRT2 mutations. PRRT2 mutation was also found in sporadic case with ICCA.

Adolescent ; Adult ; Age of Onset ; Aged ; Aged, 80 and over ; Base Sequence ; Child ; Child, Preschool ; Dyskinesias ; genetics ; Epilepsy, Benign Neonatal ; genetics ; Female ; Humans ; Infant ; Male ; Membrane Proteins ; genetics ; Middle Aged ; Molecular Sequence Data ; Nerve Tissue Proteins ; genetics ; Pedigree ; Phenotype ; Point Mutation ; Seizures ; genetics ; Young Adult

OBJECTIVETo study the phenotypes and proline-rich transmembrane protein 2 (PRRT2) mutations in families with benign familial infantile epilepsy (BFIE).

METHODData of all BFIE probands and their family members were collected from Peking University First Hospital between September 2006 and August 2013. Clinical phenotypes of affected members were analyzed. Genomic DNA was extracted from peripheral blood samples with standard protocol. Mutations in PRRT2 were screened using PCR amplification and Sanger sequencing.

RESULTTwenty-nine BFIE families were recruited in this study. In total, 110 family members were affected. The age of seizure onset of these affected members was between 2 and 12 months (median: 4.5 months). All probands presented with clusters of seizures. Two probands had one seizure induced by diarrhea respectively at 25 months and 31 months. In four BFIE families, four family members had a history of febrile seizures. PRRT2 mutations were found in 17 of the 29 (58.6%) BFIE families. Mutation c.649_650insC was detected in 12 of the 17 families with PRRT2 mutations. Mutation c.649delC (p.R217EfsX12) was identified in three families. Mutation c.323_324delCA (p. T108SfsX25) and c.904_ 905insG (p. D302GfsX39) were detected in one family, respectively.

CONCLUSIONThe minimum seizure onset age of affected members in BFIE families was 2 months of age. The seizures often occur in clusters. PRRT2 is the major causative gene of BFIE in Chinese families. Mutation c.649_650insC is the hotspot mutation of PRRT2. A novel mutation c.323_324delCA was first reported in BFIE family. Few affected members with PRRT2 mutation presented with febrile seizures phenotype.

Age of Onset ; Asian Continental Ancestry Group ; genetics ; DNA Mutational Analysis ; Epilepsy, Benign Neonatal ; genetics ; Humans ; Infant ; Membrane Proteins ; genetics ; Mutation ; genetics ; Nerve Tissue Proteins ; genetics ; Phenotype ; Seizures ; Seizures, Febrile

Objective To analyze the present situation of the dental instrument cleaning and disinfection in Hainan province and to explore the management mode of dental instrument cleaning and disinfection which is suitable for the provincial situation .Meth-ods By adopting the stratified random sampling method according to the hospital grades ,24 hospitals in Hainan province were per-formed the questionnaire survey on the cleaning mode of oral instruments ,layout of cleaning and disinfection room ,cleaning method and facilities ,protection measures and training of cleaning staff .Results 14 hospitals (58 .33% ) had the sterilization and supply center for conducting the centralized processing on the dental instruments .The tertiary hospitals and the second-grade hospitals had the independent cleaning and disinfection rooms with the rational layout and professional cleaning staff ;the safeguard facilities had the application in place ,the training of the related cleaning and disinfection work and the cleaning process conformed the require-ment of the standards .Among 10 first-grade and below hospitals ,only 1 hospital(10 .00% ) had the rational layout of cleaning and disinfection rooms ;3 hospitals(30 .00% ) had the professional cleaning staff ;the related training of the cleaning staff was not basi-cally carried out and the safeguard was not in place ,most of the cleaning and disinfection instruments and the cleaning process were not in accordance with the requirements .The qualification rates of instruments cleaning and disinfection in different grades of hospi-tals by the ATP bioluminescence assay were 100 .00% ,90 .00% and 80 .00% .Conclusion The existing problems are general and prominent in the hospitals of the first-grade and below .It is suggested that the regionalized disinfection and supply management mode is implemented for maximally realizing the optimized resource configuration in the disinfection and supply center .

In order to summarize the experience in physician recruitment and training process,an investigation was carried out on young physicians recruited from campus from 2007 to 2011.The results showed that the assessments of departments of the young physician's on theirs' medical ethics,professional values,theoretical knowledge,clinical competence and other aspects were higher.This indicated that these young physicians have higher overall quality.In addition,compared with the above-described abilities,the results also showed that the assessments on theirs' foreign language oral communication skills,research capacity,innovation capability,and so on,were lower.Therefore the hospital should continue to increase assessments to the candidates during the campus recruitment stage,and to develop targeted training plans so as to strengthen the ability of young physicians continually.

Objective To explore the activity of Elemene for glioma cell from the cellular and molecular level. Methods The human glioma cell U251 was cultured. The effect of Elemene for human glioma cell proliferation was studied by MTT assay. Cell cycle, Fas, PCNA, bcl-2, intracellular Ca~(2+) and apoptosis were evaluated by flow cytometry analysis. Results Elemene exhibited antiproliferative effect on human glioma cell U251 markedly. The fifty percent inhibition on concentration (IC_(50)) of Elemene against glioma cells at different time points. 24 h was 40.60 μg/ml, the 48 h 38.14 μg/ml and the 72 h 34.35 μg/ml.Cell cycle was blocked in the S and G_2/M phases. The apoptosis ratio was increased by Annexin V staining markedly. Elemene decreased the gene expressions of PCNA and Fas, increased the intracellular Ca~(2+). There was no significant effect on the bcl -2 gene expression. Conclusion Elemene exhibits a marked antiproliferative effect on glioma cells and induces apoptosis by decreasing the expression of PCNA and increasing intracellular Ca~(2+). It also influences the expression of Fas. It might have no relationship with bcl-2 gene expression.

Objective To investigate the clinical significance of the changes of electrocardiogram (ECG) and cardiac markers for myocardial damage after on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCABG). Method Monitoring 25 patients of OPCABG (OPCABG group) and 25 patients of CABG (CABG group) R wave amplitude of V4 and V5 on antorior electrocardiographic lead and simultaneously determining cardiac markers for myocardial damage creatine phosphokinase isoenzyme MB (CPK-MB), tropenin I (cTnI) and heat-shock protein 70 (HSPT0) on different lime. Results R wave amplitude of V4 and V5 on anterior electrocardiographic lead had no significant changes on 0, 6, 18 and 24 hours after OPCABG. On the contrary, R wave amplitude of V4 and V5 on anterior electrocardiographic lead decreased significantly on 0, 6 and 18 hours after CABG (P<0.01), and came back to preoperative values 24 hours after operation. The levels of CPK-MB and cTnI reached its peak and higher significantly for CABG than those for OPCABG on 24 hours after operation, 29.29 μg/L vs 5.98 μg/L and 6.74 μg/L vs 1.91 μg/L respectively. HSP70 increased significantly on 6 hours after operation in two groups, but median of HSP70 was higher significantly in CABG group (11044.5 pmol/L vs1702.0 pmol/L). In the first day after operation the HSP70 peak was correlated significantly with the level of CPK-MB(r=0.370, P<0.01) and cTnI (r=0.458,P<0.01). Conclusions Myocardial damage is significantly alleviated for patients of OPCABG comparing with those of CABG. The HSF70 in circulation may indicate the degree of myocardial damage.

OBJECTIVE To analyze distribution of the pathogens of catheter-related bloodstream infection ( CRBSI ), and provide doctors with the laboratory evidence of CRBSI diagnosis. METHODS A retrospective analysis of CRBSI pathogens′ distributions from 261 inpatients whose catheter culturing was positive in General Hospital of PLA from Jan 1, 2002 to Aug 31, 2004 was done, and from which true cases of CRBSI were judged and true pathogens or contaminants were identified and counted. RESULTS There were 88 (33.72%) patients diagnosed as CRBSI among 261 cases. They were from intensive care unit (41), surgical department (22), medicine (12), the old patients ward (10), and pediatric ward (3). The first four by rank order of the CRBSI pathogens were Acinetobacter baumannii (15.9%), coagulase-negative staphylococci (14.8%), Pseudomonas aeruginosa ( 11.4% ), and Candida albicans (9.1%). The prominent contaminants were as follows: coagulase-negative staphylococci , Streptococcus pyogenes, Micrococcus and Gram-positive rods. CONCLUSIONS To get a better understanding about distribution of CRBSI pathogens will help its diagnosing as early as possible.

Objective To investigate the resistance of Staphylococcus to erythromycin and clindamycin and detect the percentage and gene for inducible resistance. Methods Disk diffusion method was used to test the resistance phenotype of Staphylococcus aureus and coagulase-negative staphylococcus according to the standards of NCCLS. The inducible resistance of erythromycin to clindamycin was checked by D-test and the gene for erythromycin ribosome methylase was detected by polymerase chain reaction.Results Co-resistance to erythromycin and clindamycin accounted for 62.7% and 54.8% in MRSA and MRCNS respectively. D-test positive rate was 17.7% among all Staphylococcus tested. The rate of inducible resistance to clindamycin (D-test positive) was 67.6% and 45.3% in Staphylococcus aureus and coagulase-negative Staphylococcus which possessed erythromycin resistant and clindamycin sensitive by individual disk diffusion test. The predominant gene for inducible resistance was ermC with the percentage of 74.5%.Conclusion The inducible resistance of erythromycin to clindamycin in Staphylococcus should be checked by D-test in clinical microbiology laboratory in order to help physicians to select MLSB antimicrobial agents correctly.