Rivaxaban combined with antiplatelet drugs in ischemic stroke patients with atrial fibrillation and intracranial artery stenosis: comparison with rivaroxaban alone / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of rivaroxaban combined with antiplatelet in ischemic stroke patients with non-valvular atrial fibrillation and moderate or severe intracranial artery stenosis.Methods:The consecutive ischemic stroke patients with non-valvular atrial fibrillation and moderate or severe intracranial artery stenosis admitted to Yantai Yuhuangding Hospital of Qingdao University from August 2019 to March 2022 were retrospectively included. According to the secondary prevention drugs, the patients were divided into rivaroxaban and rivaroxaban combined with antiplatelet treatment group. The basic characteristics of the two groups were compared. The primary outcome was the recurrence rate of stroke at 3 months, and the secondary outcome included the incidence of any bleeding event at 3 months, the all-cause mortality rate, the improvement rate of neurological function, and the good outcome rate. The good outcome was defined as the modified Rankin Scale ≤2 points at 3 months.Results:A total of 108 patients aged 70.72±8.08 years old were included in the study. There were 56 patients (51.9%) in the rivaroxaban group and 52 (48.1%) in the combined treatment group. In terms of primary outcome, the recurrence rate of stroke in the combined treatment group was significantly lower than that in the rivaroxaban group at 3 months (7.69% vs. 21.43%; P<0.05). In terms of secondary outcomes, the incidence of bleeding events in the combined treatment group at 3 months was significantly higher than that in the rivaroxaban group (26.92% vs. 7.14%; P<0.05), with one death event in each group. The rate of good outcome in the combined treatment group was significantly higher than that in the rivaroxaban group (75.00% vs. 51.79%; P=0.013). Multivariate logistic regression analysis showed that high National Institutes of Health Stroke Scale (NIHSS) score at admission was an independent risk factor for poor outcome (odds ratio 1.370, 95% confidence interval 1.057-1.776; P=0.018), while the rivaroxaban combined antiplatelet treatment was an independent protective factor for stroke recurrence (odds ratio 0.203, 95% confidence interval 0.054-0.758; P=0.018). Conclusion:After ischemic stroke in patients with non-valvular atrial fibrillation complicated with moderate and severe stenosis of intracranial artery, rivaroxaban combined with antiplatelet treatment can reduce the recurrence rate of stroke and improve the clinical outcome, but it may increase the risk of bleeding.

Clinicopathological analysis of primary gastric (gastrointestinal)-type mucoglandular lesion of endometrium / 中华病理学杂志

Objective: To investigate the clinical and pathological features of primary gastric (gastrointestinal)-type mucoglandular lesions of the endometrium. Methods: Eight cases of primary gastric (gastrointestinal)-type mucoglandular lesions of endometrium diagnosed between 2014 to 2022 were retrieved from pathology archives of the Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai, China. The clinical history, pathological sections and follow-ups were analyzed. Results: The eight patients ranged in age from 35 to 67 years, with an average age of 55.5 years. Seven patients were examined for high-risk human papillary virus (HPV) before operation. Only one of them was positive for high-risk HPV52. No cervical mucinous lesions were found in any of the patients. Two cases were invasive gastric (gastrointestinal)-type adenocarcinoma, 2 cases were benign gastric (gastrointestinal)-type mucinous metaplasia, and the other 4 cases were atypical gastric (gastrointestinal)-type mucinous gland hyperplasia. Microscopically, tumor cells showed mucous epithelium with gastrointestinal differentiation. Immunophenotyping showed that MUC6 was diffusely or focally positive in 5 cases, CK20 and CDX2 were positive in 3 cases. And p16 was negative or focally positive in 5 cases and strongly positive in 1 case. ER was expressed in both benign and atypical lesions, and weakly positive or negative in the invasive adenocarcinoma. p53 showed mutant expression in one case and wild-type expression in the rest. HPV in situ hybridization was negative. Conclusions: Primary gastric (gastrointestinal)-type mucoglandular lesions of the endometrium show various forms of gastrointestinal differentiation, which are high-risk HPV independent. Morphology combined with immunohistochemistry is helpful for the diagnosis, which can only be made on exclusion of cervical gastrointestinal glandular lesion, gastrointestinal metastatic carcinoma and the mucinous subtype of endometrioid carcinoma.

Diagnosis and treatment of incomplete Kawasaki disease in children / 中国当代儿科杂志

Kawasaki disease (KD) is a febrile disease mainly observed in children aged <5 years, with medium- and small-vessel vasculitis as the main lesion. Although KD has been reported for more than 50 years and great progress has been made in the etiology and pathology of KD in recent years, there is still a lack of specific indicators for the early diagnosis of KD, especially with more difficulties in the diagnosis of incomplete Kawasaki disease (IKD). At present, there are no clear diagnostic criteria for IKD, which leads to the failure of the timely identification and standardized treatment of IKD in clinical practice and even induce the development of coronary artery lesion. This article reviews the concept, epidemiological features, diagnosis, treatment, and follow-up management of IKD, in order to deepen the understanding of IKD among clinical workers and help to improve the clinical diagnosis and treatment of KD in China.

Exploring biological connotation of blood stasis syndrome of rheumatoid arthritis and establishment of improved animal models based on syndrome-symptom mapping / 药学学报

Blood stasis syndrome is one of the core clinical syndrome of rheumatoid arthritis (RA), but the biological connotation of this syndrome is not clear, and there is a lack of disease improved animal models that match the characteristics of this disease and syndrome. The aim of this study was to screen the candidate biomarker gene set of blood stasis syndrome of RA, reveal the biological connotation of this syndrome, and explore and evaluate the preparation method of the improved animal model based on the characteristics of "disease-syndrome-symptom". The study was approved by the ethics committee of Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine (No. 2019-073-KY-01) and the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (No. TYLL2021[K]018), and the study subjects gave their informed consent. Animal welfare and experimental procedures followed the regulations of the Experimental Animal Ethics Committee of the Chinese Academy of Traditional Chinese Medicine (No. IBTCMCACMS21-2207-01). The whole blood samples were collected clinically from RA patients with blood stasis syndrome (3 cases) or other syndromes (7 types, 3 cases/type), and healthy volunteers (4 cases), and then transcriptome sequencing, KEGG, gene set enrichment analysis (GSEA) and weighted correlation network analysis (WGCNA) analysis were performed. 126 pivotal genes were screened, and their functional annotation results were significantly enriched in "immune-inflammation" related pathways and lipid metabolism regulation (sphingolipids, ether lipid metabolism and steroid biosynthesis). Syndrome-symptom mapping of hub gene set to the TCM primary and secondary symptoms, Western phenotypic symptoms and pathological links showed that joint tingling, abnormal joint morphology, petechiae and abnormal blood circulation are representative of blood stasis syndrome of RA. The results of the improved animal model showed that the rats in the collagen-induced arthritis + adrenaline hydrochloride (CIA+Adr) 3 model group had increased blood rheology, coagulation, platelet function and endothelial function abnormalities compared with the CIA-alone model group, suggesting that the rats with blood stasis syndrome of RA may be in a state of "blood stasis". The results of the study can help to advance the objective study of the evidence of blood stasis syndrome in RA, and provide new ideas for the establishment of an animal model that reflects the clinical characteristics of the disease and syndrome.

Preparation of mesoporous silica nanoparticles with different sizes and study on the correlation between size and toxicity / 药学学报

To investigate the crucial role of particle size in the biological effects of nanoparticles, a series of mesoporous silica nanoparticles (MSNs) were prepared with particle size gradients (50, 100, 150, 200 nm) with the traditional Stober method and adjusting the type and ratio of the silica source. The correlation between toxicity and size-caused biological effects were then further examined both in vitro and in vivo. The results indicated that the prepared MSNs had a uniform size, good dispersal, and ordered mesoporous structure. Hemolytic toxicity was found to be independent of particle size. At the cellular level, MSNs with smaller particle sizes were more readily internalized by cells, which initiated to more intense oxidative stress, therefor inducing higher cytotoxicity, and apoptosis rate. In vivo studies demonstrated that MSNs primarily accumulated in the liver and kidneys of mice. Pharmacokinetic analysis revealed that larger MSNs were eliminated more efficiently by the urinary system than smaller MSNs. The mice's body weight monitoring, blood tests, and pathological sections of major organs indicated good biocompatibility for MSNs of different sizes. Animal welfare and the animal experimental protocols were strictly consistent with related ethics regulations of Zhejiang Chinese Medical University. Overall, this study prepared MSNs with a particle size gradient to investigate the correlation between toxicity and particle size using macrophages and endothelial cells. The study also examined the biosafety of MSNs with different particle sizes in vivo and in vitro, which could help to improve the safety design strategy of MSNs for drug delivery systems.

The immunomodulatory effect of lactic acid within the tumor microenvironment / 药学学报

Tumor cells leads to enhanced glucose uptake and the conversion of a larger fraction of pyruvate into lactate even under the circumstance of abundant oxygen. This phenomenon of aerobic glycolysis is known as the Warburg effect. Lactic acid, as an important tool for tumor cells to modify the tumor microenvironment, promotes the process of tumor invasion and metastasis, and contributes to tumor development by inducing and recruiting immunosuppression-related cells and molecules. Lactic acid could efflux out of the cancer cells via the monocarboxylate transporters to prevent intracellular acidification. Lactate can inhibit the cytolytic activity of T cells and natural killer (NK) cells, promoting the differentiation of tolerogenic interleukin 10 (IL-10)-producing dendritic cells. Moreover, the lactate-derived lactylation of histone lysine residues can promote macrophage polarization toward the M2-like phenotype, suppressing the immune response within the tumor microenvironment. In this review, we discuss the role of lactate as an immunosuppressor molecule that contributes to tumor evasion from the aspects of lactic acid metabolism and its effect on immune cells. And we explore the possibility of targeting potential targets in lactate metabolism for tumor treatment. At last, we proposed a tumor immunotherapy strategy by inhibiting the pathway of aerobic glycolysis and proteins associated with the production and transport of lactic acid.

Transmission modes of severe acute respiratory syndrome coronavirus 2 and implications for infection control: a review

The complete picture regarding transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence on its transmission modes, our preliminary research findings and implications for infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 ribonucleic acid in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet and airborne transmission, depending on the patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.

Study on knowledge, attitudes and practices of pulse oximetry among pediatric healthcare providers in China and their influencing factors / 中华实用儿科临床杂志

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Expert consensus on the diagnosis, treatment and prevention of monkeypox in children / 中华实用儿科临床杂志

Monkeypox is a zoonotic disease.Previous studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians′ understanding of monkeypox and achieve early detection, early diagnosis, early treatment and early disposal, the committee composed of more than 40 experts in the related fields of infectious diseases, pediatrics, infection control and public health formulate this expert consensus, on the basis of the latest clinical management and infection prevention and control for monkeypox released by the World Health Organization (WHO), the guidelines for diagnosis and treatment of monkeypox (version 2022) issued by National Health Commission of the People′s Republic of China and other relevant documents.During the development of this consensus, multidisciplinary experts have repeatedly demonstrated the etiology, epidemiology, transmission, clinical manifestations, laboratory examinations, diagnosis and differential diagnosis, treatment, discharge criteria, prevention, case management process and key points of prevention and control about monkeypox.

Clinical significance of asymmetrically prominent veins sign on susceptibility-weighted imaging in patients with acute ischemic stroke / 国际脑血管病杂志

Asymmetrically prominent veins sign (APVS) displayed by susceptibility-weighted imaging (SWI) can noninvasively reflect the dynamic changes of brain tissue in patients with acute ischemic stroke (AIS). It provides blood flow and metabolic information from the perspective of pathophysiology, which is helpful to evaluate the clinical condition and outcome of patients with AIS. This article reviews the clinical significance of the presence of APVS on SWI in patients with AIS.

Active constituents of Urtica fissa in inhibition of benign prostatic hyperplasia / 中国中药杂志

The present study investigated the material basis of Urtica fissa for the inhibition of benign prostatic hyperplasia(BPH). The active fractions were screened, and the extracts of dichloromethane and ethyl acetate exhibited significantly inhibitory activities against 5α-reductase in vitro and BPH in model rats. The chemical constituents in the active fractions were systematically investigated, and 28 compounds were obtained, which were identified as lobechine methyl ester(1), dibutyl-O-phthalate(2), 1-monolinolein(3), epipinoresinol(4), 5-hydroxy-3,4-dimethyl-5-pentanyl-2(5H)-furanone(5), E-7,9-diene-11-methenyl palmitic acid(6), evofolin B(7), ficusal(8), threo-2,3-bis-(4-hydroxy-3-methoxyphenyl)-3-ethoxypropan-1-ol(9), α-viniferin(10),(9R,7E)-9-hydroxy-5,7-mengatigmadien-4-one-9-O-β-D-glucopyranoside(11), indole-3-carboxaldehyde(12), p-hydroxy ethyl cinnamate(13), benzyl alcohol-O-β-D-glucoside(14), L-methionine(15), 4-methoxyaniline(16), 6-aminopurine(17), 8'-acetyl oilvil(18), 4-methoxyl-8'-acetyl oilvil(19), vanillic acid(20), β-hydroxypropiovanillone(21), 7-hydroxy-6-methoxycoumarin(22), p-hydroxybenzaldehyde(23), pinoresinol(24), erythro-1,2-bis-(4-hydroxy-3-methoxyphenyl)-1,3-propanediol(25), urticol(26), urticol-7-O-β-D-glucopyranoside(27), and lobechine(28). Compounds 1-17 were isolated from U. fissa for the first time. Meanwhile, compound 1 was a new natural product. Compounds 10, 11, 19, 21, and 27 exhibited significant inhibitory effects on 5α-reductase.

Biological connotation of four traditional Chinese medicine syndromes of rheumatoid arthritis based on "disease-syndrome-symptom" association network / 中国中药杂志

The present study explored the biological connotation of traditional Chinese medicine(TCM) syndromes of rheumatoid arthritis(RA) from the "disease-syndrome-symptom" association network. RA patients with four TCM syndromes(dampness-heat obstruction, phlegm-stasis obstruction, Qi-blood deficiency, and liver and kidney deficiency), three for each type, were assigned as the RA TCM syndrome group, and three healthy volunteers as the normal control group. The differential gene sets of four syndromes were screened out through transcriptome expression profiling and bioinformatics mining. The relevant gene sets of syndrome-related clinical symptoms were collected from TCMIP v2.0(http://www.tcmip.cn/). The "disease-syndrome-symptom" association networks of four RA syndromes were established by using the intersection genes of syndrome-related differential genes and symptom-related genes, and the key network target genes of each syndrome were screened out and the corresponding biological functions were mined through topological feature calculation and enrichment analysis. The genes associated with clinical symptoms such as vasculitis, joint pain, and fever in the damp-heat obstruction syndrome ranked the top, and the key network target genes of this syndrome were most significantly enriched in the pathways related to material and energy metabolism and thermal reaction biological processes. The clinical symptom-related genes of the phlegm-stasis obstruction syndrome were most significantly enriched in the pathways related to "immunity-inflammation", nervous system regulation, and sensory response. The clinical symptoms such as hypoglycemia, hypotension, weight loss, palpitation, and arrhythmia in Qi-blood deficiency syndrome were predominant, and its key network target genes were most significantly enriched in the pathways related to the nervous system and "immunity-inflammation" response. The abnormal symptoms in the liver and kidney in the liver and kidney deficiency syndrome were commonly seen, and its key network target genes were most significantly enriched in the "immunity-inflammation" regulatory pathways, and liver and kidney development and metabolic response. In conclusion, the differences and connections of the biological basis between different TCM syndromes of RA are in line with the theoretical interpretation of TCM on the etiology and pathogenesis of RA. This study summarized the objective essence of syndromes to a certain extent from the "disease-syndrome-symptom" association network and is expected to provide a theoretical basis for the discovery of serum biomarkers of RA syndromes.

Radiographic features of COVID-19 based on an initial cohort of 96 patients in Singapore

INTRODUCTION@#Chest radiographs (CXRs) are widely used for the screening and management of COVID-19. This article describes the radiographic features of COVID-19 based on an initial national cohort of patients.@*METHODS@#This is a retrospective review of swab-positive patients with COVID-19 who were admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXRs were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities.@*RESULTS@#In total, 347 CXRs of 96 patients were reviewed. Initial CXRs were abnormal in 41 (42.7%) out of 96 patients. The mean time from onset of symptoms to CXR abnormality was 5.3 ± 4.7 days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXRs (51.2%) and consolidation on follow-up CXRs (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were observed in 63.4% and 59.2% of abnormal initial and follow-up CXRs, respectively. The lower zones were involved in 90.2% of initial CXRs and 93.9% of follow-up CXRs.@*CONCLUSION@#In a cohort of swab-positive patients, including those identified from contact tracing, we found a lower incidence of CXR abnormalities than was previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.

Prognosis value of immune-related gene CEBPB in clear cell renal cell carcinoma / 中华泌尿外科杂志

Objective:To explore the correlation between CCAAT enhancer binding protein beta (CEBPB) expression and clinical characteristics in ccRCC, and to investigate the effect of CEBPB on proliferation and invasion of ccRCC cells.Methods:Between March 2020 to December 2020, the transcriptome and clinical data of 537 ccRCC cases were downloaded from TCGA database, and the correlation of CEBPB expression with clinical characteristics of ccRCC were analyzed. Univariate and multivariate Cox regression analysis were used to determine the effect of CEBPB expression on the prognosis of ccRCC patients. The correlation between CEBPB expression and immunocyte infiltration in ccRCC was investigated via TIMER database. The expression levels of CEBPB mRNA and protein in human renal tubular epithelial cell line HK2 and ccRCC cell lines (Caki-1, ACHN, 786O, 769P and A498) were determined by real-time PCR and western blot, respectively. After transfected with NC siRNA or CEBPB siRNA for 48 h, the proliferation and invasion of ACHN cells and 786O cells were determined by using MTT assay and invasion assay, respectively.Results:TCGA databases analysis revealed that, compared with normal kidney tissue, the expression of CEBPB mRNA in ccRCC was up-regulated by 2.55-fold ( P<0.05). CEBPB expression was positively correlated with age, tumor grade, tumor stage, lymph node metastasis and distant metastasis ( P<0.05). The tumor grade ( HR=1.703, P=0.040), tumor stage( HR=1.773, P=0.026), distant metastasis ( HR=3.080, P<0.001) and the high expression of CEBPB ( HR=1.874, P=0.003) were independent poor prognostic factors for ccRCC patients. The analysis results by using TIMER database showed that CEBPB expression was positively correlated with infiltrating levels of B cells (Rho=0.168), M2 macrophages (Rho=0.373), Tregs (Rho=0.348), neutrophils (Rho=0.194), and natural killer T cell (Rho=0.421) in ccRCC. The expression level of CEBPB mRNA in Caki-1, ACHN, 786O, 769P and A498 cells was (9.43±1.25)-fold, (5.44±0.82)-fold, (4.50±0.52)-fold, (4.88±0.73)-fold and (7.50 ± 1.04)-fold of HK2 cells, respectively. The expression level of CEBPB protein was (6.22±0.45)-fold, (5.84±0.85)-fold, (6.51±0.55)-fold, (6.23±0.62)-fold and (3.84±0.45)-fold of HK2 cells, respectively ( P<0.05). MTT assay showed that the proliferation rates of ACHN cells and 786O cells at 24, 48, 72, 96 h were (98.4±1.7)% and (99.0±1.4)%, (97.8±2.1)% and (98.5±1.5)%, (101.3±1.2)% and (97.6±1.7)%, (97.5±2.0)% and (99.1±1.3)% in NC siRNA group, and (68.8±5.8)% and (79.5±6.2)%, (57.9 ± 6.1)% and (70.8±5.1)%, (50.9±4.6)% and (66.8±4.9)%, (43.2±5.0)% and (60.5±5.3)% in CEBPB siRNA group. Compared with NC siRNA group, the proliferation activity of ACHN cells and 786O cells was significantly inhibited in the CEBPB siRNA group ( P<0.05). Cell invasion assay showed that the invasion activity of ACHN cells and 786O cells were (95.0±5.2)% and (97.3±4.4)% in NC siRNA group, (35.2±5.4)% and (26.7±3.3)% in CEBPB siRNA group, respectively ( P<0.05). Compared with NC siRNA group, the invasion activity of ACHN cells and 786O cells were significantly inhibited in the CEBPB siRNA group ( P<0.05). Conclusions:CEBPB was highly expressed in ccRCC, which was closely related to the prognosis and immunocyte infiltration of ccRCC patients. Silencing the expression of CEBPB significantly inhibited the proliferation and invasion of ccRCC cells

Application of new media aided-teaching in training for professional postgraduates of neurosurgery / 中华医学教育探索杂志

Objective:With the development of digital technology, network technology and mobile technology, new media aided-teaching has become a hot topic in medical teaching. However, the studies about the application of new media aided-teaching in training for professional postgraduates of neurosurgery are still less studied.Methods:In this study, 24 Batch 2015-2016 professional postgraduates of neurosurgery from Neurosurgery Department of Affiliated Hospital of Southwest Medical University were divided into the test group and control group, with 12 students in each group. From September 2016 to August 2018, students in the test group were taught with conventional teaching and various new media such as WeChat official accounts, professional video sharing websites and so on. The control group adopted conventional teaching methods. Students' theoretical knowledge, operation ability and clinical research ability were assessed between the two groups. SPSS 22.0 software was used for t test and descriptive statistics on the data.Results:The results of t test analysis showed that the scores of theoretical knowledge and general ability in test group were higher than those in control group, with significant differences ( P < 0.05). Meanwhile, the scores of teaching satisfaction, professional interest, teaching participation, knowledge mastery and scientific research ability in the test group were higher than those in the control group, with significant differences ( P<0.05). Conclusion:Conventional teaching combined with new media aided-teaching is a good new training model for professional postgraduates of neurosurgery, which has improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities.

A case report of kerosene-induced chemical pneumonia with pleural effusion and abnormal pulmonary function / 中华实用儿科临床杂志

The clinical data of a child with chemical pneumonia caused by kerosene in Hainan Maternal and Children′s Medical Center in June 2019 were retrospectively analyzed.The patient was a 2 years and 1 month old boy with a history of kerosene inhalation and fever.The clinical features included low breath sounds in the left lung and dry and wet rales in both lungs.The white blood cells (WBC) level, C-reactive protein (CRP) level, and erythrocyte se-dimentation rate (ESR) were significantly increased.Chest CT showed inhalation pneumonia.Chest ultrasound suggested medium pleural effusion on the left side.The patient was given antibiotics, nebulization and other treatment.On the 12 th day of the course of the disease, his temperature returned to normal, and breath sounds on the left side were stronger than before.The WBC level, CRP level and ESR were improved according to the re-check results, but pulmonary ventilation was still obstructed mildly to moderately.Fourteen days after hospital discharge, the patient coughed less.Reexamination of chest CT prompted the lesions were further absorbed, but the mild to moderate obstructive lesions were still observed.With the reduction of kerosene use in daily life, kerosene-induced chemical pneumonia is rare, but due to its diverse and complex clinical manifestations and slow absorption of pulmonary inflammation, attention should be paid to its progression into chronic cough.

Preliminary research of / 中国针灸

OBJECTIVE@#To explore the impacts on weight reduction effect treated with acupoint thread embedding therapy at different tissue levels under ultrasonic guidance.@*METHODS@#A total of 70 patients with overweight or obesity were randomized into a shallow-tissue thread embedding group (35 cases, 5 cases dropped off) and a deep-tissue thread embedding group (35 cases, 4 cases dropped off). Under ultrasonic guidance, the thread was embedded in the shallow tissue level and the deep tissue level respectively. The acupoints were Zhongwan (CV 12), Xiawan (CV 10), Shuifen (CV 9), Zhongji (CV 3), etc. The thread embedding therapy was exerted once every 2 weeks, totally for 3 times. Before and 2 weeks after treatment, body mass, body mass index (BMI), waist circumference and hip circumference were recorded in the patients of the two groups separately. After each treatment, the number and the property of blood vessels under each acupoint were detected by ultrasound. Besides, the needling sensation and the intensity were scored and the adverse events were observed after thread embedding therapy.@*RESULTS@#After treatment, the reduction range of body mass, BMI and waist circumference in the deep-tissue thread embedding group were larger than those in the shallow-tissue thread embedding group successively (@*CONCLUSION@#The deep-tissue thread embedding therapy achieves the stronger

The epidemic trend of viral hepatitis in Nanjing from 1989 to 2020 / 预防医学

Objective@#To analyze the epidemic trend of viral hepatitis in Nanjing from 1989 to 2019 and predict the incidence in 2020, so as to provide reference for the prevention and control of viral hepatitis.@*Methods@#The incidence data of viral hepatitis in Nanjing from 1989 to 2019 was retrieved from Nanjng Center for Disease Control and Prevention and National Infectious Disease Reporting System. The epidemic trend was analyzed by estimating the annual percent change ( APC ) and the average annual percent change ( AAPC ). The seasonal incidence of different types of viral hepatitis was analyzed by seasonal index. The autoregressive integrated moving average model ( ARIMA ) was built to predict monthly incidence rate of viral hepatitis in 2020. @*Results@#The annual incidence rate of viral hepatitis was 62.00/100 000 in Nanjing from 1989 to 2019, showing a downward trend ( AAPC=8.4%, P<0.05 ). From 1998 to 2019, the annual incidence rates of hepatitis A, B, C and E were 1.98/100 000, 14.31/100 000, 2.30/100 000 and 2.60/100 000. The incidence of hepatitis A and B showed downward trends ( AAPC=-11.81%, -6.02%, both P<0.05 ); the incidence trend of hepatitis C was not obvious ( P>0.05 ); the incidence of hepatitis E showed an increasing trend ( AAPC=4.82%, P<0.05 ). From 2015 to 2019, the third and fourth quarters were the epidemic seasons of hepatitis A, B and C, while the first and second quarters were the epidemic seasons of hepatitis E. The ARIMA model predicted that the monthly incidence rates of viral hepatitis in 2020 would range from 1.26/100 000 to 3.69/100 000, among which hepatitis B ranged from 1.21/100 000 to 2.58/100 000, hepatitis C from 0.20/100 000 to 0.48/100 000, hepatitis E from 0.09/100 000 to 0.25/100 000. @*Conclusions@#The incidence of viral hepatitis in Nanjing shows a downward trend. Among different types of hepatitis, hepatitis B has a higher incidence. All types of hepatitis have epidemic seasons. It is predicted that the monthly incidence rates of viral hepatitis will be 1.26/100 000 to 3.69/100 000 in 2020.

Predictive modeling of 30-day readmission risk of diabetes patients by logistic regression, artificial neural network, and EasyEnsemble

Objective: To determine the most influential data features and to develop machine learning approaches that best predict hospital readmissions among patients with diabetes. Methods: In this retrospective cohort study, we surveyed patient statistics and performed feature analysis to identify the most influential data features associated with readmissions. Classification of all-cause, 30-day readmission outcomes were modeled using logistic regression, artificial neural network, and EasyEnsemble. F1 statistic, sensitivity, and positive predictive value were used to evaluate the model performance. Results: We identified 14 most influential data features (4 numeric features and 10 categorical features) and evaluated 3 machine learning models with numerous sampling methods (oversampling, undersampling, and hybrid techniques). The deep learning model offered no improvement over traditional models (logistic regression and EasyEnsemble) for predicting readmission, whereas the other two algorithms led to much smaller differences between the training and testing datasets. Conclusions: Machine learning approaches to record electronic health data offer a promising method for improving readmission prediction in patients with diabetes. But more work is needed to construct datasets with more clinical variables beyond the standard risk factors and to fine-tune and optimize machine learning models.

Early mortality in patients who received extensive surgical management for acute type a aortic dissection - analysis of 452 consecutive cases from a single-center experience

Abstract Objective: To detect the potential risk factors associated with early mortality in patients who received extensive surgical management, in the form of total arch replacement plus frozen elephant trunk and arch debranching (hybrid repair technique), for acute type A aortic dissection. Methods: The clinical and surgical data of 452 surgically treated patients with acute type A aortic dissection at our center, between March 2010 and December 2016, have been retrieved. Uni and multivariate logistic regression analyses were carried out to detect the effect of various preoperative demographics and different perioperative variables on early mortality. Results: Overall 30-day mortality occurred in 70 out of 452 patients (15.4%). The principal causes of death were multiple organ failure (n=38), cardiac failure (n=18), and severe pulmonary infection (n=10). Risk factors for early mortality were identified with multivariate analysis. Preoperatively, overweight (P<0.025), alcohol drinking (P<0.002), coronary artery disease (P<0.014), hemodynamic shock (P<0.006), and elevated white blood cells count (P<0.002) were associated with higher mortality rate. Postoperatively, prolonged operation time (P<0.008), stroke (P<0.0001), and acute renal dysfunction (P<0.0001) were highly associated with death. Conclusion: Considering the advantages of extensive surgical management for acute type A aortic dissection over the other less aggressive surgical approaches, it should be advised whenever indicated, provided that being carried out by experts in the field of adult aortic surgery in high-volume centers. The surgeon should be aware of the patient's preoperative comorbidities and other risk factors for early mortality, in particular, prolonged operation time.