Effectiveness of a whole-process health education model among inpatients with ascites type of advanced schistosomiasis / 中国血吸虫病防治杂志

Objective To evaluate the effectiveness of a whole-process health education model among inpatients with ascites type of advanced schistosomiasis. Methods A “admission-hospitalization-discharge” whole-process health education model was created, 101 inpatients with ascites type of advanced schistosomiasis were given the whole-process health education. The scores of schistosomiasis control knowledge, attitudes towards schistosomiasis control and healthy behaviors, and awareness of schistosomiasis control knowledge, correct rate of attitudes towards schistosomiasis control and correct rate of healthy behaviors were compared among inpatients with ascites type of advanced schistosomiasis before and after implementation of the whole-process health education. Results The scores of schistosomiasis control knowledge, schistosomiasis control attitudes and healthy behaviors were all significantly higher among inpatients with ascites type of advanced schistosomiasis after implementation of the whole-process health education than before implementation (Z = −7.688, −3.576 and −4.328, all P values < 0.01). In addition, the awareness of schistosomiasis control knowledge increased from 54.3% to 82.7% (χ2 = 188.886, P < 0.01), and the correct rate of attitudes towards schistosomiasis control increased from 88.4% to 98.0% (χ2 = 22.001, P < 0.01), while the correct rate of healthy behaviors increased from 48.2% to 59.7% (χ2 = 11.767, P < 0.01). Conclusions The whole-process health education model may remarkably improve the awareness of schistosomiasis control knowledge and promote the formation of positive attitudes towards schistosomiasis control and correct behaviors among inpatients with ascites type of advanced schistosomiasis, which is of great significance to facilitate patients’ cure.

A new form of familial platelet disorder caused by germline mutations in RUNX1 in a pedigree / 中华内科杂志

Objective: To investigate the clinical and biological characteristics of familial platelet disorder (FPD) with germline Runt-related transcription factor (RUNX) 1 mutations. Methods: Patients diagnosed with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) with RUNX1 mutations from February 2016 to December 2021 in Wuhan No.1 Hospital underwent pedigree analysis and were screened for gene mutations (somatic and germline). Patients diagnosed with FPD with germline RUNX1 mutations were enrolled and evaluated in terms of clinical characteristics and biological evolution. Bioinformatics analysis was used to assess the pathogenicity of mutations and to analyze the effect of mutated genes on the function of the corresponding protein. Results: Germline RUNX1 mutations were detected in three out of 34 patients suffering from MDS/AML who had RUNX1 mutations. A pedigree of FPD with RUNX1 (RUNX1-FPD) c.562A>C and RUNX1 c.1415T>C mutations was diagnosed, and the mutations were of patrilineal origin. Bioinformatics analysis indicated that the locus at positions 188 and 472 in the AML-1G type of RUNX1 was highly conserved across different species, and that variations might influence functions of the proteins. The mutations were evaluated to be highly pathogenic. Of the nine cases with germline RUNX1 mutations: two patients died due AML progression; one case with AML survived without leukemia after transplantation of hemopoietic stem cells; four patients showed mild-to-moderate thrombocytopenia; two cases had no thrombocytopenia. During the disease course of the proband and her son, mutations in RUNX1, NRAS and/or CEBPA and KIT appeared in succession, and expression of cluster of differentiation-7 on tumor cells was enhanced gradually. None of the gene mutations correlated with the tumor were detected in the four cases not suffering from MDS/AML, and they survived until the end of follow-up. Conclusions: RUNX1-FPD was rare. The mutations c.562A>C and c.1415T>C of RUNX1 could be the disease-causing genes for the family with RUNX1-FPD, and these mutations could promote malignant transformation. Biological monitoring should be carried out regularly to aid early intervention for family members with RUNX1-FPD.

Clinical Analysis of Patients with Blastic Plasmacytoid Dendritic Cell Neoplasm / 中国实验血液学杂志

OBJECTIVE@#To explore the clinical characteristics, treatment, and prognosis of patients with blastic plasmacytoid dendritic cell neoplasm(BPDCN).@*METHODS@#Clinical data of 5 patients diagnosed with BPDCN in Wuhan First Hospital and Wuhan Tongji Hospital from June 2016 to November 2021 were retrospectively analyzed.@*RESULTS@#Among the 5 patients, 3 were male and 2 were female, with a median age of 28(10-52) years old. Four patients showed obvious skin damage at the initial diagnosis; the other one showed clinical manifestations of acute leukemia rather than obvious skin damage at the initial diagnosis, but infiltrated skin when the disease relapsed after treatment. Other infiltration sites of lesions included bone marrow (2/5), peripheral blood (2/5), lymph nodes (3/5), liver and spleen (2/5). All patients had no clinical manifestation of central nervous system infiltration. Tumor cell specific immune markers CD4, CD56, CD123 were all positive, and the median Ki-67 index was 70%. TET2, ASXL1 and NRAS gene mutations were found respectively in 3 patients by next-generation sequencing technique (NGS). ALL-like, AML-like and invasive NK/T cell lymphoma-like first-line induction chemotherapy regimens were used for the patients. One patient died of severe complications during the early stage of chemotherapy, 3 patients were evaluated as CR, and 1 patient was evaluated as PR. 2 patients were recurred and progressed after induction of chemotherapy, and one of them was evaluated as CR after re-treatment. One patient received autologous hematopoietic stem cell transplantation (auto-HSCT) and got long-term survival (OS 87 months). 3 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), of which one died of transplantation related complications, and 2 cases survived. The median follow-up time of 4 patients with evaluable efficacy was 28.5(9-84) months, the median OS time was 31.5(10-87) months.@*CONCLUSION@#BPDCN is a highly heterogeneous malignant tumor with a poor prognosis. HSCT, especially allo-HSCT can significantly improve the prognosis of BPDCN patients.

Establishment of Poly （I∶C）-induced Cytokine Storm Model in Mice and Intervention Effect of Artesunate and Qingfei Paidu Decoction / 中国实验方剂学杂志

ObjectiveTo observe the intervention effect of artesunate （ART） and Qingfei Paidu decoction （QFPD） on the mouse model of cytokine storm （CS） induced by viral mimic Poly （I∶C）. MethodEighty-four SPF male BALB/c mice were randomly divided into seven groups， with 12 mice in each group. Mice， except for those in the blank group （n=12）， were subjected to CS model induction by tail vein injection of Poly （I∶C） at 15 mg·kg-1， followed by drug treatments of low-dose ART （ART-l， 10 mg·kg-1）， medium-dose ART （ART-m， 20 mg·kg-1）， high-dose ART （ART-h， 40 mg·kg-1）， Qingfei Paidu Decoction （QFPD， 2.4 g·kg-1）， and dexamethasone （DXM， 10 mg·kg-1）. After 6 hours， lung tissues， bronchoalveolar lavage fluid （BALF）， spleen， lung， and peripheral blood were collected. The lung and spleen indexes were calculated and the number of inflammatory cells in BALF was detected. The pathological changes in lung tissues were observed by hematoxylin-eosin （HE） staining and the levels of tumor necrosis factor-α （TNF-α）， interferon-γ （IFN-γ）， interleukin-1β （IL-1β）， and IL-6 in BALF were detected by enzyme-linked immunosorbent assay （ELISA）. The expression of immune cells in BALF and peripheral blood was detected by flow cytometry. ResultThe analysis of lung and spleen indexes showed that compared with the blank group， the model group showed increased lung and spleen indexes to varying degrees （P<0.05）. Compared with the model group， the ART groups showed reduced spleen index （P<0.05） and the ART-l group showed reduced lung index （P<0.05）. Additionally， the QFPD group showed reduced lung and spleen indexes （P<0.05）. ELISA results showed that except for TNF-α， the levels of IFN-γ， IL-1β， and IL-6 in the model group increased compared with those in the blank group （P<0.05）. Compared with the model group， the ART-l group and the QFPD group showed reduced content of TNF-α （P<0.05）， and all groups with drug intervention showed reduced content of IFN-γ， IL-1β， and IL-6 （P<0.05）. The number of inflammatory cells in BALF showed a downward trend in the model group， and the number of cells increased in the groups with drug intervention except for the DXM group （P<0.05）. Flow cytometry showed that compared with the blank group， the model group showed decreased number of CD3 in the peripheral blood （P<0.05）， increased Ly-6G and F4/80 （P<0.05）， decreased expression of CD45， CD3， and F4/80 in BALF （P<0.05）， and increased expressions of Ly-6G （P<0.05）. Compared with the model group， the ART groups and QFPD group showed increased CD45 content in peripheral blood （P<0.05）， decreased Ly-6G and F4/80 content （P<0.05）， increased CD45 and F4/80 content in BALF （P<0.05）， and decreased expression of Ly-6G （P<0.05）. ConclusionART and QFPD have a good protective effect on Poly （I∶C）-induced CS in mice， and the mechanism is related to the effective intervention in immune cell disorder.

Clinical analysis of seven cases of hemophagocytic lymphohistiocytosis secondary to cutaneous T-cell lymphoma / 中华皮肤科杂志

Objective:To investigate clinical and laboratory characteristics of secondary hemophagocytic lymphohistiocytosis (sHLH) associated with secondary cutaneous T-cell lymphoma (CTCL) .Methods:CTCL patients with clinically suspected sHLH were collected from Department of Hematology, Wuhan No.1 Hospital from January 2016 to October 2021, and were evaluated according to the HLH-2004 diagnostic criteria and HScore.Results:Seven CTCL patients were confirmedly diagnosed with sHLH, including 2 with primary cutaneous γδT-cell lymphoma (PC-GDTCL) , 3 with cutaneous extranodal natural killer/T-cell lymphoma (C-ENKTCL) , and 2 with primary cutaneous anaplastic large cell lymphoma (PC-ALCL) . All the 7 patients received chemotherapy, but 6 died finally, and the median overall survival duration was 26.5 days (range: 14 - 60 days) after the confirmed diagnosis of CTCL complicated by sHLH. HLH-related gene mutations, which were located in the PRF1 and LYST genes, were identified in 2 patients; lymphoma-related gene mutations were identified in the KRAS and KMT2D genes in 1 PC-GDTCL patient,and in the JAK3 and SAMHD1 genes in another PC-GDTCL patient.Conclusions:CTCL complicated by sHLH usually progresses rapidly, so early diagnosis and treatment are needed. Bone marrow biopsy and mutation screening of lymphoma- and HLH-related genes at initial diagnosis and during disease progression may facilitate early diagnosis.

Measures of anterior hip coverage in adult patients with hip dysplasia / 中华骨科杂志

Hip dysplasia occurs when the acetabulum does not cover the femoral head sufficiently, causing hip instability and pain. Acetabular coverage of the femoral head is an important index to evaluate the stability of the hip joint. Further, anterior hip coverage is as important as lateral coverage in the stability of the hip joint. However, the measurements of anterior hip coverage received less attention and enjoyed less consensus than those of lateral hip coverage. The existing measurements of the adult hip joint can be divided into 2 categories, namely three-dimensional (3D) measurements and two-dimensional (2D) measurements. 2D measurements include the anterior central-edge (ACE) angle and the anterior acetabular head index on false-profile radiographs, the ACE angle on sagittal CT radiographs, and the anterior wall index, the rule of thirds, the crossover sign and the crossover index on standing pelvic anteroposterior radiographs. Among the above indexes, the ACE angle and anterior acetabular head index can be directly measured on false-profile radiographs, which can reproduce the weight-bearing function of the standing hip joint. Currently, these indexes are widely used in the clinical practice to determine the stability of hip joints. Some evidence indicated correlation of these indexes with satisfied clinical outcomes. The ACE angle on CT sagittal radiographs acquired from CT data reproduces the patients' status in the supine position. It is used for determining the potential femoroacetabular impingement after hip correction. The anterior wall index, rule of thirds, crossover sign and crossover index are obtained on standing pelvic radiographs, which can reproduce the weight-bearing status of hip joints and reduce the need for a false-profile radiograph. The surgeon can reach a preliminary judgment from these measurements in a short time. However, due to some potential influence factors, the accuracies of these 2D measurement indexes are limited. Further, their clinical relevance according to published studies is not consistent. 3D measurements include real 3D measurement based on CT and the simulated 3D (2.5D) measurement based on statistical models. The details of acetabular morphology are most accurately described in 3D measurements. They are used to determine the influence of acetabular osteotomy on the range of motion and to predict the risk of postoperative iatrogenic femoroacetabular impingement. Although 2.5D measurement based on statistical models is more accurate than that based on 2D measurements, it is still based on the anteroposterior radiographs of the pelvis. Therefore, the drawback caused by using anteroposterior radiographs cannot be eliminated completely. In summary, the ACE angle on false-profile radiographs is the most commonly method in clinical practice.

Effect of Systemic Administration of Granulocyte-Colony Stimulating Factor on Rate of Fracture Healing of Bone Defect in Goats as Animal Model

@#Granulocyte-colony stimulating factor (G-CSF) serves as an important cytokine in haematopoiesis; released at both physiological and pathological conditions by a range of cells. We hypothesized that the systemic administration of G-CSF would produce an accelerated fracture-healing rate in non-union bone defects; thus, potentially leading to useful clinical applications. Ten male adult Katjang goats, weighing about 15-26 kilograms were randomly chosen and a tibial bone defect was induced in each animal. The defect was maintained by internal fixation with a titanium plate and reinforced by an external fiberglass cast. Post-operative radiographs were performed twice weekly and radiographic assessments were performed by evaluating the bridging and union measurements through a validated method. In the treatment group, the time for bridging and union exhibited statistically significant differences when compared with a control group. The outcomes of the present study establishing a notion that administration of G-CSF besides inducing haematopoiesis, promotes healing of fractures and non-union bone defects as well.

Alveolar Ridge Preservation after Tooth Extraction and Replacement with Fibre reinforced Composite Bridge in a Young Patient: A Case Report

ABSTRACT@#Alveolar ridge preservation is a surgical procedure aimed to preserve the alveolar bone after tooth extraction to eliminate or reduce the need for bone augmentation during implant placement. It includes the use of membrane that is either being used alone or in combination with a bone replacement graft. This case report describes the technique of alveolar ridge preservation after tooth extraction using a xenogenic bone graft combined with a resorbable collagen membrane, and the fabrication of an anterior fibre-reinforced composite (FRC) bridge in an 18-year-old male patient. This treatment allows him to have a good preservation of the volume and architecture of the alveolar ridge as well as soft tissues and temporarily replace a missing anterior tooth until a definitive restoration can be achieved.

Comparation between Guidance for Judicial Expertise of Medical Malpractice and Medical Association Identification Rules of Medical Damage / 法医学杂志

On the basis of retaining the technical identification system of medical negligence, the Medical Association Identification Rules of Medical Damage mainly provides technical services for various types of conciliation work about doctor-patient dispute. Its identification work is still influenced by the thinking of medical negligence technical identification and has certain administrative color. Guidance for Judicial Expertise of Medical Malpractice is mainly reflected that the trial of civil cases and pre-trial mediation of courts need service. Its procedures and evidence review are strictly required by the litigation rules and has the characteristics of public legal services provided as a third-party neutral institution. Technical identification of medical damage, whether organized by the Medical Association or the forensic identification institutions, is carried out under the background of the current Regulations on the Prevention and Treatment of Medical Disputes and the Civil Code of the People's Republic of China; both have a corresponding positive role in regulating the medical damage identification activities, and have also laid a certain foundation for the establishment of a unified identification system in the future in China. To understand the different characteristics of the medical damage identification rules issued by the Chinese Medical Association and the Ministry of Justice, and to improve the understanding of the standardization of the forensic identification of medical damage, a comparative study was conducted on Medical Association Identification Rules of Medical Damage and Guidance for Judicial Expertise of Medical Malpractice from seven aspects: Concept and legal status, entrust of identification, identification acceptance, identification procedures, identification presentation meeting, theory of medical malpractice evaluation, consequences and causality of medical damage. The subject of evaluation, the function of evidence review, the role of consulting experts, the technical standard system of malpractice evaluation and other contents were emphatically analyzed.

Effects of powder size and pre-sintering heating rate on dental recycled zirconia / 中华口腔医学杂志

Objective: To evaluate the effects of pre-sintering heating rate and powder size on dental recycled zirconia. Methods: Recycled zirconia powders were sieved to obtain the large (50 μm<particle diameter≤125 μm) and small (particle diameter≤50 μm) particles, these powders were then formed into green bodies. According to the pre-sintering heating rates, the recycled-zirconia green bodies were divided into 3 groups: group A, pre-sintering heating rate of 2 ℃/min; group B, pre-sintering heating rate of 5 ℃/min; group C, pre-sintering heating rate of 8 ℃/min. The relative density open porosity and machinability of the recycled zirconia pre-sintered bodies were evaluated and compared with the commercial zirconia pre-sintered bodies. Zirconia pre-sintered bodies were then fully sintered according to the manufacturer's instructions. The relative density, open porosity, linear shrinkage and flexural strength of fully sintered zirconia were further compared. The microstructure of fracture surfaces and the crystalline structure were analyzed by scanning electron microscope and X-ray diffractometer, respectively. Results: With the same particle size, the recycled zirconia pre-sintered at different heating rates showed no significant differences in the relative densities, and the open porosities (P>0.05). When the pre-sintering heating rates were 2 ℃/min, 5 ℃/min, and 8 ℃/min, the flexural strengths of the large-particle recycled zirconia were (421.2±54.7), (444.2±70.1) and (427.5±68.4) MPa, the flexural strengths of the small-particle recycled zirconia were (750.1±74.1), (777.2±95.5) and (746.7±73.0) MPa, respectively. The flexural strength of commercial zirconia was (988.4±129.8) MPa. The flexural strengths of the recycled zirconia were significantly lower than that of the commercial zirconia (P<0.05). At the same pre-sintering heating rate, the flexural strengths of the small-particle recycled zirconia were significantly higher than that of the large-particle recycled zirconia (P<0.05). Conclusions: Compared with the large particles, small-particle recycled zirconia powders can effectively improve the properties of recycled zirconia, while the pre-sintering heating rate has no effect on the properties of the recycled zirconia.

Evaluation of eCura scoring system for treatment strategy selection after non-curative endoscopic resection of early gastric cancer / 中华消化内镜杂志

Objective:To evaluate the adjuvant role of the eCura scoring system in selecting appropriate treatment strategies after non-curative endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) patients.Methods:The clinicopathological data of 110 EGC patients who underwent non-curative ESD at Fujian Provincial Hospital from January 2015 to June 2019 were retrospectively analyzed. According to the eCura score, patients were divided into three lymph node metastasis (LNM) risk groups: low-risk group (79 cases), middle-risk group (22 cases), and high-risk group (9 cases). The receiver operator characteristic (ROC) curve analysis was used to test the diagnostic efficacy of eCura scoring system in predicting LNM. Logistic regression analysis was used to explore the influence of risk stratification of eCura scoring system on LNM. Kaplan-Meier method was used to evaluate cancer survival rate, which was then compared with log-rank test.Results:Thirty-five patients underwent additional standard surgery after ESD, including 22 in the low-risk group, 8 in the middle-risk group, and 5 in the high-risk group. Among them, 5 cases had LNM, including 1 case in the low-risk group and the middle-risk group respectively and 3 cases in the high-risk group. The area under the ROC curve was 0.857 (95% CI: 0.697-0.952, P=0.001), and when the cut-off value of the eCura score was set at 3, the Yuden index reached the maximum value of 0.7, with the corresponding sensitivity and specificity of 80% and 90%, respectively. Logistic regression analysis showed that the probability of LNM in the middle-risk group was about 3.00 times (95% CI: 0.17-54.57, P=0.458) as high as that in the low-risk group, and the probability of LNM in the high-risk group was about 31.50 times (95% CI: 2.14-463.14, P=0.012) of that in the low-risk group. The follow-up time was 12 to 58 months, and the median follow-up time was 40 months. There were 10 cases of recurrence, including 4 cases in the low-risk group, 3 cases in the middle-risk group and 3 cases in the high-risk group, of which 2 cases in the low-risk group were from those of additional standard surgery after ESD, and the remaining 8 cases were from those who did not receive additional standard surgery after ESD. Kaplan-Meier survival curve analysis showed that the survival rate of patients with additional surgery in the low-risk group was similar to that of patients without ( P=0.319), and the survival rate of patients with additional surgery in the middle-risk group was also similar to that of patients without ( P=0.296). The survival rate of patients with additional surgery in the high-risk group was significantly higher than that of those without ( P=0.013). Conclusion:The eCura scoring system can assist the selection of treatment strategies after non-curative resection of EGC, and can accurately predict the risk of subsequent LNM and recurrence. Close follow-up may be an acceptable option for patients with low risk of LNM, and additional standard surgical treatment may be more conducive to improving the prognosis in patients with high risk of LNM.

Ixazomib-Based Regimen Followed by Autologous Hematopoietic Stem Cell Transplantation in the Treatment of POEMS Syndrome / 中国实验血液学杂志

OBJECTIVE@#To investigate the safety and efficacy of a new proteasome inhibitor Ixazomib followed by autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of POEMS syndrome.@*METHODS@#The clinical manifestations, diagnosis and treatment process and follow-up results of 4 patients with POEMS syndrome who were treated with Ixazomib-based regimen combined with AHSCT in Wuhan No.1 Hospital from February 2018 to July 2020 were analyzed retrospectively. All patients were male, aged from 37-54 years old, with varying degrees of peripheral neuropathy, organ enlargement (liver, spleen or lymph nodes), circulatory overload (peripheral edema and/or pleural effusion), osteosclerosis, endocrine diseases (thyroid, gonads, etc.), skin changes (pigmentation, hemangioma, white nails, etc.), M protein, papilledema and other clinical manifestations and characteristics at the time of initial treatment. Two patients were pathologically diagnosed as hyaline vascular Castleman disease by lymph node biopsy. Three patients underwent lumbar puncture examinations and all showed elevated cerebrospinal fluid protein. All patients received at least 2 cycles of sequential AHSCT after induction chemotherapy based on ixazomib. The follow-up time was 10-28 months, and the median follow-up time was 16 months.@*RESULTS@#All cases survived. The complications were controllable during the treatment. Moreover, the clinical symptoms related to the disease were improved to a certain extent after the treatment. The levels of vascular endothelial growth factor (VEGF) showed a gradual decline.@*CONCLUSION@#Ixazomib combined with AHSCT is safe and effective in the treatment of POEMS syndrome.

Acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache (CH).@*METHODS@#One hundred and eighty patients with episodic CH were randomly divided into a combined group (60 cases, 3 cases dropped off)，an acupuncture group (60 cases, 2 cases dropped off) and a sphenopalatine ganglion group (60 cases, 2 cases dropped off and 1 case was removed). The patients in the acupuncture group were treated with conventional acupuncture at Touwei (ST 8), Yintang (GV 24+), Yangbai (GB 14), Hegu (LI 4), etc., once a day, 6 times a week. The patients in the sphenopalatine ganglion group were treated with acupuncture at sphenopalatine ganglion, once every other day, 3 times a week. On the basis of the conventional acupuncture, the combined group was treated with acupuncture at sphenopalatine ganglion once every other day. Two weeks were taken as a course of treatment, and 3 courses of treatment were required in the 3 groups. The score of visual analogue scale (VAS), the number of headache attacks per week, the duration of each headache attack and the score of migraine-specific quality of life questionnaire version 2.1 (MSQ) were observed before and after treatment and in follow-up of 3 months after treatment. The clinical efficacy of each group was compared.@*RESULTS@#After treatment and in follow-up, the VAS score of headache, the number of headache attacks per week, the duration of each headache attack, and each various scores and the total score of MSQ of each group were lower than those before treatment (P<0.01). Except that the number of headache attacks per week in the combined group was lower than the sphenopalatine ganglion group (P<0.01), other indexes in the combined group were lower than the other two groups (P<0.05, P<0.01). The total effective rate in the combined group was 93.0% (53/57), which was higher than 75.9% (44/58) in the acupuncture group and 73.7% (42/57) in the sphenopalatine ganglion group（P<0.05, P<0.01).@*CONCLUSION@#Acupuncture at sphenopalatine ganglion combined with conventional acupuncture could reduce the degree of pain in patients with episodic CH, reduce the number and duration of headache attacks, and improve the quality of life of patients. It is more effective than simple conventional acupuncture or acupuncture at sphenopalatine ganglion alone.

Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation

INTRODUCTION@#This study aimed to identify risk factors that are associated with increased mortality that could prompt a serious illness conversation (SIC) among patients with chronic kidney disease (CKD).@*METHODS@#The electronic health records of adult CKD patients admitted between August 2018 and February 2020 were retrospectively reviewed to identify CKD patients with >1 hospitalisation and length of hospital stay ≥4 days. Outcome measures were mortality and the duration of hospitalisation. We also assessed the utility of the Cohen's model to predict 6-month mortality among CKD patients.@*RESULTS@#A total of 442 patients (mean age 68.6 years) with median follow-up of 15.3 months were identified. The mean (standard deviation) Charlson Comorbidity Index [CCI] was 6.8±2.0 with 48.4% on chronic dialysis. The overall mortality rate until August 2020 was 36.7%. Mortality was associated with age (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.29-1.77), CCI≥7 (1.58, 1.08-2.30), lower serum albumin (1.09, 1.06-1.11), readmission within 30-day (1.96, 1.43-2.68) and CKD non-dialysis (1.52, 1.04-2.17). Subgroup analysis of the patients within first 6-month from index admission revealed longer hospitalisation stay for those who died (CKD-non dialysis: 5.5; CKD-dialysis: 8.0 versus 4 days for those survived, P<0.001). The Cohen's model demonstrated reasonable predictive ability to discriminate 6-month mortality (area under the curve 0.81, 95% CI 0.75-0.87). Only 24 (5.4%) CKD patients completed advanced care planning.@*CONCLUSION@#CCI, serum albumin and recent hospital readmission could identify CKD patients at higher risk of mortality who could benefit from a serious illness conversation.

The effects of periacetabular osteotomy in the treatment of borderline developmental dysplasia of the hip / 中华骨科杂志

Objective:To investigate the effects of periacetabular osteotomy (PAO) in treating borderline developmental dysplasia of the hip (DDH).Methods:The patients with borderline DDH [lateral center-edge angle (LCEA): 18°-25°) who received PAO with follow-up duration for more than 2 years from January 2011 to January 2018 in our hospital were retrospectively analyzed. The patients in the control group were matched on a 1∶2 ratio based on gender, age, body mass index (BMI) and follow-up duration. There were 66 patients in the 0°≤LCEA<10° group and 66 patients in the 10°≤LCEA<18° group. The LCEA, anterior center-edge angle (ACEA), T?nnis angle, femoral head extrusion index, femoro-epiphyseal acetabular roof (FEAR) index, femoral anteversion angle, West Ontario and McMaster University (WOMAC) index and International Hip Outcome Tool (iHOT-12) were compared among the three groups before operation and the last follow-up.Results:In the preoperative 18°≤LCEA<25° group, three of 33 patients (9.1%) had LCEA, because the only imaging feature suggested acetabular dysplasia, while other parameters were evaluated within the normal range. There were 17 patients with ACEA <20° (51.5%), 24 patients (72.7%) with T?nnis angle >10°, 12 patients (36.4%) with ACEA <20° and T?nnis angle >10°. The positive rate of posterior wall signs in the 18°≤LCEA<25° group (72.7%) was lower than that in the 10°≤LCEA<18° group (77.3%) and the 0°≤LCEA<10° group (90.9%) with statistically significant difference (χ 2=6.417, P=0.040) at preoperation. The positive rate of cross sign (27.3%) and ischial spine sign (48.5%) in the 18°≤LCEA<25° group were higher than those in the 10°≤LCEA<18° group (10.6% and 18.2%, respectively, χ 2=7.002, P=0.030) and the 0°≤LCEA<10° groups (9.1% and 13.6%, respectively, χ 2=16.497, P<0.001). The FEAR index in the 18°≤LCEA<25° group (3.7±8.0) lower than that in the 10°≤LCEA<18° group (4.3±7.9) and the 0°≤LCEA<10° group (11.0±8.8) with significant difference ( F=12.703, P<0.001). In the 18°≤LCEA<25° group, postoperative LCEA increased from 20.4°±1.8° to 37.8°±7.1°, ACEA increased from 18.3°±7.8° to 36.3°±6.3°. T?nnis angle decreased from 12.7°±6.2° to -5.6°±9.2°, the femoral head extrusion index decreased from 22.9%±6.7% to 10.7%±12.2%, the WOMAC index decreased from 20.1±13.4 to 6.0±6.3, and the iHOT-12 score increased from 50.2±19.9 to 90.0±13.7. The above difference before and after surgery was statistically significant ( P<0.05). At the last follow-up, the WOMAC score in the 18°≤LCEA<25° group was 6.0±6.3, wich was less than 10°≤LCEA<18° group (9.3±9.6) and 0°≤LCEA<10° group (12.0±16.0) ( F=6.515, P=0.002). The iHOT-12 score in the 18°≤LCEA<25° group was 90.0±13.7, which was greater than 10°≤LCEA<18° group (77.7±17.3) and 0°≤LCEA<10° group (78.1±20.5) ( F=15.833, P<0.001). Conclusion:After 2 years follow-up, PAO significantly improved bone coverage of femoral head and hip function in patients with borderline DDH. Before surgery, we should pay attention to the comprehensive evaluation of different radiological parameters of the acetabulum, to make better preoperative planning.

Analysis of prevalence and risk factors of overweight and obesity among children and adolescents in Jiangxi Province / 中国学校卫生

Objective@#To investigate prevalence and influencing factors of overweight and obesity among children and adolescents in Jiangxi Province, and to provide the basis for strategies for prevention and treatment of overweight and obesity.@*Methods@#Using stratified random cluster sampling ,a total of 77 780 primary and middle school students in 11 districts of Jiangxi Province were investigated with physical examination and questionnaire during March to November in 2019.@*Results@#The detection rates of overweight and obesity of children and adolescents in Jiangxi province were 20.5% and 8.4%, respectively. Which decreased with the increase of the learning stage（ χ 2=178.65, 389.86）,with significantly higher in boys and urban areas （ χ 2=1 061.06, 504.21;56.17, 34.14）（ P ＜0.01）.In different economic areas, the detection rates of overweight and obesity in moderate economic area( 23.3 %, 9.7%) were the highest, followed by high economic area (21.1%, 8.7%) and low economic area(18.2%, 7.2%), and the differences were statistically significant（ χ 2=266.29, 143.90， P ＜0.01）.The results of multivariate Logistic regression analysis showed that in terms of social demography, overweight and obesity of children and adolescents in Jiangxi Province were associated with economic area, residence, learning stage and gender; in terms of dietary behavior, overweight of children and adolescents in Jiangxi Province was associated with consumption frequency of sugary drinks, sweets, fresh fruits and vegetables, and the influencing factors of obesity were consumption frequency of sweets and fresh fruits( P <0.05).@*Conclusion@#The situation of overweight and obesity of children and adolescents in Jiangxi Province is sorrisome, and comprehensive prevention and control should be carried out with the joint efforts of society, school and family.

Relationship between aggressive behavior and emotion management of middle school students in Bengbu / 中国学校卫生

Objective@#To explore the relationship between aggressive behavior and emotional management of middle school students.@*Methods@#A total of 1 046 middle and high school students in Bengbu were randomly selected by cluster sampling. Information was collected through the Children s Emotion Management Scales and Buss & Perry Aggression Questionnaire.@*Results@#The scores of emotional management of male students (11.74±2.25, 9.29±1.98) were higher than that of female students(11.19±2.11, 8.76±1.95)( t =4.06, 4.29, P <0.01), and the scores of anger management of grade 8 students (8.55±2.13) were lower than that of grade 9, grade 10 and grade 11 students(9.21±2.06, 9.14±1.73, 9.16±1.85)( F=3.53, P <0.01). The score on anger (18.42± 5.71 ) was high among male students (16.32±5.06) ( t=6.27, P <0.01) and the total score (78.48±16.39) was high among female students(75.78±17.79)( t=-2.55, P <0.01). The aggression level in grade 8 students (82.09±19.21) was significantly higher than grade 9, grade 10 and grade 11 students(76.57±16.83, 75.05±15.34, 74.42±13.09)( H=25.16, P <0.01). The results of correlation analysis showed that sadness management was negatively correlated with physical aggression, angry behavior, hostility and aggressive behavior( r=-0.10, -0.18, -0.08, -0.12, P <0.01), anger management was negatively correlated with physical aggression, verbal aggression, anger, hostility, and aggressive behavior( r=-0.25, -0.09, -0.36, -0.15, -0.29, P <0.05). Regression analysis showed, anger management was negatively associated with aggressive behaviors in both boys( B=-2.48, 95%CI =-3.17- -1.79 ) and girls( B=-2.93, 95%CI =-3.67--2.20), sadness management was negatively associated with girl s hostility( B= -0.26 , 95%CI =-0.54-0.01)( P <0.01).@*Conclusion@#Higher level of emotional management, less aggressive behavior. Emotional management improvement among middle school students can effectively prevent and reduce the occurrence of aggressive behavior.

The influence of unilateral periacetabular osteotomy on bony birth canal in female patients with DDH using maximum-inscribed-sphere method / 中华骨科杂志

Objective:To investigate the influence of unilateral periacetabular osteotomy (PAO) on the bony birth canal (BBC) in female patients with developmental dysplasia of the hip (DDH) by using pelvic 3D-CT maximum-inscribed-sphere (MIS) method.Methods:A total of 62 female DDH patients of childbearing age were included in the present study. The DICOM data of their pre- and post-operative pelvic CT was collected. The diameters of the MIS in 25 layers of the BBC were measured on the Medical Imaging Interaction Toolkit (MITK) platform. Lateral center edge angle (LCE), T?nnis angle and the distance between the medial margin of the femoral head and Kohler's line were measured on standing anteroposterior pelvic radiographs before and after unilateral PAO. Patients were divided into severe (LCE≤0°) and non-severe group (0°<LCE<20°) according to their LCE values.Results:After unilateral PAO, the BBC above the sciatic spine (1-20th layer) narrowed (0.86-5.95 mm, P<0.05). However, there was no change in levels below the sciatic spine (21-25th layer, P>0.05). The anterior margin of acetabular fragment (1-13th layer) narrowed significantly (4.23-5.95 mm) after unilateral PAO with the narrowest part (5.62-5.95 mm) locating at the inferior margin of pubic ramus and the region superior to the lateral margin of obturator foramen (5-10th layer). The narrowest part of BBC before and after the surgery occurred at the level of bilateral sciatic spines (20th layer). The diameter of MIS changed significantly from 105.34±7.16 mm pre-operatively to 104.47±7.06 mm post-operatively ( t=2.198, P=0.032). There was a positive correlation between the inward displacement of the hip center and the narrowing of the 1-20th layer of the BBC. The decrease of T?nnis angle was positively correlated with the narrowing of the 1-10th layer of the BBC. The increase of LCE was negatively correlated with the narrowing of 2-5th layer of the BBC ( P<0.05). The standardized coefficients were with statistical significance when comparing the distance between the Kohler's line and the medial margin of the femoral head to the size of the 1-20th layer of the BBC ( β=0.27-0.50, P<0.05). The height was positively correlated with the size of the narrowest part of the BBC before and after the surgery ( r=0.565, r=0.586, P<0.001). There was no difference between severe group and non-severe group in their extent of BBC narrowing before and after surgery ( t=-0.685-0.655, P>0.05). Conclusion:Unilateral PAO results in mild narrowing of the BBC superior to the sciatic spine. The narrowest part of the BBC is located at the sciatic spine. Unilateral PAO has slight effects on the narrowest position of the BBC. Normal delivery of a healthy fetus in female patients with DDH of childbearing age could not be affected by unilateral PAO in normal BBC settings.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse / 中华医学杂志(英文版)

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.

Research Advance of the Roles of N6-methyladenosine in the Regulation of Hematopoiesis--Review / 中国实验血液学杂志

There are more than 150 types of chemical modifications in RNA, mainly methylation, which are widely distributed in all kinds of RNA, including messenger RNA, transfer RNA, ribosomal RNA, non-coding small RNA and long non-coding RNA. In recent years, the identification of RNA methylation modification enzymes and the development of high-throughput sequencing technology at transcriptome level laid a foundation for revealing the expression and function of genes regulated by chemical modification of RNA. In this review, the most recent advances of RNA methylation, especially N6-methyladenosine (m