Integrated Metagenomics and UPLC-Q-TOF-MS/MS to Explore the Mechanism of Dexamethasone on Pneumonia in Rats / 中山大学学报(医学科学版)

ObjectiveUsing multi-omics technology， we conducted the present study to determine whether dexamethasone has therapeutic effect on pneumonia rats through the regulation of intestinal flora and metabolites. MethodsTotally 18 Sprague-Dawley rats were randomly divided into 3 groups （n = 6 each）： Control group， Model group and Dexamethasone （Dex） group. Lipopolysaccharide （LPS） was continuously injected intraperitoneally into rats at a dose of 4 mg/kg for 7 days to induce pneumonia except the Control group. Then the Dex group was given Dex at a dose of 2 mg/kg via oral gavage for 12 days， and both the other two groups received continuously equal volume of sterile PBS buffer for 12 days. On the 19th day， lung， plasma， feces and intestinal contents of rat were collected. Hematoxylin-eosin （H&E） staining and Bio-plex suspension chip system were applied to evaluate the effect of Dex on pneumonia. Furthermore， metagenomic sequencing and UPLC-Q-TOF-MS/MS technology were employed to determine the intestinal flora and metabolites of rats， respectively. ResultsH&E staining results showed that the lung tissue of the Model group was infiltrated with inflammatory cells， the alveolar septum was increased， alveolar hemorrhage， and histological lesions were less severe in Dex group than in the model group. The levels of 3 inflammatory cytokines including TNF-α （P < 0.000 1）， IL-1α （P = 0.009 6） and IL-6 （P < 0.000 1） in the Model group were increased compared with the Control group， while Dex treatment reduced the levels of the three inflammatory factors. Taken together， Dex treatment effectively reversed the features of pneumonia in rats. Metagenomic analysis revealed that the intestinal flora structure of the three groups of rats was changed. In contrast with the Model group， an increasing level of the Firmicutes and an elevated proportion of Firmicutes/Bacteroidetes were observed after Dex treatment. Dex-treated rats possessed notably enrichment of Bifidobacterium， Lachnospiraceae and Lactobacillus. Multivariate statistical analysis showed a great separation between Model group and Dex group， indicating metabolic profile changes. In addition， 69 metabolites （P < 0.05） were screened， including 38 up-regulated in the Model group and 31 elevated in the Dex group， all of which were mainly involved in 3 metabolic pathways： linoleic acid metabolism， tryptophan metabolism and primary bile acid biosynthesis. ConclusionsIn summary， we demonstrate the beneficial effects of Dex on the symptoms of pneumonia. Meanwhile， integrated microbiome-metabolome analysis reveals that Dex improves LPS-induced pneumonia in rats through regulating intestinal flora and host metabolites. This study may provide new insights into the mechanism of Dex treatment of pneumonia in rats.

Association between body mass index with premature eruption of second permanent molars in children aged 9-12 in Bengbu City / 中国学校卫生

Objective@#To investigate the epidemiological characteristics of premature eruption of permanent molars and its aasociation with body mass index (BMI), to provide a reference for childhood oral health promotion.@*Methods@#A total of 861 children aged 9 to 12 years from two primary schools in Bengbu City were selected by cluster sampling method. Parental questionnaire was administered to collect socio demographic information. The eruption of second permanent molars were examined. Data was analyzed by multivariate Logistic regression model and margins command.@*Results@#The detection rate of premature eruption of second permanent molars was 26.5%(228), 27.5% in boys and 24.9% in girls( χ 2=0.73, P =0.39). Early detection rate of second permanent molars (39.0%) was significantly higher in obese group than normal weight group (21.5%)( χ 2=21.85, P <0.01). Logistic regression analysis showed that obesity was positively correlated with the risk of premature eruption of second permanent molars( OR= 3.55 , 95%CI=2.14-5.87, P <0.01). Overweight was not associated with higher risk of premature eruption of second permanent molars( OR=1.64, 95%CI=0.95-2.81, P =0.07). Being female was associated with higher risk of premature eruption of second permanent molars compared to age matched peers( OR=2.19, 95%CI=1.42-3.39, P <0.01).@*Conclusion@#Childhood obesity is associated with higher risk for premature eruption of second permanent molars. Girls are more likely to have second permanent molar erupted in advance compared to age matched boys.

Knowledge and practice of nosocomial infection control among medical professionals in grassroots healthcare institutions / 预防医学

Objective@#To investigate the current status of knowledge and practice pertaining to nosocomial infection control among medical professionals in grassroots healthcare institutions, so as to provide the evidence of improving the level of infection control in grassroots healthcare institutions.@*Methods@#All medical professionals working in grassroots healthcare institutions in Pukou District, Nanjing City, were enrolled. The participants' demographic features and knowledge and practice of nosocomial infection control were collected using self-designed questionnaires and descriptively analyzed.@*Results@#A total of 402 participants were enrolled, included 116 men ( 28.86% ) and 286 women ( 71.14% ). The respondents were predominantly at ages of 41 years and older ( 187 subjects, 46.52% ), with bachelor and above as the predominant educational level ( 200 subjects, 49.75% ) and intermediate title and above as the predominant professional title ( 168 subjects, 41.79%) , and there were 236 participants ( 58.71% ) with the length of service for more than 10 years. The awareness rate of nosocomial infection control knowledge was 56.22% among medical professionals working in grassroots healthcare institutions, with the highest awareness for COVID-19 prevention and control ( 89.55% ) and the lowest awareness for the key aspects in nosocomial infection control ( 39.55% ). The formation rate of implementing nosocomial infection control practices was 84.08%, with a low rate for “Implement satisfactorily the isolation interventions for patients with multidrug resistant bacteria” ( 71.14% ) and “Implement satisfactorily the control measures for nosocomial infections in key departments and key aspects”( 64.68% ).@*Conclusions@#Low levels are seen in the awareness of nosocomial infection control, behaviors of multidrug resistance management and key aspects in nosocomial infection control among medical professionals in grassroots healthcare institutions in Pukou District.

Value of baseline IgM level in predicting the treatment response of primary biliary cholangitis / 临床肝胆病杂志

Objective To investigate the association between baseline IgM level and treatment response to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC). Methods A retrospective analysis was performed for the clinical data of 637 PBC patients who were diagnosed and treated with UDCA for the first time in The Fifth Medical Center of Chinese PLA General Hospital from January 2010 to January 2020. The PBC patients were divided into UDCA complete response group with 436 patients and UDCA poor response group with 201 patients, and baseline clinical data were compared between the two groups. According to the optimal cut-off value of IgM determined by the area under the ROC curve (AUC) of baseline indices in predicting the risk of poor treatment response, the patients were divided into IgM ≥1.5×ULN group and IgM < 1.5×ULN group, and baseline parameters, treatment response, and prognostic model score were compared between groups. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Cochran-Mantel-Haenszel test was used for subgroup analysis, and forest plots were plotted for related risk values. Results Compared with the UDCA complete response group, the UDCA poor response group had significantly higher proportion of patients with liver cirrhosis, levels of total bilirubin, aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bile acid, total cholesterol (TC), IgA, and IgM, and positive rate of anti-Gp210 antibody at baseline ( χ 2 =4.596, Z =-9.932, -8.931, -8.361, -7.836, -4.694, -3.242, and -2.115, χ 2 =15.931, all P < 0.05). The UDCA poor response group had significantly higher Mayo Risk Score, Globe score, and UK-PBC risk score than the UDCA complete response group ( t =4.092, Z =-10.910 and -11.646, all P < 0.001). Compared with the normal IgM group, the elevated IgM group had significantly higher levels of AST, ALP, TC, IgA, and IgG and a significantly higher positive rate of anti-Gp210 antibody ( Z =-3.774, -5.063, -4.344, -2.051, and -6.144, χ 2 =25.180, all P < 0.05). IgM had an AUC of 0.552 in predicting poor treatment response. Compared with the IgM < 1.5×ULN group, the IgM ≥1.5×ULN group had significantly higher levels of AST, ALP, TC, and IgG, a significantly higher positive rate of anti-Gp210 antibody, and a significantly higher poor UDCA response rate ( Z =-4.193, -5.044, -3.250, and -5.465, χ 2 =25.204 and 8.948, all P < 0.05). IgM ≥1.5×ULN had an odds ratio of 1.416 (95% confidence interval [ CI ]: 1.129-1.776, P =0.003) in predicting poor response. The subgroup analysis showed that for patients without liver cirrhosis, IgM ≥1.5×ULN had an odds ratio of 1.821 (95% CI : 1.224-2.711, P =0.003) in predicting poor response. Conclusion Baseline IgM level has an important value in predicting UDCA response. IgM level should be closely monitored during treatment in PBC patients with a high baseline IgM level, and second-line drugs should be given in time if the abnormality persists.

Content determination ，fingerprint establishment and differential markers screening of Rougui renshen granules / 中国药房

OBJECTIVE To determine the conte nts of 4 main components in Rougui renshen granules ，and to establish the fingerprint and to screen differential markers affecting its quality. METHODS HPLC method was employed to determine the contents of ammonium glycyrrhizinate ，glycyrrhizin，cinnamic acid and cinnamaldehyde. HPLC fingerprints of 10 batches of Rougui renshen granules were established simultaneously. Similarity Evaluation System of Chromatographic Fingerprint of TCM （2012 edition）was used to evaluate the similarity and determine the common peak ；SPSS 25.0 and SIMCA 14.1 software were applied for cluster analysis （CA），principal component analysis （PCA）and partial least square-discriminant analysis （OPLS-DA）. The differential markers affecting sample quality were screened by using the variable importance in projection （VIP）value＞ 1 as standard. RESULTS The methodology of content determination met the relevant requirements. The contents of ammonium glycyrrhizinate，glycyrrhizin，cinnamic acid and cinnamaldehyde were 1.808 4-2.770 0，1.137 2-1.481 4，0.076 5-0.091 8 and 0.130 9-0.478 4 mg/g，respectively. A total of 16 common peaks were found in the fingerprints of 10 batches of Rougui renshen granules. Four chromatographic peaks were identified ，i.e. glycyrrhizin （peak 6），cinnamic acid （peak 10），cinnamaldehyde（peak 11）and ammonium glycyrrhizinate （peak 15）. The similarities of samples were ＞0.95. Results of CA showed that 10 batches of samples could be classified into three categories ：S3 was grouped into one category ；S1-S2，S4-S5 and S 10 were grouped into one category；S6-S9 were grouped into one category. The results of PCA showed that the cumulative contribution rate of the first three principal components was 91.918％，and the classification results were consistent with CA. The results of OPLS-DA showed that the four peaks with VIP value ＞1 were peak 11（cinnamaldehyde），peak 15（ammonium glycyrrhizinate ），peak 6（glycyrrhizin） and peak 9. CONCLUSIONS Established methods of content determination and fingerprint are accurate and reproducible ，and can be used for the quality evaluation of Rougui renshen granules. The components as ammonium glycyrrhizinate ，cinnamaldehyde， glycyrrhizin may be differential markers affecting the quality of Rougui renshen granules.

Inhibition of TAK1 aggravates airway inflammation by increasing RIPK1 activity and promoting macrophage death in a mouse model of toluene diisocyanate-induced asthma / 南方医科大学学报

OBJECTIVE@#To explore the effect of transforming growth factor-β (TGF-β)-activated kinase 1 (TAK1) on toluene diisocyanate (TDI)-induced allergic airway inflammation in mice.@*METHODS@#Thirty-two mice were randomly divided into AOO group, AOO+5Z-7-Oxozeaenol group, TDI group, and TDI+5Z-7-Oxozeaenol group. Another 32 mice were randomly divided into AOO group, TDI group, TDI +5Z-7-Oxozeaenol group, and TDI +5Z-7-Oxozeaenol + Necrostatin-1 group. TAK1 inhibitor (5Z-7-Oxozeaenol, 5 mg/kg) and/or RIPK1 inhibitor (Necrostatin-1, 5 mg/kg) were used before each challenge. Airway responsiveness, airway inflammation and airway remodeling were assessed after the treatments. We also examined the effect of TDI-human serum albumin (TDI-HSA) conjugate combined with TAK1 inhibitor on the viability of mouse mononuclear macrophages (RAW264.7) using CCK8 assay. The expressions of TAK1, mitogen-activated protein kinase (MAPK) and receptor interacting serine/threonine protease 1 (RIPK1) signal pathway in the treated cells were detected with Western blotting. The effects of RIPK1 inhibitor on the viability of RAW264.7 cells and airway inflammation of the mouse models of TDI-induced asthma were evaluated.@*RESULTS@#TAK1 inhibitor aggravated TDI-induced airway inflammation, airway hyper responsiveness and airway remodeling in the mouse models (P < 0.05). Treatment with TAK1 inhibitor significantly decreased the viability of RAW264.7 cells, which was further decreased by co-treatment with TDI-HSA (P < 0.05). TAK1 inhibitor significantly decreased the level of TAK1 phosphorylation and activation of MAPK signal pathway induced by TDI-HSA (P < 0.05). Co-treatment with TAK1 inhibitor and TDI-HSA obviously increased the level of RIPK1 phosphorylation and caused persistent activation of caspase 8 (P < 0.05). RIPK1 inhibitor significantly inhibited the reduction of cell viability caused by TAK1 inhibitor and TDI-HSA (P < 0.05) and alleviated the aggravation of airway inflammation induced by TAK1 inhibitors in TDI-induced mouse models (P < 0.05).@*CONCLUSION@#Inhibition of TAK1 aggravates TDI-induced airway inflammation and hyperresponsiveness and may increase the death of macrophages by enhancing the activity of RIPK1 and causing persistent activation of caspase 8.

Clinicopathological features of NTRK3 gene rearrangement papillary thyroid carcinoma / 中华病理学杂志

Objective: To investigate the clinicopathological features and differential diagnosis of NTRK3 gene rearrangement thyroid papillary carcinoma (PTC). Methods: The PTC cases without BRAF V600E mutation were collected at Fujian Provincial Hospital South Branch from January 2015 to January 2020. The cases of NTRK3 gene rearrangement PTC were examined using immunohistochemistry and fluorescence in situ hybridization (FISH). The clinical data, histopathological characteristics, immunohistochemical features and molecular pathological changes were retrospectively analyzed. Data from the TCGA PTC dataset and the literature were also studied. Results: A total of 3 PTC cases harboring NTRK3 gene rearrangement were confirmed. All the patients were female, aged from 26,49,34 years. Histologically, two of them demonstrated a multinodular growth pattern. Only one case showed prominent follicular growth pattern; the other two tumors showed a mixture of follicular, papillary and solid growth patterns. All tumors showed a typical PTC nuclear manifestation, with some nuclear pleomorphism, vacuolated foci and oncocytic features. The characteristic formation of glomeruloid follicular foci was present in two cases which also showed psammoma bodies, and tumoral capsular or angiolymphatic invasion. The background thyroid parenchyma showed chronic lymphocytic thyroiditis. Mitotic rates were low, and no cases had any tumor necrosis. The pan-TRK and TTF1 testing was both positive in 3 cases, while S-100 and mammaglobin were both negative in them. FISH studies confirmed the NTRK3 gene rearrangement in all 3 cases. Studies on the TCGA datasets and literature revealed similar findings. Conclusions: NTRK3 gene rearrangement PTC is rare. It may be easily misdiagnosed due to the lack of histological and clinicopathological characteristics. Molecular studies such as pan-TRK immunostaining, FISH and even next-generation sequencing are needed to confirm the diagnosis. Immunohistochemistry of pan-TRK performed in the PTC cases without BRAF V600E mutation can be used as a good rapid-screening tool. With the emergence of pan-cancer tyrosine receptor kinase inhibitors, proper diagnosis of these tumors can help determine appropriate treatments and improve their outcomes.

Prenatal pyrethroid pesticides exposure and neurodevelopment of 2-year-old children: a birth cohort study / 中华预防医学杂志

Objective: To investigate the influence and critical windows of prenatal exposure to pyrethroid pesticides (PYRs) on neurodevelopment of 2-year-old children. Methods: The subjects of this study were derived from the Xuanwei Birth Cohort. A total of 482 pregnant women who participated in the rural district of Xuanwei birth cohort from January 2016 to December 2018 were included. Maternal urinary concentrations of PYRs metabolites during 8-12 gestational weeks, 20-23 gestational weeks and 32-35 gestational weeks were measured with ultra high performance liquid chromatography system coupled with a tandem mass spectrometry detector. Child neurodevelopment was evaluated with the Bayley Scales of Infant and Toddler Development-Third Edition at 2 years of age. Multivariate linear regression models and binary logistic regression models were used to assess the association between PYRs exposure during pregnancy and children's neurodevelopment. Results: A total of 360 mother-child pairs had complete data on maternal urinary PYRs metabolites detection and children's neurodevelopment assessment. The detection rate of any one PYRs metabolites during the first, second and third trimester were 93.6% (337/360), 90.8% (327/360) and 94.2% (339/360), respectively. The neurodevelopmental scores of Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior of 2-year-old children were (102.3±18.9), (100.2±16.3), (102.0±20.3), (107.8±23.3) and (85.8±18.6) points, respectively. After controlling for confounding factors, 4-fluoro-3-phenoxybenzoic acid (4F3PBA, one of PYRs metabolites) exposure in the first trimester reduced Motor (β=-5.02, 95%CI: -9.08, -0.97) and Adaptive Behavior (β=-4.12, 95%CI:-7.92, -0.32) scores of 2-year-old children, and increased risk of developmental delay of adaptive behavior (OR=2.07, 95%CI:1.13-3.82). Conclusion: PYRs exposure during the first trimester of pregnancy may affect neurodevelopment of 2-year-old children, and the first trimester may be the critical window.

Pathogenic spectrum and laboratory indicators of fungal infections in the central nervous system / 中华预防医学杂志

Central nervous system (CNS) fungal infections are challenging and difficult to diagnose and treat. This article introduces the high risk factors, pathogen spectrum and laboratory indicators that cause CNS fungal infection. As patients with CNS fungal infections are often accompanied by immunodeficiency, it is especially necessary for clinical early detection, early prevention, and early diagnosis, and timely and effective implementation of optimized diagnosis and treatment programs to prevent further deterioration of the disease.

Evaluation of immune persistence of vaccine / 中华预防医学杂志

The evaluation methods of immune persistence include direct evaluation, indirect evaluation, model prediction, and meta-analysis and so on. Direct evaluation is the gold standard for evaluating the immune persistence of vaccines by quantifying the protective effect of vaccines on the onset and (or) infection of preventable diseases. Indirect evaluation of immune persistence by immunological surrogate indicators is more widely used in practice. In addition, mathematical models and meta-analysis can also be used to evaluate the immune persistence of vaccines. It is of great significance to select the appropriate evaluation method to analyze the immune persistence of the vaccine according to the specific situation.

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods    The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results     A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion     The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult  patients undergoing elective cardiac surgery with cardiopulmonary bypass.

A comparative study on the human resources deployment of public general hospitals in Pudong New Area / 中华医院管理杂志

Objective:To compare the actual situation and measurement data of human resources deployment in public general hospitals in Pudong New Area, so as to provide a data basis for further optimizing the human resources deployment plan.Methods:The Pudong New Area Health Statistical Information System was used to collect the staffing information and business data of 9 public general hospitals in Pudong New Area, Shanghai in 2019. On such basis, the numbers of officially budgeted positions and actual positions were calculated. Descriptive analyses of the data were performed to compare the theoretical and actual quantities by paired t-test and Wilcoxn signed-rank sum test. Results:The actual number of officially budgeted positions of the 9 hospitals was less than the theoretical number( Z=-2.55, P=0.011), while the actual number of positions was less than that of theoretical number( t=3.36, P=0.010). The proportion of the officially budgeted position shortage at tertiary hospitals(72.77%)was higher than that of secondary hospitals(36.94%). The proportion of position shortage at tertiary hospitals(16.14%)was less than that at secondary hospitals(38.78%). Conclusions:Area-owned general hospitals are in shortage of human resources, while secondary and tertiary hospitals have different needs for human resources. The actual situation of a hospital should be comprehensively considered to develop an optimal deployment plan for human resources.

Application of artificial neural network in evaluation of IVF embryo / 中华检验医学杂志

Artificial neural network (ANN) is a network framework that drives artificial intelligence (AI). Classical convolutional neural networks (CNN) are mainly used for cell count and image recognition at fixed time in embryo evaluation. Fully connected deep neural networks (DNN), with increased accuracy of image recognition, are suitable for the units equipped with high configuration hardware and need comprehensive prediction according to the integrated clinical information. Residual networks improve the accuracy by increasing layers and solving the gradient disappearance problem through jump connection to realize dynamic embryo assessment. Bayesian networks (BN) and multi-layer perceptron (MLP) are two machine learning methods. The former is especially used for comprehensive prediction combined with complex clinical information in case of lack of conditions. The latter has gradient disappearance and explosion problem, and is easy to lose some spatial features of images, so it is used for small sample volumes. ANN has advantages in the prediction of implantation rate and aneuploidy and reducing invasive detection in quality assessment of embryos, which is an important research direction of human-assisted reproductive technology (ART).

Repetitive low-frequency transcranial magnetic stimulation can improve sleep disorders and abnormal behavior among children on the autism spectrum / 中华物理医学与康复杂志

Objective:To observe any effect of repetitive low-frequency transcranial magnetic stimulation (rTMS) on sleep disorders and abnormal behaviors of children on the autism spectrum.Methods:Forty autistic children were randomly divided into an observation group and a control group, each of 20. Both groups were given sleep behavior training and individualized conventional rehabilitation training. Those in the observation group also received 30min of rTMS at 1Hz applied over the left dorsolateral prefrontal cortical area once a day, 5 days a week. Before and after 8 weeks of this treatment, both groups were evaluated using the Autism Behavior Checklist (ABC), the Child Autism Rating Scale (CARS) and the children′s Sleep Habit Questionnaire (CSHQ).Results:The average CARS and CSHQ scores, as well as the total ABC score of both groups increased significantly over the 8 weeks, but the average CARS and CSHQ scores, as well as the total ABC score of the observation group were then significantly better than in the control group. After the treatment, the average ABC scores for sensory ability, communication ability, motor ability, and language ability were significantly lower than before the treatment for both groups, but the observation group′s averages were then significantly better than those of the control group.Conclusions:Supplementing routine intervention with low-frequency rTMS can effectively improve the sleeping and correct the abnormal behavior patterns of autistic children.

Analysis of the current status of knowledge, attitude and practice of metabolic syndrome and its influencing factors among the elderly in Beijing community / 中华老年医学杂志

Objective:To understand the status of knowledge, attitude and practice of metabolic syndrome(MS) among the elderly in the community and analyze its influencing factors, so as to provide guidance for the prevention and treatment of MS.Methods:From January 2021 to August 2021, permanent residents(residence duration ≥6 months)aged 65 and above with regular health check examination in Fangzhuang Community Health Service Center of Fengtai District, Beijing were investigated using self-designed MS knowledge, attitude and practice questionnaire.After excluding 34 incomplete questionnaires, the 491 valid questionnaires were recycled with questionnaire valid percentage of 93.5%(491/525). The survey results were analyzed by descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test and multiple linear regression analysis and multiple linear regression.Results:The scores of MS knowledge, attitude and practice of the elderly in the community were 7(5, 10), 9(8, 10)and 19(18, 21)respectively.The correct answer rate of the diagnostic criteria of MS components was less than 50%.The score of knowledge about MS in the elderly was positively correlated with the scores of attitudes( r=0.263)and practice( r=0.134)(all P<0.01). The results of univariate and multiple linear regression analysis showed that gender, attending educational lectures and the prevalence of MS were the influencing factors of MS knowledge score(all P<0.05). Leisure time, attending educational lectures, pre-retirement occupation and regular health check examination were the influencing factors for MS attitude score(all P<0.05); attending educational lectures, leisure time, regular health check examination and pre-retirement occupation were the influencing factors for MS practice score(all P<0.05). Conclusions:The elderly in the community have a low level of knowledge about the components and diagnostic criteria of MS, but have a positive attitude and practice towards the prevention and treatment of MS.The level of knowledge, attitude and practice of MS is affected by health education lectures, occupation, regular health check examination and other factors.Health education on the diagnostic criteria and the awareness of disease prevention for the elderly in the community should be strengthened to improve the levels of the knowledge, attitude and practice of MS.

Analysis of clinical characteristics of in-stent reocclusions after coronary stenting for chronic total occlusions in elderly patients / 中华老年医学杂志

Objective:To investigate clinical characteristics for in-stent reocclusion lesions after coronary stent implantations in aged patients.Methods:229 patients diagnosed with chronic total reocclusions were recruited from Jan 2005 to Dec 2019 in this retrospective study.According to age, patients were divided into a 40-49 year-old group(n=60), a 50-59 year-old group(n=58), a 60-69 year-old group(n=55), and a 70-80 year-old group(n=56)to examine different lesion characteristics after coronary stent implantations.Results:In the 40-49 year-old group, the 50-59 year-old group, the 60-69 year-old group and the 70-80 year-old group, the rates of multi-vessel reocclusions were 11.6%, 15.5%, 21.8% and 25.0%, respectively( χ2=10.03, P=0.01). For each group, lesions with concurrent proximal and middle coronary reocclusions accounted for 8.3%, 12.0%, 30.9% and 35.7%, respectively( χ2=11.83, P=0.005); Reocclusions with severe coronary calcification accounted for 6.6%, 15.5%, 36.3% and 37.5%, respectively( χ2=11.56, P=0.006); Long coronary reocclusion lesions(36-47 mm)accounted for 15.0%, 17.2%, 21.8% and 25.0%, respectively( χ2=11.56, P=0.007); Coronary reocclusions with diffuse long calcified lesions accounted for 8.3%, 13.7%, 32.7% and 35.7%, respectively( χ2=10.80, P=0.01). Conclusions:The clinical characteristics of in-stent reocclusion lesions after coronary stent implantations include multiple chronic total coronary reocclusions, concurrent proximal and middle coronary reocclusions, heavily calcified coronary reocclusions, long coronary reocclusions and diffuse long calcified coronary reocclusions in aged patients.

Analysis of prognostic factors in 135 patients with pulmonary metastasis from esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To investigate the prognostic factors of patients with esophageal squamous cell carcinoma with pulmonary metastasis.Methods:Clinical characteristics of 135 esophageal squamous cell carcinoma patients presenting with pulmonary metastasis after treatment in Zhejiang Cancer Hospital from 2008 to 2018 were retrospectively analyzed. Thesurvival rate was calculated by Kaplan-Meier method. Univariate analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox models.Results:The median follow-up time of 135 patients with esophageal squamous cell carcinoma was 94.2 months (19.5-258.9 months), and 109 patients died (80.7%). The 1-and 2-year overall survival rates were 47.4% and 25.1%, with the median survival time was 11.1 months (7.3-14.9 months). Univariate prognostic analysis showed that age, number of lung metastases, treatment of lung metastases, lymph node metastasis, distant organ metastasis, and the interval between the first treatment and lung metastasis were the prognostic factors of esophageal squamous cell carcinoma with lung metastasis (all P<0.05). Multivariate analysis demonstrated that age and number of lung metastases were the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases (all P<0.05). Conclusions:Age and number of lung metastases are the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases. Surgery or radiotherapy-based regional therapy can enhance clinical prognosis.

Application and effect evaluation of multidisciplinary collaboration in patients with tophi during perioperative period / 中华风湿病学杂志

Objective:To explore the application and effect of multidisciplinary collaboration in patients with tophi during perioperative period.Methods:Forty-five patients undergoing tophaceous gout surgery in our hospital from May to October 2020 were selected as the control group and treated with routine treatment.From November 2020 to April 2021, 41 patients undergoing tophaceous gout surgery in our hospital who were treated with multidisciplinary collaboration management mode were included as the intervention group. Postoperative pain, blood uric acid level, hospitalization expenses, hospitalization days and patient satisfaction were compared between the two groups.Results:After implementing the multidisciplinary integration man-agement mode, the pain score of the patients at 4 hours, 1 day and 3 days after operation was lower than that of the control group [(3.6±1.0) vs (4.1±1.0), t=2.33, P=0.022; (2.5±0.8) vs (3.0±0.6), t=3.85, P<0.001; (1.8±0.5) vs (2.2±0.7), t=3.52, P<0.001], the serum uric acid level was significantly lower than that of the control group at 1 month and 3 months after operation [(355±58) vs (3928±39), t=3.50, P=0.001; (316±48) vs (366±47), t=4.84, P<0.001], the hospitalization days and hospitalization expenses were significantly decreased [(8.90±2.48) d vs (10.62±3.96) d, t=2.44, P=0.017; (1.00±0.13) ten thousand yuan vs (1.11±0.17) ten thousand yuan, t=3.34, P=0.001], and the patient satisfaction was markedly improved (97.6% vs 82.2%, χ2=3.87, P=0.049). Conclusion:The multi-disciplinary collaboration mode in patients with tophi during perioperative period can effectively reduce the postoperative pain, improve the quality of care, promote reha-bilitation, improve the outcome, and reduce the economic burden of patients, which is worthy of popularization and being applied in clinic.

Lengths of intramedullary nails and treatment efficacy of osteoporotic unstable intertrochanteric fracture / 中华创伤骨科杂志

Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.

Hepatic venous pressure gradient affects the efficacy of endoscopic treatment of gastroesophageal varices in hepatitis B cirrhosis / 中国医师杂志

Objective:To investigate the effect of hepatic venous pressure gradient (HVPG) on the prevention of rebleeding in cirrhotic patients of hepatitis B with gastroesophageal variceal hemorrhage receiving endoscopic therapy, and its influence on prognosis.Methods:Fifty eight patients with esophageal and gastric varices due to cirrhosis of hepatitis B admitted to Minhang Hospital Affiliated to Fudan University (from January 2019 to September 2021, n=18) and Zhongshan Hospital Affiliated to Fudan University (from January to September 2017, n=40) were retrospectively included. All of them underwent HVPG determination and endoscopic treatment. They were divided into HVPG≤18 mmHg group and HVPG>18 mmHg group. The rebleeding and survival status of these patients with endoscopic treatment was compared after a follow-up period of 2 years, and Cox regression was performed to analyze the related factors for rebleeding and survival. Results:A total of 58 individuals were included, which were divided into two groups: HVPG≤18 mmHg group (35) and HVPG>18 mmHg group (23). During the 2-year follow-up after the first endoscopic treatment, 13 patients (22.41%) developed rebleeding, including 4 patients in the HVPG≤18 mmHg group and 9 patients in the HVPG>18 mmHg group. The non-bleeding rate in HVPG≤18 mmHg group was significantly higher than that in HVPG>18 mmHg group (91.3% vs 68.7%, RR=3.54, 95% CI: 1.08-11.60, P=0.026), and the difference was statistically significant. Four patients died, including 1 patient in the HVPG≤18 mmHg group and 3 patients in the HVPG>18 mmHg group. There was no statistically significant difference in 2-year survival between the two groups (96.7% vs 86.5%, RR=4.44, 95% CI: 0.45-43.58, P=0.162). Cox regression multivariate analysis was used to analyze the above data, and the results suggested portal vein thrombosis ( HR=3.826, 95% CI: 1.263-11.585, P=0.018), HVPG>18 mmHg ( HR=4.243, 95% CI: 1.290-13.955, P=0.017) were independent risk factors for rebleeding in 2 years after endoscopic therapy. Conclusions:For patients with high HVPG, it should be fully evaluated and considered to receive other pressure lowering therapy, and treatment conversion should be carried out as soon as possible after endoscopic treatment failure.