Preparation of nanocellulose light porous material adsorbed with tannic acid and its application in fresh-keeping pad

This study fabricated nanocellulose lightweight porous material (TOCNF-G-LPM-TA) as absorbent fresh-keeping pad for meat products, using TEMPO-oxidized cellulose nanofibril (TOCNF) and gelatin as structural skeleton and tannic acid (TA) as antibacterial component of TOCNF lightweight porous material (TOCNF-G-LPM). The adsorption kinetics, capacity and mechanism of TOCNF-G-LPM in different initial concentrations of TA solutions were investigated, the antioxidant and antibacterial properties of TOCNF-G-LPM-TA and its fresh-keeping effect on refrigerated pork at 4 ℃ were studied. Due to strong hydrogen bonding and porous structure, TOCNF-G-LPM exhibited excellent TA adsorption ability (230 mg/g) conforming with pseudo-second-order kinetic and Langmuir isotherm models. TA endowed TOCNF-G-LPM with good antioxidant and antibacterial activities. According to changes in appearance, pH and TVB-N values of pork during storage at 4 ℃, TOCNF-G-LPM-TA effectively extended the shelf life of refrigerated pork. This work provides a facile method for preparing nanocellulose based absorbent fresh-keeping pads.

Measurement of liquid viscosity using quartz crystal microbalance (QCM) based on GA-BP neural network

Sensor technology plays a pivotal role in various aspects of the petroleum industry. The conventional quartz crystal microbalance (QCM) liquid-phase detection method fails to discern the viscosity and density of solutions separately, rendering it incapable of characterizing the properties of unknown liquid solutions. This presents a formidable challenge to the application of QCM in the petroleum industry. In this study, we aim to assess the feasibility of exclusively utilizing a single QCM sensor for liquid viscosity measurements. Validation experiments were conducted, emphasizing the influence of temperature and solution concentration on the viscosity measurement results. The results indicate that the QCM liquid viscosity response model can achieve viscosity measurements in the temperature range of 20 to 60 °C and concentration range of 10%-95% glycerol solution using a single QCM, with a maximum error of 7.32%. Simultaneously, with the objective of enhancing the model's measurement precision, as an initial investigation, we employed a backpropagation neural network combined with genetic algorithm (to optimize the measurement data. The results demonstrate a substantial improvement in the measurement accuracy of the QCM sensor, with a root mean square error of 3.89 and an absolute error of 3.07% in predicting viscosity values. The purpose of this research was to extend neural networks into the evaluation system of QCM sensors for assessing the viscosity properties of liquid in the oil industry, providing insights into the application of QCM sensors in the petroleum industry for viscosity measurement and improving measurement accuracy.

Melatonin promotes parthenogenetic development of vitrified-warmed mouse MII oocytes, potentially by reducing oxidative stress through SIRT1

Previous studies have demonstrated that melatonin could ameliorate oxidative stress during the cryopreservation of mouse MII oocytes and their in vitro culture after parthenogenetic activation. However, the underlying molecular mechanism remained poorly understood. This study was conducted to investigate whether melatonin could modulate the oxidative stress in the parthenogenetic 2-cell embryos derived from vitrified-warmed oocytes through SIRT1. The results showed that the reactive oxygen species levels increased, the glutathione levels and SIRT1 expression decreased significantly in parthenogenetic 2-cell embryos derived from cryopreserved oocyte, and the parthenogenetic blastocyst formation rates significantly decreased when compared to those derived from control oocytes. These unfavorable phenomena were prevented by the addition of either 10-9 mol/L melatonin or 10-6 mol/L SRT-1720 (SIRT1 agonist), and it was restored by the supplementation of 10-9 mol/L melatonin in combination with 2 × 10-5 mol/L EX527 (SIRT1 inhibitor). Therefore, the findings from the present study concluded that melatonin may reduce oxidative stress via regulating SIRT1, and potentially promote the parthenogenetic development of vitrified-warmed mouse MII oocytes.

A comparison of radiofrequency Coblation and cold steel excision in the treatment of idiopathic vocal process granulomas

OBJECTIVE

To compare the effectiveness of radiofrequency Coblation assisted excision and cold steel excision in the treatment of idiopathic vocal process granulomas.

METHODS

A retrospective study was performed of patients with idiopathic vocal process granulomas who underwent radiofrequency Coblation excision or cold steel excision between January 2013 and January 2020. The recurrence rate was compared among the two groups at six months post-operatively.

RESULTS

Of the 47 patients with vocal process granulomas, 28 were in the cold steel excision (control) group and 19 were in the Coblation-assisted group. The recurrence rate in the control group was significantly higher than that in the Coblation-assisted group (60.7 per cent vs 5.3 per cent; p < 0.001). In addition, the voice recovery of the Coblation-assisted group was significantly better than that of the control group; vocal quality recovered one month after surgery in the Coblation-assisted group.

CONCLUSION

Radiofrequency Coblation should be considered the optimal method when approaching idiopathic vocal process granulomas surgically.

Association between Antibiotic Exposure and the Risk of Rash in Children with Infectious Mononucleosis: a Multicenter, Retrospective Cohort Study

Present evidence suggests that the administration of antibiotics, particularly aminopenicillins, may increase the risk of rash in children with infectious mononucleosis (IM). This retrospective, multicenter cohort study of children with IM was conducted to explore the association between antibiotic exposure in IM children and the risk of rash. A robust error generalized linear regression was performed to address the potential cluster effect, as well as confounding factors such as age and sex. A total of 767 children (aged from 0 to 18 years) with IM from 14 hospitals in Guizhou Province were included in the final analysis. The regression analysis implied that exposure to antibiotics was associated with a significantly increased incidence of overall rash in IM children (adjusted odds ratio [AOR], 1.47; 95% confidence interval [CI], ~1.04 to 2.08; P = 0.029). Of 92 overall rash cases, 43 were probably related to antibiotic exposure: two cases (4.08%) in the amoxicillin-treated group and 41 (8.15%) in the group treated with other antibiotics. Regression analysis indicated that the risk of rash induced by amoxicillin in IM children was similar to that induced by other penicillins (AOR, 1.12; 95% CI, ~0.13 to 9.67), cephalosporins (AOR, 2.45; 95% CI, ~0.43 to 14.02), or macrolides (AOR, 0.91; 95% CI, ~0.15 to 5.43). Antibiotic exposure may be associated with an increased risk of overall rash in IM children, but amoxicillin was not found to be associated with any increased risk of rash during IM compared to other antibiotics. We suggest that clinicians be vigilant against the occurrence of rash in IM children receiving antibiotic therapy, rather than indiscriminately avoiding prescribing amoxicillin.

Preparation and physicochemical properties of nanocellulose lightweight porous materials: The regulating effect of gelatin

The composite lightweight porous material (TOCNF-G-LPM) based on TEMPO-oxidized cellulose nanofibril (TOCNF) and gelatin were facilely prepared by ambient pressure drying using glutaraldehyde as crosslinking agent. The influence of gelatin addition on the physicochemical properties of TOCNF-G-LPM was investigated. The long-size entangled structure of TOCNF maintained the skeleton network of TOCNF-G-LPM while gelatin can adjust the characteristics of highly porous network (porosity of 98.53%-97.40%) and light weight (density of 0.0236-0.0372 g/cm³) with increasing gelatin concentration (0.2-1.0 wt%). The results of scanning electron microscopy (SEM) and confocal laser scanning microscope (CLSM) indicated that the internal structure of TOCNF-G-LPM became more ordered, uniform and denser as gelatin concentration increased. Introducing gelatin decreased water and oil absorption properties, but improved the thermal, mechanical properties and shape recovery ability of TOCNF-G-LPM at appropriate addition. Furthermore, TOCNF-G-LPM showed no significant effect on the growth and reproduction of Caenorhabditis elegans (C. elegans), confirming a good biocompatibility.

Preliminary exploration of method for screening efficacy markers compatibility in TCM prescriptions based on Q-markers: Anti-inflammatory activity of Dachaihu decoction as an example

ETHNOPHARMACOLOGICAL RELEVANCE

Dachaihu Decoction (DD), a classic Chinese herbal prescription, is composed of radix of Bupleurum chinense DC. (Chaihu), radix of Scutellaria baicalensis Georgi (Huangqin), radix of Paeonia lactiflora Pall. (Baishao), rhizoma of Pinellia ternata (Thunb.) Breit. (Banxia), fructus of Citrus aurantium L. (Zhishi), rhizoma of Zingiber officinale Rosc. (Shengjiang), fructus of Ziziphus jujuba Mill. (Dazao) and rhizoma of Rheum officinale Baill. (Dahuang). DD has the traditional effects of soothing the liver, relieving depression and clearing heat from the stomach, and is mainly used to treat heat stagnation in the liver and stomach.

AIM OF THE STUDY

Dachaihu decoction (DD), a classic prescription commonly used in clinical practice for the treatment of pancreatitis and cholecystitis. Although its pharmacological effects are clear, the efficacy components and mechanism of action remain intricate and difficult to clarify.

MATERIALS AND METHODS

The action targets and components of the anti-inflammatory activity of DD were predicted by network pharmacology; the effective components and targets were verified by HPLC and qPCR; the efficacy markers of DD were further screened by in vitro experiments; the pharmacological value of DD and its components compatibility were evaluated by in vitro experiments.

RESULTS

The key targets MMP9, JAK2, MAP2K1 and NR3C1 were screened by network pharmacology; HPLC analysis showed that paeoniflorin, naringin, hesperidin, neohesperidin, baicalin, wogonoside, baicalein and saikosaponin B₂ were identified as potential efficacy markers of DD; molecular docking combined with qPCR verification suggested that baicalin, naringin, neohesperidin, hesperidin and baicalein and wogonoside had certain ability to regulate above targets; in vitro studies revealed that paeoniflorin, naringin, hesperidin, neohesperidin, baicalin, wogonoside, baicalein and saikosaponin B₂ could inhibit the release of NO, pancreatic lipase and α-glucosidase; after comprehensive comparison and analysis, naringin, hesperidin, neohesperidin, baicalin, wogonoside, baicalein and saikosaponin B₂ were selected as the efficacy markers of DD; in vivo studies indicated that DD and its efficacy markers (components compatibility) had definite therapeutic effects on guinea pigs with cholecystitis.

CONCLUSIONS

The efficacy markers of DD including naringin, hesperidin, neohesperidin, baicalin, wogonoside, baicalein and saikosaponin B₂ can be used as components compatibility to exert anti-inflammatory activity. In addition, a method for obtaining the compatibility of efficacy markers by simplifying the prescription is initially established.

Chitosan particles modulate the properties of cellulose nanocrystals through interparticle interactions: Effect of concentration

The physical and chemical properties of cellulose nanocrystals (CNC) were regulated by physical crosslinking with chitosan particles (CSp). At a fixed concentration (0.5 wt%) of CNC, varying CSp concentration (0.02-0.5 wt%) influenced the morphologies and chemical properties of the obtained complex particles (CNC-CSp). The results of Fourier transform infrared spectroscopy (FTIR) and zeta potential confirmed the electrostatic and hydrogen bonding interactions between CSp and CNC. At a low CSp concentration (0.02-0.05 wt%), the charge shielding effect induced the formation of particle aggregation networks, thus showing increased viscosity, turbidity and size (153.4-2605.7 nm). At a higher CSp concentration (0.1-0.5 wt%), the hydrogen bonding interaction promoted CSp adsorption onto the surface of CNC, thus facilitating the dispersion of CNC-CSp due to electrostatic repulsion caused by surface-adsorbed CSp. In addition, CSp improved the thermal stability, hydrophobicity (41.87-60.02°) and rheological properties of CNC. Compared with CNC, CNC-CSp displayed a better emulsifying ability and emulsion stability, in which CSp could play a dual role (i.e., charge regulator and stabilizer). This study suggests that introducing CSp can improve the properties and application potentials of CNC as food colloids.

Follow-up of patients with a 5-year survival after paraquat poisoning using computed tomography images and spirometry

OBJECTIVES

The study aimed to examine long-term survival of patients with acute paraquat poisoning using computed tomography (CT) images and spirometry.

METHODS

A total of 36 patients with long-term survival after paraquat poisoning were followed-up and divided into mild (11 patients), moderate (17 patients), and severe (8 patients) paraquat poisoning groups. Differences among the groups were compared using clinical indicators, such as peripheral capillary oxygen saturation, arterial partial pressure of oxygen and 6-min walk test (6-MWT), chest CT, spirometry, and serum immunoglobulin E (IgE).

RESULTS

The 6-MWT distance was significantly shorter in the severe paraquat poisoning group than that in the mild and moderate paraquat poisoning groups. In the mild paraquat poisoning group, CT revealed no obvious lung injury, and spirometry showed normal lung function in most patients. In moderate or severe paraquat poisoning group, CT images showed fibrotic lesions as cord-like high-density shadows, reticulations, and honeycombs. In addition, other pulmonary changes, including bronchiectasis, increased lung transparency, and pulmonary bullae, were discovered. In moderate or severe paraquat poisoning group, obvious obstructive ventilation dysfunction with slight restrictive and diffuse impairment were observed in some patients, with positive bronchial relaxation test and high serum IgE level.

CONCLUSION

In the long-term follow-up, patients with severe paraquat poisoning showed the lowest exercise endurance. In moderate or severe paraquat poisoning group, CT images revealed diversified changes, not only dynamic evolution of pulmonary fibrosis process, but also signs of bronchiectasis, and chronic obstructive pulmonary disease. Some patients with moderate or severe paraquat poisoning developed obstructive ventilatory dysfunction with airway hyperresponsiveness.

A transcriptomics and molecular biology based investigation reveals the protective effect and mechanism of carnosol on t-BHP induced HRMECs via Nrf2 signaling pathway

Human retinal microvascular endothelial cells (HRMECs) injury plays an essential role in the pathogenesis of diabetic retinopathy (DR). As one of the crucial pathogenetic factors, oxidative stress induces HRMECs apoptosis and microvascular lesions. Nuclear factor erythroid 2-related factor 2 (Nrf2) acts as a molecular switch in oxidative stress-induced HRMECs injury. The present study was designed to investigate the protective effect and underlying mechanism of carnosol, a potential Nrf2 agonist, in tert-butyl hydroperoxide (t-BHP) induced HRMECs oxidative stress injury. In this study, carnosol was found to inhibit HRMECs injury induced by t-BHP. Transcriptomics and molecular biology illustrated that the mechanism was associated with oxidative stress, vascular system development, apoptosis, cell cycle, cell adhesion, cytoskeleton, and nitric oxide biosynthesis. Carnosol directly scavenged free radicals or activated the Nrf2 signaling pathway to alleviate HRMECs oxidative stress. ML385 pretreatment or Nrf2 small interference RNA (siRNA) inhibited the protective effect of carnosol on HRMECs injury. Moreover, the apoptosis and cell cycle arrest in HRMECs were suppressed by carnosol. Treatment with carnosol could also effectively regulate the adhesion and cytoskeleton. Overall, our data provide a systematic perspective for the mechanism of carnosol against HRMECs oxidative stress injury and reveal that carnosol may be a candidate drug for DR therapy.

Melatonin Promotes in vitro Development of Vitrified-Warmed Mouse GV Oocytes, Potentially by Modulating Phosphorylation of Drp1

Previous studies have shown that melatonin can mitigate cryopreservation-induced mitochondrial dysfunction in oocytes; however, the underlying molecular mechanism remains unclear. The objective of the present study was to investigate whether melatonin can improve the mitochondrial function during in vitro maturation of vitrified-warmed mouse germinal vesicle (GV) oocytes by modulating phosphorylation of dynamin related protein 1 (Drp1). Vitrification/warming procedures resulted in the following: (1) After cryopreservation of mouse GV oocytes, the phosphorylation level of Drp1 at Ser616 (p-Drp1 Ser616) in metaphase II (MII) oocytes was increased (P < 0.05). Furthermore, the rates of in vitro maturation, cleavage and blastocyst formation after parthenogenetic activation were decreased (P < 0.05). (2) In MII oocytes, the expression levels of translocase of the mitochondrial outer membrane 20 (TOMM20), mitochondrial membrane potential (MMP), adenosine triphosphate (ATP) content, and mRNA levels of mitochondrial biogenesis-related genes (Sirt1, Pgc-1α, Tfam) were all decreased (P < 0.05), and (3) Reactive oxygen species (ROS) level, early apoptosis level, Cytochrome C release and mRNA levels of pro-apoptotic related genes (Bax, Caspase9, Caspase3) in MII oocytes were all increased (P < 0.05). The results of this study further revealed that negative impacts of GV oocyte cryopreservation were mitigated by supplementation of warming and in vitro maturation media with 10⁻⁷mol /L melatonin or 2 x 10⁻⁵mol/L Mdivi-1 (Drp1 inhibitor). Therefore, we concluded that 10⁻⁷mol/L melatonin improved mitochondrial function, reduced oxidative stress and inhibited apoptosis by regulating phosphorylation of Drp1, thereby enhancing in vitro development of vitrified-warmed mouse GV oocytes.

Melatonin improves the first cleavage of parthenogenetic embryos from vitrified-warmed mouse oocytes potentially by promoting cell cycle progression

Background

This study investigated the effect of melatonin (MT) on cell cycle (G1/S/G2/M) of parthenogenetic zygotes developed from vitrified-warmed mouse metaphase II (MII) oocytes and elucidated the potential mechanism of MT action in the first cleavage of embryos.

Results

After vitrification and warming, oocytes were parthenogenetically activated (PA) and in vitro cultured (IVC). Then the spindle morphology and chromosome segregation in oocytes, the maternal mRNA levels of genes including Miss, Doc1r, Setd2 and Ythdf2 in activated oocytes, pronuclear formation, the S phase duration in zygotes, mitochondrial function at G1 phase, reactive oxygen species (ROS) level at S phase, DNA damage at G2 phase, early apoptosis in 2-cell embryos, cleavage and blastocyst formation rates were evaluated. The results indicated that the vitrification/warming procedures led to following perturbations 1) spindle abnormalities and chromosome misalignment, alteration of maternal mRNAs and delay in pronucleus formation, 2) decreased mitochondrial membrane potential (MMP) and lower adenosine triphosphate (ATP) levels, increased ROS production and DNA damage, G1/S and S/G2 phase transition delay, and delayed first cleavage, and 3) increased early apoptosis and lower levels of cleavage and blastocyst formation. Our results further revealed that such negative impacts of oocyte cryopreservation could be alleviated by supplementation of warming, recovery, PA and IVC media with 10^− 9 mol/L MT before the embryos moved into the 2-cell stage of development.

Conclusions

MT might promote cell cycle progression via regulation of MMP, ATP, ROS and maternal mRNA levels, potentially increasing the first cleavage of parthenogenetic zygotes developed from vitrified–warmed mouse oocytes and their subsequent development.

The Effectiveness of Clinical Pharmacist-Led Consultation in the Treatment of Infectious Diseases: A Prospective, Multicenter, Cohort Study

Background

Antimicrobial resistance (AMR) is a serious global health threat and leads to a huge challenge to infectious diseases (ID) treatment. To tackle AMR, regional ‘Antimicrobial Stewardship Programs’ (ASP) have been implemented in many countries. Due to insufficient clinical pharmacy resources, a major intervention mode of ASP in China is through clinical pharmacist-led consultation (CPC). The current study aims to prospectively evaluate this intervention and compare the effectiveness of CPC served by ID and non-ID clinical pharmacists.

Methods

We conducted a prospective and multicenter cohort study based on a regional registry database in 17 hospitals in Western China, including consecutive patients with ID between April 2017 and December 2019. Baseline characteristics including sex, age, liver and kidney function, comorbidity, infection severity were prospectively collected and recorded. The main exposure of interest was whether the attending physician adopted recommendations of the clinical pharmacist in the therapeutic scheme. The outcome was the infection effective response, assessed during day 3–7 after completing CPC. Multivariate analyses were performed by generalized linear mixed models.

Results

A total of 2,663 ID patients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The number of patients whose treatment followed and did not follow the pharmacists’ suggestion was 2,529 and 134, respectively. CPC intervention could improve the ID patient prognosis in the context of other confounders controlled (Adjusted Odds ratio(AOR)=1.838, 95%Confidence Interval(CI)=[1.212, 2.786]), and the effectiveness of CPC served by ID and non-ID clinical pharmacists might be equivalent (AOR=0.958, 95%CI[0.740, 1.240]). Special consultation (AOR=1.832, 95%CI[1.106, 3.035]) and surgical treatment of infectious sites (AOR=1.380, 95%CI[1.039, 1.834]) had positive influences on the patient prognosis, while hypoalbuminemia (AOR=0.694, 95%CI[0.523, 0.921]), liver dysfunction (AOR=0.705, 95%CI[0.559, 0.889]), presence of high-risk factors (AOR=0.775, 95%CI[0.613, 0.980]), and increased infection severity (AOR=0.631, 95%CI[0.529, 0.753])were associated with a decrease in effective response rate, independently.

Conclusion

This study suggests that CPC is a promising pharmacist-led intervention to improve ID treatment, and it can achieve standardization among clinical pharmacists with different backgrounds by some measures. Policy/decision-makers should promote this intervention mode in developing countries or regions where there is an insufficient number of clinical pharmacists.

A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer

AIM

Sarcopenia is a robust prognostic indicator of outcomes after surgery for colorectal cancer (CRC). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI), serum creatinine (Scr) × cystatin C-based glomerular filtration rate, and investigate its association with short-term complications after curative resection of CRC.

METHOD

Consecutive patients who underwent curative resection of CRC from December 2011 to January 2017 were retrospectively identified. Skeletal muscle cross-sectional area was analysed on L3 computed tomographic images. Receiver operating characteristic curve analysis showed that the cutoff points of SI for sarcopenia were below 56.1 in men and below 43.7 in women. Patients were classified into low and high SI groups in accordance with these cutoff values. The association between SI and body composition and the impact of preoperative SI on postoperative outcomes were analysed.

RESULTS

Among 417 patients, SI showed a stronger correlation with skeletal muscle area (SMA) (r = 0.537, P < 0.001) than with the Scr/cystatin C ratio (r = 0.469, P < 0.001) and Scr (r = 0.447, P < 0.001). The low SI group had a lower SMA, lower preoperative haemoglobin, a higher prevalence of sarcopenia and experienced more postoperative complications compared with the high SI group (all P < 0.001). Multivariate logistic regression analysis showed that the independent risk factors for overall complications were low preoperative haemoglobin, low SI, sarcopenia and American Society of Anesthesiologists grade ≥ 3.

CONCLUSION

This new SI is a simple and useful surrogate marker for estimating SMM, and is associated with outcomes after CRC surgery.

Knockdown of 14-kDa phosphohistidine phosphatase expression suppresses lung cancer cell growth in vivo possibly through inhibition of NF-κB signaling pathway

In previous study, we reported that 14-kDa phosphohistidine phosphatase (PHP14) was associated with lung cancer cell migration and invasion. We also found that the expression of PHP14 was markedly increased in a part of human lung cancer tissues. In this study, we investigated the impact of PHP14 knockdown on lung cancer cell tumorigenesis in vitro and in vivo, as well as the regulatory pathway. Depletion of endogenous PHP14 expression in lung cancer cells reduced colony formation activity of lung cancer cells in vitro and inhibited the xenograft tumor growth in vivo. Further experiments revealed that the NF-κB signal pathway inhibitor PDTC inhibited the upregulated expression of MMP9 induced by PHP14 overexpression in lung cancer cells. Furthermore, knockdown of PHP14 in lung cancer cells correlated with decreased expression of a subset of NF-κB-regulated genes, such as BCL-2, COX-2, MCP-1, MMP9 and VEGF-C, which play an important role in tumor progression. Together these data suggest that knockdown of PHP14 in lung cancer cells inhibits lung cancer tumor growth in vivo, possibly via regulating the NF-κB pathway.

A new hope: the immunotherapy in small cell lung cancer

Small cell lung cancer (SCLC) is of a high-grade malignancy with a high metastatic potential and poor clinical prognosis. Unfortunately, SCLC initially exhibits a good response to chemotherapy and radiation therapy, but inevitably, relapses decrease patients' chance of survival. Despite tremendous advances on the development of new chemotherapeutic agents, the prognosis of this disease remains poor. Immunotherapy plays a role in eliciting an anticancer response by modulating the patient's immune response of the tumor. Several studies have demonstrated that abnormal autoimmune regulation has a close relationship with SCLC. Thus, several immunotherapy trials are focused on SCLC treatment, including such approaches as immune checkpoints blockers, tumor vaccine, antigenic targets and adoptive cellular immunotherapy to benefit patients with SCLC. To date, the results from immunotherapy in SCLC have not been promising. For example, tumor vaccines have not been demonstrated to have a significant survival benefit. However, there have been many promising advances with immune checkpoints blockers. This review will provide a general overview of immunotherapy in SCLC. The landmark clinical trials in previous successful immunotherapy studies are summarized here. Finally, the challenges of immunotherapy in SCLC are discussed to facilitate the prediction of possible and valuable strategies for future therapy.

[Characteristics of Dix-Hallpike test induced nystagmus]

Objective:To retrospectively analyze the characteristics of 100 cases with Dix-Hallpike test induced nystagmus, especially the vertical downward component.Method:One hundred cases with positive Dix-Hallpike test between December 2017 and January 2018 were included in this study. Dix-Hallpike test and roll test were performed in all patients, and the max slow phase velocity (SPV), latency and duration of positional nystagmus were analyzed with SPSS 22.0 software.Result:According to the difference in the direction and duration of the nystagmus in the head-hanging position on Dix-Hallpike test, 100 patients were classified into 9 types. When only the vertical components were considered, 56 cases presented with bilateral or unilateral vertical upward component, among which 52 cases had unilateral torsional with vertical upward component, 4 cases had bilateral torsional with vertical upward component; 7 cases presented with vertically upward in one side and the vertically downward in the other side; 47 cases presented with bilateral or unilateral vertical downward component. In addition, 8 cases showed the reverse phase nystagmus. Of the 100 patients with positive Dix-hallpike, 20 cases were positive in roll test and 5 cases showing horizontal nystagmus and 15 cases showing torsional and vertical nystagmus.Conclusion:Vertical component in the positional nystagmus was common, and care should be taken to interpret the nystagmus into the underlying disorder.