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Table of Content

    05 May 2020, Volume 40 Issue 5
    Special Issues of Novel Coronavirus Pneumonia(2)
    Clinical characteristics of novel coronavirus pneumonia
    LI Sheng, LI Ni-rong, LIU Ling-ling, QIN Li-hua
    2020, 40(5):  593-597. 
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    This article summarizes the features of novel coronavirus infection,the characteristics, clinical symptoms and laboratory diagnosis of novel coronavirus pneumonia, and current diagnostic criteria, including clinical symptoms, laboratory tests, CT, etc. These conclusions are important to the public awareness, prevention and control of novel coronavirus pneumonia, as well as provide the basis for diagnostic research.
    Management of West China Hospital Medical Team for COVID-19 in Wuhan
    TONG Le, CHEN Xiao-li, YE Lei
    2020, 40(5):  598-600. 
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    With the increase of diagnosed COVID-19 cases, the prevention and control of epidemic in Wuhan became tougher. To support Wuhan, West China Hospital of Sichuan University sent the third round of medical team to the city. In order to ensure a safe and relax condition for medical team members after busy works, it was crucial to manage the medical team station well comprehensively. This article summarized the management experience of West China Hospital medical team as a reference for others to fight against the epidemic.
    A survey on psychological status of healthcare providers in Yongchuan Hospital Affiliated to Chongqing Medical University, one of the designated hospitals for novel coronavirus pneumonia
    DENG Su-rong
    2020, 40(5):  601-603. 
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    Objective To investigate the psychological status of healthcare providers in Yongchuan Hospital Affiliated to Chongqing Medical University, one of the designated hospitals for novel coronavirus pneumonia during the COVID-19 epidemic. Methods The Symptom Checklist 90 (SCL-90) was used to evaluate 68 staff in the hospital. SPSS 17.0 statistical software was used to process the data. The scores of each factor got from the target population were compared with the norm. Results During the COVID-19 epidemic, the SCL-90 scores of the staff were significantly higher than the norm (P<0.05). The scores increased with enhancement of the risk of infection at different departments. Conclusions The psychological status of healthcare providers in the hospital during the COVID-19 epidemic should be followed by necessary intervention as soon as possible.
    Transport route for COVID-19 patients in emergency department
    ZHANG Jing-min, GAO Yong-li, YE Lei, CAO Yu, YAO Rong, LI Yuan-hao, MAO Yuan-zheng
    2020, 40(5):  604-608. 
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    Since December 2019, COVID-19 has broken out in Wuhan and spread rapidly across the country. In order to effectively prevent and control the spread of the disease, most provinces and cities in China initiated to restrain traffic, blocked access and other public health control measures, which have brought great challenges to the emergency transfer process of patients. In order to effectively encourage patients to hospital for treatment, the Emergency Department of West China Hospital, Sichuan University, established an innovative medical isolation transport system for COVID-19 patients, and applied to the emergency transport process of the first case. The patients were admitted to hospital smoothly, and received treatment as planned without secondary infection.
    Original Articles
    Interferon-α1b promotes the cytotoxicity of human γδT cells against Daudi cell line
    DANG Guang-lei, ZHANG Xiang-jin, ZHANG Jian-min, CHEN Hui, HE Wei
    2020, 40(5):  609-614. 
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    Objective To investigate the effect of IFN-α1b on cytotoxic activity of human γδT cells against Daudi cells. Methods Daudi cells treated with IFN-α1b were functioned as target cells and γδT cells treated with IFN-α1b as effector cells. The cytotoxic activity of γδT cells was tested by a lactate dehydrogenase release assay. ELISA kits were applied to detect the level of granzymes B and IFN-γ released from γδT cells. Flow cytometry was performed for examining Fas receptor, stress protein ligands on Daudi cells and activation markers CD69 and CD25 of γδT cells. Results Both IFN-α1b pretreated Daudi cells or γδT cells significantly augmented the cytotoxic activity of γδT cells against Daudi cells (P<0.0001). IFN-α1b also enhanced granzymes B and IFN-γ secretion of γδT cells(P<0.05); IFN-α1b significantly up-regulated the expression of Fas receptor and stress ligand ULBP4 on but not ULBP3 on Daudi cells; IFN-α1b also increased the expression of CD69 but not CD25 on γδT cells. Conclusions IFN-α1b improves cytotoxicity of human γδT cells against cancer cell line Daudi by different mechanisms.So it is believed that IFN-α1b plus γδT cells may enhance the anti-tumor effect of γδT cells.
    Indoleamine 2,3-dioxygenase 1 inhibitor Epacadostat combined with IFN-γ induces apoptosis of triple-negative breast cancer cell lines
    HU Qing-qing, LU Yan
    2020, 40(5):  615-620. 
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    Objective To investigate the effect of IFN-γ combined with IDO1 inhibitor Epacadostat(Epa) on the treatment of triple-negative breast cancer cell lines 4T1 and MDA-MB-231. Methods Following treatment with IFN-γ, Epa or IFN-γ combined with Epa on 4T1 and MDA-MB-231 cells for 48 h, the apoptosis of cells in each group was detected by flow cytometry. The expression of IDO1 was detected by Western blot and the yield of Kyn in 4T1or MDA-MB-231 cell lysate was detected by ELISA. The IDO1 was knocked out by using CRISPR-Cas9 system and knockout efficiency was examined by Western blot. Results IFN-γ showed a weaker killing effect on triple-negative breast cancer cells; IFN-γ significantly up-regulated the expression of IDO1 in triple-negative breast cancer cell lines (P<0.001), and the level of Kyn in cell lysate was also significantly up-regulated (P<0.01); cell apoptosis of IDO1 knock-out 4T1 (P<0.01) or MDA-MB-231 (P<0.01)cells treated with IFN-γ for 48 h was also significantly increased; IFN-γ combined with IDO1 inhibitor Epa promoted the apoptosis of 4T1 and MDA-MB-231 cells, and also prolonged the survival time of tumor-bearing mice. Conclusions The IDO1 inhibitor Epa might significantly enhance the therapeutic effect of IFN-γ on triple-negative breast cancer.
    Preliminary study on the mechanism of RNA-binding protein as a drug target of clofoctol
    ZHANG Mei-lian, WANG Zhi-xing, HU Yan, RAN Kun-nian, HAN Wei, PENG Xiao-zhong
    2020, 40(5):  621-626. 
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    Objective To explore the molecular mechanism of anti-glioma by clofoctol targeting on RNA-binding proteins. Methods Biotin pull-down experiments were used to detect the binding of RNA-binding protein UNR (upstream of N-ras) to the target gene Krüppel-like factor 13(KLF13) mRNA fragments, and the effect of clofoctol on the binding to UNR to KLF13 mRNA fragments; The results of clofoctol DARTS sample's mass spectrometry combined with transcriptome chip analysis were used to screen other RNA-binding protein targets and to predict other downstream target genes. Results Clofoctol enhanced the interaction between UNR and the fragment of KLF13 mRNA; Clofoctol also acted on other RNA-binding proteins, and functioned in mTOR signaling pathway and TNF-related apoptosis-inducing ligand (TRAIL)-activated apoptotic signaling pathway. Conclusions Clofoctol can resist gliomas by acting on RNA-binding proteins.
    Carboxyamidotriazole reduces programmed cell death 1 expression by inhibiting NFAT2 nuclear transport in murine CD8+T cells
    XU Meng-jiao, GAO Hong-ting, SHI Jing, JU Rui, YANG Li-xing, LI Jian-heng, GUO Lei
    2020, 40(5):  627-631. 
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    Objective To study the effect of carboxyamidotriazole (CAI) on CD8+T cells, and to explore the critical mechanism of CAI in reinforcing cytotoxicity of activated T cells. Methods CD8+T cells of mouse were isolated by immunomagnetic beads and divided into control group, CAI group, ZK756326 (Ca2+ activator) group and CAI+ZK756326 group. Flow cytometry was used to detect the level of intracellular free calcium ions in CD8+T cells; Enzyme-linked immunosorbent assay was used to detect the expression of intracellular calcineurin (CaN); Immunoflu- orescence staining was used to detect NFAT2 nuclear transportation; Chromatin immunoprecipitation-qPCR was used to detect the expression of PD-1 regulated by NFAT2. Mice spleen cytotoxic T lymphocytes (CTLs) were isolated and examined for the expression of PD-1 in CD8+T cells by flow cytometry. Results Intracellular Ca2+ concentration in CD8+T cells significantly decreased in the CAI group (P<0.001), while intracellular Ca2+ concentration increased in the CAI+ZK756326 group(P<0.01); CAI significantly decreased the content of calcineurin phosphatase in CD8+T cells (P<0.001);CAI significantly inhibited NFAT2 nuclear transportation (P<0.001) and significantly inhibited PD-1 transcription process depend on NFAT2 (P<0.001); CAI significantly reduced the proportion of PD-1+CD8+T cells in mice spleen CTLs cells (P<0.001). Conclusions CAI inhibits NFAT2 nuclear translocation by decreasing the level of calcium ions in the CD8+ T cells and inhibiting the expression of calcineurin, thereby reducing the expression of PD-1 in CD8+ T cells, which facilitated immunotherapy intervention.
    Preparation and functional identification of anti-human transforming growth factor β1 nanobodies
    WANG Yue, LI Zheng, CHEN Hui, ZHANG Jian-min, HE Wei
    2020, 40(5):  632-638. 
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    Objective To prepare alpaca-derived anti-human TGF-β1 nanobodies with high specificity and high affinity. Methods The eukaryotic expression plasmid cFUGW-TGF-β1 was constructed and transiently transfected into HEK-293T cells to obtain recombinant TGF-β1 protein. Purified TGF-β1 proteins were mixed with Freund's adjuvant before immunizing alpaca. The peripheral blood mononuclear cells were isolated from immunized alpaca for RNA extraction and cDNA library was prepared by reverse transcription. Nested PCR was performed to obtain heavy chain variable region fragments for a phage display library. ELISA was applied to screen TGF-β1-specific antibody strains. Positive clones were selected and transferred to a prokaryotic expression vector for purification of nanobodies specific against human TGF-β1. Immunoblotting, immunofluorescence and ForteBio methods were performed to identify the specificity and affinity of the antibodies. Results The recombinant plasmid cFUGW-TGF-β1 was successfully constructed and 3 mg TGF-β1 purified proteins were obtained. A TGF-β1-VHH phage display library with a capacity of 1.2×108 was obtained after 5 immunization. After four-rounds selection with ELISA, 7 strains of nanobodies that specifically bound to recombinant TGF-β1 protein were obtained. Both Western blot and immunofluorescence experiments showed that nanobodies B3 and C8 can recognize TGF-β1 in NCI-H520 tumor cells with the affinity as 1.48×10-9 mol/L and 9×10-9 mol/L, respectively. Conclusions Two TGF-β1-VHH nanobodies B3 and C8 are obtained, which can specifically bind TGF-β1 with high affinity. These nanobodiesare potential candidates for tumor immunotherapy.
    Synergistic antitumor effect of Hsp90 targeting-inhibitory peptide P7 combined with docetaxel in lung adenocarcinoma cell line A549
    WU You-ming, LIU Na-si, CAO Ming-yue, HUANG Wei, LIU Yan-yong, YANG Nan
    2020, 40(5):  639-643. 
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    Objective To investigate the effects of combination of Hsp90 bifunctional targeting-inhibitory peptide LPLTPLP (P7) with chemotherapy drug docetaxel(DTX) on lung adenocarcinoma cell line A549. Methods DTX and peptide P7 alone or combined were incubated with A549 cell for 48 hours, thereafter the effect of the drug on cell viability was evaluated using the CCK-8 method. Flow cytometry was carried out to quantify apoptotic cells. The expression of apoptotic and drug resistant protein were assessed by Western blot analysis. Results DTX and P7 exhibited a synergistic effect on cell survival. The apoptosis rate of the combined drug group was 25.8%, which was significantly higher than that of DTX group(P<0.05). Apoptosis-related proteins Bcl-2 and PARP were significantly down-regulated(P<0.05), and cleaved-PARP protein was significantly up-regulated(P<0.05). Meanwhile, drug-resistant protein major vault protein(MVP) was significantly down-regulated(P<0.05). Conclusions DTX ombined with targeted peptide P7 can significantly increase the apoptosis rate of A549 cells, which may be related to expression level of Bcl-2, inactivation of DNA repair enzyme PARP and down-regulation of multidrug-resistant protein MVP.
    miR-197-3p inhibits proliferation, migration and invasion of thyroid cancer cell line through regulating DMBT1
    CAO Deng-han, CHEN Kui-sheng
    2020, 40(5):  644-650. 
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    Objective To investigate whether miR-197-3p affects the proliferation, migration and invasion of thyroid cancer cells through regulation of deletion of malignant brain tumors 1(DMBT1) expression. Methods The expression of miR-197-3p in human normal thyroid cells Nthy-ori 3-1 and thyroid cancer cell lines SW579 and CGTHW-1 was detected by RT-qPCR,MTT assay was used to detect the proliferation of SW579 cells, and Transwell chamber assay was used to detect the migration and invasion of SW579 cells, the dual luciferase reporter gene assay verified whether miR-197-3p targets DMBT1, and the expression of DMBT1, cyclin D1, p21, MMP-2and E-cadherin in the cells was detected by Western blot. Results Compared with Nthy-ori 3-1 cells, the relative expression of miR-197-3p was increased in SW579 and CGTHW-1 cells (P<0.05). After inhibiting the expression of miR-197-3p, the proliferation, migration and invasion of SW579 cells were significantly inhibited, and the expression of cyclin D1 and MMP-2 proteins was decreased and the expression of p21 and E-cadherin proteins was increased. miR-197-3p targeting negatively regulates DMBT1 expression in SW579 cells. Over-expression of DMBT1 significantly inhibited the proliferation, migration and invasion of SW579 cells, while inhibition of DMBT1 reversed the effect of miR-197-3p on proliferation, migration and invasion of SW579 cells. Conclusions miR-197-3p inhibits the proliferation, migration and invasion of thyroid cancer cell regulation of DMBT1 expression.
    Nalbuphine inhibits remifentanil-induced hyperalgesia in rats
    PANG Hong-li, LI Hong-ying, HE Dong-hai, XU Yuan-zheng, ZHENG Xiao-zhen
    2020, 40(5):  651-654. 
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    Objective To investigate the effect of nalbuphine on hyperalgesia induced by remifentanil and its mechanism. Methods Rats were divided into the control group,remifentanil group (R group),incisional pain model group(M group),remifentanil and incisional pain model group(RM group),nalbuphine pretreatment group(N+RM group). The R group,RM group,N+RM group were intravenously infused with remifentanil 1.0 μg/(kg·min),the M group,RM group and N+RM group were constructed incisional pain model by pelmatic incision operation and the N+RM group was intravenously injected with nalbuphine 0.6 mg/kg before remifentanil. The paw withdrawal thermal latency (PWL) and paw withdrawal mechanical threshold (PWT) were measured 24 hours before modeling (T-1),2 hours after modeling(T1),6 hours after modeling(T2),24 hours after modeling(T3) and 48 hours after modeling (T4).Western blot was conducted to detect the expression of NR1,NR2A,NR2B,ERK1/2 and p-ERK1/2 at T4. Results Compared with the control group,the PWL and PWT,the expression of NR1,NR2B,p-ERK1/2 and p-ERK/ERK increased significantly in all other groups(P<0.05). Compared with the M group, the PWL and PWT, the expression of NR1,NR2B,p-ERK1/2 and p-ERK/ERK increased significantly in RM group(P<0.05). Compared with the RM group,the PWL and PWT,the expression of NR1,NR2B,p-ERK1/2 and p-ERK/ERK decreased significantly in N+RM group(P<0.05). Conclusions Naborphine can antagonize hyperalgesia induced by remifentanil.
    Glycerol may reduce intestinal mucosal barrier damage in sepsis mice through aquaporin 3
    HE Rui, ZHU Ye-ke, TENG Wen-bin, SHAN Yue, YI Sheng-hua, ZHU Sheng-mei, LI Yu-hong
    2020, 40(5):  655-661. 
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    Objective To explore the protective effect of oral glycerol on sepsis induced intestinal mucosal barrier function. Methods Mice were randomly divided to four groups: sham operation (n=6); sham operation with oral glycerol (n=6); Mouse sepsis model (n=30)was established using cecal ligation and puncture (CLP), of which 24 mice were executed at 0, 6, 12 and 24 h after CLP respectively (6 mice at each time point) as a time-dependent group,and sepsis with oral glycerol group (n=6). Besides the time-dependent group, four groups of mice were executed at 24 h after modeling. Blood and intestinal mucosal tissue samples were collected. HE staining was used to detect pathological damage of intestinal mucosa. The plasma diamine oxidase (DAO) concentration and intestinal- type fatty acid-binding protein 2(FABP2) concentration were measured by ELISA to assess intestinal mucosal permeability. Immunohistochemistry, real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to detect the expression of AQP3 in intestinal mucosa. Results Sepsis induced morphological damage of intestinal mucosa, and the ChiÚs score increased in a time-dependent manner (P<0.05). The concentrations of DAO and FABP2 in plasma were significantly increased (P<0.05), and the expression of AQP3 significantly down-regulated with the aggravation of injury (P<0.05). The administration of oral glycerol partially improved the sepsis-induced injury of the intestinal mucosa, as shown by partial recovery of the morphological structure, with decreased ChiÚs score, decreased plasma concentrations of DAO and FABP2 (sepsis vs sepsis+glycerol, P<0.05). Conclusions Oral treatment with glycerol may alleviate intestinal mucosal barrier damage in sepsis mice through aquaporin-3. The specific mechanism needs to be further studied.
    Construction and functional characterization of human recombinant adenovirus rAd-IL-23R
    YUAN Xiao-mei, LIU Li
    2020, 40(5):  662-667. 
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    Objective To construct the human recombinant adenovirus expressing interleukin 23 receptor (rAd-IL-23R), and explore the effect of the rAd-IL-23R on the proliferation of human cervical cancer(HeLa) cell line. Methods Using the AdEasyTM system, the pAd-IL-23R was constructed by homologous recombination with the pShuttle-CMV plasmid carried IL-23R and the backbone plasmid pAdeasy-1, which was identified by restriction endonuclease digestion. The linearized recombinant plasmids were packaged and expanded in HEK-293A cells. The viral titer was detected using TCID50. CCK-8 assay was used to analyze the effect of rAd-IL-23R on HeLa cells proliferation. Flow cytometric analysis and Western blot were used to demonstrate the effect of rAd-IL-23R on HeLa cells apoptosis. Results pAd-IL-23R was digested with PacⅠ to yield ~30 kb and 3.0 kb fragments, which could induce HEK-293A cells to produce cytopathic effect and express the IL-23R protein after being transfected into HEK-293A cells. After infecting HeLa cells with increased doses of rAd-IL-23R (0, 1, 2 MOI), the proliferation of HeLa cells was significantly inhibited in a dose-dependent manner (P<0.05). With the increase of MOI, not only the apoptotic rate of the infected HeLa cells was also increased significantly (P<0.05), but also the protein expression level of cleaved-caspase 3 was markedly increased. Conclusions rAd-IL-23R was constructed successfully, which may be used to inhibit the proliferation and to promote apoptosis of HeLa cells.
    Berberine activates macrophage autophagy and improves atherosclerotic plaque vulnerability
    LIU Qin, YANG Li-xing, SHI Jing, HUANG Yu-qing, GAO Hong-ting, JU Rui, GUO Lei
    2020, 40(5):  668-677. 
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    Objective To explore the effect of berberine (BBR) on the vulnerability of atherosclerotic plaques caused by hyperglycemia and hyperlipidemia, and to discover the potential mechanism. Methods Male ApoE-/-mice were randomly divided into the control group, hyperglycemia group (intraperitoneal injection of streptozotocin(STZ), a dose of 45 mg/(kg·d) for 5 consecutive days), and hyperlipidemia group (high-fat diet, HFD). After two weeks, 10 mice were randomly selected from the hyperglycemia group to form a drug prevention group[gavage, BBR 50 mg/(kg·d)].Four weeks after modeling,the animals in the hyperglycemia model group were randomly divided into the model (STZ) group (gavage, solvent), BBR25, 50, and 100 (STZ) group (gavage, different doses of berberine [25, 50, and 100 mg/(kg·d)], the atorvastatin group [gavage, 2.5 mg/(kg·d)], the englitazone group [gavage, 1.25 mg/(kg·d)], and the hyperlipidemia model group were randomly divided into the model (HFD) group (gavage, solvent), BBR50 (HFD) group [gavage, berberine 50 mg/(kg·d)]. After 6 weeks of continuous treatment, the aorta of the mouse was taken for pathological and immunohistological examination to evaluate the atherosclerotic plaque lesions and their vulnerability index; Thp1 cells were stimulated to differentiate into macrophages with phorbol ester (PMA) and were used to investigate the effect of berberine on autophagy and inflammatory signaling pathways; Western blot was conducted to detect the expression of MIF, as well as NLRP3, AMPK/mTOR signal pathway and autophagy-related protein level in mouse aorta and cells.ELISA was used to detect the level of IL-1β in serum and cell supernatant. Results Compared with the control group, the atherosclerotic lesions in the hyperglycemia and hyperlipidemia groups were worsened, and the plaque vulnerability index was significantly increased. After the treatment with berberine, the plaque lesions were significantly improved, and the plaque vulnerability index decreased significantly(P<0.05).Berberine down-regulated MIF protein expression in mouse aortic tissue homogenated and Thp1 cells, promoted AMPK activation, inhibited mTOR phosphorylation, regulated autophagy-related protein expression (LC3Ⅱ/LC3Ⅰ ratio increased, SQSTM1/P62 decreased), and down-regulated NLRP3 and IL-1β expression. Conclusions Berberine can effectively inhibit formation of atherosclerotic plaque and its vulnerability in ApoE-/-mice caused by hyperglycemia and hyperlipidemia. The mechanism may be attributed to the down-regulation of MIF protein expression and the promotion of autophagy of macrophages through the AMPK/mTOR signaling pathway to inhibit the inflammatory response.
    PRL-3 antibody combined with pemetrexed induces apoptosis of human lung adenocarcinoma cell line A549
    SHENG Xin, LIU Dan, DENG Shu-kai
    2020, 40(5):  678-683. 
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    Objective To investigate the effects of PRL-3 antibody and pemetrexed on proliferation, migration and apoptosis of A549 cells. Methods A549 cells were treated with PRL-3 antibody at different concentrations; CCK-8 method was used to measure the cell proliferation of human lung adenocarcinoma A549 cells in each group; Transwell chamber assay was used to detect cell migration ability of A549 cells; Flow cytometry assay was used to measure the apoptosis rate of A549 cells; PRL-3, P-ERK and VEGF protein expressions of A549 cells were detected by Western bolt. Results 1)Compared with the control group, the inhibitory effect of PRL-3 antibody on proliferation of A549 cells increased with the increase of PRL-3 concentration (P<0.05); 2)The inhibitory effect of the combination group on proliferation and migration ability of A549 cells was more significant than that of the monotheraphy group (P<0.05); 3)The apoptosis rate of A549 cells in the combination group 34.63%±1.65% was better than that of PRL-3 antibody group 17.24%±1.15% and pemetrexed group 15.32%±1.82% (P<0.05); 4)Compared with the monotheraphy group, the expressions of PRL-3, P-ERK and VEGF proteins in the combination group decreased more significantly (P<0.05). Conclusions PRL-3 antibody combined with pemetrexed can inhibit the proliferation, migration and induce apoptosis of A549 cells as compared to the monotherapy group. The mechanism may be attributed to the inhibition of the expressions of PRL-3, P-ERK and VEGF protein.
    Clinical Sciences
    Clinical characteristics and genetic etiology of 50 cases of Chinese male breast cancer
    QIN Ling, XING Ze-yu, LIU Jia-qi, QIAN Tian-yi, WANG Chang-chang, WANG Xin, WANG Xiang
    2020, 40(5):  684-687. 
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    Objective To review the clinical feature, current treatment, and genetic etiology of Chinese male breast cancer (MBC) patients through MBC case series. Methods This article reviewed the demographic characteristics, clinical and pathological features, treatment and follow-up outcomes of 50 MBC patients who were hospitalized in two cancer hospitals in Beijing from 2015 to 2019. Furthermore, the panel-based next-generation sequencing was performed on 25 of the MBC patients to identify the genetic etiology. Results In this study, the average age at onset of MBC patients was 58.26±11.54 years. Overweight and obesity patients accounted for 60.00%. Most MBC patients were androgen-receptor-positive (95.24%) and estrogen-receptor-positive(89.36%),while the proportion of triple-negative breast cancer (10.64%) was higher than that found in Caucasians. However, the ratio of breast-conserving surgery (6.12%) and sentinel lymph node biopsy (26.53%) was relatively low. Although endocrine therapy (84.00%) played an important role in most MBC patients' adjuvant therapy, adjuvant radiotherapy (20.00%) and chemotherapy (52.00%) is inadequate. Furthermore, two patients (8.00%) receiving the genetic test had pathogenic mutations BRCA1/2 genes. Conclusions The clinical characteristics and genetic etiology of Chinese MBC patients have shown significant specificities which suggests that for Chinese MBC patients less surgical operation and more adjuvant radiotherapy as well as chemotherapy seems to be a smart choice.
    Effect of chemotherapy on thyroid function or structure in patients with breast cancer
    LIU Yang, ZHU Yue, YAO Jing-hao, LIU Jing, ZHOU Zheng-guang, ZHAO Fu-you, YANG Yan
    2020, 40(5):  688-691. 
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    Objective To investigate the short-term effect of chemotherapy on thyroid function or structure in patients with breast cancer. Methods Forty female patients with primary breast cancer treated in the first affiliated Hospital of Bengbu Medical College from March 2017 to December 2018 were selected. The changes of thyroid function (including T3, T4, FT3, FT4 and TSH) and their structure were measured and compared between before and after chemotherapy for two and four cycles. Results The levels of T4 and FT4 were significantly lower in breast cancer patients receiving either two or four cycles of chemotherapy than those receiving no chemotherapy(P<0.05); and the levels of thyroid TI-RADS grade and the incidence of abnormal thyroid structure were significantly higher in patients receiving four courses of chemotherapy than those receiving no chemotherapy (P<0.05). Conclusions In the near future,the event of chemotherapy can cause or aggravate abnormal thyroid function or structure in patients with breast cancer. Regular physical examination and necessary intervention have important clinical significance to prevent the development of thyroid disease.
    Effects of latent phase and active phase labor analgesia with combined spinal-epidural ropivacaine and sufentanil
    ZHANG Yi, LI Ren-guo, FENG Yan-hong, HAO Su-fang, ZHAI Qin-hong, WANG Qiang, FAN Hong-fang
    2020, 40(5):  692-695. 
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    Objective To compare the effects of latent phase and active phase of labor analgesia with combined spinal-epidural ropivacaine and sufentanil. Methods The investigation covered 200 full-term, single-birth participants and they were randomized in to latent phase group and active phase group (100 cases each group) and received combined spinal-epidural labor analgesia when their cervices opening 0.5 cm to 2.5 cm, 3 cm respectively. VAS before analgesia and during various stages of labor, time for the first stage of labor and the second stage of labor, delivery methods,oxytocin usage, Apgar Score and maternal motor block degree were recorded and analyzed by t test, chi-square test. Results VAS before analgesia and 10 to 30 minutes after analgesia have no significant difference; VAS for the latent phase group was lower than active phase group when cervix opening 7cm to 8 cm, 10 cm after analgesia (P<0.01); Time length for the first and the second stage of labor, delivery way, oxytocin usage, Apgar Score and maternal motor block degree were similar. Conclusions It is feasible and safe to treat latent phase labor analgesia with combined spinal-epidural ropivacaine and sufentanil.
    Mini Reviews
    Advances in radiogenomics in precision radiotherapy
    YE Fei, YU Ying
    2020, 40(5):  696-700. 
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    In the background of precision medicine, radiogenomics is a new strategy that combines radiomics and genomics for multi-omics research. It has unique advantages in predicting changes of genome expression and structure and establishing the physics model of radiobiology. Especially in terms of precision radiotherapy, a model of radiation genomics that encompasses the two dimensions of images-gene can provide multi-omics information and accurately guide clinical therapy, which increases the rate of patient survival and reduces the radiotherapy band coming complications.
    Progress of angiotensin converting enzyme 2 in cardiovascular diseases
    JIAO Xiao-lu, QIN Yan-wen
    2020, 40(5):  701-706. 
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    Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV and SARS-CoV-2(severe acute respiratory syndrom coronavirus 2) viruses, and it is also one of the main family members of renin-angiotensin-aldosterone system. ACE2 has a protective effect on cardiovascular diseases and inhibits the development of cardiovascular diseases. SARS-CoV-2 reduces the expression of ACE2 of host, which may be one of the reasons for cardiovascular complications in the later stage of coronavirus disease 2019(COVID-19). Thus, the role and mechanism of ACE2 in the development of cardiovascular diseases were summarized in this article in order to provide potential stratigy development for the treatment of COVID-19.
    Application of artificial intelligence and machine learning in cardiovascular diseases
    SONG Qi-rui, CAI Jun
    2020, 40(5):  707-710. 
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    Artificial intelligence(AI) and machine learning(ML) have gradually been widely used in the medical field due to their unique advantages. In cardiovascular diseases, this technology has made some progress for processing complex data from electronic medical record, analyzing disease mechanisms and for predicting prognosis, automatically analyzing and identifying cardiovascular imaging and arrhythmia, and discovering new subtypes of disease. The potential of AI and ML in cardiovascular disease research will bring a new breakthrough in the cardiovascular field.
    Medical Education
    Exploration of feedback and its evaluation in the clinical postdoctoral program
    WEI Yi-zhen, SHI Yu-xi, ZHU Hui-juan, XUE Hua-dan, LUO Lin-zhi, PAN Hui, LI Yue, QIU Jie, SUN Jun, ZHANG Shu-yang
    2020, 40(5):  711-714. 
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    Objective To explore the effect of the feedback of competency-based training and its evaluation in the Clinical Postdoctoral Program of Peking Union Medical College Hospital. Methods Taking 2018 clinical postdoctoral feedback and evaluation as the object of study, collecting feedback results with the 5-point Likert Scale and reviewing the descriptive comments, to discuss the application of feedback evaluation. Results 13 clinical departments were rated above 4 on average in “individualization” “degree of recognition” “preparation”. “Feedback skill” was rated 3.6. The skills of feedback needed an improvement. Conclusions The feedback evaluation system will contribute to the improvement of feedback and competency-based training quality, and further modification is needed.
    Enlightenment of American medical physics training system to the standardization training of Chinese radiological residents
    ZHANG Da-ming, ZHOU Xue-yan, XUE Hua-dan, SUN Hao, SU Tong, JIN Zheng-yu
    2020, 40(5):  715-718. 
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    Medical physics is an interdisciplinary subject that combines physics with medical practice, resulting from a broad need for physics knowledge in the clinical practice of radiology and radiation oncology. At present, the developed countries represented by the United States have formed a systematic medical physics training system in the process of radiology resident training. The standardized training of radiology resident in China is still in its infancy. This paper introduces the system of physics training in the American radiology resident training program and explored its enlightenment to the standardized training of radiological resident in China.
    Application of flipped classroom teaching mode in eight-year internal medicine English case-discussion round
    TAN Bei, LI Yue, TANG Hao, SUN Jun, HUANG Ying-zhuo, CHEN Si-liang, QIAN Jia-ming
    2020, 40(5):  719-722. 
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    Objective Evaluate the learning outcoems of the flipped classroom teaching model applied to teaching of English case-discussion round for internal medicine in eight-year medical students. Methods Totally 88 eight-year clinical medical students of the Peking Union Medical College in 2019, applied the flipped classroom teaching mode in the internal medicine English case-discussion round. The mastery of knowledge was assessed by quiz before and after case-discussion round. The teaching effect was assessed by post-round feedback of five-score Likert Scale. Results The mastery of knowledge by pre self-learning are 29.3%, 37.3% and 17.3% of disease diagnosis and differential diagnosis, disease classification and degree, and treatment principles. Post-round the mastery can further achieved 84.8%, 60.9% and 45.7% respectively, through group discussions in class (P<0.05). The average score of teaching feedback post-round was (4.01±1.02), the evaluation items with average scores >4 points accounted 66.7%. Conclusions The teaching mode of flipped classroom combined with small group learning can significantly improve learning outcomes as acknowledged by students.
    Application of PDCA cycle method in the training of hospital pharmacy
    KANG Yi, ZHOU Ping, ZHANG Dong-su, LIU He
    2020, 40(5):  723-726. 
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    Objective To explore application value of Plan-Do-Check-Action (PDCA) cycle method in the training of hospital pharmacy and provide reliable reference for strengthening hospital pharmacy training and improving service level. Methods Students who received pharmaceutical training in our hospital from September 2015 to September 2019 were the objects of study. Samples in observation group were randomly selected from the students who were trained with PDCA cycle method and the students in control group were trained with traditional method. The assessment scores of the two groups were compared. Results The scores of theoretical knowledge and operational skills in the observation group were higher than those in the control group (P<0.05). Conclusions PDCA cycle systematic improves students knowledge and skills. It is worthy of application in hospital pharmacy teaching. Teachers play an important role in PDCA cycle. It is necessary to strengthen the faculty development and system construction.
    Teaching evaluation of “traditional Chinese medicine” course for eight-year undergraduates of Peking Union Medical College
    YANG Dan, WU Qun-li, LIANG Xiao-chun, TIAN Guo-qing, SUN Hua, PIAO Yuan-lin, ZHANG Meng-ren
    2020, 40(5):  727-732. 
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    Objective To explore the role of teaching evaluation in the practice of “traditional Chinese medicine” course for eight-year undergraduates of Peking Union Medical College. Methods With a secret questionnaire survey, statistics and summarize both the teaching and teacher evaluation forms completed by students from 2012 to 2017. Results The 6-year overall satisfaction rate of students on teaching content, teaching methods, clinical apprenticeship, teaching effect, and use of textbooks was over 94.3%, and the dissatisfaction rate was 0-5.7%. The highest satisfaction rate was on clinical apprenticeship. The satisfaction rate of school-made textbook was around 98%. The praises given to the teachers were 90.1%-97.5%. The satisfaction rate in the first 3 years was higher than that in the later 3 years. Conclusions Teaching evaluation can promote the continues improvement of traditional Chinese medicine education in non-traditional medicine hospitals and optimize teaching quality.
    Biography of Medical Celebrities
    Professor Huang Jiasi and biomedical engineering in China
    WANG Xiang-hua
    2020, 40(5):  733-736. 
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    Professor Huang Jiasi is the founder of biomedical engineering in China. He advocated and established the biomedical engineering discipline in China, strengthen the international exchanges, and push the development of biomedical engineering in-depth. He made outstanding contribution in the rise, opening up and development of biomedical engineering in China.