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供区直接缝合。

The donor site was closed directly.

术后所有皮瓣和植皮均顺利成活，供受区创面均Ⅰ期愈合。

All flaps and skin grafts survived totally, and incisions healed by first intention.

患者均获随访，随访时间 6～36 个月，平均 14.7 个月。

All patients were followed up 6-36 months (mean, 14.7 months).

随访期间无肿瘤复发，皮瓣质地良好、外形不臃肿，腹壁外观、功能恢复满意，未见腹壁疝表现。 供区外观影响小，下肢关节活动无影响。

No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying.

改良带蒂股前外侧肌皮瓣可用于修复腹壁肿瘤术后大面积全层缺损，不但减少了供区并发症，还可改善供、受区外形。

Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.

晚期肝细胞肝癌（HCC）的治疗目前仍是巨大的挑战，除了索拉菲尼、仑伐替尼，近年很少有药物获得批准应用于临床。

The treatment of late stage hepatocellular carcinoma (HCC) presently remains a great challenge. A very few drugs have been recently approved for clinical use except sorafenib and lenvatinib.

经过数十年的分子靶向与免疫抑制治疗的失败与经验，免疫检查点抑制剂正在成为中晚期HCC患者潜在的有效的治疗手段之一。

After decades of failure and experience with molecular targeted and immunosuppressive therapy, immune checkpoint inhibitors are becoming one of the potentially effective therapies for patients with HCC, whose tumor is in the middle and late stages.

免疫检查点是肿瘤发生免疫逃避的主要机制之一，程序性死亡蛋白1及其配体（PD1/PD-L1）是其中重要的免疫检查点靶点，相关通路已经被证明在多种固体或血液肿瘤中具有抗肿瘤效应，其抑制剂可以有效发挥抗肿瘤免疫抑制作用。

Moreover, immune checkpoint is one of the main mechanisms of tumor immune evasion; of which programmed cell death protein 1 and its ligand (PD1/PD-L1) are important immune checkpoint targets, and its related pathway has shown to have an antitumor effect in a variety of solid or hematologic tumors and its inhibitors can effectively exert antitumor immunosuppressive effects.

现总结目前PD1/PD-L1抑制剂在晚期HCC治疗中的作用，并探讨联合治疗策略在未来HCC治疗中的价值。

This review summarizes the current role of PD1/PD-L1 inhibitors in the treatment of late stage HCC, and explores the forecasting value of combined therapy strategy for HCC.

背景与目的：为了给亚洲国家提供一个详细的孕妇全谷物摄入量的分析报告,本 文定量分析了新加坡孕妇全谷物的摄入量。

To quantify whole grain intake in pregnant women in Singapore in order to provide the first detailed analysis of whole grain intake in an Asian country and in pregnant women.

方法与研究设计：在一个横断面队 列研究中分析24 小时膳食回顾，并分析一个亚组受试者的全谷物摄入量标志 物（血浆烷基间苯二酚）。

Analysis of 24-h diet recalls in a cross-sectional cohort study and analysis of a biomarker of whole grain intake (plasma alkylresorcinols) in a subset of subjects.

在新加坡长大的母亲子代健康结局队列研究。

The Growing Up in Singapore Towards healthy Outcomes-mother offspring cohort study based in Singapore.

998 名孕妇在她们怀孕26-28 周时完成24 小时膳食回顾。

998 pregnant mothers with complete 24-h recalls taken during their 26-28th week of gestation.

血浆样本采自随机选择的 100 个研究对象组成的亚组，用来分析血浆烷基间苯二酚 。

Plasma samples from a randomly select subset of 100 subjects were analysed for plasma alkylresorcinols.

结果：队列中全部 志愿者和队列中30%报告了摄入全谷物的人群其全谷物摄入的中位数分别为0 （0，9）和23.6（14.6，44.2）克/天。

Median (IQR) whole grain intake for the cohort and the 30% who reported eating whole grains were 0 (IQR 0, 9) and 23.6 (IQR 14.6, 44.2) g/day respectively.

血浆烷基间苯二酚浓度非常低（中位数 =9 (3，15) nmol/L），提示该人群全谷物摄入量低。

Plasma alkylresorcinol concentrations were very low [median (IQR)=9 (3, 15) nmol/L], suggesting low intake of whole grain wheat in this population.

血浆烷基间苯二酚与全谷 物摄入量相关（Spearman's r=0.35； p<0.01）。

Plasma alkylresorcinols were correlated with whole grain wheat intake (Spearman's r=0.35; p<0.01).

结论：新加坡孕妇全谷物摄入 量远远低于新加坡健康促进局推荐的每天摄入全谷物2-3 份（60-95）克。 应该 鼓励人们在他们的饮食中选择全谷物而不是精制谷物，以增加全谷物的摄入 量。

Whole grain intake among pregnant mothers in Singapore was well below the 2-3 (60-95 g) servings of whole grains per day recommended by the Singapore Health Promotion Board. Efforts to increase whole grain intake should be supported to encourage people to choose whole grains over refined grains in their diet.

心电图（ECG）信号在采集过程中容易受内部和外部噪声干扰，而且不同患者的 ECG 信号形态特征差异较大，即使同一患者在不同时间和环境下其 ECG 信号也会有差异，因此 ECG 信号特征检测与识别在心脏病远程实时监测与智能诊断中具有一定难度。

Electrocardiogram (ECG) signals are easily disturbed by internal and external noise, and its morphological characteristics show significant variations for different patients. Even for the same patient, its characteristics are variable under different temporal and physical conditions. Therefore, ECG signal detection and recognition for the heart disease real-time monitoring and diagnosis are still difficult.

基于此，本研究提出将小波自适应阈值去噪和深度残差卷积神经网络算法用于多种心律不齐的信号识别过程中。

Based on this, a wavelet self-adaptive threshold denoising combined with deep residual convolutional neural network algorithm was proposed for multiclass arrhythmias recognition.

其中，使用小波自适应阈值技术完成 ECG 信号滤波，并设计了包含多个残差块（residual block）结构的 20 层卷积神经网络（CNN），即深度残差卷积神经网络（DR-CNN），对 5 大类心律不齐 ECG 信号进行了识别。

ECG signal filtering was implemented using wavelet adaptive threshold technology. A 20-layer convolutional neural network (CNN) containing multiple residual blocks, namely deep residual convolutional neural network (DR-CNN), was designed for recognition of five types of arrhythmia signals.

然后，本文采用残差块局部神经网络结构单元构建 DR-CNN，缓解了深层网络的收敛难、调优难等问题，克服了 CNN 随着网络层数增加而导致的退化问题；进一步引入批标准化（batch normalization）技术，保证了网络的平滑收敛。

The DR-CNN constructed by residual block local neural network units alleviated the difficulty of deep network convergence, the difficulty in tuning and so on. It also overcame the degradation problem of the traditional CNN when the network depth was increasing. Furthermore, the batch normalization of each convolution layer improved its convergence.

按照美国医疗器械促进协会（AAMI）的心搏分类标准，使用麻省理工学院和波士顿贝丝以色列医院（MIT-BIH）心律不齐数据库中 94 091 个 ECG 心搏信号（2 个导联），完成了心律不齐多分类、室性异位搏动（Veb）和室上性异位搏动（Sveb）等分类识别实验。 实验结果表明，本文所提出的方法在 ECG 信号多分类、Veb 和 Sveb 识别中的准确率分别达到了 99.034 9%、99.498 0% 和 99.334 7%。

Following the recommendations of the Association for the Advancements of Medical Instrumentation (AAMI), experimental results based on 94 091 2-lead heart beats from the MIT-BIH arrhythmia benchmark database demonstrated that our proposed method achieved the average detection accuracy of 99.034 9%, 99.498 0% and 99.334 7% for multiclass classification, ventricular ectopic beat (Veb) and supra-Veb (Sveb) recognition, respectively.

在相同的数据集和实验平台下，DR-CNN 在分类准确率、特异性和灵敏度上均优于相同结构复杂度的 CNN、深度多层感知机等传统算法。

Using the same platform and database, experimental results showed that under the comparable network complexity, our proposed method significantly improved the recognition accuracy, sensitivity and specificity compared to the traditional deep learning networks, such as deep Multilayer Perceptron (MLP), CNN, etc.

DR-CNN 算法提高了心律不齐智能诊断的精度，该方法与可穿戴设备、物联网和无线通信技术相结合，可以将心脏病的预防、监测和诊断延伸到家庭、养老院等院外场景，从而提高心脏病患者的救治率，并且有效地节约医疗资源。

The DR-CNN algorithm improves the accuracy of the arrhythmia intelligent diagnosis. If it is combined with wearable equipment, internet of things and wireless communication technology, the prevention, monitoring and diagnosis of heart disease can be extended to out-of-hospital scenarios, such as families and nursing homes. Therefore, it will improve the cure rate, and effectively save the medical resources.

采用83个样点数据,研究了青藏高原栽培大麦β-葡聚糖含量的分布特征.结果表明: 在地理水平方向上,青藏高原栽培大麦β-葡聚糖含量总体呈现出斑块状交错分布的格局,并形成了以青海贵德、同德,甘肃夏河、合作为中心的青藏高原东北部和以西藏江孜、白朗、谢通门、日喀则、拉孜、康马、贡嘎、曲水为中心的青藏高原西南部等两个栽培大麦β-葡聚糖含量高值区;在地理垂直方向上,栽培大麦β-葡聚糖含量呈现出双峰曲线分布格局,在海拔2700～3000 m和3600～3900 m形成2个高峰区,这2个高峰区栽培大麦β-葡聚糖含量的平均值分别为(5.7±1.7)%和(4.6±1.1)%;对栽培大麦β-葡聚糖含量影响重要值指数在40.0%以上的因子依次是籽粒颜色>穗密度>9月平均相对湿度>土壤速效氮含量>土壤速效钾含量>6月平均气温日较差>≥10 ℃积温>年均气温>土壤速效磷含量>9月平均气温日较差.

-glucan content spatial distribution characteristics of cultivated barley in Qinghai-Tibet Plateau were investigated based on the data measured from 83 sampling sites. The results showed that -glucan content exhibited a macrocosm pattern of spatial distribution along the horizontal direction in Qinghai-Tibet Plateau, with staggered patches of different values. Two regions of higher -glucan content were observed with centers of Guide and Tongde in Qinghai Province and Xiahe and Hezuo in Gansu Province (northeast), and Jiangzi, Bailang, Xietongmen, Shigatse, Lazi, Kangma, Gongga and Qushui in Tibet (southwest). Along the vertical direction, -glucan content distribution pattern appeared with double peak curves. There were two high value zones between the altitudes from 2700 m to 3000 m and from 3600 m to 3900 m, with average -glucan content value of (5.71.7)% and (4.61.1)%, respectively. Influencing factors of -glucan content with importance value index more than 40.0% were as follows: grain color ear density average relative humidity in September soil available N content soil available K content average diurnal temperature range in June 10 accumulated temperature average annual temperature soil available P content average diurnal temperature range in September.

真核细胞中的染色质DNA高度折叠形成复杂的三维结构,其空间组织方式对精准调控基因的表达和细胞发挥正常功能都起着重要的作用。

The eukaryotic chromatin is folded into highly complex three-dimensional (3D) structures, which plays an important role in the precise regulation of gene expression and normal physiological function.

细胞终末分化成熟过程中形态及基因表达谱常发生显著改变,同时伴随着明显的基因组三维结构变化。

During differentiation and terminal maturation, cells usually undergo dramatic morphology and gene expression changes, accompanied by significant changes in the 3D structure of the genome.

本文在简单介绍三维基因组多层次组织结构(染色质领域、A/B区室、拓扑相关结构域和成环构象等)基础上,重点综述了细胞终末分化过程中三维基因组结构变化与功能调控方面的研究进展,并探讨了当前三维基因组研究在解析细胞分化成熟过程时存在的问题和前景。

In this review, we provide a comprehensive view of the spatial hierarchical organization of the genome, including chromosome territories, A/B compartment, topologically associating domains (TADs) and looping, focusing on recent progresses in the dynamic 3D genomic structural changes and functional regulation during cell differentiation and terminal maturation. In the end, we summarize the unsolved issues as well as prospects of the 3D genome research in cell differentiation and maturation. Ten permanent plots of Larix olgensis plantation were established in 1972 and 1974 at Jiangshanjiao and Mengjiagang forest farms in Heilongjiang Province, respectively. The plots including 8 thinning plots and 2 control plots were measured annually. The effects of thinning on the probability of plot mortality and individual tree mortality were analyzed. Based on the binary logistic regression, two-step models of the probability of mortality were developed.

1972和1974年分别在黑龙江省江山娇林场及孟家岗林场设置10块长白落叶松人工林固定样地(8块抚育间伐样地、2块对照样地),采用连年复测数据,分析抚育间伐对人工长白落叶松样地枯死与单木枯死的影响.基于二分类变量Logistic回归,建立了样地枯死及样地内单木枯死概率的两阶段模型(Ⅰ:抚育间伐后样地水平枯死概率模型;Ⅱ:枯死样地中单木水平枯死概率模型),采用广义估计方程(GEE)方法对模型参数进行估计.根据敏感度和特异度曲线相交点确定枯死概率最优临界点.结果表明: 样地数据按照抚育间伐次数分为4组分别建模(模型1～模型4).在模型1中,地位指数、林分年龄的自然对数、抚育间伐年龄及强度为显著自变量;模型2～模型4采用主成分分析法建模,主成分包含林分年龄、每公顷株数、平均胸径及抚育间伐因子,说明抚育间伐因子对样地枯死概率有显著影响.抚育间伐对枯死样地中单木枯死概率无显著影响,单木枯死概率模型中显著性自变量为林分初植密度、年龄、林木胸径的倒数及林分中大于对象木的所有林木断面积之和.样地枯死概率模型及单木枯死概率模型Hosmer和Lemeshow拟合优度检验均不显著,模型AUC均在0.91以上,估计正确率均超过80%,说明模型拟合效果较好.

The approach consisted of estimating the probability of mortality after thinning on a sample plot (1) and the mortality of individual tree within mortality plots (2). The generalized estimating equations (GEE) method was adopted to estimate the parameters of models. An optimal cutpoint was determined for each model by plotting the sensitivity curve and the specificity curve and choosing the cutpoint at which the specificity and sensitivity curves cross. The results showed that four models (models 1-4) were developed based on the data of plots which was divided into 4 groups by thinning times, respectively. The significant explicatory variables of model 1 were site index, the logarithm of stand age, thinning age and thinning intensity. Principal component analysis was used to develop models 2-4. The primal variables of the principal components were stand age, tree numbers per hectare, mean square diameter at breast height and thinning factors.

This showed that thinning significantly affected the probability of plot mortality.

The effect of thinning was not significant for the pro-bability of individual tree mortality.

肺癌是全世界肿瘤死亡的首要原因，肺鳞癌（squamous cell lung cancer, SQCLC）作为肺癌的一种常见的病理类型，全世界每年约40余万人因其致死。

The significant variables of the individual tree mortality model were planting density, age, the inverse of diameter at breast height and the basal area of all trees larger than the subject tree. Hosmer and Lemeshow goodness of fit tests were not significant for the mortality models of plots and individual trees (P0.05). The areas under the receiver operating characteristic curve (AUC) of the models were all greater than 0.91, the accuracies were all above 80%, suggesting the fitting results of the models performed very well. Lung cancer is the deadliest cancer in the worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of lung tumor diagnoses. Squamous cell lung cancer (SQCLC) is a common pathological type, almost 20%-30% of NSCLC.

其常规治疗方法主要包括手术治疗、化学治疗和分子靶向治疗。

Surgery, chemotherapy, and molecular targeted therapies are the mainstay of treatment for patients with SQCLC.

但是大多数患者确诊的时候已经是晚期，失去了手术的机会。

But most patients are diagnosed at advanced stage so that they miss the chance of operation.

尽管分子靶向治疗在肺腺癌的治疗中具有里程碑式的作用，但是对肺鳞癌而言，尚无特异性的分子靶标药物，因此，对于晚期肺鳞癌的标准治疗仍是含铂双药方案。

While noteworthy outcomes have improved with adenocarcinoma of lung with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), a therapeutic plateau for advanced squamous cell lung cancer patients are still not solved.

而大多数患者经历了一线、二线治疗失败后都面临无药可用的状态。

EGFR-TKIs are unsuitable for or mostly ineffective in advanced SQCLC. Patients with advanced SQCLC ramain treated with platinum based chemotherapy.

本文旨在对晚期肺鳞癌的常规治疗进行系统性的综述，探讨晚期肺鳞癌的治疗方案以及发展方向。

This reciew systematicly describe the treatment of squamous cell carcinoma of the lung.

目的：探讨声触诊组织量化(virtual touch tissue quantification，VTQ)技术和由凝血酶原时间、谷氨酰转肽酶与载脂蛋白A1组成的PGA指数无创评价酒精性肝纤维化程度的临床应用价值。

To explore the clinical value of virtual touch tissue quantification (VTQ) technique and the PGA index [prothrombin time (P), -glutamyl transpeptadase (GG) and apolipoprotein A1 (ApoAl)] in evaluating the degree of liver fibrosis in alcoholic patients.

方法：选长期饮酒史患者64例，应用VTQ技术检测肝超声弹性，测得靶区肝VTQ值，计算PGA指数。

A total of 64 patients with long-term alcohol history were enrolled for this study. The liver ultrasonography elasticity was examined by VTQ techniques, the VTQ value was assessed in the liver target region, and then the PGA index was calculated.

以肝穿刺活检病理结果为金标准，将入选患者分为无明显肝纤维化组(n=11)、肝纤维化组(n=10)、明显肝纤维化组(n=14)、肝硬化组(n=29)，比较VTQ值和PGA指数对酒精性肝纤维化的诊断价值。

According the liver biopsy biological results, a golden standard, the patients were divided into a non-fibrosis group (n=11), a fibrosis group (n=10), a significant fibrosis group (n=14) and a cirrhosis group (n=29). The diagnostic value of VTQ and PGA index were compared in alcoholic patients following the classification of liver fibrosis.

结果：无明显肝纤维化组、肝纤维化组、明显肝纤维化组、肝硬化组的VTQ值分别为(1.38±0.33)，(1.49±0.30)，(1.76±0.22)和(2.28±0.53) m/s；PGA指数分别为2.09±0.94，2.30±1.06，3.57±1.09和5.21±1.99。

The elastography VTQ values were (1.380.33), (1.490.30), (1.760.22) and (2.280.53) m/s; while the PGA indexes were 2.090.94, 2.301.06, 3.571.09, and 2.211.99 in the non-fibrosis group, the fibrosis group, the significant fibrosis group and the cirrhosis group, respectively.

两种技术测值均与肝纤维化分期存在相关，VTQ的相关系数为0.719，PGA指数的相关系数为0.683(均P<0.01)。

The VTQ value and PGA index were positively correlated with the classification of liver fibrosis (VTG: r=0.719, PGA: r=0.683; both P<0.01).

结论：VTQ技术与PGA指数均能无创定量评价酒精性肝纤维化程度，VTQ技术作为实时超声弹性成像技术较PGA指数更准确，两种检查方法结合有助于酒精性肝纤维化的早期诊断及治疗评估。

The alcoholic liver fibrosis can be assessed by noninvasive VTQ technology and PGA index. As a real-time ultrasound elastography technique, VTQ is more accurate than the PGA index. Combination of the two methods is helpful for early diagnosis and treatment in the patients with alcoholic liver fibrosis.

孟德尔随机化方法，遵循孟德尔遗传定律，'亲代等位基因随机分配给子代'，以遗传变异作为工具变量，以此推断观察性研究中暴露因素与研究结局的因果关联。

Mendelian randomization (MR) approach follows the Mendel's law of inheritance, which is called 'Parental alleles randomly assigned to the offspring', and refers to use genetic variants as an instrumental variable to develop causal inference between the exposure factor and the outcome from observational study.

近年来，随着全基因组关联研究（GWAS）及各种组学数据的飞速发展，大量汇总数据的公开，为孟德尔随机化方法在因果推断中的广泛应用提供契机。

In recent years, with the rapid development of genome-wide association study (GWAS) and various omics data,the disclosure of a large number of aggregated data provides an opportunity for the wide application of MR approach in causal inference.

本文针对目前常用的三种孟德尔随机化方法进行阐述，并将其应用于探索血液代谢物与抑郁症的因果关联，比较三种方法在因果推断的优缺点，以期为孟德尔随机化在观察性研究中的应用提供参考。

We introduce three methods widely used in MR and then apply them to explore causal relationship between blood metabolites and depressive. The advantages and disadvantages of three methods in causal inference are compared in order to provide reference for the application of MR in observational studies.

程序性死亡蛋白1(PD-1)及其配体(PD-L1)已经被证明在逃避机体的免疫系统中发挥重要的作用。

Programmed death receptor 1 (PD-1) and its ligand PD-L1 have been shown to play an important role in evading the immune system.

近年来，PD-1/PD-L1阻断在很多恶性肿瘤中显示出较为明显的临床效果，这些恶性肿瘤包括恶性黑色素瘤、肾细胞癌、经典霍奇金淋巴瘤、非小细胞肺癌等。

In recent years, PD-1/PD-L1 blockade has shown significant clinical effects in many malignancies, including malignant melanoma, renal cell carcinoma, classic Hodgkin lymphoma, non-small cell lung cancer and so on.

PD-1/PD-L1信息通路可能成为恶性肿瘤患者免疫治疗的新靶点。

PD-1/PD-L1 signaling pathway has become a new target of immunotherapy in patients with malignant tumors.

但目前免疫治疗在恶性骨肿瘤中的研究较少，PD-1/PD-L1在其中的临床研究进展仍有待阐明。

However, there are few researches on immunotherapy in malignant bone tumors, and the progress of clinical research on PD-1/PD-L1 remains to be elucidated.

文章分析了肿瘤免疫PD-1/PD-L1信号通路及作用机制，探讨了目前常用PD-1/PD-L1单抗在恶性骨肿瘤中的应用前景，以期为中国开展基于PD-1/PD-L1信号通路的恶性骨肿瘤治疗提供理论依据。

This review started from the mechanism of PD-1/PD-L1 signaling in tumor immunity, and analyzed the application prospect of PD-1/PD-L1 antibodies in malignant bone tumors. We hope to provide a theoretical basis for the treatment of malignant bone tumors based on PD-1/PD-L1 signaling pathway in China.

【中文题目：晚期肺腺癌患者一线治疗前后EGFR基因突变差异性分析】 【中文摘要：背景与目的 表皮生长因子受体（epidermal growth factor receptor, EGFR）靶向治疗能够显著提高EGFR突变的晚期肺腺癌患者预后生存，但治疗及异质性等因素可导致初次和疾病进展时EGFR基因状态发生改变。

Epidermal growth factor receptor (EGFR)-based targeted therapy improves the survival of patients with advanced lung adenocarcinoma harboring EGFR mutations. However, factors including treatment or heterogeneity partly contribute to EGFR genetic status alteration between baseline and disease progresses (PD).

为了探讨真实世界中EGFR基因突变在疾病进展和基线时的差异，我们开展了此项研究。

The aim of this study is to compare difference of EGFR mutations between biopsy and rebiopsy in real world.

方法 收集2015年1月-2017年12月在吉林省肿瘤医院进行EGFR基因检测的61例配对标本数据并进行分析。

Data from 61 paired specimens performed EGFR testing in Jilin Provincial Cancer Hospital between January 2015 and December 2017 were collected and analyzed.

标本取材时间为治疗前和疾病进展时，所有标本均经病理学或细胞学证实，标本来源为肿瘤组织﹑恶性胸腔积液和血浆，患者为初治，一线接受化疗或靶向治疗，采用扩增阻滞突变系统法（Amplification Refractory Mutation System, ARMS）对29种EGFR基因突变进行检测。

The specimens were collected at baseline and PD, confirmed by histology or cytology and categorized as tumor tissue, malignant pleural effusion or plasma. All patients were naive and received chemotherapy or targeted therapy as first-line treatment. Amplification Refractory Mutation System (ARMS) was used to detect EGFR mutations.

结果 初次和再次活检相比（n=61），肿瘤组织、恶性胸腔积液和血浆标本所占的比例分别为90.2% vs 88.5%、6.6% vs 6.6%和3.2% vs 4.9%，其中标本类型前后一致的患者（n=50）EGFR突变差异率为72.0%，标本类型不一致患者（n=11）为36.3%；治疗前EGFR突变率为95.1%，治疗后为91.8%，二者的差异率为63.9%；化疗患者（n=13）治疗前EGFR突变率为69.2%，治疗后为92.3%，二者差异率为46.1%；靶向治疗患者（n=48）治疗前EGFR突变率为100%，治疗后为91.7%，二者差异率为70.8%。

EGFR mutation rate in tumor tissue, pleural effusion or blood was 90.2% vs 88.5%, 6.6% vs 6.6% and 3.2% vs 4.9% at baseline or PD respectively and discrepancy was 72% and 36.3% for the same (n=50) or different (n=11) type of specimens. The EGFR mutation rate was 95.1% and 91.8% in patients before and after treatment, and the discrepancy was 63.9%, among which, 69.2% and 92.3% in chemotherapy-treated patients (n=13) with discrepancy to 46.1% (6/13), and 100.0% and 91.7% in EGFR-TKI-treated patients (n=48) with discrepancy to 70.8%.

EGFR基因变化类型有4类：野生型变为突变型（4.9%）、突变消失（8.2%）、敏感突变类型互变（1.6%）和突变种类增加（49.1%）。

There were four types of alterations in terms of EGFR mutations: wild type turned into mutation (4.9%), mutation disappeared (8.2%), sensitive mutations transformed (1.6%), and new mutations appeared (49.1%).

结论 临床实践中，晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者由于标本取材部位和类型及治疗的影响，治疗前后EGFR基因突变具有较大差异性，动态检测并明确EGFR基因状态，可以为临床医生选择精准的后续靶向治疗方案提供参考。 】 【中文关键词：肺肿瘤；再次活检；EGFR检测】.

In real world, the EGFR mutation status in advanced non-small cell lung cancer (NSCLC) patients altered significantly, due to tissue resources and therapeutic approaches, implying the importance of rebiopsy and real-time detection of EGFR mutation, in order to provide data to guide precise strategy in the following treatment.

2017年7月1日至8月31日,采用焦点取样和连续记录法,对甘肃兴隆山自然保护区马麝保育中心29头圈养马麝进行了行为取样,记录其行为发生持续时间及发生位点,根据动物在各位点对人为胁迫的应激程度定义其胆量水平,结合个体在各位点所占时间比例确定马麝个体的胆量值,分析性别、年龄等因素对其胆量的影响及胆量与麝香分泌和繁殖成效的关系.结果表明: 上等体况马麝胆量(1.731±0.347)显著大于下等体况(0.915±0.789);雄麝胆量(1.035±0.120)显著小于雌麝(1.901±0.391);亚成体马麝组的胆量(1.450±0.463)有高于成体组(1.093±0.321)和老龄组(1.430±0.189)的趋势,但差异未达显著水平.区分性别后,年龄组对马麝的胆量值仍无显著影响.独居马麝胆量(0.853±0.326)小于群居马麝(1.397±0.179),但差异不显著,群居个体胆量随密度增加而趋于降低.雄麝胆量与其麝香分泌呈负相关;雌麝胆量与年均产仔数略呈正相关,与空怀率呈显著负相关,即雌麝胆量越高,其空怀率越低.研究结果可为预测圈养马麝的麝香分泌及繁殖成效提供参考,也可为圈养动物个体胆量研究提供思路.

This study was conducted in 2017 from July 1st to August 31st at Xinglongshan musk deer farm in the Xinglongshan National Nature Reserve of Gansu Province, where we recorded behaviors and locations of 29 captive musk deer using the integrated methods of focal sampling and all occurrence recording. Based on the location selection patterns under artificial stress, we defined the animal's stress level and quantified individuals' boldness by combination with the occupation time ratio at each level. Then, the effects of gender, age-class, and other factors on boldness were analyzed along with musk secretion and reproduction success. The results showed that musk deer in better health (1.7310.347) were significantly bolder than those in ill health (0.9150.789). Female musk deer (1.9010.391) were significantly bolder than the males (1.0350.120). The boldness of sub-adults (1.4500.463) was higher than those of the adults (1.0930.321) and the old (1.4300.189). No significant difference in boldness was observed among three age-classes under the same gender. Deer living in groups (1.3970.179) were not significantly bolder than those living alone (0.8530.326). More individuals in groups, less boldness. Furthermore, there was negative correlation between male's boldness and musk secretion.

米洛病 (Milroy’s disease) 是 一种因淋巴管阻塞而引起的遗传 性淋巴水肿。

The litter size had positive relationship with boldness. The non-pregnant percentage was strongly correlated to the boldness, namely the bolder females had lower non-pregnant ratio. Our results provide reference for forecasting the musk secretion and reproduction success of captive musk deer, and provide new ideas for the study of boldness in captive animals. Milroy's disease is a hereditary congenital lymphedema caused by lymphatic obstruction.

此病最易感染患者 腿部，而受损的肠道淋巴流则能 够导致稀便。

The legs are most commonly affected, but impaired intestinal lymphatic flow can cause loose bowel movements.

这里，我们报告的 是，使用汉方 (Kampo) 真武汤 (shinbuto) 提取物可成功治疗米 洛病患者，并缓解其腹痛。

Here, we report the use of the Kampo extract of shinbuto for successful treatment of and abdominal pain in a patient with Milroy's disease.

米洛 病是因患者出生时左腿淋巴水肿 发作而被诊断出来的。

Milroy's disease was diagnosed because of left leg lymph-edema with onset at birth.

当时采用 的是压缩绷带的保守疗法。

Conservative therapy with a compression bandage was applied.

但当 该患者在 35 岁迁至马尼拉时， 她经常在凉爽的空调环境与炎热 潮湿的室外环境之间经历极端的 温度变化。

However, when the patient moved to Manila at 35 years of age, she was exposed to drastic temperature changes between the air-conditioned cold environment in her room and the hot and humid environment outside.

她随后变成了寒性体 质，即寒症（hiesho，“冷え 症”）。

She developed a constitutional state of coldness as in hiesho ().

接着，她突然出现每周 3 次，每次至少持续 1 小时的下 腹疼痛和腹泻，有时还伴有呕 吐。

Then sudden lower abdominal pain and diarrhea began to occur 3 times per week and lasted at least 1 hour, sometimes accompanied by vomiting.

这种症状在其进入寒冷环境 时尤为明显，并且与饮食无关。

It happened particularly when she was exposed to the cold environment and was not related to meals.

传统的抗胆碱能药物或止泻药物 无任何疗效。

Conventional anti-cholinergic or antidiarrhetic drugs had no therapeutic effect.

此病依同样的频率 持续发作了 3 年，于是，该患者 前往汉方（Kampo，传统日本医 学）诊所就诊，在那里，她患有 米洛病相关腹泻和腹痛的诊断得 到了汉方寒症，即 suitai（体液 潴留）诊断的证实。

These attacks continued in the same frequency for 3 years, so the patient visited a Kampo (traditional Japanese medicine) clinic, where her diagnosis of Milroy's disease-associated diarrhea and abdominal pain was augmented by the Kampo diagnosis of hiesho, suitai (body fluid retention).

医生给她开 了每天 7.5 克的真武汤提取物 （TJ-30；日本东京津村株式会 社）。

She was prescribed 7.5 g of shinbuto extract per day (TJ-30; Tsumura Co, Tokyo, Japan).

真武汤提取物显著缓解了 腹痛和顽固性腹泻，将频率降至 每个月 2 天左右，并在 3 个月内 完全消失。

The shinbuto extract significantly reduced abdominal pain and refractory diarrhea to about 2 days per month, and it tapered off completely in 3 months.

真武汤通常用于治疗 因寒冷引发的腹泻。

Shinbuto is usually used against cold-induced diarrhea.

真武汤可引 起复温和体液流动，进而显著改 善因寒冷环境触发的寒症和体液 潴留而引起的症状，只不过腿部 肿胀并无改善。

Rewarming and water movement by shinbuto resulted in significant improvement in symptoms induced by hiesho and suitai triggered by the cold environment, though the patient's leg swelling did not change.

背景: Bruton酪氨酸激酶 (BTK) 在B细胞信号转导中很重要。

Bruton's tyrosine kinase (BTK) is important in B-cell signalling.

已报告BTK抑制剂(BTKi)在人类自身免疫性疾病中的疗效。

Efficacy has been reported for BTK inhibitors (BTKi) in human autoimmune diseases.

犬落叶型天疱疮(cPF)是最常见的犬自身免疫性皮肤病。

Canine pemphigus foliaceus (cPF) is the most common canine autoimmune skin disease.

目的: 确定BTKi治疗cPF 的安全性和疗效。

To determine the safety and efficacy of a BTKi in cPF treatment.

动物: 9只私家犬。

Nine privately owned dogs.

方法和材料: 对诊断为PF的9只犬给予BTKi PRN473。

Nine dogs diagnosed with PF were administered BTKi PRN473.

初始剂量约为15mg/kg,每日一次,如果观察到反应不足,则增加至每日两次。

Initial dosages were 15mg/kg once daily, increased to twice daily if inadequate response was seen.

治疗最长持续20周,尝试降低到隔日一次。

Treatment continued for a maximum of 20weeks, attempting decrease to every other day.

通过全血细胞计数、血清生化全项、尿分析对犬进行监测,并使用改良版本的经验证的人天疱疮疾病活动指数(cPDAI)进行评估。

Dogs were monitored with complete blood counts, serum biochemistry panels, urinalyses and evaluated with a modified version of a validated human Pemphigus Disease Activity Index (cPDAI).

在治疗期前后进行抗桥粒糖蛋白-1(DSC-1)和桥粒芯蛋白-1(DSG-1)免疫球蛋白G(IgG)滴度检测。

Anti-desmocollin-1 (DSC-1) and desmoglein-1 (DSG-1) immunoglobulin G (IgG) titres were performed before and after the treatment period.

在外周血单核细胞中检测与靶点结合的药物。

Drug bound to target was measured in peripheral blood mononuclear cells.

结果: 在治疗前两周,所有9只犬均显示病变和cPDAI评分减少。

All nine dogs showed reduction in lesions and cPDAI score during the first two weeks of treatment.

研究结束时,认为4例缓解为“良好”,2例为“一般”,2例为“较差”,1只犬因既往切除的肥大细胞瘤复发而退出研究。

At the end of the study, four responses were considered 'good', two 'fair', two 'poor' and one dog withdrawn due to recurrence of a previously excised mast cell tumour.

4只犬在第4周时持续改善;3只犬在研究结束时持续接近完全缓解。

Four dogs continued to improve by Week 4; three sustained near complete remission by study's end.

3只犬的抗 DSC-1 IgG滴度降低,2只犬的抗 DSC-1 IgG滴度升高,3只犬中未检测到,退出犬中未进行检测。

The anti-DSC-1 IgG titre decreased in three dogs, increased in two, was undetected in three and was not performed in the withdrawn dog.

所有犬均未检出DSG1 IgG。

No dogs had detectable IgG to DSG1.

3只犬可能发生不良反应。

Possible adverse effects occurred in three dogs.

结论和临床重要性: Bruton酪氨酸激酶抑制剂单药治疗可能对某些cPF病例有益。

Bruton's tyrosine kinase inhibitor monotherapy may have beneficial effects in some cases of cPF.

近年来,生物科技在人类生产生活中越来越扮演着不可或缺的角色,随之而来的生物安全问题也日益显著。

In recent years, biotechnology is gradually getting popular and is playing a significant role in human productivity and life. The consequent biosafety problems are becoming increasingly prominent.

本文基于生物安全的内涵与外延,梳理了在传统法医学和现代法医学研究中涉及到的生物安全内容,分析了在生物安全视野下,法医学研究中面临的风险、机遇及挑战,并以此为基础,从对法医工作者的保护及工作准则的建立、法医学研究对生物安全风险防控的促进支撑作用等多个方面,对生物安全体系中法医学研究进行了展望,以期为未来法医学工作的顺利开展提供借鉴和参考。

Based on the connotation and extension of biosafety, this article sorts out the biosafety contents involved in traditional and modern forensic medicine research and analyzes the risks and challenges facing forensic medicine research from the perspective of biosafety. Based on the protection of legal medical experts, the establishment of working standards, and the promotion and support of research in forensic medicine on biosafety field and other aspects, this article discusses the prospectives of forensic medicine research from a biosafety point of view, and provides the insights and references for a smooth implementation of forensic medicine practice in the future.

分析比较2019年1月至2020年1月空军特色医学中心眩晕中心病区30例前庭神经炎（VN）患者视频头脉冲试验（vHIT）、冷热试验（CT）及感觉统合试验（SOT）在前庭康复治疗前后不同阶段评估的临床价值。

The clinical values of video head impulse test (vHIT), caloric test (CT) and sensory organization test (SOT) at different stages before and after rehabilitation of 30 patients with vestibular neuritis (VN) in Vertigo Center Ward of Air Force Special Medical Center from January 2019 to January 2020 were analyzed and compared.

男19例（63.3%），女11例（36.7%），年龄18~68（44±14）岁。

There were 19 males (63.3%) and 11 females (36.7%), respectively, aged 18-68 (4414) years.

VN患者康复治疗1周、3个月后，三种检查指标恢复率差异有统计学意义（<i>P</i><0.001）。

After 1 week and 3 months of rehabilitation in VN patients, the results of the three examinations were detached, and the recovery rates among the three observed indicators of each examination were statistically different (<i>P</i><0.001).

其中，康复治疗1周后，vHIT观察指标总恢复率为0，低于CT（40.0%）和SOT（43.3%）（均<i>P</i><0.001）；康复治疗3个月后，vHIT观察指标总恢复率为13.3%，低于CT（86.7%）和SOT（80.0%）（均<i>P</i><0.001）。

After 1 week of rehabilitation, the total recovery rate of vHIT was 0, which was lower than that of CT (40.0%) and SOT (43.3%) (both <i>P</i><0.001). After 3 months of rehabilitation, the total recovery rate of vHIT was 13.3%, which was also lower than CT (86.7%) and SOT (80.0%) (both <i>P</i><0.001).

可见，vHIT、CT和SOT三种前庭功能检查方法在VN不同康复阶段各观察指标结果分离，其临床评价意义不同但可相互补充。

The current study indicates that the results of observed indicators from vHIT, CT and SOT were detached at different stages of VN rehabilitation. Therefore, the clinical significance of different vestibular function examinations is different but complementary.