[Progress in methodological research on bridging the efficacy-effectiveness gap of clinical interventions(2): to improve the extrapolation of efficacy]

Objective: Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings. Methods: Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results: A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics. Conclusions: Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.

[Analysis methods and case analysis of effect modification (3): effect modification in individual patient data Meta-analysis]

This paper briefly introduces the unique advantages, overall analysis ideas and existing analysis methods of individual patient data Meta-analysis in terms of effect modification. In addition to Meta-regression and subgroup analysis, this paper also introduces the analysis methods based on part of individual patient data integrated with aggregated data and summarizes the current reporting of the above mentioned methods. In addition, the application and results interpretation of the above mentioned methods in individual patient data Meta-analysis are presented in this paper by taking "Effects of sodium-glucose cotransporter 2 inhibitors on SBP in patients with type 2 diabetes" as an example and by introducing their advantages and limitations.

[Application effect of a dual release system of androgen and its antagonist in the repair of full-thickness burn wounds in mice]

Objective: To explore the optimal ratio of dihydrotestosterone and hydroxyflutamide (hereinafter referred to as DH), construct a dual release system of androgen and its antagonist, and analyze the application effect of this system in the repair of full-thickness burn wounds in mice. Methods: This study was an experimental study. The HaCaT cells were divided into blank group (without drug culture), low baseline group, medium baseline group, and high baseline group according to the random number table (the same grouping method below), and the last three groups of cells were cultured by adding three different ratios of DH. Under a medium ratio, the mass of dihydrotestosterone in the three baseline groups from low to high was 1.4, 2.8, and 4.0 µg, respectively, and the mass of hydroxyflutamide was 1.2, 1.6, and 2.0 µg, respectively. On this basis, under a small ratio, the mass of dihydrotestosterone was reduced by half and the mass of hydroxyflutamide was increased by half; under a large ratio, the mass of dihydrotestosterone was increased by half and the mass of hydroxyflutamide was reduced by half. After culture of 2 days, the cell proliferation level was detected by cell counting kit 8 (n=4). Sixteen 6-8-week-old male BALB/c mice were used to establish a full-thickness burn wound on the back and divided into blank group, small ratio group, medium ratio group, and large ratio group, with 4 mice in each group. On post injury day (PID) 7, normal saline containing different ratios of DH was locally dropped to the wounds of mice in the last three groups of mice (the total mass of DH in the three ratio groups from small to large was 127.5, 165.0, and 202.5 µg, respectively, and the mass ratios of dihydrotestosterone to hydroxyflutamide (hereinafter referred to as drug mass ratio) were 8∶9, 8∶3, and 8∶1, respectively), afterwards, the administration was repeated every 48 hours until PID 27; normal saline was dropped to the wound of mice in blank group at the aforementioned time points. The wound healing status on PID 0 (immediately), 7, 14, 21, and 28 was observed, and the wound healing rates on PID 7, 14, 21, and 28 were calculated (n=4). On PID 28, the wound tissue was taken, which was stained with hematoxylin and eosin for observing re-epithelialization and with Masson for observing collagen fibers, and the proportion of collagen fibers was analyzed (n=3). Twenty 6-8-week-old male BALB/c mice were used to establish a full-thickness burn wound on the back and divided into ordinary scaffold group, small proportion scaffold group, medium proportion scaffold group, and large proportion scaffold group (with 5 mice in each group). On PID 7, the wound was continuously dressed with a polycaprolactone scaffold without drug and a polycaprolactone scaffold containing DH with a drug mass ratio of 1∶3, 1∶1, or 3∶1 (i.e. the dual release system of androgen and its antagonist, with total mass of DH being about 1.7 mg) prepared by using electrospinning technology until the end of the experiment. Histopathological analyses of tissue (n=3) at the same time points as those in the previous animal experiment were performed. On PID 7 and 14, the wound exudates were collected and the relative abundance of bacterial communities was analyzed using 16S ribosomal RNA high-throughput sequencing (n=3). Results: After culture of 2 days, under a small ratio, the proliferation levels of HaCaT cells in low baseline group and high baseline group were significantly higher than the level in blank group (P<0.05). As the time after injury prolonged, the wounds of all four groups of mice continued to shrink. On PID 14, the wound healing rate of mice in large ratio group was 72.5% (61.7%, 75.1%), which was close to 53.3% (49.5%, 64.4%) in blank group (P>0.05); the wound healing rates of mice in small and medium ratio groups were 74.2% (71.0%, 84.2%) and 70.4% (65.1%, 74.4%), respectively, which were significantly higher than the rate in blank group (with both Z values being -2.31, P<0.05). On PID 21, the wound healing rate of mice in small ratio group was significantly higher than that in blank group (Z=-2.31, P<0.05). On PID 28, the wounds of mice in the three ratio groups were completely re-epithelialized and the epidermis was thicker than that in blank group; compared with that in blank group, the collagen fiber content in the wound tissue of mice in the three ratio groups was higher and arranged more orderly, and the proportions of collagen fibers in the wound tissue of mice in small and large ratio groups were significantly increased (P<0.05). On PID 28, the wounds of mice in ordinary scaffold group were partially epithelialized, while the wounds of mice in the three proportion scaffold groups were almost completely epithelialized. Among them, the wounds of mice in small proportion scaffold group had the thickest epidermis. The proportion of collagen fibers in the wound tissue of mice in small proportion scaffold group was significantly increased compared with that in ordinary scaffold group (P<0.05). On PID 7, the bacterial communities with high relative abundance in the wound exudation of mice in the four groups included bacteria of Corynebacterium, Staphylococcus, and Rhodococcus. On PID 14, the bacterial communities with high relative abundance in the wound exudation of mice in the four groups included bacteria of Stenotrophomonas, Rhodococcus, and Staphylococcus, and the number of bacterial species in the wound exudation of mice in the three proportion scaffold groups was more than that in ordinary scaffold group. Conclusions: When the drug mass ratio is relatively small, DH has the effect of promoting the proliferation of HaCaT cells. The ratio of 8∶9 is the optimal mass ratio of dihydrotestosterone to hydroxyflutamide, and DH with this mass ratio can promote re-epithelialization and collagen deposition of full-thickness burn wounds in mice, and promote wound healing. The constructed dual release system of androgen and its antagonist with DH in a 1∶3 drug mass ratio contributes to the re-epithelialization and collagen deposition of the full-thickness burn wounds in mice, and can improve the diversity of wound microbiota.

[Analysis methods and case analysis of effect modification (2): effect modification in network Meta-analysis]

This paper briefly introduces the characteristics, research significance, and global reporting status of effect modification in network Meta-analysis, demonstrates the heterogeneity caused by effect modification in network Meta-analysis, and emphasizes the importance of exploring effect modification in network Meta-analysis. This paper also summarizes the normalized description and analysis strategies of effect modification in network Meta-analysis. Finally, by the case of "comparison of efficacy of three new hypoglycemic drugs in reducing body weight in type 2 diabetes patients", this paper demonstrates the realization of subgroup analysis and network Meta-regression in exploring effect modification, summarizes the advantages and disadvantages of the two methods, to provide references for future researchers.

[Progress in methodological research on bridging the efficacy-effectiveness gap of clinical interventions (1): to improve the validity of real-world evidence]

Objective: Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect. Methods: Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results: Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap. Conclusion: Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Dysfunction of duplicated pair rice histone acetyltransferases causes segregation distortion and an interspecific reproductive barrier

Postzygotic reproductive isolation, which results in the irreversible divergence of species, is commonly accompanied by hybrid sterility, necrosis/weakness, or lethality in the F1 or other offspring generations. Here we show that the loss of function of HWS1 and HWS2, a couple of duplicated paralogs, together confer complete interspecific incompatibility between Asian and African rice. Both of these non-Mendelian determinants encode the putative Esa1-associated factor 6 (EAF6) protein, which functions as a characteristic subunit of the histone H4 acetyltransferase complex regulating transcriptional activation via genome-wide histone modification. The proliferating tapetum and inappropriate polar nuclei arrangement cause defective pollen and seeds in F2 hybrid offspring due to the recombinant HWS1/2-mediated misregulation of vitamin (biotin and thiamine) metabolism and lipid synthesis. Evolutionary analysis of HWS1/2 suggests that this gene pair has undergone incomplete lineage sorting (ILS) and multiple gene duplication events during speciation. Our findings have not only uncovered a pair of speciation genes that control hybrid breakdown but also illustrate a passive mechanism that could be scaled up and used in the guidance and optimization of hybrid breeding applications for distant hybridization.

[Analysis methods and case analysis of effect modification (1): effect modification in epidemiology and traditional Meta-analysis]

This paper briefly introduces the definition, classification and significance of effect modification in epidemiological studies, summarizes the difference between effect modifier and confounders, and analyze the influence as well as the role of effect modification in epidemiological studies and Meta-analysis. In this paper, the possible scenarios of effect modification and related analysis strategy in Meta-analysis are indicated by graphics, aiming to arouse researchers' attention to effect modification. This paper also demonstrates how to identify and deal with effect modification in Meta-analysis through a study case of "Efficacy of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes", and shows the analysis process and interpretation of results of subgroup analysis and Meta-regression methods respectively. The advantages and disadvantages of these two methods are summarized to provide reference for the method selection of future research.

[A randomized controlled trial on the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns]

Objective: To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods: A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results: Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar (P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group (t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar (P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close (P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group (t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group (t=21.78, P<0.05). Conclusions: The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.

Exploring the reaction kinetics of methyl formate + NO2: implication for ignition behavior of methyl formate/NO2 mixtures

The reaction pathways and potential energy profiles are theoretically explored for H-abstraction, addition and addition-dissociation reactions of methyl formate (MF, HC(O)OCH3) + NO2 using the high level quantum chemical compound method CCSD(T)/cc-pVxZ(x = T, Q)//M062X/6-311+G(2df,2p). Notably, three different HNO2 isomers (cis-HONO, trans-HONO and HNO2) are all considered in each reaction pathway. The corresponding temperature- and pressure-dependent rate constants are then computed by RRKM/ME simulations with one-dimensional hindered rotor approximation and asymmetric Eckart tunneling corrections. The calculations show that the rate constants are pressure independent. Although trans-HONO is the most stable HNO2 isomer, the results reveal that the dominant channels are cis-HONO + HC(O)OCH2/C(O)OCH3 and cis-HC(O)(ONO)OCH3 for the H-abstraction and addition, respectively. Moreover, the lowest energy barrier for the H-abstraction channel (cis-abs) is 11.2 kcal mol-1 lower than the addition channel (cis-add), and thus the addition channel is less kinetically favored. The computed rate constants for the MF + NO2 reaction are then incorporated into a kinetic model and the importance of the title reaction in predicting the ignition behavior of MF/NO2 mixtures is demonstrated by kinetic modeling. The detailed reaction kinetics in this work will be helpful for kinetic model development of other ester-based fuels.

[Methods for controlling and evaluating residual confounding in the association analysis of observational study with a multicenter database]

The observational research based on big data in healthcare has attracted increasing attention, with the control and evaluation of residual confounding being the critical issue that needs to be solved urgently. This review summarized the methods for statistical adjustment and sensitivity analysis of residual confounding in the association analysis with a multicenter database. Based on individual-level data, the residual confounding can be adjusted in each subcenter using methods such as regression discontinuity design, while the pooled estimate can be obtained as a weighted average. Based on the center-level results, the Bayesian Meta-analysis method can adjust the pooled estimates. The sensitivity analysis of residual confounding can also be carried out using center-level data to calculate the E-value, p^(q), T^(r, q) and G^r,q. The abovementioned methods should be selected reasonably according to the requirements for practical applications, advantages, and disadvantages. For example, the use of subcenter individual data for residual confounding adjustment usually needs strict study design and frequent coordination; the Bayesian Meta-analysis is based on some strong assumptions; the interpretation of the results in the sensitivity analysis, such as E-value requires professional judgment to assess the risk of residual confounding. Therefore, the methods for controlling and evaluating residual confounding in association analysis based on multicenter databases still need further development and improvement.

[A risk prediction model of cervical cancer developed based on nested case-control design]

Objective: To construct a cervical cancer risk prediction model based on nested case-control study design and Yinzhou Health Information Platform in Ningbo, and provide reliable reference for self-risk assessment of cervical cancer in local women. Methods: In local women aged 25-75 years old who had no history of cervical cancer registered in Yinzhou before October 31, 2018, a follow up was conducted for at least three years, the patients who developed cervical cancer during the follow up period were selected as the case group and matched with a control group at a ratio of 1∶10. The prediction indicators before the onset was used in model construction. Variables were selected by Lasso-logistic regression, the variables with non-zero β were selected to fit the logistic regression model and Bootstrap was used for internal validation. The discrimination of the model was evaluated by area under the receiver operating characteristic curve(AUROC), and the calibration was evaluated by calibration curve and Hosmer-Lemeshow test. Results: The prediction indicators included in the final model were age, smoking status, history of cervicitis, history of adenomyosis, HPV testing, and thinprep cytologic test. The AUROC calculated in the internal validation was 0.740 (95%CI:0.739-0.740), and the calibration curve was almost identical with the ideal curve, P=0.991 in Hosmer-Lemeshow test, indicating that the model discrimination and calibration were good. Conclusions: In this study, a simple and practical cervical cancer risk prediction model was developed. The model can be used in general population with strong interpretability, good discrimination and calibration in internal validation, which can provide a reference for women to assess their risk of cervical cancer.

[Research progress of FAPI PET/CT in the diagnosis of malignant liver tumors]

Malignant liver tumors have a high incidence and mortality rate. Therefore, it is of great significance to promptly learn about tumor advancement status through relevant examinations for patients' follow-up, diagnosis, and therapy as well as the improvement of the five-year survival rate. The primary lesions and intrahepatic metastases of malignant liver tumors have been better demonstrated in the clinical study with the use of various isotope-labeled fibroblast activating protein inhibitors because of their low uptake in liver tissues and high tumor/background ratio, which provides a new method for early diagnosis, precise staging, and radionuclide therapy. In light of this context, a review of the research progress of fibroblast-activating protein inhibitors for the diagnosis of liver malignant tumors is presented.

[Impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity and pulse pressure on all-cause mortality]

Objective: To evaluate the impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity (baPWV) and pulse pressure (PP) on all-cause mortality. Methods: This study is a prospective cohort study. Individuals participated in the Kailuan Study and completed baPWV measurements between 2010 and 2016 were included in this study. After stratifying by sex, 75th percentile baPWV and PP values for different age group were calculated at five years interval. BaPWV and PP values below the 75th percentile were defined as normal, and those above or equal to the 75th percentile were defined as increased. The participants were allocated to four groups according to their PP and baPWV status: normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group. The primary outcome was all-cause mortality during the follow-up period. Cox proportional hazards models were used to explore the impact of individual and combined assessment of baPWV and PP on all-cause mortality events. Results: A total of 39 339 participants were enrolled in this study, aged (49.3±12.8) years, of which 28 731 (73.03%) were males. There were 23 268, 6 025, 6 210 and 3 836 cases in the normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group, respectively. The average follow-up duration was (4.98±2.53) years. During the follow-up period, all-cause mortality occurred in 998 individuals. Multivariate Cox regression analysis showed increased risk of all-cause mortality in the high baPWV/normal PP group (HR=1.27, 95%CI 1.07-1.50), and in the high baPWV/PP group (HR=1.33, 95%CI 1.08-1.65) compared to the normal baPWV/PP group. Increased pulse pressure alone had no impcat on all-cause death (HR=1.06, 95%CI 0.87-1.29). Conclusions: The risk of all-cause mortality significantly increases with increased age-and sex-specific baPWV and PP values. BaPWV may be a better predictor of all-cause mortality than PP in this cohort.

Optimization of rice panicle architecture by specifically suppressing ligand-receptor pairs

Rice panicle architecture determines the grain number per panicle and therefore impacts grain yield. The OsER1-OsMKKK10-OsMKK4-OsMPK6 pathway shapes panicle architecture by regulating cytokinin metabolism. However, the specific upstream ligands perceived by the OsER1 receptor are unknown. Here, we report that the EPIDERMAL PATTERNING FACTOR (EPF)/EPF-LIKE (EPFL) small secreted peptide family members OsEPFL6, OsEPFL7, OsEPFL8, and OsEPFL9 synergistically contribute to rice panicle morphogenesis by recognizing the OsER1 receptor and activating the mitogen-activated protein kinase cascade. Notably, OsEPFL6, OsEPFL7, OsEPFL8, and OsEPFL9 negatively regulate spikelet number per panicle, but OsEPFL8 also controls rice spikelet fertility. A osepfl6 osepfl7 osepfl9 triple mutant had significantly enhanced grain yield without affecting spikelet fertility, suggesting that specifically suppressing the OsEPFL6-OsER1, OsEPFL7-OsER1, and OsEPFL9-OsER1 ligand-receptor pairs can optimize rice panicle architecture. These findings provide a framework for fundamental understanding of the role of ligand-receptor signaling in rice panicle development and demonstrate a potential method to overcome the trade-off between spikelet number and fertility.

[Exploration of family rehabilitation model for children with scar contracture after hand burns]

Objective: To explore the family rehabilitation model for children with scar contracture after hand burns and observe its efficacy. Methods: A retrospective non-randomized controlled study was conducted. From March 2020 to March 2021, 30 children with scar contracture after deep partial-thickness to full-thickness burns of hands, who met the inclusion criteria, were hospitalized in the Burn Center of PLA of the First Affiliated Hospital of Air Force Medical University. According to the rehabilitation model adopted, 18 children (23 affected hands) were included in a group mainly treated by family rehabilitation (hereinafter referred to as family rehabilitation group), and 12 children (15 affected hands) were included in another group mainly treated by hospital rehabilitation (hereinafter referred to as hospital rehabilitation group). In the former group, there were 11 males and 7 females, aged (4.8±2.1) years, who began rehabilitation treatment (3.1±0.8) d after wound healing; in the latter group, there were 7 males and 5 females, aged (4.6±2.1) years, who began rehabilitation treatment (2.8±0.7) d after wound healing. The children in hospital rehabilitation group mainly received active and passive rehabilitation training in the hospital, supplemented by independent rehabilitation training after returning home; after 1-2 weeks of active and passive rehabilitation training in the hospital, the children in family rehabilitation group received active and passive rehabilitation training at home under the guidance of rehabilitation therapists through WeChat platform. Both groups of children were treated for 6 months. During the treatment, they wore pressure gloves and used hand flexion training belts and finger splitting braces. Before treatment and after 6 months of treatment, the modified Vancouver scar scale, the total active movement of the hand method, and Carroll quantitative test of upper extremity function were used to score/rate the scar of the affected hand (with the difference of scar score between before treatment and after treatment being calculated), the joint range of motion (with excellent and good ratio being calculated), and the function of the affected limb, respectively. Data were statistically analyzed with independent sample t test, equivalence test, Fisher's exact probability test, and Mann-Whitney U test. Results: The differences of scar scores of the affected hands of children in family rehabilitation group and hospital rehabilitation group between after 6 months of treatment and those before treatment were 3.0 (2.0, 7.0) and 3.0 (2.0, 8.0) respectively (with 95% confidence interval of 2.37-5.38 and 1.95-5.91). The 95% confidence interval of the difference between the differences of the two groups was -2.43-2.21, which was within the equivalent boundary value of -3-3 (P<0.05). The excellent and good ratios of joint range of motion of the affected hand of children in family rehabilitation group and hospital rehabilitation group were 3/23 and 2/15 respectively before treatment, and 15/23 and 12/15 respectively after 6 months of treatment. The ratings of joint range of motion of the affected hand of children in family rehabilitation group and hospital rehabilitation group after 6 months of treatment were significantly higher than those before treatment (with Z values of 3.58 and 2.30, respectively, P<0.05), but the ratings of joint range of motion of the affected hand between the two groups were similar before treatment and after 6 months of treatment (with Z values of 0.39 and 0.55, respectively, P>0.05). The functional ratings of the affected limbs of children in family rehabilitation group and hospital rehabilitation group after 6 months of treatment were significantly higher than those before treatment (with Z values of 3.98 and 3.51, respectively, P<0.05), but the functional ratings of the affected limbs between the two groups were similar before treatment and after 6 months of treatment (with Z values of 1.27 and 0.38, respectively, P>0.05). Conclusions: The WeChat platform assisted rehabilitation treatment with mainly family rehabilitation, combined with hand flexion and extension brace can effectively reduce the scarring after children's hand burns, improve the joint range of motion of the affected hands, and promote the recovery of affected limb function. The effect is similar to that of hospital-based rehabilitation providing an optional rehabilitation, treatment method for children who cannot continue to receive treatment in hospital.

[A prospective randomized controlled study on the effects of progressive core muscle group training combined with lower limb intelligent rehabilitation training for burn patients with lower limb dysfunction]

Objective: To observe the effect of progressive core muscle group training combined with lower limb intelligent rehabilitation training on burn patients with lower limb dysfunction. Methods: A prospective randomized controlled study was conducted. From March 2017 to May 2020, 60 patients with motor and balance dysfunction after deep partial-thickness burns or full-thickness burns of both lower extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Military Medical University. They were divided into simple intelligent rehabilitation group (30 cases, 20 males and 10 females, aged (40±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (39±3) years) according to the random number table method. The patients in both groups started red light treatment after the wound healing or when the scattered residual wound area was less than 5% total body surface area. After 2 weeks of red light treatment, patients in the combined rehabilitation group started progressive core muscle group training on the basis of lower limb intelligent rehabilitation training in simple intelligent rehabilitation group, and the training time was 6 weeks. Before and after 6 weeks of training, the lower limb motor function was evaluated with the simple Fugl-Meyer scale, the balance capacity was evaluated with the Berg balance scale, and the walking capacity was evaluated with the Holden walking ability rating scale. After 6 weeks of training, a self-designed questionnaire was used to investigate patients' satisfaction for the treatment effect. The patients were followed up for 6 months after the treatment to observe the balance stability of standing on one foot in the flexion position and their participation in activities of daily life. Data were statistically analyzed with independent sample t test, paired sample t test, and chi-square test. Results: Before training, the lower limb motor function score of patients in simple intelligent rehabilitation group was 24.9±2.7, which was close to 23.9±2.3 in combined rehabilitation group (P>0.05). After 6 weeks of training, the lower limb motor function score of patients in combined rehabilitation group was 29.6±3.9, which was significantly higher than 27.3±3.8 in simple rehabilitation group (t=-2.28, P<0.05). The lower limb motor function scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -6.50 and -3.21, respectively, P<0.01). After 6 weeks of training, the balance capacity score of patients in combined rehabilitation group was 41±7, which was significantly higher than 36±5 in simple intelligent rehabilitation group (t=-2.68, P<0.05); the balance capacity scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -8.72 and -8.09, respectively, P<0.01). After 6 weeks of training, the walking capacity grading of patients in combined rehabilitation group was significantly improved compared with that in simple intelligent rehabilitation group (χ2=-2.14, P<0.05), and the walking capacity grading of patients in simple intelligent rehabilitation group and combined rehabilitation group after 6 weeks of training was significantly improved compared with that before treatment (with χ2 values of -4.94 and -5.26, respectively, P<0.01). After 6 weeks of training, the satisfaction score for the treatment effect of patients in combined rehabilitation group was 13.7±1.2, which was significantly higher than 7.8±1.4 in simple intelligent rehabilitation group (t=22.84, P<0.01). The patients in both groups could stand on one foot to maintain balance in the flexion position of lower limb, and their activities of daily life were not affected 6 months after treatment. Conclusions: On the basis of conventional rehabilitation therapy, the combination of progressive core muscle group training and lower limb intelligent rehabilitation training can significantly promote the recovery of lower limb motor and balance function of burn patients.

An α/β hydrolase family member negatively regulates salt tolerance but promotes flowering through three distinct functions in rice

Ongoing soil salinization drastically threatens crop growth, development, and yield worldwide. It is therefore crucial that we improve salt tolerance in rice by exploiting natural genetic variation. However, many salt-responsive genes confer undesirable phenotypes and therefore cannot be effectively applied to practical agricultural production. In this study, we identified a quantitative trait locus for salt tolerance from the African rice species Oryza glaberrima and named it as Salt Tolerance and Heading Date 1 (STH1). We found that STH1 regulates fatty acid metabolic homeostasis, probably by catalyzing the hydrolytic degradation of fatty acids, which contributes to salt tolerance. Meanwhile, we demonstrated that STH1 forms a protein complex with D3 and a vital regulatory factor in salt tolerance, OsHAL3, to regulate the protein abundance of OsHAL3 via the 26S proteasome pathway. Furthermore, we revealed that STH1 also serves as a co-activator with the floral integrator gene Heading date 1 to balance the expression of the florigen gene Heading date 3a under different circumstances, thus coordinating the regulation of salt tolerance and heading date. Notably, the allele of STH1 associated with enhanced salt tolerance and high yield is found in some African rice accessions but barely in Asian cultivars. Introgression of the STH1^HP46 allele from African rice into modern rice cultivars is a desirable approach for boosting grain yield under salt stress. Collectively, our discoveries not only provide conceptual advances on the mechanisms of salt tolerance and synergetic regulation between salt tolerance and flowering time but also offer potential strategies to overcome the challenges resulted from increasingly serious soil salinization that many crops are facing.

[Progress in research of determinants of healthy life expectancy]

Objective: To analyze the influencing factors of healthy life expectancy (HLE). Methods: Seven Chinese and English databases were used for the retrieval of related literatures published by May 7, 2022 to identify influencing factors of HLE, including diseases and injuries and their risk factors. Based on the ecological model of health determinants, this study classifies the risk factors of diseases and injuries into five levels: personal characteristics, individual behavior and lifestyle, social network, living and working conditions, and macroscopic socio-economic, cultural and environmental conditions. Contents of research area, HLE indicators, research population, influencing factors, data sources and results were extracted. The frequencies of reported documents of different HLE indicators and influencing factors of different dimensions were visualized by using evidence map, and the empirical studies of four authoritative English medical journals and Chinese core medical journals were further compared and described. Results: A total of 90 studies were selected, in which 26 were conducted in China (28.9%). Fifty-three studies are about diseases and injuries in the first dimension, and all of them have studied non-communicable diseases, accounting for the highest proportion (58.9%). There were 77 studies about the analysis on the determinants of health at five levels by an ecological model, all the studies reported multi-level results. Among them, 53 studies reported personal characteristics (58.9%), 47 studies reported individual behavior and lifestyle (52.2%), 10 studies reported social networks (11.1%), 35 studies reported living and working environment (38.9%), 8 studies reported social economy, culture status and environment condition (8.9%). The literatures about HLE published by 4 authoritative English medical journals and 21 Chinese core medical journals in recent three years were selected. Non-communicable diseases and personal characteristics were the top two most commonly studied factors of HLE, and 11 (52.3%) and 12 (57.1%) studies reported these two kinds of factors respectively. The most important factor contributing to the global disability-adjusted life years of non-communicable diseases was individual behavior and lifestyle, which was the most changeable factor. Conclusions: In recent three years, studies involving influencing factors of HLE were mainly non-communicable diseases and personal characteristics. In the future, individual behavior, lifestyle and working environment should be strengthened.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 1)]

In recent years, researchers, pharmaceutical companies, and political makers gradually using more real-world data (RWD) to produce real-world evidence (RWE) for policy-making. A research team of Harvard University launched the RCT DUPLICATE project in 2018, aiming to replicate 30 randomized controlled trials using the medical claims database in order to explore methods for quantifying the efficacy-effectiveness gap and explain its potential sources, to enhance the credibility of the RWE. This paper reviews the background of RCT DUPLICATE Initiative, highlights the research purposes, research design and implementation process of the RCT DUPLICATE Initiative, to help domestic scholars better understand the scope and application value of RWE.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 2)]

With the promotion and application of big medical data, non-interventional real-world evidence (RWE) has been used by regulators to assess the effectiveness of medical products. This paper briefly introduces the latest progress and research results of the RCT DUPLICATE Initiative launched by the research team of Harvard University in 2018 and summarizes relevant research experience based on the characteristics of China's medical service to provide inspiration and reference for domestic scholars to conduct related RWE research in the future.

[A multicenter epidemiological study of acute bacterial meningitis in children]

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.

A genetic module at one locus in rice protects chloroplasts to enhance thermotolerance

How the plasma membrane senses external heat-stress signals to communicate with chloroplasts to orchestrate thermotolerance remains elusive. We identified a quantitative trait locus, Thermo-tolerance 3 (TT3), consisting of two genes, TT3.1 and TT3.2, that interact together to enhance rice thermotolerance and reduce grain-yield losses caused by heat stress. Upon heat stress, plasma membrane-localized E3 ligase TT3.1 translocates to the endosomes, on which TT3.1 ubiquitinates chloroplast precursor protein TT3.2 for vacuolar degradation, implying that TT3.1 might serve as a potential thermosensor. Lesser accumulated, mature TT3.2 proteins in chloroplasts are essential for protecting thylakoids from heat stress. Our findings not only reveal a TT3.1-TT3.2 genetic module at one locus that transduces heat signals from plasma membrane to chloroplasts but also provide the strategy for breeding highly thermotolerant crops.

[Artificial intelligence-based literature data warehouse for vaccine safety]

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.

[Methods for controlling time-varying confounding in pharmaco-epidemiological studies: a systematic reveiw]

Objective: To systematically review the application of methods for controlling time-varying confounding in pharmaco-epidemiological studies. Methods: PubMed, Embase, CNKI, and Wanfang were searched for pharmaco-epidemiological studies involving time-varying confounding on June 15^th, 2020. The basic characteristics, drug exposure and outcome, time-varying confounders and the application of methods to control these confounders were analyzed. Results: A total of 298 articles were included. An increasing trend was observed in numbers of studies dealing with time-varying confounding in pharmaco-epidemiological studies in recent years. A total of 106 (35.6%) studies involved the safety or effectiveness of medication use in HIV/AIDS patients and 92 of them involved antiretroviral drugs. The most common outcome was mortality, while the most commonly concerned time-dependent confounders were laboratory examination results (179, 60.1%), comorbidities (136, 45.6%), and co-used medications (108, 36.2%). Marginal structure model (MSM) and inverse probability of treatment weighting (IPTW) were the most commonly used methods to control time-varying confounding factors (244, 81.9%). Compared with the results after properly controlling time-varying confounding, traditional methods adjusting only baseline confounders resulted in substantial bias (median 18.2%, interquartile range, 7.4%-40.8%). As for basic assumptions needed for causal methods controlling time-varying confounding, 28.9% and 64.8% of the included studies examined or discussed the assumptions of positivity and no unmeasured confounders, respectively. Conclusions: At present, most of the fields of drug therapy for chronic diseases still pay insufficient attention to time-varying confoundings. Information collected in routine medical practice, such as laboratory tests, comorbidities, and co-used drugs, was the most commonly concerned time-varying confounder. MSM and IPTW were the most commonly applied methods for dealing with time-varying confounding.

[Application effects of failure mode and effect analysis on the limb posture positioning nursing of extremely severe burn patients]

Objective: To explore the application effects of risk assessment method of failure mode and effect analysis (FMEA) on the limb posture positioning nursing of extremely severe burn patients. Methods: A retrospective observational study was conducted. According to the different limb posture positioning methods, 30 extremely severe burn patients who met the inclusion criteria and underwent routine limb posture positioning in the First Affiliated Hospital of Air Force Medical University from January 2018 to June 2019 were included into routine limb positioning group (19 males and 11 females, aged (40±10) years), and 30 extremely severe burn patients who met the inclusion criteria and underwent limb posture positioning with FMEA risk assessment from July 2019 to December 2020 in the department were included into FMEA limb positioning group (20 males and 10 females, aged (38±10) years). Patients in routine limb positioning group received only routine limb posture positioning by rehabilitation therapists with bare hand every day from the time when their limb wounds healed until they were discharged from hospital. Patients in FMEA limb positioning group received FMEA risk assessment by physicians, rehabilitation therapists, and nurses within 24 hours after admission to analyze the potential failure modes of limb posture positioning, and target-directed limb posture positioning measures were adopted until they were discharged. The risk priority numbers (RPNs) of six major failure modes of patients in FMEA limb positioning group before and after intervention were compared. The range of motion (ROM) of shoulder abduction, elbow extension, wrist dorsiflexion, ankle plantarflexion, total action motion of hand, and modified Barthel index scores of the patients in two groups before and after intervention were also assessed. Data were statistically analyzed with independent sample t test, chi-square test, and paired sample t test. Results: The RPNs of 6 main potential failure modes of patients in FMEA limb positioning group i.e. untimely interference of limb posture positioning, not strong awareness of limb posture positioning of nurses, inconsistent of evaluation standards of limb posture positioning, nurses' lacking knowledge about limb posture positioning, nurses' lacking active participation, unsatisfying effects of patients' limb posture positioning were respectively (146±31), (140±22), (125±34), (136±23), (110±28), and (110±5) points after intervention, which were significantly lower than (578±64), (543±57), (419±89), (269±64), (240±41), and (222±48) points before intervention (t=18.441, 23.681, 10.035, 5.362, 9.438, 7.171, P<0.01). After intervention, the ROMs of shoulder abduction, elbow extension, wrist dorsiflexion, and ankle plantarflexion of patients in FMEA limb positioning group were significantly better than those in routine limb positioning group (t=-4.250, 11.400, -15.928, 10.963, -7.470, P<0.01); the ROMs of shoulder abduction, elbow extension, wrist dorsiflexion, and ankle plantarflexion of patients in FMEA limb positioning group and routine limb positioning group were significantly better than those before intervention (t=-35.573, 33.670, -31.090, 32.902, -19.647, -14.952, 11.411, -33.462, -12.818, -13.672, P<0.01). After intervention, the Barthel index score of patients in FMEA limb positioning group (78±9) was significantly higher than 57±9 in routine limb positioning group (t=-9.055, P<0.01), and the Barthel index scores of patients in FMEA limb positioning group and routine limb positioning group were significantly higher than those before intervention (35±5 and 34±4, t=-22.964, -12.329, P<0.01). Conclusions: In the limb posture positioning nursing of extremely severe burn patients, risk assessment method of FMEA can effectively avoid the high risk factors in the limb posture positioning of patients, thus maintain the effects of limb posture positioning and improve the ROM of patients, as well as increase the daily living ability of patients in prognosis.

[Chordoid glioma: a clinicopathological study]

Objective: To analyze the clinicopathological features of chordoid glioma. Methods: A total of 12 cases of chordoid gliomas from 2009 to 2020 in Xuanwu Hospital of Capital Medical University and General Hospital of Chinese People's Liberation Army were retrospectively analyzed. The clinical and imaging characteristics, pathologic and molecular characteristics were analyzed, and the relevant literature was reviewed. Results: All 12 patients (4 males and 8 females) aged from 25 to 67 years (mean 39 years) and mainly had a history of headache or/and vision loss. MRI showed that the lesions located in the third ventricle, and they showed abnormal enhancement. Pathologically, these 12 cases displayed the morphologic characteristics of chordoid gliomas, including papillary structures in two cases. Immunohistochemically, GFAP and vimentin were expressed in all 12 cases (12/12). TTF1 was also expressed in all cases (10/10). CD34 and CKpan were seen in 11 cases (11/12). EMA with dot-and/or-ring like positivity was seen in 9 cases (9/10). Tissues were available in nine chordoid gliomas for Sanger sequencing to detect PRKCA and IDH gene mutation, and eight cases (8/9) showed PRKCA gene D463H mutation. None of these cases showed IDH1 R132 and IDH2 R172 mutation. All 12 patients underwent surgery, and four were lost to follow up. The remaining eight patients were progression or recurrence free at last follow-up in January 2021. Conclusions: Chordoid gliomas have relatively distinguishing clinical and histopathological features. PRKCA gene mutation in chordoid gliomas can be considered as a biomarker for the diagnosis and differential diagnosis of chordoid gliomas, and may provide a direction for future targeted therapy.

[Application of multi-state Markov model in studying transition of number of chronic complications and influencing factors in type 2 diabetes mellitus patients]

Objective: To establish a multi-state Markov model of type 2 diabetes mellitus (T2DM) patients and explore the transition rule between the cumulative number of different chronic complications, estimate the transition probability and intensity between status, and explore the possible factors affecting the transition between status. Methods: A retrospective cohort study of 33 575 patients with T2DM was conducted. According to the baseline and the cumulative number of chronic complications during the follow-up period, the patients were classified based on five status: T2DM, one complication, two complications, three complications, four and above complication, indicated by S0, S1, S2, S3 and S4, respectively. A time-continuous and state-discrete multi-state irreversible Markov model was used for statistical analysis. Results: The study included 33 575 T2DM patients, and their average age was 60 years old, the median of follow-up length was 8 years. In these patients, 32 653 had no baseline complications. At the end of follow-up, the transition probabilities of S0→S1, S1→S2, S2→S3 and S3→S4 were 16.4%, 32.4%, 45.6% and 25.9%, respectively. The results of multivariate analysis showed that being female (HR=0.919), less than 60 years old (HR=0.929), higher fasting plasma glucose (HR=1.601), lower high-density lipoprotein (HR=1.087), higher total cholesterol (HR=1.090),weekly exercise (HR=0.897), vegetarian diet (HR=0.852) and heavy diet (HR=1.887) were the risk factors for S0 to S1. And being female (HR=0.768), less than 60 years old (HR=0.859) and lower high-density lipoprotein (HR=1.160) were the risk factors for S1 to S2. Conclusions: The probability of multiple complications in T2DM patients increased over time, the transition intensity of S2→S3 was largest, followed by S1→S2. Therefore, we need to conduct both early and long-term indicators monitoring and disease prevention, strengthen the health education to improve patients' daily living habits at early stage of the illness, encourage patients to have moderate exercise and balanced diet, strengthen the monitoring of fasting blood- glucose, cholesterol and high-density lipoprotein levels to prevent the deterioration of the illness.

[Characteristics of primary cutaneous rare nasal extranodal NK/T cell lymphoma: a clinicopathological study of 15 cases]

Objective: To investigate the clinicopathological features and differential diagnosis of primary cutaneous nasal extranodal NK/T cell lymphoma (pcENKTCL-NT). Methods: Fifteen cases of pcENKTCL-NT were collected at the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019. The clinical characteristics, morphological features, immunophenotypes, and results of in situ hybridization and gene detection were analyzed. Results: Among the 15 patients, 7 were male and 8 were female, with a male to female ratio of 1.0∶1.1. Their ages ranged from 29 to 86 years, and the median age was 59.3 years. All patients were hospitalized for skin lesions, including skin ulcers, scattered patchy red papules, and local blisters. The skin lesion might be a hard nodular mass, and part of it was a confluent patchy erythema; it could be manifested as multiple scattered nodules of different sizes, and some lesions were like round ulceration. There were 8 cases of lower limbs, 4 cases of chest (1 case with upper limb lesions), 2 cases of trunk and 1 case of neck. Most of the patients were sensitive to GGDP regimen (cisplatin, dexamethasone, gemcitabine and pemostatin). Histologically, most lesions showed tumor cells invading the epidermis and skin appendages, dermal infiltration, diffuse distribution, vascular and peritubular destruction, and some subcutaneous adipose tissue involvement. Morphologically, most of the tumor cells were mixed with small-to medium-size lymphocytes, and some were large cells, mixed cells or small cells. Immunohistochemistry showed that CD3, CD3 ε and TIA-1 were expressed in all cases, but not CD20 and CD8. CD56 and granzyme B were expressed in most of the cases, and CD5 was not expressed. Ki-67 positive index was about 50%-90%. EBV in situ hybridization was positive in all cases. The clonal rearrangement of T cell receptor gene was found in some CD56 negative cases. The 15 patients were followed up for 5-45 months, and one of them was lost to follow-up. Five patients died within 5-13 months after the diagnosis, accounting for 35.7% (5/14) of the 14 patients. The average survival time of the deceased patients was 8.6 months. Conclusions: The incidence rate of pcENKTCL-NT is relatively low, but its biological behavior is aggressive and its prognosis is overall poor. Its skin lesions and histopathological features are relatively diverse. The diagnosis should be determined with using clinical data, histological morphology, immunophenotype and EB virus in situ hybridization. At the same time, attention should be paid to differential diagnosis from other cutaneous lymphoma with cytotoxic phenotype to avoid missed diagnosis and misdiagnosis.

[Effects of hand continuous passive motion system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand]

Objective: To observe the effects of hand continuous passive motion (CPM) system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand. Methods: A retrospective cohort study was conducted in 43 patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from June 2017 to December 2019 with scar contracture after deep partial-thickness to full-thickness burn on the back of the hand. According to the treatment methods applied, 13 patients were enrolled into pressure glove alone group (9 males and 4 females, aged (31±6) years), 14 patients were enrolled into pressure glove+functional training group (11 males and 3 females, aged (30±5) years), and 16 patients were enrolled into pressure glove+functional training+CPM system group (10 males and 6 females, aged (29±5) years). All the patients in the three groups received skin grafting on the back of the hand. The corresponding rehabilitation treatment was started 6-8 days after wound healing, and the treatment lasted for 3 months. Before treatment and after 3 months of treatment, the total active motion range of the hand was measured to evaluate the motion range of the hand joint and the ratio of excellent and good was calculated; the Carroll upper limb function evaluation method was used to evaluate the upper limb function score, and the difference before and after treatment was calculated; the Vancouver Scar Scale was used to evaluate the scar score, and the difference before and after treatment was calculated. Data were statistically analyzed with chi-square test, Fisher's exact probability test, McNemar's exact probability test, one-way analysis of variance, Bonferroni correction, least significant difference test, Kruskal-Wallis test, and paired sample t test. Results: The ratio of excellent and good of the motion range of the hand joint of patients in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group were 2/13, 2/14, and 3/16 respectively before treatment, and 4/13, 6/14, and 14/16 respectively after 3 months of treatment. The ratio of excellent and good of the motion range of the hand joint of patients was significantly higher in pressure glove+functional training+CPM system group than in the other two groups after 3 months of treatment (P<0.05 or P<0.01). Compared with that before treatment, the ratio of excellent and good of the motion range of the hand joint of patients in pressure glove+functional training+CPM system group was significantly increased after 3 months of treatment (P<0.01). Before treatment, the upper limb function score and hand scar score of patients in the three groups were similar (F=0.598, 0.035, P>0.05). After 3 months of treatment, the upper limb function score of patients was significantly higher in pressure glove+functional training+CPM system group than in pressure glove alone group (P<0.05); the hand scar score of patients was significantly lower in pressure glove+functional training group and pressure glove+functional training+CPM system group than in pressure glove alone group (P<0.05 or P<0.01), and the hand scar score of patients was significantly lower in pressure glove+functional training+CPM system group than in pressure glove+functional training group (P<0.05). Compared with those before treatment, the upper limb function scores of patients were significantly increased (t=-5.295, -7.252, -15.342, P<0.01) and the hand scar scores of patients were significantly decreased (t=13.361, 16.982, 40.334, P<0.01) in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group after 3 months of treatment. The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training+CPM system group were significantly higher than those in pressure glove+functional training group and pressure glove alone group (P<0.05 or P<0.01). The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training group were significantly higher than those in pressure glove alone group (P<0.05). Conclusions: Hand CPM system combined with functional training and pressure gloves can significantly improve the motion range of hand joint in treating early scar contracture after burn on the back of the hand, with better restoration of hand function and improvement of hand scar. Its effect is better than routine rehabilitation treatment such as functional training, etc., which is worthy of clinical reference.

Measurement of the Cosmic Ray Helium Energy Spectrum from 70 GeV to 80 TeV with the DAMPE Space Mission

The measurement of the energy spectrum of cosmic ray helium nuclei from 70 GeV to 80 TeV using 4.5 years of data recorded by the Dark Matter Particle Explorer (DAMPE) is reported in this work. A hardening of the spectrum is observed at an energy of about 1.3 TeV, similar to previous observations. In addition, a spectral softening at about 34 TeV is revealed for the first time with large statistics and well controlled systematic uncertainties, with an overall significance of 4.3σ. The DAMPE spectral measurements of both cosmic protons and helium nuclei suggest a particle charge dependent softening energy, although with current uncertainties a dependence on the number of nucleons cannot be ruled out.

[Study on the mechanisms of the intestinal tight-junction destruction caused by Blastocystis hominis infection in rats]

OBJECTIVE

To explore the mechanism of the intestinal barrier damage caused by Blastocystis hominis infections in rats.

METHODS

Thirty SD rats were randomly divided into the control group, and the 1-, 3-, 6- and 9-week-infection groups, of 6 rats in each group. Rats in each infection group were orally infected with B. hominis trophozoites at a density of 2 × 10⁸ parasites per rat, and the control group was given an equal volume of phosphate buffered saline solution. The 7-hour urine samples were collected 1, 3, 6 and 9 weeks post-infection for the measurement of the intestinal permeability. Then, rats were sacrificed using the cervical dislocation method, and the cecum specimens were collected for the detection of the intestinal epithelial cell permeability. The expression of tight junction-related Occludin and Claudin - 1 genes and apoptosis-related Bcl - 2 and Bax genes was quantified in cecum epithelial cells using the real-time fluorescent quantitative PCR (qPCR) assay, and cell apoptosis was detected in the rat cecum using the TdT-mediated dUTP nick-end labeling (TUNEL) assay.

RESULTS

The median urinary lactolose to mannitol ratios were 0.29, 0.72, 0.44, 0.46 and 0.38 in the control group, and the 1-, 3-, 6- and 9-week-infection groups, respectively, and the difference was statistically significant (H = 12.09, P < 0.05). B. hominis invasion and epithelial injury were observed in intestinal epithelial cells of rats infected with B. hominis, and transmission electron microscopy displayed the destruction of tight junctions between intestinal epithelial cells. The relative expression of Occludin, Claudin-1, Bcl-2 and Bax genes was 1.04, 0.62, 0.71, 0.68 and 0.96; 1.03, 0.61, 0.63, 0.76 and 0.86; 1.08, 0.70, 0.75, 0.74 and 1.03; and 1.00, 1.57, 1.33, 1.35 and 1.10 in the control group and the 1-, 3-, 6- and 9-week-infection groups, respectively, and all differences were statistically significant (F = 2.86, 2.85, 3.37 and 4.45, all P values < 0.05). The median number of positive staining cells were 1.00, 13.00, 9.00, 3.50 and 1.00 in rat cecum specimens in the control group, and the 1-, 3-, 6- and 9-week-infection groups, respectively, and the difference was statistically significant (H = 22.95, P < 0.01).

CONCLUSIONS

B. hominis infection may cause an increase in the rat intestinal permeability through triggering the apoptosis of intestinal epithelial cells to destroy the tight junction between intestinal epithelial cells, thereby destroying the intestinal barrier function.

[A comparative study on diagnosis of silicosis by digital and high kV film-screen chest radiography]

Objective: To explore the feasibility of soft copy image of chest digital radiography (DR(SC)) in pneumoconiosis diagnosis by observing the reading effect of DR(SC) and comparing it with high kV film-screen chest radiography (FSR(HkV)) . To provide a basis for the establishment of a regional information network platform for pneumoconiosis diagnosis. Methods: A total of 119 miners who were exposed to silica dust and engaged in copper or lead-zinc mining were collected by the Third People's Hospital of Yunnan from October 2017 to August 2019. The pulmonary X-ray findings of DRSC and FSR(HkV) in each case were independently judged and diagnosed by three experienced diagnostic physicians, and the final decision was made according to the consensus of most doctors. The consistency of the two imaging methods was analyzed by observing the main small opacity shape, the overall density, the range of distribution, the aggregation of the small opacity and the big opacity, and the diagnosis stage. Results: there were 118 males and 1 female with an average age of 46.21 years. Average exposure time 7.38 years. The pulmonary X-ray findings of 113 cases with two imaging methods were mainly the round small opacity of p,q and r,but the reticular irregular opacity were not prominent, Only one case of FSR(HkV) judgment p shape and DR(SC) judgment q shape were observed, The coincidence rate was 99.12% (112/113) . huger opacity were observed in the other 6 cases. The coincidence rate was 95.51% (4/89) between pneumoconiosis-free and stageⅠ, and there was no significant difference between stageⅡand stage Ⅲ (30/30, P>0.05) . Conclusion: The x-ray findings of Silicosis with small round shadow in lung can be used by DR(SC) in diagnosis and staging.

[Design and application of static progressive ankle foot orthosis]

The scar contracture of Achilles tendon in burn patients after operation is easy to cause " foot drop" , which leads to ankle dorsiflexion dysfunction. To solve this problem, the authors designed and made a static progressive ankle foot orthosis. The foot support part and the crus support part of the orthotic device are connected by rivets, and the distal end of the foot support part and the proximal end of the crus support part are pulled by the traction belt on both sides, gradually improving the ankle dorsiflexion function. This static progressive ankle foot orthosis is simple, practical, cost-effective, and worthy of clinical promotion.

Influence of electron cyclotron resonance ion source parameters on high energy electrons

In order to diagnose the electron cyclotron resonance (ECR) plasma, a high-efficiency collimation system has been developed at the Institute of Modern Physics, and the bremsstrahlung spectra in the range of 10 keV-300 keV were measured on a third generation superconducting ECR ion source, SECRAL-II, with a CdTe detector. Used as a comparative index of the mean energy of the high energy electron population, the spectral temperature, T_s, is derived through a linear fitting of the spectra in a semi-logarithmic representation. The influences of some main source parameters, such as the neutral gas pressure, extraction voltage, microwave power, and bias disk voltage, on the high energy electrons are systemically investigated.

[Effect and mechanism of low-dose chidamide on the treatment of primary immune thrombocytopenia]

目的

探讨低剂量（0.1 mg/kg）西达本胺治疗原发免疫性血小板减少症（ITP）的作用及机制。

方法

①应用C57BL/6J小鼠建立ITP被动模型，灌胃给予0、0.01、0.1、0.5、5.0 mg/kg西达本胺，观察治疗前后ITP小鼠模型外周血血小板计数。②应用C57BL/6J小鼠建立ITP主动模型，灌胃给予0.1 mg/kg西达本胺，观察治疗前后ITP小鼠模型外周血血小板计数；4周后处死小鼠，流式细胞术检测脾细胞中CD4⁺CD25⁺Foxp3⁺自然调节性T细胞（nTreg）比例并应用ELISA方法检测小鼠外周血IL-6水平。③分离ITP患者外周血单个核细胞，与低剂量西达本胺共培养72 h后检测nTreg细胞比例；免疫磁珠法分离CD4⁺CD25⁺调节性T细胞（Treg细胞）以及CD4⁺CD25⁻效应T细胞，将二者以1∶4比例混合共培养，加入低剂量西达本胺干预，检测Treg细胞对效应T细胞增殖的抑制作用。

结果

①低剂量西达本胺可明显提高ITP被动模型鼠外周血血小板水平。②低剂量西达本胺可显著提高ITP动物模型外周血血小板水平，降低出血相关死亡率。③低剂量西达本胺可显著提高ITP动物模型脾细胞中nTreg比例、降低血清IL-6水平。④低剂量西达本胺可显著提高ITP患者外周血单个核细胞培养体系中nTreg细胞比例、增强Treg细胞对效应T细胞增殖的抑制作用。

结论

低剂量西达本胺可促进nTreg生成、增强Treg细胞的免疫抑制功能、降低IL-6水平，促进免疫耐受，对ITP有较好的治疗作用。

[A cohort study on the association between resting heart rate and the risk of new-onset heart failure]

Objective: To prospectively explore the relationship between resting heart rate (RHR) and risk of new-onset heart failure. Methods: It was a prospective cohort study. People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography (ECG) recordings were eligible for this study. A total of 88 879 participants aged 18 years old or more who were free of arrhythmia, a prior history of heart failure and were not treated with β-blocker were included. Participants were divided into 5 groups according to the quintiles of RHR at baseline (Q(1) group, 40-60 beats/minutes (n=18 168) ; Q(2) group, 67-70 beats/minutes (n=18 970) ; Q(3) group, 71-74 beats/minutes (n=13 583) ; Q(4) group, 75-80 beats/minutes (n=22 739) ; and Q(5) group,>80 beats/minutes (n=15 419) ) .The general clinical data and laboratory test results were collected. The outcome was the first occurrence of heart failure at the end of follow-up (December 31, 2016) .We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: Among the included patients 68 411 participants were male, mean age was (51.0±12.3) years old, and RHR was (74±10) beats/minutes. Statistically significant differences among the RHR quintiles were found for the following variables: age, gender, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, body mass index, the level of high-sensitivity C-reactive protein, education status, physical activity, smoking status, drinking status, history of diabetes, history of hypertension and history of use antihypertensive drugs (all P<0.01) . Higher RHR was linked with higher prevalence of diabetes, hypertension history, and higher systolic blood pressure, diastolic blood pressure and FBG levels (all P<0.01). After a mean follow-up of 9.5 years, the incidence of new-onset heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.60%(290/18 168), 1.36%(258/18 970), 1.80%(245/13 583), 1.76%(400/22 739) and 2.35%(362/15 419),respectively (P<0.01) . The person-year incidence of heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.7, 1.5, 1.9, 1.9 and 2.6 per 1 000 person-years respectively. Compared with the Q(2) group, multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q(3),Q(4),and Q(5) group were 1.23 (95%CI 1.03-1.48, P<0.05) , 1.19 (95%CI 1.01-1.41, P<0.05) , 1.39 (95%CI 1.18-1.65, P<0.01) , respectively. In the absence of hypertension, diabetes, smoking and acute myocardial infarction, the Cox regression model showed that compared with Q(2) group, the HR of new-onset heart failure in Q(5) group was 1.58 (95%CI 1.02-2.45, P<0.05) . Conclusion: Increased RHR is associated with increased risk of new-onset heart failure in this cohort.

[Establishment and characterization of patient derived xenograft model of malignant peritoneal mesothelioma in nude mice]

Objective: To establish patient derived xenograft (PDX) model of malignant peritoneal mesothelioma (MPM), and to identify the key characteristics of tumor biology of the model, so as to provide an experiment platform for studying the pathologic mechanisms and new therapeutic strategies for MPM. Methods: Surgically excised MPM tumor tissues were inoculated subcutaneously in BALB/c-nu/nu mice for 3 stable passages. In the 4th passage, the subcutaneous tumors were harvested under aseptic conditions, cleaned and made into MPM tumor cell homogenate. Four nude mice (two males and two females) were selected and one male and one female nude mouse were inoculated in the abdominal cavity at the dose of 100 μL, others were inoculated at a dose of 200 μL. The PDX model of MPM was established. The changes of body mass in nude mice were measured regularly, the extent of abdominal and pelvic tumors was judged by experimental peritoneal cancer index (ePCI) score, and the pathologic characteristics of tumors were analyzed. Results: The subcutaneous and abdominal animal models of MPM were successfully established. The subcutaneous tumor model grew into tumor on the 20th day, followed by a slow growth stage between the 20th and 29th day, then a rapid growth stage between the 30th and 57th day. According to the dose of tumor cells (100, 200 μL) and timing (14th and 69th days after grafting), the abdominal tumor model successfully simulated the early and late clinical stages of MPM. The HE staining results of the MPM nude mice model showed that the tumor was epithelial mesothelioma and invaded most of the organs, including liver, spleen, pancreas, mesentery. Immunohistochemical staining for calretinin, cytokeratin 5/6, WT1 and Ki-67 were positive. Whole-genome exon sequencing identified 26 and 36 high frequency gene mutations in tumors derived from the PDX model and clinical sample from patients, including 21 common gene mutations. Conclusions: The PDX model of MPM is established. The model is characterized by highly malignant tumor with rapid growth and high invasiveness.

Overview of high intensity ion source development in the past 20 years at IMP

Ion source development over the last 20 years at the IMP is reviewed. For versatile purposes, several types of ion sources have been involved in the research and development work at the IMP, i.e., the highly charged ECR (Electron Cyclotron Resonance) ion source, intense microwave ion source or the 2.45 GHz intense beam ECR ion source, and laser ion source (LIS). In the development of ECR ion sources, SECRAL (Superconducting ECR ion source with Advanced design in Lanzhou), Lanzhou ECR ion source, and Lanzhou all permanent magnet ECR ion source series have been made, which can cover the operation microwave frequency range of 10-28 GHz. The LIS with an Nd:YAG laser with a maximum output energy of 8 J in 8 ns pulse duration has been developed for very intense short pulse ion beams from solid materials such as C, Ti, Ni, Ag, and so on. Microwave ion sources have been built to produce intense pulsed or direct current beams from several mA to 100 mA for either high intensity accelerators or applications. This paper will give an overview of the high intensity ion source development at the IMP, especially on the recent progress and new results, such as the status of the fourth generation ECR ion source (first fourth generation ECR ion source), the production of recorded highly charged ion beams with SECRAL sources, key technology research studies, and so on.

[Application of low temperature thermoplastic plate combined with special abdominal band in fixing abdominal pedicled flap for repairing 17 patients with deep electric burn wounds in hands]

If the abdominal pedicled flaps are not well fixed after repair of deep electric burn wounds in hands, many problems such as poor blood supply may occur. In order to solve the above problems, we designed and manufactured the individualized low temperature thermoplastic plate combined with special abdominal band to fix abdominal pedicled flaps for repairing of 17 patients (12 males and 5 females, aged 2-35 years) with deep electric burn wounds in hands from February 2016 to August 2018, and achieved the desired results. The shoulder joint, elbow joint, and wrist joint were fixed by low temperature thermoplastic plate according to the 1/2 circumference of the patient's side chest and upper arm, and the braking of wrist joint and elbow joint was strengthened by special abdominal band. Application of the combined method of fixing abdominal pedicled flaps in repairing deep electric burn wounds in hands has high success rate of flap transplantation. It is simple to make and practical, and worthy of clinical promotion.

Ion charge state and energy distributions of laser produced plasma from pure metals and their alloy

A high intensity highly charged laser ion source has been studied at the Institute of Modern Physics for the last few years. In order to investigate the processes of plasma heating and expansion of laser produced plasma, the charge state and energy distributions of the ions from pure copper, silver, and copper-silver alloy, in which the atom number ratio between copper and silver is 2:3, were measured with a 90° cylindrical electrostatic ion analyzer. It was shown that the yields of highly charged copper ions from the pure copper target are higher compared with those of the alloy target. In contrast, higher yields of highly charged silver ions were obtained from the copper-silver alloy target. Moreover, the ion energy distributions were derived from the time-of-flight spectra for the ions with different ion charge states and compared between the pure metal and alloy targets.

[Clinical study of apatinib combined with chemotherapy for advanced non-small cell lung cancer with negative driving genes]

Objective: To evaluate the efficacy and safety of apatinib combined with chemotherapy in the first-line treatment of advanced non-small cell lung cancer (NSCLC) with negative driving genes. Methods: From January 2016 to March 2018, 62 advanced NSCLC patients with negative driving genes diagnosed at Xuzhou Cancer Hospital were randomly divided into study group (30 cases) and control group (32 cases), respectively. The patients in the study group were treated with standard first-line chemotherapy combined with apatinib, while those in control group were treated with chemotherapy alone. Results: The disease control rate (DCR) and objective remission rate (ORR) in the study group were 60.0% and 16.7%, respectively, higher than 46.9% and 9.3% in the control group, but without statistical difference (P>0.05). The median progression-free survival (PFS) of study group and control group were 6.4 months and 4.9 months, respectively (P=0.004), and the median overall survival (OS) were 11.3 months and 9.2 months, respectively (P=0.006). Multivariate survival analysis indicated that treatment regimen (P=0.001) was the independent prognostic factor of PFS, and PS score (P=0.002), clinical stage (P=0.02) and treatment regimen (P<0.001) were the independent prognostic factors of OS. After treatment, the incidence of hypertension and hand-foot syndrome in the study group were 46.7% and 53.3%, respectively, significantly higher than 3.3% and 0 in the control group, respectively (P<0.05). The incidence of grade 3-4 adverse drug reactions (ADRs) in the study group was 26.7% (8/30), mainly including hypertension, hand-foot syndrome and bone marrow suppression. The incidence of grade 3-4 ADRs in the control group was 15.6% (5/32), all of which were bone marrow suppression, without significant difference (P=0.286). There was no difference in serum levels of VEGF and CEA between the two groups before treatment. After treatment, the serum level of VEGF in the study group was (169.3±10.1) pg/ml, lower than (211.8±16.7) pg/ml of the control group (P<0.05). Conclusion: Apatinib combined with first-line chemotherapy for advanced NSCLC patients with negative driving genes is safe and beneficial for survival. This therapeutic strategy can significantly prolong the PFS and OS, and further improvement and application can be considered as a choice in the clinical treatment.

Laser ablation plasma with solenoid field confinement

A Laser Ion Source (LIS) can produce high charge state and high intensity ion beams (∼emA), especially, refractory metallic ion beams, which makes it a promising candidate as an ion source for heavy ion cancer therapy facilities and future accelerator complexes, where pulsed high intensity and high charged heavy ion beams are required. However, it is difficult for the LIS to obtain a long pulse width while ensuring high current intensity, thus limiting the application of the LIS. To solve the conflict, magnetic fields are proposed to confine the expansion of the laser produced plasma. With a solenoid along the normal direction to the target surface, the lateral adiabatic expansion of the laser ablation plasma is suppressed which extends the pulse width of the ion beam effectively. The characteristics of laser ablation plasma with solenoid field confinement will be presented and discussed in this paper.

[Cerebral hyper perfusion syndrome after carotid artery stenting]

OBJECTIVE

To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS).

METHODS

From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed.

RESULTS

In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately.

CONCLUSION

HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.

[Pathological prognostic factors of pseudomyxoma peritonei]

Objective: To analyze the pathological features of pseudomyxoma peritonei (PMP) in correlation with the survival status and independent prognostic factors. Methods: One-hundred and fifty-five PMP specimens were collected at Beijing Shijitan Hospital, Capital Medical University, from 2012 to 2018. Conventional histopathological evaluation was performed to document the primary tumor site, histopathological type, lymph nodes metastasis, tumor emboli in the blood and lymph vessels, nerve invasion and cellular density. The immunohistochemical parameters including Ki-67, p53, MMR-related protein, MUC2 and MUC5AC were analyzed. Clinical follow-up data were reviewed to correlate with pathological prognostic factors using Kaplan-Meier estimator and Cox proportional hazards regression model for univariate and multivariate analysis. Results: Among 155 PMP patients, there were 77 males and 78 females. There were 98 cases (63.2%) of low-grade peritoneal mucinous carcinomatosis, 49 cases (31.6%) of high-grade peritoneal mucinous carcinomatosis, 8 cases (5.2%) of high-grade mucinous carcinoma peritonei with signet ring cells; only 15 cases (9.7%) with lymph node metastasis; 18 cases (11.6%) with tumor emboli in the blood and lymph vessels; 8/126 (6.3%) were positive dMMR; 100 cases (64.5%) had Ki-67 label index <50%, and 56 cases(36.1%) presented with mutant type p53. Univariate analysis revealed 11 survival-related pathological parameters including gender, age, primary tumor site, histopathological type, lymph node metastasis, tumor emboli in the blood and lymph vessels, nerve invasion, cellular density, Ki-67 label index rate, p53 and dMMR. Multivariate analysis identified 4 independent prognostic factors including the histopathological type (HR 59.78, P<0.01), lymph node metastasis (HR 3.74, P=0.028), nerve invasion (HR 7.81, P=0.007) and dMMR (HR 9.82, P<0.01). Conclusions: Histopathological type is the most important prognostic factor of PMP with dMMR as an independent molecular prognostic indicator.

[Association between resting heart rate trajectory pattern and risk of cardiovascular and cerebrovascular diseases]

Objective: To examine whether the long-term resting heart rate (RHR) pattern can predict the risk of cardiovascular and cerebrovascular diseases (CVDs). Methods: This prospective cohort study included 63 040 participants who took part in the health examination in 2006 and one of the health examinations on 2008 or 2010 and were free of myocardial infarction, stroke, arrhythmia, cancer and not treated with β-recepter blocker. The outcomes were the first occurrence of myocardial infarction and stroke during the follow up ended on December 31, 2015. RHRs were measured in 2006, 2008, and 2010. We used latent mixture modeling SAS Proc procedure to identify RHR trajectories. We identified 4 distinct RHR trajectory patterns based on the data derived from 2006 and on the pattern change during 2006 to 2010 (low-stable, moderate-stable, moderate-increasing, elevated-decreasing). Collected the general clinical data of the patients. Cox regression model was used to determine the association between RHR trajectory patterns and the risk of CVDs during follow up. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: There were statistical significance among the 4 distinct RHR trajectory patterns on the following variables: age, gender, smoking status, drinking status, physical activity, education status, history of use antihypertensive drugs, history of hypertension,history of diabetes, body mass index, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, and the level of high-sensitivity C-reactive protein (all P<0.01). The moderate-increasing pattern experienced the highest risk of developing stroke and CVDs among all 4 patterns. The cumulative incidence of cerebral infarction, cerebral hemorrhage and CVDs in the order of low-stable trajectory, moderate-stable trajectory and moderate-increasing trajectory. The cumulative incidences of cerebral infarction, cerebral hemorrhage and CVDs in elevated-decreasing trajectory group were significantly lower than those in moderate-increasing trajectory group, but higher than those in moderate-stable trajectory group. Compared to the low-stable pattern, adjusted HR was 1.3 (95%CI 1.0-1.6) for the moderate-increasing pattern after adjustment for potential confounders. Conclusion: Our study finds that individuals with moderate-increasing RHR trajectory pattern are associated with higher risk of cardiovascular and CVDs.

[Clinical pathologic characteristics of extranodal follicular dendritic cell sarcoma]

Objective: To investigate the clinical pathologic characteristics of extranodal follicular dendritic cell sarcoma (FDCS). Methods: We collected 7 cases of extranodal FDCS, HE staining, immunohistochemical study were performed. The V600E mutation of BRAF in 7 cases were detected by real-time PCR and EBER in situ hybridization was performed on 4 cases. Results: Among the 7 cases of FDCS, 5 cases were male and 2 cases were female, the median age was 55 years old, including 4 cases of low-grade FDCS and 3 cases of high-grade FDCS. The tumor location of 2 cases was in mediastinum, the tumor locations of others were in nasopharynx, kidney, lung, rectum and liver, respectively. The results of immunohistochemistry showed that, the tumor cells were diffusely or focally positive for CD21, CD23, CD35, D2-40, EGFR and CXCL13, but negative for S-100, CD68, HMB45, SMA, Desmin, CD117, Dog-1, CD34, CD30, EMA and CK.Five cases were positive for PD-L1 and the its expression in high-grade FDCS were higher than that in low-grade FDCS.Two cases of low-grade FDCS were positive for BRAF V600E, but the BRAF V600E mutation weren't detected in all of 7 cases. The result of EBER in-situ hybridization showed that only the nasopharynx FDCS was positive.The follow-up information of 5 patients were available (7~43 months), 4 patients died and 1 still alive with rectum metastasis. Conclusions: FDCS is a rare malignant disease with relapse and metastatic tendency. The combined applications of the first-line antibodies including CD21, CD23, CD35 and second-line antibodies including D2-40, CXCL13, EGFR are helpful for its diagnosis and differential diagnosis. The high expression of PD-L1 implicates the potential benefit of FDCS patients acquired from immunotherapy.

[Clinical efficacy observation on combination of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser in treating post-burn eczema]

Objective: To investigate the clinical effects of combined utilization of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser on treatment of post-burn eczema. Methods: From July 2014 to July 2017, 80 patients with post-burn eczema who met the study inclusion criteria were treated in our burn rehabilitation center, and their clinical data were analyzed retrospectively. Patients were divided into ultraviolet treatment group, red light treatment group, laser treatment group, and combination treatment group according to the utilized treatment methods, with 20 cases in each group. Patients in ultraviolet treatment group were treated with narrow-spectrum medium-wave ultraviolet once every other day for 10 minutes each time. Patients in red light treatment group and laser treatment group were treated with red-light and low power He-Ne laser respectively once a day for 10 minutes each time. Patients in combination treatment group were treated with combination of the above three methods without sequence or interval time, and the treatment time and interval time were the same as the previously described. All patients were treated for four weeks since the time of admission. The itching degree, surface area of the affected body, degree of keratosis, and degree of cracking of target tissue were evaluated using Eczema Area and Severity Index (EASI) scoring method after each treatment. Eczema improvement rate was calculated according to the total score of EASI to determine the curative effect. The therapeutic effective time was recorded. The therapeutic effective rate was calculated according to the total scores of EASI before treatment for the first time and 4 weeks after treatment. Besides, the adverse reactions of patients were also observed and recorded. Data were analyzed by Chi-square test, Kruskal-Wallis rank sum test, Wilcoxon signed rank sum test, one-way analysis of variance, Least Significant Difference-t test, and Bonferroni correction. Results: Therapeutic effective times of eczema of patients in ultraviolet treatment group, red light treatment group, and laser treatment group were similar, respectively (13.7±1.3), (16.4±1.6), and (15.1±1.7) d (t=0.32, 0.58, 0.74, P>0.05). The therapeutic effective time of combination treatment group was (6.3±0.9) d, significantly shorter than that of ultraviolet treatment group, red light treatment group, or laser treatment group (t=5.62, 4.72, 4.61, P<0.05 or P<0.01). Compared with those before treatment for the first time, eczema itching degree, surface area of affected body, degree of keratosis, degree of cracking, and total score of EASI of patients in ultraviolet treatment group, red light treatment group, laser treatment group, and combination treatment group showed obvious improvement in 4 weeks after treatment (Z=5.372, 4.392, 4.284, 3.998, 4.092, 3.904, 4.042, 4.216, 3.684, 3.890, 5.081, 4.794, 4.094, 3.493, 3.995, 5.084, 4.903, 4.384, 3.995, 4.063, P<0.05 or P<0.01). Each item score and total score of EASI of eczema of patients in the first three groups were close (P>0.05), while each item score and total score of EASI of eczema of patients in combination treatment group was significantly better than those of ultraviolet treatment group, red light treatment group, and laser treatment group (H=2.482, 2.491, 3.583, 3.462, 6.025, 2.492, 3.693, 3.085, 3.482, 6.042, 5.831, 5.831, 4.893, 4.092, 6.931, P<0.05). Therapeutic effective rates of eczema of patients in ultraviolet treatment group, red light treatment group, and laser treatment group were close, respectively 60%, 60%, and 55% (χ(2)=1.46, 1.63, 0.97, P>0.05). The therapeutic effective rate of eczema of patients in combination treatment group was 90%, significantly higher than that of ultraviolet treatment group, red light treatment group, or laser treatment group (χ(2)=3.43, 4.15, 2.97, P<0.05 or P<0.01). There were no serious adverse reactions appeared in patients of all the four groups after treatment. Three patients in ultraviolet treatment group had local skin erythema, which was alleviated after symptomatic treatment. Conclusions: Combination of narrow-spectrum medium-wave ultraviolet, red light, and low power He-Ne laser in treating post-burn eczema is superior to single therapy in terms of clinical effective time and efficacy, which has no obvious adverse reaction and is worthy of promotion.