Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry.

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.

[Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach].

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

[Prognostic factors of autologous hematopoietic stem cell transplantation in intermediate-risk acute myeloid leukemia patients with minimal residual disease negativity].

To explore prognostic factors in intermediate-risk acute myeloid leukemia (AML) patients with minimal residual disease (MRD) negativity (MRD<0.1%,MRD-)receiving autologous hematopoietic stem cell transplantation (auto-HSCT).A total of 59 intermediate-risk AML patients with MRD-were treated with auto-HSCT from January 2015 to September 2021 at Affiliated People's Hospital of Ningbo University. The clinical data and laboratory results were collected retrospectively. Efficacy, clinical outcome and prognostic factors were analyzed. Univariate analysis was conducted by using log-rank test, the multivariate analysis by Cox proportional risk model.Among 59 patients, there were 27 males and 32 females with median age of 55 (31-69) years old.The median follow-up was 761(317-1 861)days. The 2-year overall survival (OS) rate and event-free survival (EFS) rate were 76.1%±11.4% and 73.4%±11.6% respectively.The univariate analysis showed that age older than 50 years, TET2 gene mutation (TET2+), achieving MRD negativity over 30 days (MRD30+) were unfavorable factors of OS (χ2=6.20, 33.20, 7.18;P=0.013,<0.001, 0.007). TET2+, WT1 gene mutation (WT1+), CD34+cells<2×106/kg, MRD30+were negative factors of EFS (χ2=17.29, 4.47, 3.94, 9.393;P<0.001, 0.035, 0.047, 0.002).Multivariate analysis showed that MRD30+, TET2+ were independent prognostic factors of OS and EFS (OS:HR=9.251, 25.839, P=0.036, 0.001;EFS:HR=5.851, 9.199, P=0.043, 0.002). Intermediate-risk AML patients with MRD30+or TET2+ have very poor prognosis after auto-HSCT. Alternative regimens should be investigated.

[Effects of moderate dose rosuvastatin on carotid plaque in patients with diabetes mellitus evaluated by magnetic resonance imaging].

Objective: To observe the effect of lipid regulating therapy on carotid atherosclerotic plaque in diabetic patients. Methods: The REACH study, conducted between March 2009 and February 2012, enrolled asymptomatic patients with magnetic resonance imaging (MRI) confirmed carotid atherosclerotic plaque, who had never taken lipid-lowering drugs. Patients were treated with a moderate dose of rosuvastatin for 24 months. Blood lipid levels were measured and carotid MRI was performed at baseline, 3 and 24 months after treatment. The volume of carotid wall and lipid-rich necrotic core (LRNC) were measured by image analysis software. This study retrospectively analyzed patients in the REACH study. Patients were divided into diabetes group and non-diabetic group. The changes of blood lipid level and MRI parameters of carotid atherosclerotic plaque were compared between the two groups and their correlation was analyzed. Results: A total of 38 patients with carotid atherosclerotic plaque were included in this study, including 13 patients (34.2%) in the diabetic group and 25 patients (65.8%) in the non-diabetic group. Baseline parameters were comparable between the two groups, except higher HbA1c level in diabetes group (P<0.05). Compared with baseline, the total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels were significantly decreased at 3 and 24 months in both two groups (P<0.05). The change of high-density lipoprotein cholesterol (HDL-C) in diabetes group was not obvious, while it was significantly increased in non-diabetic group at 24 months ((1.38±0.33) mmol/l vs. (1.26±0.26) mmol/l, P<0.05). MRI results showed that the volume and percentage of LRNC remained unchanged at 3 months, slightly decreased at 24 months (64.86 (45.37, 134.56) mm3 vs. 75.76 (48.20, 115.64) mm3, P>0.05) and (15.84% (11.47%, 24.85%) vs. 16.95% (11.64%, 22.91%), P>0.05) in diabetic group. In non-diabetic group, the volume and percentage of LRNC were significantly decreased at 3 months (63.01 (44.25, 188.64) mm3 vs. 72.49 (51.91, 199.59) mm3, P<0.05) and (13.76% (8.81%, 27.64%) vs. 16.04% (11.18%, 27.05%), P<0.05) respectively. Both parameters further decreased to (55.63 (27.18, 179.40) mm3) and (12.71% (8.39%, 24.41%)) at 24 months (both P<0.05). Wall volume, lumen volume and percent wall volume (PWV) were not affected post therapy in both two groups(P>0.05). There were no correlations between the changes of plaque parameters including volume and percentage of LRNC, wall volume, lumen volume, PWV and the changes of blood lipid parameters (TC, LDL-C, HDL-C and TG) in 3 and 24 months (P>0.05). Conclusion: Lipid-lowering therapy possesses different effects on carotid atherosclerotic plaque in diabetic and non-diabetic patients, and the LRNC improvement is more significant in non-diabetic patients as compared to diabetic patients.

[The labor motivation in professional groups of medical organization].

The motivation of work is based on personnel needs. The directivity of organization management to meeting needs of employees of any professional group is capable to increase their labor motivation and job satisfaction creating at that favorable working environment. The purpose of the study is to determine value of motivational factors-needs for employees of professional groups of medical organization and to justify application of obtained motivational complexes of factors-requirements for increasing labor motivation of personnel. The continuous anonymous survey of 603 employees of six departmental medical organizations was carried out. The respondents were distributed in such professional groups as Administration (42); Experts (97); Nurses (257); Other professionals (86) and Paramedical staff (121). The group Specialists included subgroups Surgical (13) and Therapeutic (84 people) profiles. The group Other specialists included subgroups with higher (51 people) and secondary education (40 people). The factors-needs determining work motivation were estimated by P. Martin and S. Ritchie "Motivational profile Test". The statistical data processing was carried out using "Statistica-10" software. The criteria of Kruskal-Wallis, Kolmogorov-Smirnov and Kendall τ-criterion were applied. The motivational value of factors-needs in employees of professional groups of medical organization, including characteristics of estimates of needs respondents with different work experience considering their gender and marital status is defined. The hierarchical structure of factors-needs according to degree of their motivational value in employees of each professional group can be represented in form of group motivational complex. The indices of motivational value of factors-needs of complex correspond to specific expectations of employees of professional groups. The derived motivational factors-needs complexes can be applied in determining directions of management activities targeted to increasing of work motivation of personnel, creating favorable social and psychological work environment and establishing social responsibility of organization in terms of personnel.

Primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst: case series and literature review.

BACKGROUND: The aim of this study was to investigate the clinicopathologic features of primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst (PIOSCC ex OKC) and comprehensively improve the understanding of this disease. MATERIAL AND METHODS: We retrospectively investigated five cases of PIOSCC ex OKC at Peking University School and Hospital of Stomatology. We also conducted a systematic review of studies on PIOSCC ex OKC by using online databases from their inception until February 2020. RESULTS: In our series of five cases, all lesions were located in the mandible. Three cases (60%) showed recurrent OKCs and two cases (40%) showed primary OKCs. During the follow-up period, one patient died of local relapse. No patients developed metastasis. On the basis of our literature survey, we selected 22 articles reporting 29 patients with PIOSCC ex OKC. Seven of these patients (24.1%) showed local recurrence, three patients (10.3%) developed cervical metastasis, three patients (10.3%) developed distant metastasis (in the pleura in one case and in the lung in two cases), and seven patients died from the disease during the follow-up period. The disease-specific 5-year survival rate in the study group was 53.2%. Through univariate and multivariate analysis, local recurrence was identified as the only significant independent prognostic factor for survival (P < 0.05). CONCLUSIONS: The results suggest that PIOSCC ex OKC is a rare intermediate-grade malignancy. Although elective neck dissection is typically unnecessary, adequate therapy should be applied to achieve the lowest local recurrence rate possible to ensure a favorable survival rate.

[The relationship between genotype of familial hypercholesterolemia and the efficacy of PCSK9 inhibitors].

Objective: This study intends to explore the difference in the efficacy of PCSK9 inhibitors in patients with different FH phenotypes by analyzing the level of blood lipids before and after treatment with PCSK9 inhibitors in patients with familial hypercholesterolemia (FH) with different allele grades. Methods: Patients with FH phenotype, who admitted to Beijing Anzhen Hospital from January 2019 to October 2020, were enrolled. Age, sex and other clinical information were collected from enrolled, and the pathogenic genes were detected by the second generation sequencing technique. The patients were divided into five groups according to the number of alleles involved and the degree of gene damage: single allele-null mutation group, single allele-defect mutation group, multi-allele-null mutation group, multi-allele-defect mutation group and no major pathogenic gene mutation group. The results of blood lipids were collected before medication, 4-6 weeks of intensive statin treatment and one month after combined treatment with PCSK9 inhibitor (PCSK9i). The LDL-C level were compared among groups. ASCVD risk stratification was performed in all patients, and the proportion of LDL-C level reaching the corresponding risk stratification target value of each genotype group after treatment was analyzed. Results: A total of 66 patients with FH phenotype were included, including 47 males (71.2%) and 19 females (28.8%),the mean age was(43.1±13.4 years). There were 7 cases in single allele-null mutation group (10.6%), 25 cases in single allele-defect mutation group (37.9%), 8 cases in multi-allele-null mutation group (12.1%), 18 cases in multi-allele-defect mutation group (27.3%) and 8 cases in no major pathogenic mutation group (12.1%). The degree of LDL-C reduction post combined PCSK9 inhibitor therapy was as follows: single allele mutation group>no major pathogenic mutation group>multi-allele mutation group, general distribution was in the range of 0-90.0%. Two groups of single allele mutation and no major pathogenic mutation group>50.0%>multi-allele mutation group. Under the combined treatment of PCSK9 inhibitors, the further decrease of LDL-C was in the order of single allele mutation group>non-major pathogenic mutant group>multi-allele mutation group. The efficacy of combined therapy on reducing LDL-C at 1 month after treatment decreased with the increase of baseline LDL-C level (r = 0.46, P<0.001) in patients with FH phenotype. In addition, the further decrease of LDL-C level post high-intensity statin therapy combined with PCSK9 inhibitors decreased with the increase of baseline LDL-C levels (r = 0.40, P<0.001). The degree of LDL-C decrease was high and stable by statin combined with PCSK9 inhibitor therapy in single allele mutation group. In the single allele-defect mutant group, the decrease of LDL-C increased with the increase of baseline LDL-C level post intensive statin treatment and combined PCSK9 inhibitor treatment ((r=0.54, P=0.009); r=0.45,P=0.030), and the further decrease of LDL-C level decreased with the increase of baseline LDL-C level in single allele-defect mutant group post combined therapy with PCSK9 inhibitor (r=0.43, P=0.040). The decrease of LDL-C in patients with the multi-allele mutation group varied with different pathogenic gene loci and combinations post combined therapy with PCSK9 inhibitor. There was no significant difference in the level of blood lipids between the group without major pathogenic gene mutation and the group with single allele mutation before and after treatment. The percentage of patients achieving LDL-C goals with different genotypes of phenotypic FH were as follows: single allele mutation group (86.7%), non-major pathogenic mutant group (75.0%) and multi-allele mutation grou (<5.0%). Conclusions: All patients with different FH phenotypes could benefit from the intensive lipid-lowering therapy with statins and PCSK9 inhibitors, however, there are significant differences in the efficacy of lowering LDL-C in Chinese patients with FH phenotype with different molecular etiologies. Therefore, the pathogenic gene analysis may suggest the lipid-lowering effect of PCSK9 inhibitors in patients with FH.

[Cross sectional study of familial hypercholesterolemia in dyslipidemia patients receiving lipid-lowering therapy: DYSIS-China subgroup analysis].

Objectives: To analyze the incidence, blood lipid levels and cardiovascular disease of familial hypercholesterolemia (FH) in dyslipidemia patients receiving lipid-lowing therapy from the DYSIS-China. Methods: Dyslipidemia International Study-China (DYSIS-China) database was re-analyzed according to the criteria of "Chinese guidelines for prevention and treatment of dyslipidemia in adults-2016 version". DYSIS-China database included 25 317 dyslipidemia out-patients who received at least one lipid-lowering drug for at least three months. All the patients were divided into three groups: unlikely HF, possible FH and definite FH according to the Dutch Lipid Clinic Network diagnostic criteria. Age, gender, lipids levels, drug use and complications were compared among the three groups. Factors were compared between Possible FH group and definite FH group in terms of age stratification. Results: A total of 23 973 patients with dyslipidemia were included. The average age was (64.8±9.9) years, 11 757 patients were females (49.0%). The proportion of unlikely FH in the total population was 20 561 (85.7%), possible FH was 3294 (13.7%), and the definite FH was 118(0.5%). Patients in the definite FH group (58.3±8.5 years) was younger than in unlikely HF(65.3±9.8 years) and possible FH(61.8±9.9 years) group. LDL-C ((5.6±1.9) mmol/L) levels were significantly higher in definite FH group than in unlikely HF ((2.5±0.9) mmol/L) and possible FH ((4.3±1.0) mmol/L) group. TC ((7.4±1.8) mmol/L) levels were also significantly higher in definite FH group than in unlikely HF ((4.3±1.0) mmol/L) and possible FH ((6.0±1.0) mmol/L) group. Percent of female sex, sedentary lifestyle and systolic blood pressure value were significantly higher in definite FH group than in other two groups (all P<0.05). Statin use was similar among the 3 groups. Prevalence of ischemic cardiomyopathy (70(59.3%)) was significantly higher in the definite FH group than in unlikely FH group7519 (36.6%) and possible FH group1149 (34.9%). The rate of hypertension (82 (69.5%)) was also significantly higher in the definite FH group than in unlikely FH group (2 063 (62.6%) and in possible FH group (13 928 (67.7%)). The possible FH group had the highest proportion of patients aged 55-64 years (1 146 (34.8%)), and the prevalence of hypertension 358 (76.8%), diabetes 189 (40.6%), ischemic heart disease 186 (39.9%), cerebrovascular disease 149 (32.0%) and heart failure 28 (6.0%) was the highest in patients over 75 years old. The definite FH group had the highest proportion of patients aged 55-64 years (49 (41.52%)), and the prevalence of ischemic heart disease (70 (59.3%)) was the highest in patients aged 45-54 years old group, there was no significant difference in the prevalence of diabetes,hypertension,heart failure,peripheral artery disease and cerebrovascular disease among different age groups. Conclusion: The detection rate of FH in Chinese patients with dyslipidemia is not low, the blood lipid level is poorly controlled, and the risk of cardiovascular disease is high in Chinses FH patients.

[Risk factor distribution features and trends of young adults with first acute coronary syndrome].

Objective: To observe the characteristics and trends during the last 11 years of risk factors of young adults with first acute coronary syndrome (ACS). Methods: It was a cross-sectional study. We included young adults (18 to 44 years old) hospitalized for acute coronary syndrome in Beijing Anzhen Hospital for a first time from January 2007 to December 2017. Acute coronary syndromes include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). The general information, medical history and laboratory test were recorded. Risk factors of ACS were smoking, dyslipidemia, overweight/obesity, hypertension and diabetes. Results: Data from 7 106 patients were analyzed, mean age was (39.8±4.2) years old and 6 593(92.8%)were men, including 2 254 (31.7%) STEMI, 704 (9.9%) NSTEMI and 4 148 (58.4%) UA. Most patients were male (6 593(92.8%)). Dyslipidemia (85.8%(6 094/7 106)), overweight/obesity (82.3%(5 850/7 106)), and smoking (63.9%(4 545/7 106)) were most prevalent. 98.3% (6 885/7 106) patients had at least 1 risk factor. The prevalence of hypertension, diabetes and overweight/obesity increased from 2007 to 2017. Rates of hypertension increased from 37.1%(111/299) to 48.1%(498/1 035) (Ptrend<0.01), diabetes from 12.0%(36/299) to 19.4%(201/1 035) (Ptrend<0.01), overweight/obesity from 74.2%(222/299) to 83.9%(868/1 035) (Ptrend<0.05), respectively. Conclusions: Dyslipidemia, overweight/obesity and smoking are most prevalent risk factors in young adults with a first ACS and most patients have at least 1 risk factor for ACS. Rates of hypertension, diabetes and overweight/obesity progressively increases over time in this patient cohort.

[Distributions of time, place, and population of novel coronavirus disease 2019 (COVID-19) from January 20 to February 10, 2020, in China]. / Distribución temporal, geográfica y por población de la nueva enfermedad por coronavirus (COVID-19) desde el 20 de enero hasta el 10 de febrero del 2020, en China.

Background and objective: Since December 2019, increasing cases of novel coronavirus disease 2019 (COVID-19) are being detected worldwide. The purpose of this paper is to provide a scientific reference for the global prevention and control of COVID-19. Methods: General demographic characteristics, epidemiological history, and clinical symptoms of COVID-19 were collected that had been reported on the websites of multiple Municipal Health Commissions in China. We herein describe distributions in time, place, and population of COVID-19. Results: As of midnight on February 10, 2020, the number of confirmed cases of COVID-19 in China was 42,638, and the province with the largest number of confirmed cases was Hubei (31728), followed by Guangdong (1177), Zhejiang (1117), and Henan (1105) province. The number of cases and the speed of confirmed cases in provinces other than Hubei were more moderate than those of the Hubei province. The median (interquartile range) age of patients with COVID-19 was 44 (33, 54) years, with a range of 10 months to 89 years. Conclusions: The COVID-19 epidemic should be considered a global threat and the steps for control include early diagnosis and treatment, as well as isolation.

[Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure].

Objective: To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients. Results: Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs(P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion: HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

[The death trend of children under 5 years old due to foreign body in airway in China from 1990 to 2017].

Objective: To analyze the current situation and the trend of the death due to foreign body in airway in children less than 5 years old in China from 1990 to 2017. Methods: Using the mortality data of foreign body in airway in China from 1990 to 2017 from the Global Disease Burden 2017 (data covered 31 provinces, autonomous regions, municipalities, as well as Hong Kong and Macau Special Administrative Regions, excluding Taiwan Province) to describe the death status of children under 5 years old due to foreign body in airway in China, and to calculate the relative change and 95% uncertainty interval (UI) of mortality rate and proportion of children under 5 years old due to foreign body in airway between 1990 and 2017. The robust linear regression was performed with the first-order lag of mortality, and the supremum Wald test was used to explore whether the mortality trend had obvious structural changes around a certain time point. Results: In 2017, the mortality rate of children under 5 years old due to foreign body in airway in China was 8.57/100 000 (95%UI: 7.41/100 000-9.57/100 000), and there was no significant difference between boys (9.05/100 000, 95%UI: 6.82/100 000-10.23/100 000) and girls (8.02/100 000, 95%UI: 7.02/100 000-9.12/100 000). The supremum Wald test showed that there was a structural change around the year of 2005 (P<0.001) in terms of the mortality rate of foreign body in the airway among children under 5 years old, which depicted a relatively stable trend before 2005 and a significant downward trend after 2005. Compared with 1990, the mortality rate of foreign body in airway among children, boys and girls under 5 years old in 2017 decreased by 49.32% (95%UI: 37.78%-65.41%), 41.22% (95%UI: 25.68%-68.26%) and 56.91% (95%UI: 44.78%-66.70%), respectively; the mortality proportion of foreign body in airway among increased by 153.33% (95%UI: 75.99%-204.56%), 171.05% (95%UI: 48.75%-239.63%) and 137.90% (95%UI: 86.62%-198.09%), respectively; the rank of foreign body in airway in all disease increased by 6 and became the first leading cause of injury from the second. Conclusion: From 1990 to 2017, the mortality rate of foreign body in airway among children, boys and girls under 5 years old in China generally showed a downward trend. Compared with 1990, the mortality proportion of foreign body in airway among these population increased by a relatively large extent in 2017.

[Analysis on suicide mortality and self-inflicted injury/suicide hospital cases in China from 2006 to 2016].

Objective: To describe the epidemiological characteristics of suicide death and self-harm/suicide in China from 2006 to 2016. Methods: Data in this study are from the datasets of National Death Cause Surveillance from 2006 to 2016 and the National Injury Surveillance Dataset 2016. The age-standardized death rate based on the population census in 2000 was used to describe the trend of suicide over years. This study also described the epidemiological characteristics of suicide death and the demographic characteristics, suicide methods and severity of patients who sought medical help after committing suicide or self-inflicted injury in 2016. Results: Age-standardized suicide mortality had been declining from 9.23/100 000 in 2006 to 5.33/100 000 in 2016 by 42.25%. Suicide mortality increased with age. In 2016, the suicide mortality in China was 7.05/100 000, and among people over 85 years old was 49.49/100 000. In 2016, the dominant two suicide methods were poisoning (39.12%) and sharp injury (25.62%). The first leading method of suicide in rural population, urban population and young people aged 10-to 17-year-old was poisoning (65.13%), sharp injury (29.90%) and fall (25.47%), respectively. As age increased, the severity of suicide/self-inflicted injury increased. The proportions of serious cases among young people aged 10-to 17-year-old and older people aged 60 years old and above who sought medical help after committing suicide or self-inflicted injury were 4.88% and 26.86%, respectively. Conclusion: China's suicide mortality has been declining and special attention should be given to the suicide of old people.

[Characteristics of cardiometabolic risk factors of children and adolescents aged 6-17 years in seven cities in China from 2013 to 2015].

Objective: To describe characteristics of cardiometabolic risk factors of children and adolescents aged 6-17 years in 7 cities in China from 2013 to 2015. Methods: Data was from the China Child and Adolescent Cardiovascular Health (CCACH) study. 12 590 children and adolescents were selected from 24 schools (3 kindergartens, 7 primary schools, 7 junior high schools and 7 senior high schools) in seven cities (Changchun, Yinchuan, Beijing, Jinan, Shanghai, Chongqing and Tianjin) during 2013-2015 by using a stratified cluster random sampling method. The demographic characteristics, e.g. birth date, feed status and history of disease, were collected by questionnaires. Anthropometric measurements, i.e. weight, height, waistline, blood pressure, total cholesterol, fasting plasma glucose, triglyceride and high-density lipoprotein, were also collected. The detection rate of metabolic syndrome was calculated respectively according to "international diabetes federation standard " and "definition and prevention of metabolic syndrome in Chinese children and adolescents " . Results: The prevalence of cardiometabolic risk factors such as obesity, hypertension, hyperglycemia and dyslipidemia was 12.0%(1 497/12 491), 18.2%(2 193/12 035), 24.4%(3 028/12 422) and 15.8%(1 977/12 490), respectively. The prevalence of these four cardiometabolic risk factors in males was significantly higher than that in females (all P values<0.05). The prevalence of metabolic syndrome was 3.3%(272/8 328) with international diabetes federation 2007 definition and 5.4% (453/8 325) with Chinese definition among children above 10 years old. The prevalence of hypertension, hyperglycemia, hypertriglyceridemia, high total cholesterol, low high-density lipoproteincholesterol and dyslipidemia increased with the change of obesity type from non-obesity to complex obesity (all P values<0.001). Conclusion: The prevalence of cardiometabolic risk factors was still high in children and adolescents, which has become an important factor threatening the healthy growth of children and adolescents.

[The analysis of the trend of mortality rate of falls in China from 1990 to 2015].

Objective: To understand the status and trend of the mortality rate of falls in different gender, age groups and provinces in China from 1990 to 2015, to explore the number of subgroups of different trends in all provinces, and to determine the different trajectory of subgroups. Methods: Using the mortality rate of falls in China from 1990 to 2015 from the Global Disease Burden 2015 (data covers 31 provinces, autonomous regions, municipalities, as well as Hong Kong and Macau Special Administrative Regions, excluding Taiwan Province) to describe the status of the mortality rate of falls in different gender, age group and provinces in China 2015 and to calculate the corresponding relative change. Using log linear model to calculate the annual percent changes from 1990 to 2015. The number of subgroups and corresponding characteristics of different trajectories were analyzed by trajectory model to analyze with four indicators, P value of the coefficient of independent variables with different orders in all subgroups, Bayesian information criterion, log Bayes factor and average posterior probability. Results: In 2015, the age standardized mortality rate of falls in China was 8.38/100 000 (95%UI: 5.54/100 000-9.30/100 000), which was higher in men (10.81/100 000, 95%UI: 6.58/100 000-12.14/100 000) than that in women (5.84/100 000,95%UI: 3.41/100 000-6.62/100 000), and in the elderly aged 70-year-old and above (60.50/100 000, 95%UI: 38.36/100 000-67.75/100 000) than that in other age groups. From 1990 to 2015, there was no obvious change in the age standardized mortality rate of falls in total population, men and women with average percent change about 0.37 (95%UI: -0.08-0.83), 0.45 (95%UI: 0.05-0.84) and 0.31 (95%UI: -0.26-0.87) respectively, but a significant decrease and increase could be seen in children under 15-year-old, especially under 5-year-old with average percent change about -4.07 (95%UI: -5.62--2.51), and the elderly aged 70-year-old and above with average percent change about 1.89 (95%UI: 1.42-2.37) respectively. Four types of trajectories could be categorized for different trends of age standardized mortality rate of falls in all provinces. The first group had the lowest fall mortality with a downward trend. The fall mortality was close in the second and third group but with different change tendency, a decreasing propensity in the former and an increasing one in the latter. The fourth group had the highest fall morality with obvious fluctuation. Conclusion: There was no significant change in the age standardized mortality rate of falls in China from 1990 to 2015. However, the trend of age standardized mortality rate of falls varied in different age and provinces during the same period of time.

Hybrid capture-based genomic profiling of circulating tumor DNA from patients with estrogen receptor-positive metastatic breast cancer.

BACKGROUND: Genomic changes that occur in breast cancer during the course of disease have been informed by sequencing of primary and metastatic tumor tissue. For patients with relapsed and metastatic disease, evolution of the breast cancer genome highlights the importance of using a recent sample for genomic profiling to guide clinical decision-making. Obtaining a metastatic tissue biopsy can be challenging, and analysis of circulating tumor DNA (ctDNA) from blood may provide a minimally invasive alternative. PATIENTS AND METHODS: Hybrid capture-based genomic profiling was carried out on ctDNA from 254 female patients with estrogen receptor-positive breast cancer. Peripheral blood samples were submitted by clinicians in the course of routine clinical care between May 2016 and March 2017. Sequencing of 62 genes was carried out to a median unique coverage depth of 7503×. Genomic alterations (GAs) in ctDNA were evaluated and compared with matched tissue samples and genomic datasets of tissue from breast cancer. RESULTS: At least 1 GA was reported in 78% of samples. Frequently altered genes were TP53 (38%), ESR1 (31%) and PIK3CA (31%). Temporally matched ctDNA and tissue samples were available for 14 patients; 89% of mutations detected in tissue were also detected in ctDNA. Diverse ESR1 GAs including mutation, rearrangement and amplification, were observed. Multiple concurrent ESR1 GAs were observed in 40% of ESR1-altered cases, suggesting polyclonal origin; ESR1 compound mutations were also observed in two cases. ESR1-altered cases harbored co-occurring GAs in PIK3CA (35%), FGFR1 (16%), ERBB2 (8%), BRCA1/2 (5%), and AKT1 (4%). CONCLUSIONS: GAs relevant to relapsed/metastatic breast cancer management were identified, including diverse ESR1 GAs. Genomic profiling of ctDNA demonstrated sensitive detection of mutations found in tissue. Detection of amplifications was associated with ctDNA fraction. Genomic profiling of ctDNA may provide a complementary and possibly alternative approach to tissue-based genomic testing for patients with estrogen receptor-positive metastatic breast cancer.

Reliable passivation of black phosphorus by thin hybrid coating.

Black phosphorus (BP) possesses several extraordinary physical properties, which include in-plane anisotropy, thickness dependent direct bandgap and high carrier mobility. These physical properties make BP highly desirable from the point of view of fundamental science and modern optoelectronics applications. The excitement about this material has always been accompanied by unreserved skepticism due to its extraordinary degradation under ambient conditions. Here we show ambient degradation of exfoliated BP can be effectively suppressed using thin layer of hybrid metal organic chemical vapor deposition coating of boron nitride (BN) followed by atomic layer deposition coating of Al2O3. We have extensively studied the time dependent surface, optical and electrical properties of BP encapsulated by BN and/or Al2O3 using nanoscale infrared imaging and I-V characterizations. Our results show hybrid thin layer (∼5 nm) BN/Al2O3 coated BP exfoliated on SiO2 substrate is protected from degradation in ambient for over 6 months, much longer than those coated only by BN or Al2O3 layers. Our theoretical modeling of the experimental degradation growth pattern shows that the influence of neighboring elements on the degradation of a given element is minimal for BP flakes with hybrid coating. Electrical characterization further confirms the effectiveness of BN/Al2O3 as encapsulation layer and gate dielectrics with minor changes after several weeks.

Chemically exfoliating large sheets of phosphorene via choline chloride urea viscosity-tuning.

Exfoliation of two-dimensional phosphorene from bulk black phosphorous through chemical means is demonstrated where the solvent system of choice (choline chloride urea diluted with ethanol) has the ability to successfully exfoliate large-area multi-layer phosphorene sheets and further protect the flakes from ambient degradation. The intercalant solvent molecules, aided by low-powered sonication, diffuse between the layers of the bulk black phosphorus, allowing for the exfoliation of the multi-layer phosphorene through breaking of the interlayer van der Waals bonds. Through viscosity tuning, the optimal parameters (1:1 ratio between the intercalant and the diluting solvent) at which the exfoliation takes place is determined. Our exfoliation technique is shown to produce multi-layer phosphorene flakes with surface areas greater than 3 µm2 (a factor of three larger than what has previously been reported for a similar exfoliation method) while limiting exposure to the ambient environment, thereby protecting the flakes from degradation. Characterization techniques such as optical microscopy, Raman spectroscopy, ultraviolet-visible spectroscopy, and (scanning) transmission electron microscopy are used to investigate the quality, quantity, and thickness of the exfoliated flakes.