The high intra- and inter-tumor heterogeneity of gastric cancer leads to a great difference in the immunotherapy efficacy and the prognosis among patients. Several biomarkers, including programmed death-ligand 1, human epidermal growth factor receptor 2, the features of tumor microenvironment, the peripheral blood inflammatory markers and Claudin18.2 have predictive value in the immunotherapy efficacy and the prognosis of gastric cancer patients, which might help the clinicians find the potential patients who will benefit from immunotherapy, and achieve the goal of precision medicine.

Objective:To study the efficacy and influencing factors of ursodeoxycholic acid (UDCA) in the treatment of cholesterol gallstone, so as to provide reference for the treatment of cholesterol gallstone by internal medicine.Methods:From March 1, 2017 to March 31, 2018, at outpatient department of gastroenterology of 9 Beijing medical centers including Peking University People′s Hospital, the Sixth Medical Center of PLA General Hospital, Beijing Huaxin Hospital, PLA Rocket Force Characteristic Medical Center, Peking University Aerospace Center Hospital, Beijing Youan Hospital of Capital Medical University and Beijing Tiantan Hospital of Capital Medical University, Beijing Tongren Hospital of Capital Medical University, and Beijing Shijitan Hospital of Capital Medical University, the data of patients with cholesterol gallstone treated by UDCA were collected. The inclusion criteria were that the largest diameter of stone was ≤10 mm and the stone was not detected under X-ray. The treatment plan was taking UDCA orally for 6 months at a dose of 10 mg·kg -1·d -1. The basic information of patients, the ultrasound examination results before treatment and 6 months after treatment, and scores of biliary abdominal pain and dyspepsia symptom were collected. Univariate and multivariate logistic regression were used to analyze the influencing factors of the efficacy in gallstrone dissolution by UDCA, and Wilcoxon signed rank test was used for statistical analysis. Results:A total of 215 patients were enrolled. The complete dissolution rate of gallstone was 19.5% (42/215) and partial dissolution rate was 50.7% (109/215), and the total effective rate was 70.2% (151/215). The complete dissolution rate of sandy stone was significantly higher than that of lumped stones (37.0%(17/46) vs. 14.8%(25/169); OR=3.377, 95% confidence interval (95% CI) 1.621 to 7.035, P=0.001). In lumped stones, the complete dissolution rate of the stones with diameter ≤5 mm was significantly higher than that of the stones with diameter >5 mm (37.5%(9/24) vs. 11.0%(16/145); OR=4.837, 95% CI 1.823 to 12.839, P=0.002). The complete dissolution rate of patients with higher body mass index ( OR=0.872, 95% CI 0.764 to 0.995, P=0.043) and longer disease course ( OR=0.942, 95% CI 0.912 to 0.973, P<0.001) was low. The results of multivariate logistic analysis indicated that long disease course of gallstone ( OR=0.940, 95% CI 0.908 to 0.974, P=0.001), rough gallbladder wall ( OR=0.438, 95% CI 0.200 to 0.962, P=0.040) and lumped stone ( OR=0.236, 95% CI 0.101 to 0.550, P=0.001) were independent risk factors of influencing the efficacy of stone dissolution by UDCA. As for lumped stones, the independent risk factors included long disease course of gallstone ( OR=0.926, 95% CI 0.877 to 0.978, P=0.006) and stone diameter >5 mm ( OR=0.142, 95% CI 0.043 to 0.470, P=0.001). After 6 months of UDCA treatment, score of biliary abdominal pain decreased from 0 (0 to 6) to 0 (0 to 0) and the score of dyspepsia symptom decreased from 1 (0 to 2) to 0 (0 to 0), and the differences between before treatment and after treatment were statistically significant ( Z=-8.50, and -9.13, both P<0.001). Conclusions:UDCA has a certain efficacy in cholesterol gallstone dissolution and can ease biliary abdominal pain and dyspepsia symptom. Long disease course of gallstone, rough gallbladder wall and stone diameter >5 mm are independent risk factors of poor efficacy in gallstone dissolution by UDCA.

Fibroblast growth factor receptors (FGFRs) have emerged as promising targets for anticancer therapy. In this study, we synthesized and evaluated the biological activity of 66 pyrazolo[3,4-

This article introduces the health management service specification for a chronic patient population. The concept of this specification comes from the whole process of people-centered and integrated health management of the chronic patient population. It is also based on the World Health Organization′s integrated chronic patient population management model. The completion of the specification has gone through several rounds of expert discussion in related fields in China. The contents include seven key links: suspect selection, clinical diagnosis, health assessment, intervention plan development, intervention plan implementation, follow-up, and health reassessment. It also includes establishing a professional team and developing a support system and mechanism of financing, compensation, and incentives. The specification aims at integrating regional health resources through standardizing service technology and scientific management concepts. It would help to improve the efficiency and quality of health management of chronic patient population in China, thereby reducing the economic burden of chronic diseases for patients and their families, and achieving the goal of improving residents′ health.

Objective To understand the distribution of water iodine in the external environment of Shanxi Province, and to provide a basis for redefining and implementation of scientific iodine supplementation in iodine deficiency, iodine adequate or iodine high areas. Methods In 2012 - 2016, administrative villages (neighborhood committees)in 119 counties(cities,districts)in 11 cities of Shanxi Province were selected as the investigation units, and 1 to 5 drinking water samples were collected. Water iodine content was detected using arsenic-cerium catalytic spectrophotometry. Areas standard was designated: water iodine content < 10 μg/L as iodine deficiency areas, > 100 μg/L as iodine high areas. Results A total of 26 213 administrative villages (neighborhood committees) of 1 362 townships (towns) of 119 counties (cities, districts) were surveyed, covering 2 850.94 ten thousand people. A total of 32 766 water samples were collected and the median iodine was 5.2 μg/L. There were 18 199 villages with water iodine < 10 μg/L, accounting for 69.4% (covering 1 812.17 ten thousand people, accounting for 63.6%), 6 471 villages with water iodine 10-<50 μg/L,accounting for 24.7%(covering 787.44 ten thousand people,accounting for 27.6 %),1 166 villages with water iodine 50 - < 100 μg/L,accounting for 4.4% (covering 181.46 ten thousand people, accounting for 6.4%), 377 villages with water iodine ≥100 μg/L, accounting for 1.4%(covering 69.87 ten thousand people, accounting for 2.5%).In 1 362 townships (towns), 71.1% (969)water iodine median was<10 μg/L,24.2%(330)water iodine median was in 10-<50 μg/L,3.4%(46)water iodine median was in 50-<100 μg/L,and 1.2%(17) water iodine median was ≥100 μg/L. In 119 counties(cities,districts),there were 90 counties(accounting for 75.6%) with the water median < 10 μg/L, there were 26 counties (accounting for 21.8%) with the water median 10 - < 50 μg/L. Conclusions Most parts of Shanxi Province(or the resident population) are iodine deficiency areas, the external environment water iodine contents in the rest of the regions are different, we should adopt different iodine supplement or iodine reduction measures in regions with different water iodine levels.

Objective To evaluate the clinical characterisitics of polyarteritis nodosa (PAN) patients with acromelic gangrene,and to improve the understanding of this disease by clinicians.Methods The clinical and laboratory data of PAN patients with acromelic gangrene admitted to Peking Union Medical College Hospital (PUMCH) between November 1986 to October 2016 were collected and summarized.According to the ratio of 1∶2,PAN patients without acromelic gangrene during the same period were randomly selected and compared with patients with acromelic gangrene.The comparison of the demographic data,system involvement,laboratory and other auxiliary examination results,the treatment were included in this study.All data were analyzed by SPSS 19.0 statistical software.T test,Mann Whitney U test,x2 test were used for statistical analyses.Results Among 204 PAN patients admitted to PUMCH during this period,22 cases were complicated with gangrenes.In PAN patients with gangrenes,-male/female ratio was 4.5/1,the mean age was (43±19) years,and the disease duration (from onset of disease to gangrene) was 3.5 months (ranged from 1 week to 20 years).Simple finger gangrenes occurred in 7 cases(32％),simple toe gangrenes in 8 cases (36％),both gangrenes in 7 cases (32％).In the involvements of limb arteries,15 cases (68％) were posterior tibial artery involvement,12 cases (55％) were anterior tibial artery involvement,10 cases (45％) were radial artery involvement,7 cases (32％) were ulnar artery involvement,5 cases (23％) were peroneal artery involvement,5 cases (23％) were superficial femoral artery involvement,4 cases (18％) were dorsal foot artery involvement,3 cases (14％) were popliteal artery involvement,1 case (5％) was anterior interosseous artery involvement.There were significant difference in PAN patients with and without acromelic gangrene as patients with acromelic gangrene were more prone to arthritis/pain (45％ vs 2％;x2=16.71,P＜0.01),new-onset hypertension (41％ vs 7％;x2=9.28,P＜0.01),intestinal bleeding/perforation (41％ vs 14％;x2=6.21,P=0.01),increased eosinophils (55％ vs 7％;x2=19.02,P＜0.01),artery (91％ vs 27％;x2=23.78,P＜0.01) involvement in extremities,head and neck (41％ vs 18％;x2=3.96,P=0.05),arteriovenous thrombosis (27％ vs 2％;x2=7.21,P=0.007),glucocorticoid pulse therapy (73％ vs 14％;x2=23.05,P＜0.01).Conclusion PAN patients with acromelic gangrene have significant increase of eosinophils and widespread internal organ ischemia.Aggressive treatment should be taken in these patients.

OBJECTIVETo explore the acupoint electrosensitivity and regularity for assisting the clinical diagnosis and treatment so as to improve the clinical therapeutic effects.

METHODSBy means of the computer retrieval (CBMdisc, CNKI, VIP, WanFang, PubMed and EMBASE) and manual retrieval, the relevant literature on acupoint electrosensitivity was reviewed and the modern literature database of acupoint electrosensitivity was established. Using bibliometric, the relations were analyzed among the detected indexes, acupoints, meridians and disorders in the conditions of acupoint electrosensitivity, and the potential regularity was explored.

RESULTSThe general detection indexes of acupoint electrosensitivity were resistance, inertia area, volt-ampere area, electric conduction quantity, electric potential, electric current and capacitance. The electrosensitive points included meridian points, auricular points and extraordinary points. Among those points, the electrosensitivity easily occurred at the special points.

CONCLUSIONThe acupoint electrosensitivity is mainly reflected on the electrical impedance and volt-ampere characteristics. The relative specificity exists between acupoint electrosensitivity and disorders. In clinical practice, detecting acupoint electrosensitivity may assist the diagnosis and instruct acupoint selection to improve the clinical therapeutic effects.

Objective · To investigate the gender-related metabolomic differences in human saliva. Methods · The saliva metabolomic profiles of 5 male and 5 female healthy volunteers with matched age, body mass index (BMI), living and tooth-brushing condition were acquired using ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry. Metabolites were identified using publicly accessible databases and further confirmed individually with standard compounds. Both multivariant and univariate statistics were conducted to find inter-gender differences.Results · Forty-eight metabolites in human saliva were identified including 13 amino acids, 6 choline metabolites, 15 carnitines, 4 sphinganine metabolites,7 lysophosphatidylcholine and 3 organic acids. Levels of phenylalanine, acetylcarnitine, propionylcarnitine, butyrylcarnitine, isobutyrylcarnitine,isovalerylcarnitine and sphinganine were higher in the saliva of females than that of males. Conclusion · Rich metabolic information present in human saliva with significant gender diffference which ought to be taken into consideration in study on the metabonomics of saliva.

Objective To investigate the situation of nurse job burnout and the occurrence of nursing adverse events in western area of Chongqing,and to analyse the correlation between them.Methods A total of 5 hospitals in different district of west area of Chongqing was randomly selected.Then the sample of nurses meeting the inclusion and exclusion criteria was selected by random number table method,200 nurses were selected in each hospital.Multivariate logistic regression analysis was used to analyze the factors influencing the adverse events of nursing,and the structural equation model was applied to analyze the relationship between nurses job burnout and nursing adverse events.Results A total of 1 000 nurses were surveyed,and 998 valid questionnaires were collected.The rate of nurse job burnout and the incidence of nursing adverse events in the survey year were 56.41％ and 54.21％,respectively.Among nurses with job burnout,85.08 ％ occurred nursing adverse events.The increased workload,night shift,no officially budgeted post and with occupational burnout were factors affecting the incidence of nursing adverse events (OR=1.250,1.445,1.615,1.991,P＜ 0.05).The emotional exhaustion dimension of job burnout had the greatest effect on nursing adverse events (the standard partial regression coefficient was 0.31,P＜0.05),followed by the disintegration of personality (the standard partial regression coefficient was 0.29,P＜0.05),while the reduction in the sense of accomplishment had no direct effect on nursing adverse events.Conclusion In hospitals of the western area of Chongqing,the prevalence of nurse job burnout is comparatively serious,and the incidence of nursing adverse events is relatively high.The nurse job burnout and nursing adverse events might be positively correlated.

This study was conducted to explore a proper training model of interns' clinical thinking ability under the construction of a new four-year system of medical laboratory technology courses, combined with the establishment of innovative standard whole process practice mode. Multi-teaching methods of clinical thinking, such as explanation of laboratory sheet, interactive teaching based on micro digital system, interdisciplinary multiple information system, combined PBL teaching and intern report, were applied and evaluated in the laboratory. Integrated application of these methods remarkably improved the intern's com-prehensive professional quality and their practice performance. All methods received high evaluation from both the interns and teachers.