Association of lean tissue index with arteriovenous fistula dysfunction in maintenance hemodialysis patients / 中华肝脏病杂志

The clinical data of maintenance hemodialysis (MHD) patients from twenty hemodialysis centers in Guizhou province from June to September 2020 were collected by cross-sectional study. The patients were divided into AFD group and non-AFD group according to whether AFD had occurred. LTI was measured by body composition monitor. The results showed that the incidence of AFD in 2 781 MHD patients was 30.0% (835/2 781). Median LTI level was 15.2 (13.2, 17.5) kg/m2. The LTI level in the AFD group was higher than that in the non-AFD group (P < 0.05). According to the tertiles of LTI, low LTI group (LTI ≤ 13.9 kg/m2) had the highest incidence of AFD (35.5%, 334/940), and the high LTI group had the lowest incidence of AFD (26.3%, 241/916), and the difference among the three groups was statistically significant (χ2=20.182,P < 0.001). Multivariate logistic regression analysis showed that low LTI group as the reference, the risk of AFD in moderate LTI group (13.9 kg/m2 < LTI ≤ 16.6 kg/m2) and high LTI group were associated with the 20.0% (OR=0.800, 95% CI 0.650-0.986, P=0.036) and 22.8% (OR=0.772, 95% CI 0.616-0.966, P=0.024) decrease, respectively. These results suggest that low LTI level is independently associated with an increased risk of AFD in MHD patients.

The timing of pericardial drainage catheter removal and restart of the anticoagulation in patients suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran: Experiences from 20 cases / 中华心血管病杂志

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.

Association of Next Generation Sequencing Based Genotypic Profiling with MICM Characteristics in NPM1 Mutated Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To explain the clinicobiological heterogeneity of NPM1 mutated (NPM1mut) acute myeloid leukemia (AML) by analyzing the association between next-generation sequencing (NGS) profiles and MICM characteristics in patients with this AML subtype.@*METHODS@#Data of 238 NPM1mut patients with available NGS information on 112 genes related to blood disease was collected, and χ2 test and nonparametric test were used to analyze the distribution association between NGS-detecting mutations and conventional MICM parameters.@*RESULTS@#In entire NPM1mut cohort, totaling 240 NPM1 mutation events were identified, of whom 10 (10/240, 4.2%) were missense mutations, which did not involve any W288 or W290 locus and were found exclusively in NPM1mut/FLT3-ITD- group. All but one of these missense mutations (9/10, 90%) were accompanied by AML subtype-defining recurrent cytogenetic or molecular abnormalities, of which 7 cases were in the low risk and 2 in the high risk. NPM1mut occurred solely as an insertion/deletion (indel) type in the NPM1mut/FLT3-ITD+ group. The incidence of favorable plus unfavorable karyotypes in NPM1mut/FLT3-ITD- group was higher than in NPM1mut/FLT3-ITD+ group (6.4% vs. 0, P=0.031). The positive rates of CD34 and CD7 in NPM1mut/FLT3-ITD+ group were significantly higher than in NPM1mut/FLT3-ITD- group (CD34: 47.9% vs. 20.6%, P<0.001; CD7: 61.5% vs. 29.9%, P<0.001). Logistic analysis showed that FLT3-ITD independently predicted for CD34+ and CD7+ [odds ratio (OR)=5.29, 95%CI: 2.64-10.60, P<0.001; OR=3.47, 95%CI: 1.79-6.73, P<0.001; respectively]. Ras-pathway mutations independently predicted for HLA-DR+ (OR=4.05, 95%CI: 1.70-9.63, P=0.002), and KRAS mutation for MPO- (OR=0.18, 95%CI: 0.05-0.62, P=0.007). TET2/IDH1 mutations independently predicted for CD34- and CD7- (OR=0.26, 95%CI: 0.11-0.62, P=0.002; OR=0.30, 95%CI: 0.14-0.62, P=0.001; respectively), and MPO+ (OR=3.52, 95%CI: 1.48-8.38, P=0.004). DNMT3A-R882 independently predicted for CD7+ and HLA-DR+ (OR=3.59, 95%CI: 1.80-7.16, P<0.001; OR=13.41, 95%CI: 4.56-39.45, P<0.001; respectively), and DNMT3A mutation for MPO-(OR=0.35, 95%CI: 1.48-8.38, P=0.004).@*CONCLUSION@#Co-existing FLT3-ITD in NPM1mut AML independently predicts for CD34+ and CD7+, co-existing Ras-pathway mutation for HLA-DR+ and MPO-, co-existing TET2/IDH1 mutation for CD34-, CD7-, and MPO+, and co-existing DNMT3A mutation for HLA-DR+, CD7+, and MPO-, thereby providing a new mechanism explanation for the immunophenotypic heterogeneity of these AML patients.

Effect of Modified Xiaoyaosan on Dopamine Transporter in Rats with Hyperprolactinemia / 中国实验方剂学杂志

ObjectiveTo investigate the effect of modified Xiaoyaosan on central dopamine transporter （DAT）/protein kinase C （PKC）-dependent signaling pathway in hyperprolactinemia （HPRL） rats. MethodHPRL rat model was established by chronic combined stress combined with intraperitoneal injection of metoclopramide. Ninety-six rats were randomly divided into six groups， namely， the blank group， model group， western medicine （bromocriptine， 0.001 g·kg-1·d-1） group， and high-， medium-， and low-dose （60， 30， 15 g·kg-1·d-1） modified Xiaoyaosan groups. After 14 days of administration， the serum prolactin （PRL） content was detected by enzyme-linked immunosorbent assay， the expression of tyrosine hydroxylase （TH） in rat hypothalamus by immunohistochemistry， and the protein expression of DAT and PKC in hypothalamus by Western blot. ResultCompared with the blank group， the model group exhibited significantly increased PRL and DAT （P<0.01）， but decreased TH and PKC （P<0.01）. Compared with the model group， bromocriptine and modified Xiaoyaosan at the medium dose significantly lowered the content of PRL （P<0.01）. The modified Xiaoyaosan at the medium and high doses elevated the expression of TH （P<0.05， P<0.01）. The expression levels of PKC in the medium- and low-dose modified Xiaoyaosan groups and the western medicine group were significantly increased （P<0.01）， while the DAT expression levels in the high-， medium-， and low-dose modified Xiaoyaosan groups and the western medicine group were decreased （P<0.01）. ConclusionThe modified Xiaoyaosan is able to up-regulate the expression of TH and down-regulate the level of DAT through PKC-dependent signaling pathway， thereby regulating the PRL.

Multimodal imaging analysis of congenital optic disc pit / 中华实验眼科杂志

Objective:To analyze the characteristics of eyes with congenital optic disc pits (ODPs) through multimodal imaging.Methods:A cross-sectional study was conducted.Thirty-eight patients (38 eyes) diagnosed with congenital ODPs in the Second Hospital of Hebei Medical University from January 2009 to January 2020 were enrolled.A comprehensive summary analysis of the imaging results including fundus photography, spectral domain-optical coherence tomography (SD-OCT), infrared imaging, fundus autofluorescence (FAF), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) was performed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of The Second Hospital of Hebei Medical University (No.2021-P011). Written informed consent was obtained from each subject prior to any medical examination.Results:Among the 38 eyes, there were 32 eyes with ODPs located in or below the temporal side of optic disc, 4 eyes with ODPs located above the temporal side of optic disc, and 2 eyes with ODPs located at the center of optic disc, which were round or quasi-circular pale depression, and dark red eminences with clear or unclear boundaries between milk spots were found in 29 eyes with optical-disc macular degeneration (ODP-M) by fundus photography.SD-OCT examination showed that the structure of lamina cribrosa in the lesion area in all ODPs patients was incomplete, which presented a dark area with no tissue reflection, and the fissure led to the deep optic nerve.Fluid was found in the outer nuclear layer in all ODP-M patients, and there were 27 eyes with fluid in the inner nuclear layer, 13 eyes in the ganglion cell layer, and 4 eyes under the inner limiting membrane.Among the 29 eyes with ODP-M, there were 21 eyes with retinoschisis in outer layer, 27 eyes with neuroepithelial detachment.In the 27 eyes with neuroepithelial detachment, spot-like high reflection and reduced or disappeared ellipsoid band reflectance were seen above the neuroepithelium in 18 eyes.In infrared images, there were circular or quasi-circular low-reflection areas in the temporal side of the optic disc, and the lesion of ODP-M eyes presented low-reflection areas.FAF examination showed that in 27 eyes with ODP-M, there was a hypofluorescent region at the posterior pole consistent with the lesion range, among which, there was a granular or sheet-like hyperfluorescence at the center of the hypofluorescent region in 18 eyes.FFA showed that the optic disc depression in the arterial phase of patients was in a localized hypofluorescence state.During the venous phase, fluorescein dye extravasation along the temporal side of the optic disc could be found.A strong fluorescent arc with unclear boundaries at the temporal edge of the optic disc was formed in the late stage of angiography.Among the 29 eyes with ODP-M, the area of the macular lesion showed hyperfluorescence during the late stage of angiography in 27 eyes with neuroepithelial detachment, and no extension of dye toward the macula was found.ICGA showed that the optic disc depression of ODPs patients presented a localized hypofluorescence, and the lesion showed hyperfluorescence in 27 of the 29 ODP-M eyes with neuroepithelial detachment.Conclusions:Multimodal imaging can be helpful to realize the early diagnosis, etiology analysis of ODPs and make treatment plan.

Effect of Tai Chi and Resistance Training on Cancer-Related Fatigue and Quality of Life in Middle-Aged and Elderly Cancer Patients / 中国结合医学杂志

OBJECTIVE@#To study the effect of Tai Chi (TC) and resistance training (RT) with different intensity on the cancer-related fatigue (CRF) and quality of life (QoL) of middle-aged and elderly cancer patients.@*METHODS@#Totally 120 cancer patients were enrolled and randomly assigned to 4 groups by a random number table, including TC group, high-intensity 60% one repetition maximum (1-RM) RT group (HIRT), low-intensity (30% 1-RM) RT group (LIRT) and control group, 30 patients in each group. Participants in the TC group received 24-form simplified Yang-style TC training at a frequency of 40 min per day, 3 days per week for 12 weeks. Patients in the two RT groups received 10 sessions, 6 designated movements per day, 3 days per week for 12 weeks. The 1-RM of 6 muscle groups, fat mass (FM), lean body mass (LBM), along with the scores of Brief Fatigue Inventory (BFI), QoL questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI) were measured before and after training. The adverse effect was also observed.@*RESULTS@#After 12-week intervention, patients in both TC and RT groups showed significant improvements in CRF and QLQ-CCC compared to pre-treatment (P<0.05). Compared with the LIRT and TC groups, patients in the HIRT group improved more significantly in increasing muscle strength and LBM, and reducing in FM (P<0.05). Patients in the TC group significantly increased in lower limb muscle strength compared with the LIRT group (P<0.05). In addition, patients in the TC group showed more significant improvements in scores of GAD-7, PHQ-9 and PSQI than 2 RT groups (P<0.05).@*CONCLUSIONS@#TC and RT, both low- and high-intensity training, can significantly increase muscle strength, reduce CRF and improve QoL in the middle-aged and elderly cancer patients. TC has a better effect than RT in terms of sleep quality and mental health. The long-term application is needed to substantiate the effect of TC as an alternative exercise in cancer patients.

Application of posterior gastric mesentery in laparoscopic gastric surgery / 中华胃肠外科杂志

The posterior gastric mesentery is one of the six mesenteries of the stomach in the membrane anatomy theory. It locates in the upper area of the pancreas, surrounds the posterior gastric vessels, and is adjacent to the short gastric mesentery by the left side, and is adjacent to the left gastric mesentery by the right side, which fixes the fundus body to the posterior abdominal wall of the upper area of pancreas. Due to its anatomical structure, in complete mesentery excision (CME)+D2 surgery, it is a surgical approach to deal with gastric mesentery in the upper area of pancreas; the second step of the "Huang's three-step method" corresponds to the posterior gastric mesentery in the theory of membrane anatomy. In the surgery of benign diseases of the stomach, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Nissen fundoplication, if the short gastric vessels are difficult to be exposed and safely divided, we can dissect the posterior gastric mesentery firstly, and then hoist the fundus of the stomach in order to help dissection of the short gastric vessels. The membrane anatomy theory, as a frontier theory, provides us the new surgical perspectives and paths in gastric surgery.

Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis / 中华心血管病杂志

Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA2DS2-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.

Effectiveness and safety of idarucizumab in the management of perioperative complications of atrial fibrillation catheter ablation in atrial fibrillation patients under dabigatran therapy / 中华心血管病杂志

Objective: To investigate the efficacy and safety of idarucizumab in the treatment of perioperative cardiac tamponade and thromboembolic events during catheter ablation in atrial fibrillation (AF) patients under dabigatran therapy. Methods: This study was a retrospective analysis enrolling patients under dabigatran therapy, who underwent catheter ablation for AF at Beijing Anzhen Hospital from January 2019 to December 2020 and developed perioperative cardiac tamponade or acute ischemic stroke (AIS) and received idarucizumab to reverse the anticoagulant effect of dabigatran. Patients' age, sex, renal function, coagulation test and safety events at 30 d after idarucizumab administration were collected and analyzed. The clinical presentation and prognosis were also analyzed. Results: A total of 7 patients were included, 2 (2/7) were male, mean age was (66.3±11.2) years, serum creatinine level was (66.3±13.6) μmol/L, estimated glomerular filtration rate was (89.4±11.2) ml·min-1·1.73 m-2, CHA2DS2-VASc and HAS-BLED scores were (3.2±1.9) and (1.3±1.3), respectively. Five patients (5/7) developed cardiac tamponade during the perioperative period and the time interval to the last dose of dabigatran was (6.3±2.6) h. Idarucizumab was given at (36.4±16.7) min after the definitive diagnosis of cardiac tamponade. A significant decrease of activated partial thromboplastin time was achieved after idarucizumab administration in all five cases. Pericardial puncture and drainage were applied to all patients (5/5) with cardiac tamponade, the drainage volume was (1 037.0±846.9) ml, the retention time of pericardial drainage catheter was (27.9±13.9) h, and the recovery time of anticoagulation was (28.4±13.2) h. One patient (1/5) underwent thoracotomy for hemostasis due to excessive blood loss with the aim of ensuring complete hemostasis. Bleeding occurred in 1 patient (1/5) after the first restart of anticoagulation. AIS occurred in 2 patients (2/7) after operation. One case (1/2) received intravenous thrombolysis after receiving 5.0 g idarucizumab, no hemorrhagic transformation was observed, and the recovery process was satisfactory. Another patient in this group experienced significantly prolonged onset time and 5.0 g idarucizumab was applied before intravascular thrombectomy, there was no bleeding complication in this patient after thrombectomy. At the time of discharge, the consciousness was not significantly improved, and the muscle strength of the right lower limb was recovered somehow compared with that before operation. No hypersensitivity reactions or thrombotic events occurred in these patients within 30 days of the administration of idarucizumab. Conclusion: In AF catheter ablation-associated cardiac tamponade and AIS, idarucizumab is safe and effective in rapidly reversing the anticoagulant effect of dabigatran, use of thrombectomy saves valuable time for timely hemostasis and improvement of cerebral blood circulation.

The Mutated Gene Sequenced by NGS and the Correlation of Their Coexistent Mutual Exclusiveness in NPM1 Mutated Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the clinicobiological heterogeneity of NPM1 mutated (NPM1@*METHODS@#The NGS data based on 112 genes related to blood disease in 238 newly diagnosed patients with NPM1@*RESULTS@#Among all the patients, at least one co-mutation was detected out. The median number per case of the mutated genes, including NPM1@*CONCLUSION@#Prognoses of AML involving less common NPM1 missense mutations should be stated on a case by case basis. The mutational landscape and co-occurrence and mutual exclusivity correlations of NPM1

Clinical effect of perforated Kirschner wire tension band in the treatment of olecranon fractures in adults / 中华创伤杂志

Objective:To investigate the clinical effect of perforated kirschner wire tension band in the treatment of olecranon fractures in adults.Methods:A retrospective case-control study was conducted on 56 adult patients with olecranon fractures admitted in Ningbo NO.6 Hospital from May 2013 to February 2017. The perforated Kirschner wire tension band fixation was used in Group A ( n=24), while the common Kirschner wire tension band fixation was used in Group B ( n=32). Group A was composed of 16 males and 8 females at age of (34.0±12.1)years, and Group B was composed of 19 males and 13 females at age of (36.5±11.4)years. According to the Mayo classification, there were 7 patients with type I and 17 with type II in Group A, 15 with type I and 17 with type II in Group B. The operation time, bleeding volume, X transmission times, postoperative visual analogue score (VAS), fracture union time, loosening or failure of internal fixation, skin irritation and elbow joint function Broberg-Morrey score were compared between the two groups. Results:All patients were followed up for 15-21 months (mean, 18 months). In Group A, the operation time, bleeding volume, Xray transmission times, fracture union time and skin irritation were (79.6±22.5)minutes, (111.3±26.2)ml, (7.2±2.2)times, (3.7±0.6)months, 1 case, respectively. In Group B, the operation time, intraoperative hemorrhage, transmission times, fracture healing time and skin irritation were (94.3±27.5)minutes, (152.0±31.4)ml, (11.0±3.4)times, (4. 7±2.2)months, 9 cases, respectively. The difference between the two groups were all significant ( P<0.05). There were no significant difference in VAS, failure of internal fixation and elbow function Broberg-Morrey score between the two groups ( P>0.05). Conclusions:Compared with the anatomic plate, the perforated Kirschner wire tension band in the treatment of adult patients with olecranon fractures cannot only reduce the operation time and transmission times, reduce the intraoperative bleeding volume, but also shorten the fracture union time and avoid the occurrence of skin irritation and other complications.

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study / 中华医学杂志(英文版)

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.

Analysis on epidemic characteristics of COVID-19 in Qingpu District of Shanghai / 上海预防医学

Objective To analyze epidemic characteristics of COVID-19 epidemic in Qingpu District of Shanghai and provide evidence for prevention and control of COVID-19. Methods The COVID-19 cases diagnosed in the medical facilities in Qingpu District were included in the study.Descriptive epidemiology was employed to describe diagnosis, clinical symptoms and possible exposure. Results There were 53 suspected cases identified in Qingpu District, 47 of which were excluded and 6 were confirmed.Two confirmed cases were identified when seeking medical treatment and 4 by other means.Of the confirmed cases, 83.3% were male and 66.7% were imported.Their initial symptom was mainly cough.The 75.0% of the confirmed cases had underlying diseases.By PCR testing of SARS-CoV-2, 100.0% of the sputum specimens tested positive, 50.0% of the nasopharyngeal swabs were positive, whereas 100.0% of the throat swabs were negative. Conclusion COVID-19 is more common in men than in women.The positive rate of SARS-CoV-2 in sputum samples is highest, followed by nasopharyngeal swabs and throat swabs.It is crucial to implement the countermeasures at earlier stages, such as strengthening the road entrance monitoring, at-home or intensive health observation of foreign visitors for early identification of suspected COVID-19 cases.

Management status of pulmonary nodules in the central hospital of Putuo district, Shanghai / 中华健康管理学杂志

Objective To investigate the status of pulmonary nodules management in central hospital of Shanghai Putuo District. Methods In 2016 and 2017, patients with solitary pulmonary nodules found by low-dose spiral CT were selected during the initial physical examination in Putuo District Central Hospital of Shanghai. The pulmonary nodules were 4-8 mm in diameter and aged 30-85 years. The patients with pulmonary nodules in 2016 were the control group, and only routine management was carried out. The patients with pulmonary nodules in 2017 were in the health management group. Health records were established, health education was carried out, and follow-up was carried out. After one year of comparative intervention, the effect of health management of pulmonary nodules was evaluated in the two groups by their awareness of pulmonary nodules, negative psychological status, follow-up and the number of pulmonary nodules diagnosed as lung cancer by dynamic changes in pulmonary nodules during one year of follow-up. Results The detection rates of the pulmonary nodules were 11.2% (4 361/38 793) and 12.1% (5 056/41 482) in the first physical examination population in 2016 and 2017, respectively, with no significant difference (χ2=29.641, P=0.128). The control group included 4 361 cases and the health management group included 5 056 cases. The follow-up rate of health management group was 78.0% (2 878 cases) higher than that of the control group (66.0%, 3 944 cases). The difference was statistically significant (χ2 =4.174, P=0.016). In the health management group, 4 651 patients (95.4%) had comprehensive knowledge of pulmonary nodules, higher than 1 820 patients (44.6%) in the control group (χ2=10.363, P=0.078). There were 1 213 (24.9%) patients with negative psychology such as panic and anxiety in the health management group, which was lower than 3 303 (81.0%) patients in the control group (χ2=6.414, P=0.102). During the follow-up period of the following year, 37 cases (0.7%) in the health management group were diagnosed as early lung cancer due to the dynamic changes of small nodules, and 19 cases (0.4%) in the control group. The difference was statistically significant (χ2=4.093, P<0.05). Conclusion Health management of patients with pulmonary nodules can improve their awareness of pulmonary nodules , reduce their negative psychology and increase the detection rate of early lung cancer. Health management of pulmonary nodules is valuable for early detection of lung cancer.

Detection of the anterior segment biological parameters of primary angle closure glaucoma and the normal eyes by optical coherence tomography / 中华实验眼科杂志

Objective To measure quantitatively and analysis the differences in the anterior segment biological parameters between the normal subject and patients suffering primary angle closure glaucoma (PACG),as well as the distinction among different stages of PACG by using anterior segment optical coherence tomography (OCT).Methods A retrospective case series study was designed.Medical records of 217 cases (217 eyes) from The Second Hospital of Hebei Medical University from December 2013 to December 2014 were recruited,including 5 groups as follows:35 cases (35 eyes) with pre-clinical stage acute primary angle closure glaucoma (APACG),32 cases (32 eyes) with remission period of APACG,35 cases (35 eyes) with early stage of chronic primary angle closure glaucoma (CPACG),35 cases (35 eyes) with progress period of CPACG and 80 cases (80 eyes) coming for regular eye health examination in general clinic.The anterior segment biological parameters of each group was measured by Heidelberg Spectralis OCT,including the anterior chamber width (ACW),angle opening distance (AOD),trabecular iris area (TISA),iris thickness (IT) and crystalline lens rise (CLR).Results The IT and CLR of APACG and CPACG were significantly greater than normal control group,while other anterior segment parameters were significantly smaller,with significant differences between them (all at P＜0.01).The IT and CLR of APACG was bigger than those of CPACG,with significant differences between them (both at P＜0.05),the ACW,AOD,TISA of the two gruops showed no significant differences.The AOD and TISA of remission period of APACG were significantly decreased than those of pre-clinical stage (all at P＜O.01).The IT and CLR of remission period APACG was significantly greater than pre-clinical stage (both at P＜0.01).The difference in ACW of the two group was not statistically significant (P＞0.05).Compared with progress period of CPACG,the IT of the early stage of CPACG was thicker,while the CLR was smaller (both at P＜0.01).There was no significant difference in ACW,AOD and TISA between the two groups.The IT2000 and ITmax of pre-clinical stage of APACG were significantly smaller than those of early stage of CPACG (both at P＜0.01).There was no significant difference in other parameters between the two groups (P＞0.05).The IT750,IT2 000 and ITmax of the pre-clinical stage of APACG were significantly thicker than those of progress period of CPACG (all at P＜0.05).There was no significant difference in other parameters between the two groups (P＞0.05).Conclusions Compared with normal people,the PACG patients have a more crowding anterior segment structure,smaller AOD,smaller TISA,thicker IT and more anterior located lens.The APACG patient at remission period has a more crowding anterior segment structure,smaller AOD,smaller TISA,thicker IT and more anterior located lens than APACG patient at per-clinic stage.The CPACG patient at progress period has a higher CLR,but thinner IT than patient at early stage.The APACG patients at per-clinic stage has thicker IT and a more crowding anterior segment structure than the CPACG patient at early stage,and the APACG patient at remission period has thicker IT than CPACG patient at progress period.

Study on mechanism of differentiation of esophageal carcinoma Kyse30 cells induced by p-hydroxylcinnamaldehyde / 中草药

Objective To investigate the effects of p-hydroxylcinnamaldehyde (CMSP) on cell proliferation, migration, cell cycle and the expression level of malignant biomarkers, and to investigate the underlying mechanism of differentiation of esophageal carcinoma Kyse30 cells (ESCC cells). Methods The effect of different concentration of CMSP at 0, 10, 20, and 40 μg/mL on viabilities of ESCC cell lines (Kyse30, Eca109, and Kyse180) for 24, 48, and 72 h was determined by MTS assay. Optical microscope and scanning electronic microscopy (SEM) were used to observe the morphologic changes of Kyse30 cells. The effect of CMSP at different concentration on cell cycle distribution and apoptosis of Kyse30 cells was assessed by flow cytometry analysis. ELISA was used to detect the effect of CMSP on expression of tumor related antigens (CEA and SCC) and malignant biomarkers (IL-6 and MIC-1) in Kyse30 cells at protein secretion level. Influence of different concentration of CMSP on migration and invasiveness of Kyse30 cells were determined by colony-formation, wound healing and Transwell assays. Western blotting was used to evaluate the effect of CMSP on expression of protein biomarkers C-myc and N-myc of Kyse30 cells and the related proteins in RhoA-MAPK pathway. Results The proliferation of esophageal cancer cell lines (Kyse30, Eca109, and Kyse180) was significantly inhibited by CMSP in a dose- and time-dependent manner. The cell cycle Kyse30 was blocked in G0/G1 phase. After the treatment with CMSP, Kyse30 cells showed typical dendrite-like cellular protrusions, and the percentage of such elongated cells was significantly and progressively increased with the increase in CMSP concentration (P 0.05). CMSP could decrease the expression of CEA, SCC, IL-6, and MIC-1 both in protein secretion levels significantly in a dose- and time-dependent manner (P < 0.05, 0.01). Western blotting analysis showed that C-myc and N-myc proteins were all decreased significantly in Kyse30 cells after treatment with CMSP (P < 0.05). CMSP significantly inhibited the proliferation and migration ability of Kyse30 cells (P < 0.05) and induced cell differentiation; The protein levels of p-P38 was significantly increased (P < 0.01), while protein levels of ERK1/2, SAPK/JNK, and GTP-RhoA were obviously decreased in Kyse30 cells after treatment with CMSP (P < 0.01). Conclusion CMSP suppressed the proliferation and induced the differentiation of Kyse30 cells through regulating the RhoA-MAPK signal pathway, which might provide new potential strategies for ESCC treatment.

Expression of IL-17 and estrogen and its receptor in HPV16 continuously infected patients / 局解手术学杂志

Objective To understand the role of estrogen,estrogen receptor and IL-17 in human papillomavirus (HPV) infection and clearance.Methods We selected the clinic or the hospitalized patients in People' s Hospital of Pudong New District hospital with HPV negative or single-HPV16 positive during the period of August 2014 to January 2017.Cervical exfoliated cells were harvested by Thinprep cytologic test (TCT).The reverse spot hybridization technique was carried out for HPV subtype analysis.RT-PCR was employed for HPV16 DNA viral load.The levels of E2 and IL-17 were detected by ELISA.Immunohistochemical was used to detect ER expression.The experiments were repeated every three months.According to the difference in the outcome of human papilloma virus 16 infection,the experiment was divided into three groups.The first group was HPV negative,which was negative for one year.The second group was HPV16 positive,but within one year the difference was gradually cleared.The third group was HPV16 positive,but the HPV16 persistently existed after one year.Results The results of the last test were compared with the first test results.We found that There was no significant difference among the three groups in the expression of E2 and ER.Also,there was no significant difference between the HPV negative group and the HPV16 persistently infected group in variation of IL-17 concentration.But the difference between the HPV16 cleared group and the anyone of the two groups above was significantly.The variation of IL-17 concentration was significantly higher in the HPV16 cleared group.Conclusion In normal cytology,and only HPV16 infected stage,endogenous E2 and ER of cervix may not play a role in HPV infection,or they may have little effect on HPV infection.Local immune factor IL-17 plays an important role in the process of HPV16 removal,and the increase of IL-17 concentration can help to eliminate HPV16.

Fructose induces HK-2 ceils to express monocyte chemoattractant protein-1 through uric acid and reactive oxygen species / 上海交通大学学报（医学版）

Objective·To investigate the mechanism of fructose-induced monocyte chemoattratant protein-1(MCP-1) production in HK-2 cells.Methods·The HK-2 cells were divided into fructose incubated (1,5 and 10 mmol/L) group,fructose and ketohexo-kinase inhibitor (KHK-IN) coincubation (fructose 5 mmol/L,KHK-IN was 12,100 and 1 000 nmol/L,respectively) group,uric acid incubation (5,15 and 50 mg/dL) group,fructose and allopurinol co-incubation (fructose 5 mmol/L,allopurinol were 0.01,0.1 and 0.5 mmol/L) group,uric acid and allopurinol co-incubation (uric acid 50 mg/dL,allopttrinol respectively 0.01,0.1and 0.5 mmol/L) group,H2O2 incubation (0.1 and 0.3 mmol/L) group,fructose and N-acetylcysteine (NAC) coincubation (fructose 5 mmol/L,NAC respectively 5,10 and 50 mmol/L) group,and uric acid and NAC co-incubation (uric acid 50 mg/dL,NAC was 5,10and 50 mmol/L,respectively) group.The quantitative PCR method and Western blotting method were used to observe the expression ofMCP-1 mRNA and protein.The effects of fructose and uric acid on the production of ROS in HK-2 cells were observed by using a fluorescent probe.Results·Fructose doseand time-dependently induced MCP-1 gene transcription and protein production in HK-2 cells,which could be blocked by the ketohexo-kinase blockers.Exogenous uric acid induced MCP-1 production in HK-2 cells.Allopurinol inhibited fructose,but not exogenous uric acid-induced MCP-1 expression.Both fructose and uric acid induced ROS generation.Incubation with H2O2promoted MCP-1 production in HK-2 cells.NAC completely inhibited MCP-1production induced by fructose and H2O2.Conclusion·Catalyzed by the ketohexo-kinase,fructose resultes the production of MCP-1 through uric acid and reactive oxygen species.

Analysis of suicidal ideation and its related factors among migrant construction male workers in Pudong New Area, Shanghai / 上海交通大学学报（医学版）

Objective·To understand the suicidal ideation among migrant construction male workers in Pudong New Area,Shanghai,and analyze the influence factors based on social cognitive theory.Methods · Surveys were carried out among 1 850 migrant construction male workers from 3 randomly chosen construction sites using cluster random sampling.Univariate and multivariate Logistic regressions analysis were used to explore the association between suicidal ideation and its related factors such as negative psychology,negative cognition and high-risk behavior.Results· Among the total 1 580 respondents completed the survey,126 (8.0％) reported having suicidal ideation.In the univariate Logistic regression analysis,drug abuse,alcohol abuse,depression,generalized anxiety and loneliness were risk factors for suicidal ideation,while perceived social support was a protective factor.Five of the six variables,alcohol abuse (Orm=2.15,95％CI 1.42-3.24),depression (Orm=2.47,95％CI 1.17-5.21),generalized anxiety (Orm=2.24,95％CI 1.50-3.35),loneliness (Orm=2.09,95％CI 1.28-3.40) and perceived social support (Orm=1.84,95％CI 1.20-2.83) were selected by the multivariate Logistic regression analysis.Conclusion · Suicidal ideation among migrant construction male workers in Pudong New Area,Shanghai occurs under the influence of negative psychology,negative cognition and high-risk behavior.For the crowds,family and society should be actively promoted and mental health interventions should be strengthened,which could effectively prevent suicide ideation.

Distribution characteristics of placental lead and cadmium elements among full term neonates in Chengdu area / 重庆医学

Objective To investigate the lead and cadmium contents in different sampling sites from full term neonatal placenta and to explore the role of placental sample in the evaluation of intrauterine heavy metals exposure.Methods The placentas from 30 healthy full term neonates were collected from the West China Second Hospital of Sichuan University during May and June 2016.Each placenta fetal side was divided into the left and right parts with the umbilical vein in the umbilical cord cross-section as the 12 o'clock direction.The villus lobular tissue samples were taken from the 1/4 radius in left part (site A) and 3/4 radius in the right part (site B).The graphite furnace atomic absorption spectrometry was used to detect the lead and cadmium contents in the samples.The elements contents in the site A and B were performed the paired t-test and correlation analysis.Results The mean contents of lead and cadmium in dry weight sample at placental site A were 91.8 and 66.7μg/kg which at the site B were 88.9 and 64.8 μg/kg respectively.The lead and cadmium contents at these two sites presented the positive correlation,the coefficients were 0.98 and 0.97 respectively,whereas the difference in contents between the tissues from different placental sites had no statistical significance.Conclusion The lead and cadmium contents of villus lobular tissue in the central part of placenta fetal side (1/4-3/4 radius area) are basically consistent,which is a reliable indicator for evaluating the intrauterine heavy metals exposure.