Acta Academiae Medicinae Sinica

Objective To explore the inhibitory effect of aspirin and clopidogrel on platelet adhesion and aggregation behaviors under the physiological flow condition using microfluidic chip technology for health volunteers.Methods Peripheral venous blood samples collected from twelve randomly recruited health volunteers were treated with 20 μmol/L acetylsalicylic acid,50 μmol/L 2-methlthioadenosine-5’-monophosphate triethylammonium salt,and their combination,respectively,with untreated blood samples being control group. The blood samples were flowed through a microchannel modified with type I collagen protein at a physiological relevant shear rate of 1000 s^-1 for 300 s,while the fluorescent images of platelet aggregations were dynamic captured using a microscope. Based on the images,the platelet coverage rates were calculated and used as quantitative parameters for evaluating platelet adhesion and aggregation behaviors.Results Under a flow condition of 1000 s^-1 shear rate,an expected in vivo-like platelet adhesion and aggregation behaviors were observed at the surfaces of collagen proteins for control blood samples. Aspirin alone or clopidogrel alone suppressed platelet adhesion and aggregation at the later period of flow(200-300 s),while the combination of aspirin and clopidogrel reduced the adhesion numbers of platelets at the earlier stage of flow(≤150 s) and compromised the stability of platelet aggregation at the later period of flow(200-300 s). The combination showed synergistic effect in inhibiting platelet aggregation. Furthermore,such inhibitory effect was heterogeneous among 12 volunteers.Conclusion This simple microfluidic technology can offer a new technical platform for analyzing the inhibitory effect of antiplatelet drugs.

Objective To investigate the role of methyltransferase-like 3(METTL3) in the proliferation of acute myeloid leukemia (AML) cells and its mechanism.Methods METTL3 expression in AML patients was analyzed in Gene Expression Omnibus data files. METTL3 expression was inhibited by lentivirus-mediated gene transduction in MOLM13 cells,after which cell proliferation was analyzed by cell counting kit-8,N6-methyladenosine (m6A) levels of total mRNA was analyzed by ELISA,specific m6A on MYC was analyzed by gene-specific m6A RNA immunoprecipitation,and MYC expression was analyzed by RT-qPCR and Western blot analysis.Results METTL3 level was slightly increased in AML-M5 patients,and its expression was significantly higher in immature cells than in mature monocytes (t=4.504,P=0.0098). METTL3 knock-down significantly suppressed cell proliferation (P<0.001),reduced m6A level of total mRNA (t=3.606,P=0.042) and specific m6A level on MYC mRNA (P<0.01),and suppressed MYC expression (P<0.01).Conclusion METTL3 acts as an oncogene in MOLM13 cells by upregulating MYC expression.

Objective To observe the effect of Gui Zhi Fu Ling Jiao Nang (GZFLJN) on the expressions of alpha smooth muscle actin (α-SMA) and proliferating cell nuclear antigen (PCNA) in uterine vascular smooth muscle cells (VSMC) of rat models with an intrauterine device (IUD) and to determine the thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-keto-PGF1α) levels in peripheral blood.Methods Female Wistar rats were randomly divided into four groups:normal group (n=16,with normal breed without treatment),model group (n=18,drenching 0.9% normal saline after modeling of IUD),GZFLJN group (n=18),and aminocaproic acid tablets group (n=17). Immunohistochemical SP method was used to detect the expressions of α-SMA and PCNA in uterine VSMC.ELISA was served to detect the levels of TXB2 and 6-keto-PGF1α in peripheral blood.Results The positive rate of α-SMA were (50.89±9.41)%,(26.93±6.80)%,(48.92±6.80)%,and (34.63±7.26)%,respectively,in normal group,model group,GZFLJN group,and aminocaproic acid tablets group;obviously,it was significantly higher in normal group (t=14.43,P=0.00) and GZFLJN group (t=11.37,P=0.00) than that in model group and it was significantly lower in aminocaproic acid tablets group than in normal group (t=9.96,P=0.00) and GZFLJN group (t=8.23,P=0.00). The positive rate of PCNA were (25.66±7.24)%,(61.26±9.98)%,(28.36±9.17)%,and (50.23±8.71)%,respectively,in these four groups;obviously,it was significantly lower in the normal group (t=20.86,P=0.00) and GZFLJN group (t=19.12,P=0.00) than in model group and it was significantly higher in aminocaproic acid tablets group than in normal group (t=17.82,P=0.00) and GZFLJN group (t=16.05,P=0.00). Serum TXB2 level in these four groups were (445.86±24.43),(508.78±12.42),(448.11±9.63),and (498.11±13.63)ng/L;obviously,it was significantly higher in model group than in normal group (t=16.55,P=0.00) and aminocaproic acid tablets group (t=-4.12,P=0.00) and it was significantly lower in GZFLJN group than in model group (t=-15.23,P=0.00) and aminocaproic acid tablets group (t=-12.08,P=0.00). Serum 6-keto-PGF1α level in these four groups were (23.17±1.93),(18.09±0.93),(22.70±1.61),and (20.70±1.41)ng/L,respectively;obviously,it was significantly lower in model group than in normal group (t=-13.98,P=0.00) and aminocaproic acid tablets group (t=5.26,P=0.00) and it was significantly higher in GZFLJN group than in model group (t=11.43,P=0.00) and aminocaproic acid tablets group (t=8.76,P=0.00).Conclusion GZFLJN can regulate the expressions of α-SMA and PCNA of VSMC in the endometrium of IUD rats and the concentrations of TXB2 and 6-keto-PGF1α in the serum.

Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients.Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,laboratory results,and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis.Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ ²=102.331,P=0.000),American Society of Anesthesiologists(ASA) score≥3 (χ ²=69.748,P=0.000),leukocyte count (t=7.453,P=0.000),C-reactive protein (t=2.128,P=0.034),segmental mesenteric fluid (χ ²=78.655,P=0.000),thick-walled small bowel (χ ²=100.806,P=0.000),intestinal wall of hyperattenuation (χ ²=69.068,P=0.000),ascites (χ ²=89.299,P=0.000),mesenteric fat stranding (χ ²=80.255,P=0.000),bird’s beak sign (χ ²=84.451,P=0.000),and stranding sign (χ ²=98.635,P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576,95%CI:1.043-12.261,P=0.043),ASA score≥3 (OR=3.463,95%CI:1.149-10.441,P=0.027),muscle guarding (OR=3.288,95%CI:1.010-10.707,P=0.048),thick-walled small bowel (OR=3.046,95%CI:1.074-8.638,P=0.036),and increased leukocyte count (OR=1.307,95%CI:1.170-1.458,P=0.000).Conclusion Muscle guarding,ASA score≥3,segmental mesenteric fluid,thick-walled small bowel,and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

Objective To summarize the clinical features and outcomes of paraduodenal pancreatitis (PP).Methods Five clinically or pathologically diagnosed PP patients in Peking Union Medical College Hospital and 31 other PP cases reported in Chinese literature since 1988 were retrospectively analysed.Results Most PP patients were young or middle-aged males with a history of alcohol abuse. The clinical symptoms included upper abdominal pain,vomiting,weight loss,and fluctuating jaundice. Serum pancreatic enzymes were normal or elevated. Radiological features in most cases included thickening of the duodenal wall and duodenal stenosis (88.9%,32/36),cysts in the duodenal wall and groove area (47.2%,17/36),dilated bile duct (36.1%,13/36),and dilated pancreatic duct (16.7%,6/36). The main pathological finding was chronic pancreatitis,which could be accompanied by local acute inflammation,which was limited in the groove-duodenal area in most cases. The disease can be well controlled by conservative treatment,although surgery was needed in a small number of cases.Conclusions PP typically occurs in young or middle-aged males. Radiological examination is valuable for diagnosis. Conservative treatment is the mainstream treatment in most patients.

Objective To explore the association between the severity of scrub typhus (ST) and the serum procalcitonin (PCT) level.Methods The clinical data of 58 ST patients who were treated in the First Affiliated Hospital of Xiamen University and confirmed by Xiamen Municipal Center for Disease Prevention and Control (CDC) from January 2016 to October 2017,were retrospectively analyzed. According to clinical manifestations and related laboratory tests,these patients were divided into four grades:Ⅰ,Ⅱ,Ⅲ,and Ⅳ. These four grade groups were compared in terms of age,interval from symptom onset to hospital presentation,hospitalization days,and serum PCT level.Results These 58 patients were divided into four grade groups:grade Ⅰ group (n=17),grade Ⅱ group (n=17),grade Ⅲ group (n=11),and grade Ⅳ group (n=13). No significant difference was found among these four groups in terms of age (F=0.618,P=0.606),interval from symptom onset to hospital presentation (F=1.744,P=0.169),and hospitalization days (F=0.398,P=0.755).However,the median serum PCT level in the grade Ⅳ patients[2.60(1.33,61.08)ng/ml] was significantly higher than those in grade I[0.24(0.10,0.33)ng/ml;Z=-4.63,P=0.000], grade Ⅱ[0.29(0.21,0.51)ng/ml;Z=-4.63,P=0.000], and grade Ⅲ[1.33(0.89,2.41)ng/ml;Z=-2.09,P=0.040].The median serum PCT level in the grade Ⅲ patients was also significantly higher than grade Ⅰ (Z=-4.16,P=0.000)and grade Ⅱ(Z=-3.83,P=0.000).There was no significant difference between the grade Ⅰ patients and grade Ⅱ patients(Z=-1.37,P=0.170).There was significantly positive correlation between PCT level and the severity of ST (r=0.804,P=0.000).Conclusion There is positive correlation between serum PCT level and the severity of ST,and serum PCT level may be a biomarker in assessing the severity of ST.

Objective To explore the relationship between serum uric acid (SUA) level and coronary heart disease(CHD) in male and female patients.Methods A total of 760 hospitalized patients undergoing coronary angiography in our department from June 2013 to June 2017 were enrolled. Gensini score was calculated according to the result of coronary angiography,and SUA was tested.Patients were divided according to SUA quartiles. The relationship between SUA level and the prevalence of CHD in male and female patients was analyzed.Results Among females,there was significant difference in SUA level between patients with and without CHD (t=4.415,P=0.000). Univariate logistic regression analysis showed that SUA level was independently associated with CHD (OR=1.32,95%CI:1.12-1.58,P=0.002). The prevalence of CHD was 31.2%,52.6%,47.4%,and 59.7%,respectively,in four quartile groups (χ ²=13.652,P=0.003);in addition,female patients displayed significantly higher prevalence of CHD in the quartile 2 (P=0.007),3(P=0.038),and 4(P=0.000) groups than in quartile 1 group. Among female patients with CHD,there were significant differences in number of target vessels (Z=4.627,P=0.008),number of lesion vessels (χ ²=18.522,P=0.005),and Gensini score (Z=3.683,P=0.029) in four groups. The Gensini scores of coronary artery were significantly higher in the quartile 4 group than in quartile 1 (P=0.012) and 2 (P=0.014) groups. Multiple linear regression analysis showed that there was a dose-response relationship between SUA level and Gensini score (B=1.105,SE=0.365,P=0.003). Among males,however,there was no significant difference in SUA level between patients with and without CHD(t=1.271,P=0.205). The prevalence of CHD in four quartile groups was 77.9%,69.0%,61.7%,and 79.6%,respectively,showing no significant difference(χ ²=4.514,P=0.211).Conclusions SUA is an independent risk fact for female CHD patients. High SUA level is correlated with severity of CHD only in women.

Objective To evaluate the effectiveness of radial extracorporeal shockwave therapy(rESWT) for the treatment of superior lateral brachial cutaneous nerve(SLBCN) compression syndrome.Methods A total of 40 patients with SLBCN compression syndrome who were treated in our department from March 2013 to October 2015 were equally randomized into two groups according to random number table:rESWT group(treated with rESWT for 1 cycle) and control group(treated with local hormone injection for 1 cycle). Visual analogue scale(VAS) and Constant-Murley scale(CMS) were applied to evaluate the shoulder joint function before treatment and 1 month and 1 year after treatment.Results The average CMS scores were(66.7±0.9) and(65.7±1.1)scores in rESWT group and control group,respectively,before treatment(t=0.67,P=0.510) and were(86.9±1.0) and(86.4±1.1)scores one month after treatment(t=0.35,P=0.730);it increased to(89.7±0.7) scores in rESWT group one year later,which was significantly higher than that in control group[(85.3±0.8)scores](t=3.56,P=0.002). The improvement rate was 95% in rESWT group and only 75% in control group. Before treatment,the median VAS score in rESWT group and control group were 5.00(5.00,6.00) and 5.00(4.00,5.75)scores(u=1.13,P=0.29);one month after treatment,the median VAS score in these two groups were 2(1.00,2.75) and 2.00(1.00,2.00)scores(u=0.04,P=0.85);one year later,it was 1.00(0.00,1.00) scores in rESWT group,significantly lower than that in [2.00(1.00,2.00)scores] control group(u=5.09,P=0.02).Conclusion Compared with local hormone injection,rESWT can remarkably alleviate pain and restore shoulder joint function in patients with SLBCN compression syndrome after one year of treatment.

Objective To compare the clinical efficacy of lactated Ringer’s (LR) and normal saline (NS) in treating patients with septic shock.Methods The clinical data of 198 patients with septic shock who received fluid resuscitation in the Intensive Care Unit of Quzhou People’s Hospital from January 2014 to January 2016 were retrospectively analyzed. These patients were divided into NS group (n=100) and LR group (n=98) according to fluids used. The amounts of trial fluid,other liquids,and blood products and the average total fluid volume were recorded. The oxygenation index (PO₂/FiO₂),mean artery pressure (MAP),central venous pressure (CVP),and B-type natriuretic peptide (BNP) before and after treatment as well as the early goal-directed therapy (EGDT) 8 h (EGDT8),EGDT 24 h recovery rate,EGDT recovery time,28-day mortality rate were compared. Other secondary outcomes including bleeding,allergic reaction,acute kidney injury (AKI),venous blood filtration (RRT) rate,hyperkalemia,and ICU stay were also recorded. The 28-day survival rate was calculated using the Kaplan-Maier method,and the difference in survival rate was compared by log-rank test.Results The two groups showed no significant difference in gender,age,body weight,source of admission to ICU,procalcitonin level,source of sepsis,Acute Physiology and Chronic Health Evaluation Ⅱ score,number of AKI patients,amount of white blood cells,and C-reactive protein level (all P>0.05). The amount of blood products on the first day [(782±357)ml vs.(606±273)ml;t=2.044,P=0.046] and the average total amount of liquid on the first three days [(5470±1078)ml vs.(5092±929) ml;t=2.640,P=0.009] were significantly higher in NS group than in LR group. The amount of trial fluid and the volumes of other fluids were not significantly different (both P>0.05). The PO₂/FiO₂,MAP,CVP,and BNP levels significantly increased after treatment in both groups (all P<0.05);however,they were not significantly different between LR group and NS group at different time points before and after treatment (all P>0.05). The incidences of hyperlactacidemia (86.0% vs.71.4%,OR:2.457,95%CI:1.202-5.023,P=0.012) and hyperchloremia (25.0% vs.13.2%,OR:2.179,95%CI:1.041-4.562,P=0.036) were significantly higher in NS group than in LR group. These two groups showed no significant difference in EGDT8,24 h recovery rate,EGDT recovery time,28-day mortality rate,AKI,RRT rate,hyperkalemia,and ICU stay (all P>0.05). Kaplan-Meier survival analysis showed that the 28-day survival rate was not significantly different (χ ² log-rank=0.012,P=0.911).Conclusion When liquid resuscitation is applied in patients with septic shock,the use of LR can lower blood transfusion requirement on the first day and total liquid dosage on the first three days (compared with NR), along with lower incidences of hyperlactacidemia and hyperchloremia,although there was no significant difference in the 28-day mortality rate.

Objective To explore the influence of the iodine disinfection on nasal bacterial colonization through the transsphenoidal approach.Methods Totally 133 pituitary adenoma patients who underwent transsphenoidal surgery in our department from January to August 2017 were enrolled in this study. Before disinfection,pharyngeal swabs of inferior turbinate root secretions were taken for bacterial culture. After iodine disinfection,pharyngeal swabs were taken again at the same site. Changes in the nasal bacterial spectrum before and after disinfection were compared. Patients were followed up for three months after the surgery,during which any intracranial infection/bacteraemia was recorded,and its correlation with nasal bacteria colonization was analyzed.Results Nasal bacterial colonization was detected in 45 (33.8%) of 133 patients before iodine disinfection and in only 6 cases (4.5%) after iodine disinfection (χ ²=34.5,P=0.000). Thus,iodine disinfection eliminated 86.7%(39/45) of the colonized bacteria. The most common nasal bacterium was Staphylococcus aureus (24.4%,11/45),followed by Klebsiella pneumoniae (24.4%,11/45),and Staphylococcus epidermidis (13.3%,6/45). One patient had high fever and chills 2 days after surgery,but blood culture and cerebrospinal fluid culture showed negative results. After the administration of third-generation cephalosporins,the symptoms disappeared after two days.Conclusions There are colonized bacteria in nasal cavity. Iodine disinfection of nasal cavity can effectively clear most of the nasal bacteria. The possibility of intracranial infection/bacteremia after transsphenoidal approach is low.

Objective To evaluate the value of combined special staining technique in observing pathological changes in blood vessels.Methods Totally 999 vascular specimen were harvested from patients with complete medical records,clear diagnosis,and age≥18 years in the Pathology Department of Beijing Anzhen Hospital from January 2014 to September 2017.All specimen were stained with HE,Verhoef-Van Gieson,AB/PAS,and Masson. Then,the result of HE staining was compared with that of the combined special staining (Verhoef-Van Gieson,AB/PAS,and Masson).Results HE staining only showed a small amount of elastic fiber fracture. In contrast,the combined special staining clearly showed the pathological changes including fractures,decreased elastic fibers,and aggregation of extracellular mucous matrix. Diseases in these 999 patients included aneurysm of sinus of valsalva (SVA) (n=3),aortic root aneurysm (ARA) (n=177),thoracic aortic aneurysm (TAA) (n=78),abdominal aortic aneurysm (AAA) (n=17),total thoracoabdominal aortic aneurysm (tTAAA) (n=32),and aortic dissection (AD) (n=692). The median scores of combined special staining of SVA (Z=3.857,P=0.040),ARA (Z=14.307,P=0.000),TAA (Z=26.939,P=0.000),AAA (Z=22.412,P=0.000),tTAAA (Z=15.926,P=0.000),and AD (Z=39.213,P=0.000) were significantly higher than that of HE staining.Conclusion The combined Verhoeff-Van Gieson,AB/PAS,and Masson special staining is an effective technique for observing pathological changes of elastic fibers and mucus in blood vessels.

Objective To compare the difference in perioperative management for patients with or without autism spectrum disorders(ASD) undergoing general anesthesia.Methods We retrospectively analyzed the clinical data of 10 ASD patients(case group) and 10 non-ASD patients(control group) undergoing general anesthesia from January 2013 to February 2018. Both groups were matched by age,gender,and surgical procedures. The induction mode,premedication patterns,narcotic drugs,time to wake up,post-anesthesia care unit(PACU) stay,and perioperative vital signs were compared.Results The main induction mode was combined intravenous and inhaled anesthesia(CIIA) in case group(6/10) and total intravenous anesthesia(TIVA) in control group(10/10)(χ ²=8.571,P=0.003). The wake-up time are significantly longer in case group[(36.0±10.7) min] than in control group [(22.7±6.6)min] (t=18.000,P=0.005). Case group [(12.7±6.7)min] needed more time to obtain first vital sign than control group[(6.7±3.3)min](t=23.000,P=0.038). There were also significant differences in first systolic blood pressure (SBP)(t=15.500,P=0.007),preinductive SBP(t=24.000,P=0.048),and heart rate(t=22.000,P=0.033) between two groups.Conclusion Compared with non-ASD patients,ASD patients tend to use CIIA as the induction mode,have longer wake up time and later vital sign record,and are more likely to have peri-inductive vital signs.

Objective To evaluate the application of adding ondansetron in morphine intravenous analgesia pump for prevention of postoperative nausea and vomiting(PONV)in women.Methods Data of surgical female inpatients who received general anesthesia and postoperative intravenous analgesia with morphine in our center from January 1st,2013 to December 31st,2014 were retrospectively analyzed. Based on whether ondansetron was added,patients were divided into the observation group(n=834) and the control group(n=856). Outcome variables including morphine consumption,visual analogue scale(VAS) score,nausea score,and total times of vomiting within 48 hours after surgery were collected and compared.Results Age(t=0.432,P=0.665),morphine consumption during the first post-operative day(t=0.599,P=0.548) and during the second post-operative day(t=0.236,P=0.813),maximum VAS score of postoperative pain during movement during the first post-operative day [3(2,4) vs. 3(2,5);Z=1.850,P=0.064] and at rest during the second post-operative day [0(0,1) vs. 0(0,1);Z=1.511,P=0.131] were not significantly different between two groups. While the maximum VAS score of postoperative pain at rest during the first post-operative day [0(0,2) vs.0(0,2);Z=2.435,P=0.015] and during movement during the second post-operative day [3(1,3)vs.3(2,4);Z=3.445,P=0.001] were significantly different between two groups. The maximum score of postoperative nausea(χ ²=9.810,P=0.020) and cumulative frequency of postoperative vomiting(Z=3.726,P=0.002)in the observation group were significantly lower than those in the control group during the first post-operative day;however,there was no significant difference during the second post-operative day(χ ²=5.017,P=0.170;Z=0.000,P=1.000). Logistic regression analysis showed that adding ondansetron in morphine intravenous analgesia pump was an independent influencing factor of reduced postoperative nausea. The probability of nausea during the first post-operative day was 0.781 time(P=0.015)of that in the control group and 0.736 time(P=0.030)during the second post-operative day.Conclusion Adding ondansetron in morphine intravenous analgesia pump may reduce PONV in women.

Objective To investigate the role of 17-MHz high-frequency linear array probe in detecting the microcalcification of papillary thyroid carcinoma (PTC) and its pathological basis.Methods The clinical data of 75 patients with PTC diagnosed by ultrasonography and pathology in China-Japan Friendship Hospital from January 2016 to January 2017 were analyzed. The detection rate of microcalcification was compared between 17-MHz high-frequency ultrasound and conventional ultrasound,and the imaging findings and pathological results were analyzed.Results Among 93 thyroid nodules,the detection rate of PTC microcalcification by 17-MHz ultrasound was 74.2% (69/93),which was significantly higher than that of conventional ultrasound (59.1%,55/93) (χ ²=4.742,P=0.029). The diagnostic sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the conventional ultrasound and the 17-MHz ultrasound were 73.6% and 98.1%,60.0% and 57.5%,67.7% and 80.6%,70.9% and 75.4%,and 63.1% and 95.8%,respectively. Pathology confirmed the presence of microcalcification at 53 nodules,among which psammoma bodies were found in 10 nodules;in addition,all the psammoma bodies were located in the cell mass,whereas irregular calcium deposits were mainly in proliferated fibrous tissues.Conclusions The 17-MHz high-frequency ultrasound can increase the detection rate of microcalcification in thyroid nodules. The ultrasonic manifestations of microcalcification do not completely correspond to the psammoma bodies found in pathology;rather,they may represent the irregular calcium deposits on fibrous tissues.

Palliative care focuses on improving the quality of life for patients and families facing life-threatening illness. Since its introduction in China,palliative care has developed rapidly with greater numbers of elderly adults and increasing chronic disease. However,palliative care education lags behind somehow,especially for undergraduate medical students. This article summarizes the history and status quo of palliative care education for undergraduate medical students in countries and regions including the United Kindom,the United States,Japan,and Taiwan Province,with an attempt to further promote the palliative care education for medical students in mainland China.

Objective To analyzed the current situations and needs of the continuing education on hospice and palliative care (HPC) in China based on the response from trainees in the 2016 National Hospice and Palliative Medicine Training Program.Methods A questionnaire-based survey was performed among 141 trainees who attended the program held by Peking Union Medical College Hospital in 2016. The questionnaire items included the awareness and knowledge of HPC,learning objectives,learning gains,and future plans.Results The trainees came from 19 provinces and municipalities. Their professions included doctors (66.0%),nurses (17.0%),physical therapists (1.4%),psychologists (5.0%),social workers (2.1%),volunteers (6.4%) and hospital managers (2.1%). Doctors’disciplines included geriatrics (56.0%),medical oncology (11.8%),and others (32.2%). Among these 141 participants,111 (78.7%) had not attended any HPC course before,134 (95.0%) were aware of HPC,and 131 (92.9%) needed help from others when providing care for terminally-ill patients. The median score for symptom control and communication skills among 141 trainees were 3.0(2.0,4.0) points and 1.0(0.0,2.0) points,respectively. The average score of the final examination involving case analysis and medical knowledge of symptom control was (59.1±18.0)scores (centesimal system). Finally,136 trainees (96.5%) were willing to receive further training on HPC.Conclusion It is important to do more HPC education and training among medical staff,so as to strengthen their knowledge and capability in symptom control,communication,and evaluation of death quality.

Objective To investigate the experience of accompanying dying patients among hospice and palliative care (HPC) volunteers.Methods By applying the methodologies of phenomenological research and participatory observation,the experiences,awareness,and expectations of accompanying dying patients of 10 volunteers in our center were investigated.Results The experiences of 10 volunteers in HPC could be summarized into three subjects:volunteer personal cognition,volunteer demand and family support,and volunteers’ expectations of hospital and society. These could be further divided into 6 sub-themes regarding the personal cognition and feelings of the volunteers:unknown,hostile,suspicious,helpless,role positioning,and passing the message of illness. Three sub-themes associated with individual needs and family support were:self motivation,family ties,and family support. Five sub-themes concerning volunteers’ expectations for hospitals and society were:confusion of concept,lack of palliative idea,reach-out service,humanistic care,and adoption of palliative concept.Conclusions HPC team should widely promote the concept of HPC,seeking supports from individuals,families,and the whole society. A strong volunteer team with robust volunteer service mode and standardized admittance,training,and supervision systems are needed. In particular,strengthened supervision and training of HPC volunteers and standard volunteer system are conducive to the improvement of HPC services in hospitals.

According to the World Health Organization,palliative care is an approach that prevents and alleviates the pain of patients with life-threatening illness and improves the quality of life of patients and their families through early identification,assessment and treatment of pain and other physical,psychosocial and spiritual problems. It is the active holistic care accomplished by multidisciplinary team. This article describes the practice of the palliative care in a patient with advanced retroperitoneal sarcoma.

Overweight and obesity are associated with a range of chronic diseases and have become a major global health concern. With the progress of Internet technology,electronic health care has emerged,providing new tools and methods for weight management. Internet-based technology has shown certain effectiveness in facilitating interventions on overweight,obesity,and their associated diseases. This article reviews the recent advances in these interventions and evaluates their effectiveness,efficiency,and feasibility.

The past few years have witnessed rapid advances in the immunotherapies for non-small-cell lung cancer (NSCLC). CIMAvax-EGF is a therapeutic vaccine against lung cancer independently developed by Cuba. It can exert its anti-tumor effect by forming epidermal growth factor (EGF) antibodies to block the binding of EGF to EGF receptor. So far stage both phases Ⅱ and Ⅲ trials have proved its effectiveness and long-term safety,and phases Ⅲ and Ⅳ trials are underway. A deeper understanding of the role of CIMAvax-EGF in NSCLC will accelerate the application of immunotherapy. This article summarizes the recent advances of CIMAvax-EGF R&D and its application in treating NSCLC.

Crosslinks belong to the pedicle screw internal fixation system. However,whether they can provide stable internal fixation remains controversial. In this article we review the origin/development,design/types,and clinical applications of crosslinks and evaluate the biomechanical function of crosslinks in the whole internal fixation system.

Insulin resistance and insulin deficiency have long been believed to be the two main causes of type 2 diabetes mellitus (T2DM). However,recent studies have shown that paradoxical hypersecretion of glucagon may also contribute the pathogenesis of T2DM. This article reviews the role of paradoxical hypersecretion of glucagon in the pathogenesis of T2DM and the recent advances in relevant treatment options.

Sellar malignant tumors are uncommon and usually reported as metastatic diseases from breast or lung cancers. Spindle cell carcinoma (SCC) is a rare malignancy and has been found in breast,oral cavity,lungs,kidneys,and hepatobiliary pancreatic system but not in sellar region. We report here the first case of isolated sellar SCC with aggressive features in Peking Union Medical College Hospital. This patient was referred to our hospital on September 9,2015 and discharged on October 16,2015. We described the clinical manifestations,imaging findings,and pathological features of this rare disease.

This article reports a female type Ⅱ Lynch syndrome patient who suffered from colon cancer and endometrium carcinoma consecutively. We also briefly elucidate the pathogenesis,clinicopathological features,screening,and management of Lynch syndrome. Regular screening and early diagnosis and treatment may help to reduce the incidences and mortality rates of tumors associated with Lynch syndrome.

We reported a case with epidermoid cyst (EC) in the fourth ventricle. The insinuation and scalloping growth pattern were the distinctive imaging characteristics of EC in the fourth ventricle on magnetic resonance imaging. The accurate identification of the punctate enhancement of vessels around the lesion may be helpful for its differential diagnosis from hemangioblastoma.