目的 探讨银翘散联合左氧氟沙星治疗老年社区获得性肺炎的临床疗效及对免疫功能的影响。方法 选取2018年7月至2021年2月我院收治的98例老年社区获得性肺炎患者为研究对象，随机分为对照组和观察组，每组49例。对照组给予左氧氟沙星片口服，观察组在对照组基础上加用银翘散水煎服。比较两组患者临床疗效、临床症状改善时间、不良反应发生率，治疗前后免疫功能水平。结果观察组患者治疗有效率(87.75%)高于对照组(73.46%)(P<0.05);观察组患者体温和白细胞数恢复正常、湿啰音消失、咳嗽消失时间与对照组相比均缩短(P<0.05);治疗后观察组和对照组患者IgA、IgG、CD4~+T细胞、CD4~+/CD8~+、NK均上升，CD8~+T细胞下降，观察组IgA、IgG、CD4~+T细胞、CD4~+/CD8~+、NK水平高于对照组，CD8~+T细胞低于对照组(P<0.05);对照组患者总不良反应发生率(18.36%)高于观察组(4.08%)(P<0.05)。结论 银翘散联合左氧氟沙星治疗老年社区获得性肺炎，能够提高治疗有效率，缩短临床症状改善时间，降低不良反应发生率，改善机体免疫功能。

In recent years, with the development of science and technology, mass spectrometry (MS) has emerged as an innovative analytical technique. MS is suitable for a large number of analyses and is widely used in the field of protein analysis. It has become the main choice for proteomics applications with its efficiency, sensitivity, accuracy, stability and convenience. Proteomics is essential for early stage diagnosis, prognosis and monitoring of disease development. Among them, the protein post-translational modification(PTM) is an important way of regulating protein functionand. The testing of PTM is very important in the experimental process. This article reviews mass spectrometry analysis of PTM(ubiquitination, sumoylation, acetylation, glycosylation)andthe new sumoylation mass spectrometry detection method defined in our laboratory.This article also discusses the application of mass spectrometry in precision medicine.

Under the influence of the new coronavirus pneumonia epidemic, public health human resources in community hospitals are one of the main forces in the emergency state of epidemic prevention and control. The quantity, quality and distribution of public health human resources are the influencing factors of epidemic prevention and control. Establishing an information sharing mechanism, rationally arranging public health human resources, and implementing grid management, and applying for transfer if necessary are issues that every community hospital needs to think about. By investigating the public health human resources of 9 representative community hospitals, the common problems and causes are analyzed, and corresponding suggestions are made.

Homocysteine is formed as an intermediate during methionine metabolism. Hcy is known to be an independent risk factor for cardiovascular disease and neurological diseases including epilepsy, stroke, cognitive disorders, Parkinson's disease and Alzheimer's disease. Epilepsy is one of the common diseases of neurology, and it has characteristics of episodic, transient, repetitive and stereotypic. One research has shown that severe hyperhomocysteinemia causes seizures and increases the frequency of seizures. But the interactions between hyperhomocysteinemia and seizures are rare reported in China. This review focuses on the interactions among homocysteinemia, NMDA receptors and epilepsy to further explore the pathogenesis of epilepsy and provides new clinical treatments.

ε-polylysine is a kind of natural amino acid polymer produced by microbial fermentation, which has a broad application prospect in food, medicine and other industries. This paper reviewed the research progress in the biosynthesis of ε-polylysine in recent years, and especially discusses the new breeding methods of ε-polylysine production strains and the application of ε-polylysine in medicine field. The aim is to provide theoretical basis for the industrial production and application development of ε-polylysine.

Objective To explore the causes, prevention and treatment of complications in patients after transepithelial photorefractive keratectomy (transPRK).Methods The cases were retrospectively studied. One hundred and sixteen eyes of 58 patients were followed up and reexamined. The patients with complications were examined and treated. The patients were followed up for 3 months.Results The side effects and complications of transPRK were pain within 3 days, haze, delayed healing (1.72%), dry eye symptoms or original dry eye symptoms aggravation (18.97%), transient or persistent glare (5.17%), and hormone induced ocular hypertension (5.17%). After proper treatment of all the complications, the visual acuity of naked eyes reached or exceeded the corrected visual acuity before operation.Conclusion The causes of postoperative complications are related to many factors. Standardized preoperative evaluation and procedures can reduce the incidence of complications.

Routine examination of cerebrospinal fluid is a common clinical examination item of cerebrospinal fluid. It is an indispensable monitoring item in the diagnosis, treatment and evolution of various diseases of the central nervous system. However, in the aspect of cell classification and counting, because routine examination is wet-film microscopy, it only relies on refractive power to observe and classify cells roughly and is easily disturbed by various factors to produce errors. The cerebrospinal fluid cytology examination is a meticulous microscopic examination of cells after cell collection and staining by various methods. It not only makes up for the shortcomings of routine examination, but also has its unique advantages in the identification of central nervous system diseases and cancer cells. With the development of technology, cerebrospinal fluid cytology is also developing. Many new technologies, such as the detection of lymphocyte subsets in cerebrospinal fluid by immunology and the accurate diagnosis of central nervous system tumors by cytochemical methods, have emerged. The future research route of CSF should start from three aspects: structural research, information research and hierarchical research.

CD4⁺ T cells are a kind of immune cells that play an important role in the immune response, which can be differentiated into Th1, Th2, Th17, Treg and other cell subsets after being activated. Th17 cells are new subtype of CD4⁺ effector T cells and play important roles in host defense against various pathogens and inflammatory pathogenesis. PI3K/AKT/mTOR signaling pathway can regulate cell metabolism, proliferation, differentiation, survival and other life processes, meanwhile, participate in the occurrence of tumors and autoimmune diseases. This review concentrated on the research progress in the regulation of the PI3K/AKT/mTOR signaling pathway on Th17 cells.

Objective To investigate the effect of alanyl-glutamine supplements in elderly patients with esophageal cancer on concurrent chemo-radiotherapy.Methods From November 2015 to November 2018,60 Elderly patients who were treated in our hospital with esophageal cancer on concurrent chemo-radiotherapy were recruited and randomly divided into the experimental group and the control group by random digits table.Both groups received routine nutritional support and dietary guidance,while only the experimental group received alanyl-glutamine supplements (20 g/d) on radiotherapy day.We compared blood indicators,changes in body weight,incidence of complications,completion rates of therapy and the T lymphocyte percentage of peri-pheral blood between the two groups.Results After chemoradiotherapy,albumin and hemoglobin of the control group decreased significantly,and the difference between the two groups was statistically significant,P<0.05.Compared with before treatment,the serum prealbumin level of the experimental group was higher than that of the control group,P<0.05.After chemoradiotherapy,serum transferrin of the control group decreased,P<0.05,and serum transferrin of the experimental group was higher than that of the control group,P<0.05.The incidence of radiation esophagitis and bone marrow suppression of the experimental group was significantly lower than that of the control group,P<0.05.There were no significant changes of body weight and incidence of radiation pneumonia before and after treatment in the two groups.The difference of immune indexes between the two groups was statistically significant,P<0.05.The completion rate of the treatment plan of the experimental group was higher than in the control group,P<0.05.Conclusion For patients undergoing concurrent chemoradiotherapy for esophageal cancer,supplementing alanyl glutamine is beneficial to improve nutritional status,reduce the incidence of complications,reduce the possibility of immune decline,and thus improve the therapeutic compliance of patients.

T helper cell 17 (Th17) is a specific subset of T helper lymphocytes determined by high secretion of IL-17 and other inflammatory cytokines. Compared with the typical Th1/Th2 cells, Th17 cells show stronger instability and plasticity, and play a part in different diseases, including infectious diseases, autoimmune disorders and cancer. Th17 cells increase tumor progression by activating angiogenesis and immunosuppressive activities. They can also mediate antitumor immune responses through changing their own phenotype and secreting related factors. Recent studies show that the infiltration of Th17 cells is associated with poor prognosis in breast cancer^[1]. In contrast, infiltration of Th17 cells notably enhanced survival in lung cancer patients^[2]. So Th17 cells are supposed as a double-edged sword in cancer. Further studies will be needed to advance our understanding of the role of Th17 cells in the immunopathogenesis of individual cancers. This article briefly reviews the differentiation and regulation of Th17 cells, the role and the latest progress of Th17 cells in the development of malignant tumors, in order to provide the improvement of more helpful ways for cancer immunotherapy.

Objective To analyze the physical and mental health of parents of children with cerebral palsy by the status survey to study the quality of life and its influencing factors.Methods Totally 104 cases including children with cerebral palsy and healthy babies were as the research object, and they were divided into the experiment group and the control group. The questionnaire survey were conducted, All the parents were issued with SF-36 scale, and the experimental group still needed to fill in the family general situation questionnaire. The results of the two groups were analyzed to get the influencing factors affecting the quality of life of parents of children with cerebral palsy.Results Compared with the parents of normal children, the quality of life of the parents of children with cerebral palsy was significantly lower. The scores of the 8 dimensions of the parents of children with cerebral palsy all decreased to different degrees. The scores of each dimension of the parents of children with cerebral palsy were correlated with the main factors to different degrees. The influencing factors were included in the regression equation and the results showed that the older the children were, the more serious the disease was, and the older the parents were, the lower the quality of life of their parents.Conclusion The quality of life of the parents of children with cerebral palsy has different degrees of decline, and it is affected by a variety of factors, while the most important factors are the age of the children, the severity of the children′s condition, and the age of the parents.

Objective To study the function evaluation of ileocecal valve in ileocecal inflammatory lesions using MR FIESTA small intestine film imaging . Methods From February 2018 to February 2019, 17 patients were diagnosed by enteroscopy and pathology as inflammatory lesions of the ileus were collected, including 9 males and 8 females, range, 18~45 years, with a median age of 38year old. All patients met the inclusion criteria and signed informed consent.In the 50 minutes before the MR scan, 2000 ml non-absorbable fluid(mannitol,2.5%) was ingested at a rate of 200 mL/5 min. After drinking mannitol for 90-100 minutes, the ileocecal valve was dynamically observed in the 2D-FIESTA-cine sequence without breath-hold. The opening times of ileocecal valve and the presence or absence of reflux were observed within 2 minutes. MR multi-FIESTA sequence scanning parameters are: TR 3.3 MS, TE minum, turning angle: 50 °; FOV420 × 420mm; Matrix: 256 × 256; Layer thickness: 6.5 mm. After the scan is completed, the images is transmitted to the post-processing workstation (GE ADW4.7). Two senior radiologists measured and analyzed the images of different patients, and discuss the differences in diagnosis. The observation indicators include: ①Observe the anatomical structure of the ileocecal valve and measure the thickness and length; ②Observe the movement of the ileocecal valve and recorded whether there is a return flow; ③Record the effective opening of ileocecal valve (the ileocecal valve open and can be observed to discharge water into the colon) and the ineffective opening of ileocecal valve (only the ileocecal valve was observed opened but not can be observed to discharge water into the colon). Results Continuous observation for 2 minutes 4 patients with internal regurgitation were opened 8 times per minute (all were effectively opened),6 patients with internal regurgitation were opened 9 times per minute (1 invalid opening and 5 effective opening),7 patients with internal regurgitation were opened 10 times per minute (3 cases of effective opening, 4 cases of invalid opening), and the average number of openings was 9 / min; There was no return flowing. In the inflammatory lesions of the ileocecal junction, the thickness of the ileocecal valve increased, the average thickness of the upper lip was 0.61 cm, the average thickness of the lower lip was 0.63 cm, and the average length of the blind valve was 1.68 cm. The number of ileocecal valve opening increased, but the contraction of the ileum became smaller. Conclusion MRI Multi-FIESTA is fast scan technique , can dynamically observe the function of the ileocecal valve in patients with ileocecal inflammatory in real time, can be used as an effective method for the evaluation of the function of the ileocecal valve.

Objective To explore the strategies and methods to improve the scientific research innovation ability of clinical medicine candidates with master′s degree under the double-track integration mode, in order to cultivate compound high-quality medical talents with scientific research innovation consciousness, and meet the requirements of the times.Methods Two grades of students with master′s degree in medicine from Binzhou Medical University in 2017 and 2018 were selected. Forty-two students were randomly divided into the control group (20) and the observation group (22). The observation group solved the contradiction between clinical and scientific research by setting up the joint training mechanism of double tutors, optimizing the course setting, building the online course platform, improving the examination and supervision mechanism, and setting up the academic and professional graduate student support group, so as to enhance the scientific research awareness and ability of graduate students majoring in clinical medicine. The number and quality of articles published before graduation was counted, and the graduation thesis of master′s degree students were reviewed and scored by senior professional title personnel of relevant specialties.Results The number and quality of articles published before graduation and the scores of master′s degree papers in the observation group were better than those in the control group, and the differences were statistically significant, P＜0.05. The number of SCI papers published, the number of papers published in Chinese core journals and the total number of published articles in the experimental group were higher than those in the control group, P＜0.05.Conclusion The new training method can effectively stimulate the study interest of the master′s degree candidates in scientific research, enhance the enthusiasm of study and the interaction between the tutor and the students, and improve the students′ ability of scientific research innovation.

Objective To evaluate the value of shear wave elastography in diagnosing BI-RADS 4 breast lesions.Methods One hundred and sixty-four breast nodules of BI-RADS 4 breast lesions were examined by conventional ultrasonic and shear wave elastography, and their elastic modulus Emax and ERatio values were determined, and their diagnostic threshold was calculated.Results The elastic modulus value of breast lesions were statistically significant, including Emax and Eratio. As the ROC curve displayed, The diagnosing boundary value of Emax and Eratio was 66.9kpa and 3.88, respectively. The sensitivity of Emax and Eratio were 87.8% and 92.9% , and the specificity of Emax and Eratio were 87.7% and 96.0%.Conclusion Shear wave elastography plays more important role in the differential diagnosis of BI-RADS 4 breast lesions.

Objective To compare the effect of two different incision positions on the original astigmatism of cornea.Methods One hundred and eighty-six cases (186 eyes) of age-related cataract with preoperative astigmatism≤2.0 D in our hospital were selected as the study objects. All the patients underwent phacoemulsification combined with IOL implantation with 3.0 mm transparent corneal incision. According to the incision position, the patients were divided into group A (88 eyes) and group B (98 eyes). The incision of clear cornea was made at 10-12 points in group A, while the incision of steep corneal axis was selected in group B according to the preoperative corneal curvature examination. According to whether the preoperative astigmatism degree≤0.75 D, the changes of postoperative corneal astigmatism degree and visual acuity recovery were compared between the two groups.Results In patients with astigmatism ≤0.75 D, compared with that before surgery, the astigmatism degree decreased significantly 1 week after surgery, with P<0.05, without significant changes in astigmatism 1 month and 3 months after the operation. In patients with astigmatism≤0.75 D, compared with group A, the astigmatism degree of group B decreased significantly at different time points after the operation, P<0.05. In group B, the astigmatism degree gradually decreased with the extension of postoperative time, P<0.05.Conclusion For the patients with preoperative astigmatism≤0.75 D, the early astigmatism of different incisions decreased, but for the patients with preoperative astigmatism>0.75 D, the postoperative astigmatism decreased, and the better uncorrected visual acuity could be obtained by incision on the steep axis of cornea.

Objective To evaluate the safety, refraction changes and tissue repair of stromal lenticule transplantation assisted by femtosecond laser.Methods Six New Zealand white rabbits underwent SMILE in left eyes after anesthesia, and underwent femtosecond laser-assisted autologous corneal stromal lenticule surgery in right eyes. We observed the ocular inflammation,anterior segment OCT, refractive status, Pentacam corneal topography and corneal confocal laser microscope 1 day, 1 week, 1 month, 2 months, and 3 months after the operation. After 3 months of observation, the rabbits were sacrificed, the eyeballs were removed, the rabbit corneas were separated, stained with hematoxylin and eosin, and observed under an optical microscope.Results During the postoperative follow-up, the lenticule remained transparent and no rejection was seen. The central corneal thickness before lenticule implantation was (357.17±12.97) μm, it was (433.67±12.19) μm, (423.50±13.49) μm, (417.33±12.08) μm 1 week, 1 month, and 3 months after the operation. The spherical equivalent was (0.57±1.13)D before the surgery, and it was (-1.98±1.18)D, (-2.65±0.47)D, (-1.84±0.68)D 1 week, 1 month, and 3 months after the surgery. The anterior surface Km was (47.80±1.02) D before the surgery, and it was (53.85±0.99) D, (52.67±1.32)D, (52.53±0.96)D 1 week, 1 month, and 3 months after the surgery. The posterior surface Km was (-6.18±0.15)D before the surgery, and it was (-5.78±0.19)D and (- 5.73±0.20)D, (-5.50±0.14)D 1 week, 1 month, and 3 months after the surgery. After the overall comparison of the preoperative and postoperative central corneal thickness, spherical equivalent, anterior surface Km and posterior surface Km, the differences were statistically significant (P<0.001). The indexes of 1 week, 1 month, and 3 months after the surgery were significantly different from those before the surgery (P<0.05), but no significant changes of each index were seen among different time points after the surgery (P>0.05). After 3 months of follow-up, the lenticule interface can be observed in the anterior segment OCT examination, but the lenticule boundary gradually becomes blurred with time. At early postoperatively, high reflective particles can be seen at the lenticule interface by corneal confocal laser microscopy. Nerve fibers can be seen to grow into the lenticule at 1 month after the surgery. The morphology of corneal cells was close to normal at 2 months after the surgery, and the morphology and number of corneal cells were basically normal at 3 months after the surgery, with small branches of nerve fibers. HE staining showed that the corneal structure was intact, the transplanted lenticule was in place, and the front and back interface of the lenticule could be observed. The fibers are arranged neatly, distributed in parallel, and the structure is clear.Conclusion Autologous corneal stromal lenticule implantation is safe, predictable, and has potential clinical value. Corneal remodeling and changes in refraction after corneal implantation need to be observed for a longer period of time with more samples.

Objective To investigate the clinical application value of chromosomal microarray analysis (CMA) in prenatal diagnosis. Methods Totally 132 pregnant women who underwent amniocentesis in Binzhou Medical University Hospital from July 2018 to June 2019 were selected as subjects. The traditional karyotype analysis and CMA test were performed in all cases. The data acquired from these two methods were statistically analyzed. Results Thirteen cases with chromosomal aneuploidies, 1 case with unbalanced rearrangements were detected both from karyotyping and CMA, while CMA could more accurately give the abnormal sites of copy number variation. Submicroscopic rearrangements with pathological significance were detected in 3 cases with normal karyotypes (+2.27%) and CNV of unclear significance were detected in 4 cases (3.03%). However, the chromosome inversion, polymorphism and balance translocation could not be detected by CMA. Conclusion Compared to karyotype analysis, CMA technology has the same detection efficiency for aneuploidy and copy number variations, while CMA has higher sensitivity and resolution, and can also find additional clinical significant gene copy number. However, the CMA analysis technique itself has limitations, so CMA cannot completely replace the traditional karyotype analysis technology.

Objective To explore the anti-inflammatory effect of dexamethasone (DEX) combined with curcumin (CUR) on RAW264.7 cells induced by lipopolysaccharide.Methods The Griess colorimetric method was used to investigate the effect of DEX and CUR alone and in combination in inhibiting NO secretion. The Chou-Talalay combined index method was used to judge the drug interactions, and screen the synergistic anti-inflammatory ratio of the two drugs. Rhodamine-123 efflux experiment was used to clarify the reversal effect of CUR on DEX multidrug resistance (MDR) under a synergistic compatibility ratio. DEX and CUR were administered according to the screened synergistic anti-inflammatory ratio, DEX and CUR co-loaded nanoparticles (DEX/CUR-NPs) were prepared by emulsification solvent evaporation method, and their pharmaceutical properties and anti-inflammatory activity in vitro were investigated. Results When the compatibility molar ratio of DEX and CUR was 1∶5, the CI of each dose was less than 1, showing a synergistic anti-inflammatory effect, and CUR can inhibit the MDR phenomenon of DEX at this ratio. DEX/CUR-NPs was prepared according to the molar ratio of DEX and CUR with 1∶5. The particle size of the DEX/CUR-NPs was (145.5±2.1) nm, the zeta potential was (-20.54±0.98) mV, and the entrapment efficiency of DEX and CUR were (78.9±5.6)% and (96.4±2.4)%, respectively. DEX/CUR-NPs had good sustained-release properties and synergistic anti-inflammatory activity in vitro, and reverse the MDR of DEX.Conclusion DEX and CUR can play a good synergistic anti-inflammatory effect under the compatibility ratio of 1∶5. DEX combined with CUR is a potential candidate combination of anti-inflammatory drugs.

Objective To investigate the clinical effect of the triple therapy of extracorporeal shock wave combined with hyperbaric oxygen and blood circulation drugs in the treatment of adult early necrosis of femoral head, so as to provide valuable experience for clinical work.Methods Thirty patients with femoral head necrosis in the department of joint surgery were chosen. ARCO stage was Ⅰ period of 17 cases, Ⅱ period 13 cases, and patients received triple therapy treatment of extracorporeal shock wave combined with hyperbaric oxygen and blood circulation drugs. The patients were followed up for 3 months, and before the treatment and after three periods of treatment, the calculation was performed on VAS scores, Harris scores, limb medial femoral circumflex artery blood flow resistance index (RI), and the percentage of femoral head necrosis volume in overall femoral head volume.Results VAS scores and Harris scores were lower after the same stage of treatment than those before the treatment, P<0.01. Compared with those of stage I, the VAS scores of stage II decreased and Harris scores of stage II increased before and after treatment, P<0.05. The blood flow signal of the medial circumflex femoral artery of the femoral head could be detected in 20 of the 30 patients, includingⅠperiod 13 cases and Ⅱperiod 7 cases. Compared with that before the treatment, RI of medial rotated femoral artery decreased at the same stage, P<0.05. The percentage of femoral head necrosis in femoral head volume was lower after the same stage of treatment than that before the treatment, P<0.05. Compared with that of stage I, the percentage of femoral osteonecrosis volume in stage II increased before and after the treatment, P<0.01.Conclusion Triple therapy for the treatment of early adult femoral head necrosis has clinical curative effect, which was better in Ⅰ period than in Ⅱ period, so it has great clinical application value.

Objective To investigate the factors affecting the prognosis of children immune thrombocytopenia,and to establish a clinical scoring system for the prognosis of children immune thrombocytopenia.Methods (1)Data of 206 children with immune thrombocytopenic treated in our hospital from March 2016 to February 2019 were statistically analyzed.Gender,age,i-nitial platelet count,bleeding,infection,and therapeutic effect were recorded,respectively.Moreover,the number of megakaryocytes of 103 children who underwent bone marrow biopsy were recorded.(2)Outpatient and telephone follow-up were conducted for the children.(3)To make univariate and multivariate Logistic regression analysis on the prognostic factors.(4)To assign reasonable scores to risk factors and to calculate the relationship between score and prognosis.Results Among 206 cases with immune thrombocytopenic,170 cases had a good prognosis and 36 had a poor prognosis;among the 103 cases who underwent bone marrow biopsy,76 cases had good prognosis and 27 cases had poor prognosis.The results of statistical analysis showed that there were statistically significant differences in age,prodromal infection,bleeding,initial platelet count and initial Megakaryocyte count,without statistically significant differences in gender or treatment.In the multivariate Logistic regression analysis,the independent risk factors affecting prognosis were age,bleeding,prodromal infection,initial platelet count and initial Megakaryocyte count.The above factors were assigned and the total score was calculated.The results showed that the lower the score was,the better the prognosis was.Conclusion Age,bleeding,prodromal infection,initial platelet count and initial Megakaryocyte count have important predictive significance for the prognosis of immune thrombocytopenia and can be used to guide the treatment.

Objective To detect the application of quantitative dot blot analysis (QDB analysis) detection technology for protein expression level analysis by determining the protein level of high throughput tissue samples and cell samples. Methods The relative expression of tubulin in the prostate tissues from 87 mice and the absolute expression of tubulin from 8 human cell lines were detected by QDB analysis. Results The results showed that the expression level of tubulin protein in prostate tissue from mice was different according to the age, and the absolute expression level of tubulin protein in 8 cell lines was between 90～140 fmol/μg. Conclusion QDB analysis can be applied to the relative and absolute quantification in a high throughput tissue samples and cell samples.

Objective To observe the clinical efficacy and side effects of pemetrexed combined with bevacizumab in the maintenance treatment of advanced lung adenocarcinoma.Methods Fifty-four patients with driver gene negative advanced lung adenocarcinoma received 4-6 cycles of first-line pemetrexed +/- bevacizumab + cisplatin chemotherapy. After the disease was controlled, they were divided into the pemetrexed + bevacizumab + cisplatin group and pemetrexed monotherapy group, and then the PFS, effective rate and adverse reactions of the two groups were observed. At the same time, fasting venous blood of patients before maintenance treatment and after 4 cycles of maintenance treatment was collected, and the vascular endothelial growth factor (VEGF) level was detected by ELISA to evaluate the correlation between changes in serum VEGF level and the efficacy.Results Both ORR and DCR of the two drug groups were significantly higher than those of the single drug group (P<0.05 or <0.01). The median PFS of two groups were 7.8 and 3.9 months and there was statistically significant difference between the two groups by log-rank test. After 4 cycles of maintenance treatment, the serum VEGF level of patients in the two groups significantly decreased after treatment, compared with VEGF level before treatment (P<0.01); compared with the single drug group, the serum VEGF level of patients in the two drug groups decreased significantly after treatment (P<0.01).Conclusion The combination of pemetrexed and bevacizumab in the maintenance treatment of advanced lung adenocarcinoma is more effective in the near term, with better efficacy and safety, and is worthy of clinical promotion. Meanwhile, dynamic monitoring of serum VEGF expression level can effectively predict the efficacy of anti-tumor therapy and is convenient and non-invasive.

Objective To further explore the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on early neurologic deterioration (END) in patients with acute cerebral infarction through clinical prospective study.Methods Seventy-six OSAHS patients with acute cerebral infarction were selected, and 76 cases of acute cerebral infarction in the same period were selected as the control group. Age, disease history, blood glucose, blood lipid and blood pressure were measured and collected. All patients were examined by head and neck CT vascular imaging to determine the stenosis and stenosis rate. By referring to the definition of END, the incidence and time of END were compared between the two groups, and Cox multivariate regression analysis was performed for the relationship between OSAHS and END.Results There was statistically significant difference in the overall incidence of END admission between the two groups (P<0.05). The time interval between END and onset, END and admission in THE OSAHS group was smaller than that in the control group (P<0.05). After taking diabetes history, coronary heart disease history, hypertension history, thrombolytic therapy, body weight, systolic blood pressure, diastolic blood pressure, A1c, total cholesterol and other covariate factors into account, OSAHS was still a significant risk factor for END, P=0.035, RR=3.359.Conclusion OSAHS disease is a significant risk factor for END.

Diffuse large B-cell lymphoma is one of the heterogeneous hematological malignancy accounting for approximately a third of non-Hodgkin lymphomas, with versatile clinical, morphological and molecular characteristics. P53 is an important tumor suppressor gene, which inhibits the occurrence and development of tumors by inducing cell cycle arrest, DNA repair and apoptosis, and regulating multiple signal transduction pathways. The cell cycle disorder and the inactivation of signal transduction pathway caused by p53 mutation are factors in the occurrence and progression of many malignant tumors. This article reviews the role of mutationtype p53 (mutp53) in diffuse large B-cell lymphoma and its possible mechanisms.

<strong>目的 </strong> 研发靶向免疫球蛋白超家族成员9(IGSF9)的特异阻断型单克隆抗体，并验证该抗体的功能。<strong>方法 </strong> 将带有His标签的IGSF9细胞外结构域(IGSF9 extracellular domain, IGSF9-ECD)克隆到pcDNA3.1(-)的表达载体上，转染HEK293细胞，亲和层析获得IGSF9-ECD-His蛋白，应用SDS聚丙烯酰胺凝胶电泳(SDS-PAGE)和Western blotting进行蛋白鉴定。应用IGSF9-ECD-His蛋白免疫6周龄BALB/c小鼠4次，ELISA和流式细胞仪检测小鼠抗血清效价。分离小鼠脾脏细胞，与小鼠多发性骨髓瘤细胞SP2/0进行融合，ELISA和流式细胞仪筛选阳性克隆，并进一步筛选亚克隆细胞，制备靶向IGSF9的单克隆抗体。将IGSF9抗体加入到T细胞和THP-1细胞共培养体系中，检测上清中IFN-γ和TNF-α水平。<strong>结果 </strong> IGSF9-ECD-His蛋白条带单一，分子量与预期相一致。在T细胞培养体系中加入该蛋白，显著抑制T细胞增殖。IGSF9-ECD-His蛋白免疫小鼠后，小鼠抗血清效价为1∶364 500,而且抗血清能够显著逆转THP-1对T细胞的增殖抑制。本研究获取了64株克隆阳性细胞株，其中有6株能够用于流式细胞仪检测。本研究选择了阻断效应最好的5C3母克隆制备单克隆抗体，流式细胞仪和T细胞共培养结果筛选后，选择了阻断效应最好的5C3-1A4作为IGSF9单克隆抗体(anti-IGSF9),该抗体能够显著逆转IGSF9对T细胞的增殖抑制，并促进IFN-γ和TNF-α的分泌。<strong>结论 </strong> 本研究成功制备了IGSF9单克隆抗体，而且该抗体能够显著逆转IGSF9对T细胞增殖抑制。

Objective To analyze the current situation of the health equity of middle-aged and elderly residents in China and its contributions of its influencing factors.Methods Data came from the CHARLS 2015 survey, the middle-aged and elderly people aged 45 and above were selected as the research objects, and the self-rated health status was used as the result variable of health status. The concentration index and concentration index decomposition were used to evaluate and explore the health equity and its influencing factors.Results The good proportion of self-rated health of middle-aged and elderly residents in China was 29%, the concentration index was 0.0614, and the horizontal inequity index of the health level fairness index was 0.0102. the main influencing factors of health equity are the economic level, education level, and urban-rural distribution.Conclusion There is a certain degree of inequity in the health status of middle-aged and elderly people in China. Economic factors are the most important contribution of inequity. Therefore, improving the economic status of low-income middle-aged and elderly people will help promote the health and health equity.

Objective To explore the relationship between LHCGR gene mutation and empty follicular syndrome and to guide the diagnosis and treatment of related reproductive diseases. Methods An analysis was carried out on LHCGR gene mutation and pedigree of a infertile patient with empty follicular syndrome by gene sequencing. Results There was homozygous mutation in exon 11 of LHCGR gene in this patient: chr2:48915113A>G, c.1823T>C, p. Leu608Pro. The mutation resulted in the mutation of LHCGR protein from leucine (Leucine, Leu) to proline (Proline, Pro) at position 608. The family analysis of the patient and sequencing of the family members showed that the parents belonged to the heterozygous mutation, the proband brother (46, XY) was a homozygous mutation, and the proband sister (with a girl and a boy) belonged to a heterozygous mutation. Conclusion LHCGR gene mutation can lead to empty follicle syndrome, which in turn leads to the occurrence of related reproductive diseases.