Effect of Acupuncture on Endometrial Blood Flow in Women Undergoing in vitro Fertilization Embryo Transfer: A Single Blind, Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of manual acupuncture on endometrial blood flow parameters by three-dimensional (3D) power Doppler ultrasound in women undergoing in vitro fertilization embryo transfer (IVF-ET).@*METHODS@#Seventy patients undergoing IVF-ET were equally randomized into traditional or sham acupuncture treatment group for totally 4 days (from the day of oocyte aspiration to the day of embryo transfer) of treatment by random envelope method at the Reproductive Medicine Center and Outpatient Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology from January 2013 to December 2015. Patients in the traditional acupuncture group accepted traditional acupuncture methods with manual acupuncture, and Zhongji (CV3), Qihai (CV 6), Sanyinjiao (SP6), Taichong (LR 3), Tianshu (ST 25), Guilai (ST 29) and Zusanli (ST 36) were chosen. Patients at the sham acupuncture group accepted shallow acupuncture methods at 4 non-meridian points at each shoulder and upper arm. Outcome measures included endometrial ultrasonic indices such as vascularization index (VI), flow index (FI) and vascularization flow index (VFI), endometrial thickness and volume, subendometrial VI (sVI), subendometrial FI (sFI), subendometrial VFI (sVFI), implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births.@*RESULTS@#Finally, 34 patients in the traditional acupuncture group and 35 in the sham acupuncture group completed this trial. VI, FI and VFI of the traditional acupuncture group were significantly higher than those in the sham acupuncture group (P<0.05). No significant differences were found in endometrial thickness, endometrial volume, sVI, sFI, sVFI, implantation rate, clinical pregnancy rate, abortion rate, live birth rate and number of live births (P>0.05).@*CONCLUSIONS@#Manual acupuncture performed after oocyte aspiration and before transplantation improved the endometrial blood flow parameters VI, RI and VFI in women who underwent IVF-ET, instead of sVI, sFI and sVFI. Therefore, acupuncture might be beneficial in women undergoing IVF-ET by increasing endometrial blood flow and endometrial receptivity. (Registration No. ChiCTR2100053354).

Correlation between clinical distribution characteristics of streptococcal pharyngitis in children and seasonal variations in Ziyang Area> / 公共卫生与预防医学

Objective To explore the correlation between clinical distribution characteristics of streptococcal pharyngitis in children and seasonal variations in Ziyang area, so as to provide basis for disease prevention and control. Methods A multistage and stratified random sampling technique was used to investigate 583 children with streptococcal pharyngitis attending Ziyang first people's Hospital from January 2022 to January 2023. The clinical data were recorded. The pharyngeal specimens were cultured for streptococci test. The number of streptococcal pharyngitis cases per season was counted. The metereological conditions (average barometric pressure, temperature, rainfall, and wind speed) were recorded. Pearson method was used to discuss the correlation between metereological factors and streptococcal pharyngitis onset. Results A total of the 583 children, 329 were male and 254 were female. The main age of onset was 7-12 years old, with a total of 227 cases (38.94%), followed by 199 cases (34.13%) aged 3-6 years old, 126 cases (21.61%) aged 1-2 years old, and 31 cases (5.32%) under 1 year old. A total of 614 strains of pathogenic bacteria were detected, of which 479 strains of Streptococcus hemolyticus were dominant, accounting for 78.01%, followed by 175 strains of Streptococcus pyogenes, accounting for 28.50%. Seasonally, 192 cases of streptococcal pharyngitis occurred in spring, 51 in summer, 72 in autumn and 268 in winter. In Ziyang, spring and winter were characterized by high mean wind speeds and barometric pressure, while summer and autumn were characterized by high mean temperatures and heavy rainfall. Pearson correlation analysis revealed that the prevalence rate streptococcal pharyngitis was positively correlated with average wind speed and barometric pressure (P<0.05), and negatively correlated with mean temperature and rainfall (P<0.05). Conclusion In Ziyang, streptococcal pharyngitis occurs mostly in children over 5 years old, and the main pathogen is Streptococcus hemolyticus. The onset of the disease is mostly in spring and winter, which is closely related to the seasonal variations of the region.

Intervention effect and mechanism of breviscapine on hepatic fibrosis in rats / 中国药房

OBJECTIVE To investigate the intervention effect and potential mechanism of breviscapine on hepatic fibrosis （HF） in rats based on the transforming growth factor-β（1 TGF-β1）/Smad2/extracellular signal-regulated protein kinase 1（ERK1） and Kelch-like epichlorohydrin-associated protein 1（Keap1）/nuclear factor-erythroid 2-related factor 2（Nrf2）/heme oxygenase-1（HO-1） pathways. METHODS Totally 60 rats were randomly divided into normal control group， model group， breviscapine low-dose， medium-dose and high-dose groups （5.4， 10.8， 21.6 mg/kg）， and colchicine group （positive control， 0.45 mg/kg）， with 10 rats in each group， half male and half female. Except for the normal control group， HF model of the other groups was induced by carbon tetrachloride. Subsequently， each drug group was given corresponding medicine by gavage once a day for 28 days. The liver appearance of rats in each group was observed and their liver coefficients were calculated. The levels of alanineaminotransferase （ALT） and aspartate aminotransferase （AST）in serum， those of ALT， AST， superoxide dismutase （SOD），malondialdehyde （MDA） and glutathione peroxidase （GSH- Px） in liver tissue were detected. The liver tissue inflammatory and fibrotic changes were observed. The protein and mRNA expressions of TGF-β1， Smad2， ERK1， Nrf2， Keap1 and HO-in liver tissue were detected. RESULTS Compared with the normal control group， the model group showed large areas of white nodular lesions in the liver， obvious inflammatory cell infiltration and collagen fiber deposition. The body weight， the levels of SOD and GSH-Px in liver tissue， the protein and mRNA expressions of Nrf2 and HO-1 were significantly lowered in the model group （P＜0.05）； the liver coefficient， the percentage of Masson staining positive area， ALT and AST levels of serum and liver tissue， MDA level of liver tissue， the protein and mRNA expressions of TGF-β1， Smad2， ERK1 and Keap1 were significantly increased （P＜0.05）. Compared with the model group， the liver lesions of rats in each drug group were improved， and the above quantitative indexes were generally reversed （P＜0.05）. CONCLUSIONS Breviscapine has a good intervention effect on HF rats， which may be related to inhibiting TGF-β1/Smad2/ERK1 pathway for anti-fibrosis and regulating Keap1/Nrf2/HO-1 pathway to inhibit oxidative stress.

Effects of fractionated low-dose ionizing radiation in the induction of EA.hy926 cell senescence / 中国辐射卫生

Objective To investigate the mechanism of fractionated low-dose ionizing radiation (LDIR) in the induction of EA.hy926 cell senescence. Methods EA.hy926 cells were irradiated with X-ray at 0, 50, 100, and 200 mGy × 4, respectively, and cultured for 24, 48, and 72 h. Several indicators were measured, including the levels of cellular senescence-associated β-galactosidase (SA-β-gal) staining, mRNA levels of senescence-associated cell cycle protein-dependent kinase inhibitor genes CDKN1A and CDKN2A, reactive oxygen species (ROS), total antioxidant capacity (T-AOC), and phosphorylated H2A histone family member X (γ-H2AX). Results After 4 fractionated LDIR, compared with the control group, the treatment groups showed increased nucleus area, blurred cell edge, and increased SA-β-gal positive area (P < 0.05) at 24, 48 and 72 h. After 4 fractionated LDIR, the mRNA level of CDKN1A increased in the 100 and 200 mGy × 4 groups at 24 and 48 h (P < 0.05), and CDKN2A mRNA level increased in the 100 and 200 mGy × 4 groups at 48 and 72 h (P < 0.05). The fluorescence intensity of ROS increased in treatment groups at 24, 48, and 72 h after 4 fractionated LDIR (P < 0.05). After 4 fractionated LDIR, the T-AOC level increased in the 100 and 200 mGy × 4 groups at 24 h (P < 0.05), and T-AOC level increased in all treatment groups at 48 and 72 h (P < 0.05). After 4 fractionated LDIR, γ-H2AX fluorescence intensity increased in all treatment groups at 24 h (P < 0.05), and the fluorescence intensity increased in the 100 and 200 mGy × 4 groups at 48 and 72 h (P < 0.05). Conclusion Fractionated LDIR can induce cellular senescence in EA.hy926 cells by impacting the cellular oxidation-antioxidation and oxidative damage levels, and the effects were relatively evident at 100 and 200 mGy.

Research progress on the manifestations and prognosis of neonatal lupus erythematosus in various systems / 中国当代儿科杂志

Neonatal lupus erythematosus (NLE) is caused by the transmission of maternal anti-Ro/SSA antibodies, anti-La/SSB antibodies, and other autoantibodies to the fetus through the placenta. Usually, with the disappearance of autoantibodies in the children's body, abnormal changes in the mucocutaneous, blood system, and digestive system can spontaneously subside, but the damage to various systems caused by autoantibodies may persist for a long time. This article provides a comprehensive review of the manifestations and prognosis of NLE in various systems, including mucocutaneous, blood system, circulatory system, nervous system, digestive system, respiratory system, aiming to provide reference for clinical work.

Improvement effect and mechanism of Baicao fuyanqing suppository on bacterial vaginitis in rats / 中国药房

OBJECTIVE To explore the improvement effect and potential mechanism of Baicao fuyanqing suppository on bacterial vaginitis （BV） in rats. METHODS The female SD rats were randomly divided into normal group， model group， metronidazole group （positive control， 0.03 g/kg）， Baicao fuyanqing suppository low-dose， medium-dose and high-dose groups （0.18， 0.36， 0.72 g/kg）， with 8 rats in each group. Except for the normal group， the rats in other groups were injected subcutaneously with 0.2 g of Estradiol benzoate injection+20 μL of Escherichia coli suspension （2×108～3×108 cfu/mL） through the vaginal opening to establish the BV rat model. Administration groups were given relevant medicine vaginally， while the normal group and the model group were given normal saline， once a day， for 6 consecutive days. Twenty-four hours after the last administration， the vaginal appearance score and vaginal pH were measured for each group of rats. The levels of cytokines [interleukin-1β （IL-1β）， IL-2， IL-13， immunoglobulin A （IgA）] in vaginal lavage fluid were determined. The morphology of the uterus and accessories， and pathological changes in the vaginal tissue were observed. The expressions of Toll-like receptor 2 （TLR2）， TLR4 and nuclear factor-κB （NF-κB） in vaginal tissues were determined. RESULTS Compared with the normal group， the uterus edema， the irregular shape of uterus and accessories， the vaginal mucosa hyperplasia， and the massive desquamation of epithelial cells were observed in the model group， complicating with massive infiltration of inflammatory cells； vaginal opening redness and swelling score and secretion score， vaginal pH， the levels of proinflammatory cytokine IL-1β and IL-2， the protein expressions of TLR2， TLR4 and NF- κB were all increased or up-regulated， while the levels of IgA and anti-inflammatory cytokine IL-13 decreased significantly （P＜0.05 or P＜0.01）. Compared with the model group， varying cn degrees of improvement in uterine and accessories， and vaginal tissue lesions in rats were observed in administration groups， and most of the quantitative indicators mentioned above showed significant improvement （P＜0.05 or P＜0.01）. CONCLUSIONS Baicao fuyanqing suppository has a certain improvement effect on inflammatory symptoms in BV rats， and its mechanism may be related to the inhibition of the TLR/NF-κB signaling pathway.

Pre-hospitalization process reengineering based on the failure mode and effect analysis combined with process analysis method / 中华医院管理杂志

The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.

Observation of vortex venous anastomosis in central serous chorioretinopathy / 中华眼底病杂志

Objective:To observe the anastomotic status of the vortex veins in patients with central serous chorioretinopathy (CSC).Methods:A cross-sectional study of clinical practice. From July 2021 to July 2022, 50 cases (50 eyes) of monocular CSC patients diagnosed through ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, there were 37 males (74.0%, 37/50) and 13 females (26.0%, 13/50), with the mean age of (44.30±9.59) years old. The course of disease from the onset of symptoms to the time of treatment was less than 3 months. The affected eye and contralateral eye of CSC patients were divided into the affected eye group and contralateral eye group, respectively. Fifty healthy volunteers of the same age and gender were selected as the normal control group with 50 eyes. The macular area scanning source optical coherence tomography (OCT) vascular imaging examination was performed with Visual Microimaging (Henan) Technology Co., Ltd. VG200D. Horizontal watershed vortex veins anastomosis rate and asymmetric vortex-venous dilation rate were observed by en face OCT. The device comes with software to calculate the central foveal choroidal thickness (SFCT), mean choroidal thickness (MCT), and choroidal vascular index (CVI). One-way analysis of variance and χ2 test were used to compare the three groups. When variances were unequal between groups, nonparametric tests were performed. Results:The SFCT values of the affected eye group, contralateral eye group, and normal control group were (567.12±129.02), (513.26±133.17), (327.64±97.40) μm, respectively; MCT were (407.38±97.54), (388.24±94.13), (275.46±60.55) μm, respectively; CVI were 0.34±0.05, 0.32±0.04, and 0.27±0.04, respectively; anastomosis rates of vortex veins were 98% (49/50), 78% (39/50), and 40% (20/50), respectively; asymmetric dilation rates of vortex veins were 96% (48/50), 88% (44/50), and 48% (24/50), respectively. The differences of SFCT ( F=53.974), MCT ( Z=51.415), CVI ( F=28.082), vortex vein anastomosis rate ( χ2=43.056), asymmetric dilation rate of vortex veins ( χ2=37.728) among three groups were statistically significant ( P<0.001). Compared with the contralateral eye group, the SFCT, MCT, CVI, vortex vein anastomosis rate, and vortex vein asymmetric dilation rate in the affected eye group were significantly higher than those in the contralateral eye group. Among them, the differences of SFCT ( t=2.054), CVI ( t=2.211), and vortex vein anastomosis rate ( χ2=9.470) were statistically significant ( P<0.05); the differences of MCT ( Z=7.490), asymmetric dilation rate of vortex veins ( χ2=2.714) were not statistically significant ( P=1.000, 0.140). Conclusions:SFCT, MCT, and CVI in the affected and contralateral eyes of monocular CSC patients significantly increase. The anastomotic rate and asymmetric dilation rate of the vortex vein in the opposite eye were lower than those in the affected eye.

Roles and responsibilities of functional departments of the training base in general practice residency training / 中华全科医师杂志

The standardized residency training of general practice is a complex project, the functional departments of the training base should play an active role for its management. The functional department of education in Zhongshan Hospital constantly explores its position and role, connects relevant departments vertically and horizontally to provides management and service for general practice residency training. That means that it should not only to provide advice for leadership decision-making, but also coordinate with all functional departments of the training base. The department has participated in the teaching management and supervision, educational research and training quality control, and accomplished positive results in general practice residency training for last 35 years.

Assessment of 3D-printed tissue compensators for superficial tumor X-ray radiation compensation / 中华放射医学与防护杂志

Objective:To investigate the advantage of three dimensional(3D)-printed tissue compensators in radiotherapy for superficial tumors at irregular sites.Methods:A subcutaneous xenograft model of prostate cancer in nude mice was established. Mice were randomly divided into no tissue compensator group( n=6), common tissue compensator group( n=6), and 3D-printed tissue compensator group( n=6). Computed tomography (CT) images of nude mice in the 3D-printed tissue compensator group were acquired. Compensator models were made using polylactic acid, and material properties were evaluated by measuring electron density. CT positioning images of the three groups after covering the corresponding tissue compensators were acquired to delineate the gross tumor volume (GTV). Nude mice in the three groups were irradiated with 6 MV X-rays at the prescribed dose. The prescribed dose for the three groups was 1 500 cGy. The dose distribution in the GTV of the three groups was calculated and compared using the analytical anisotropic algorithm in the Eclipse 13.5 treatment planning system. The metal-oxide-semiconductor field-effect transistor was used to verify the actual dose received on the skin surface of nude mice. Results:The air gap in the 3D-printed tissue compensator group and the common tissue compensator group was 0.20±0.07 and 0.37±0.07 cm 3, respectively ( t=4.02, P<0.01). For the no tissue compensator group, common tissue compensator group, and 3D-printed tissue compensator group, the D95% in the target volume was (1 188.58±92.21), (1 369.90±146.23), and (1 440.29±45.78) cGy, respectively ( F=9.49, P<0.01). D98% was (1 080.13±88.30), (1 302.76±158.43), and (1 360.23±48.71) cGy, respectively ( F=11.17, P<0.01). Dmean was (1 549.08±44.22), (1 593.05±65.40), and (1 638.87±40.83) cGy, respectively ( F=4.59, P<0.05). The measured superficial dose was (626.03±26.75), (1 259.83±71.94), and (1 435.30±67.22) cGy, respectively ( F=263.20, P<0.001). The percentage variation in tumor volume growth after radiation was not significantly different between the common tissue compensator group and the 3D-printed tissue compensator group ( P>0.05). Conclusions:3D-printed tissue compensators fit well to the body surface, which reduces air gaps, effectively increases the dose on the body surface near the target volume, and provides ideas for radiotherapy for superficial tumors at some irregular sites.

Predictive value of MR myocardial strain in predicting recent adverse cardiovascular events after primary PCI in patients with acute ST-segment elevation myocardial infarction / 中华放射学杂志

Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.

Preliminary study on thyroid ultrasound image restoration algorithm based on deep learning / 中华超声影像学杂志

Objective:To explore the feasibility of deep learning-based restoration of obscured thyroid ultrasound images.Methods:A total of 358 images of thyroid nodules were retropectively collected from January 2020 to October 2021 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and the images were randomly masked and restored using DeepFillv2. The difference in grey values between the images before and after restoration was compared, and 6 sonographers (2 chief physicians, 2 attending physicians, 2 residents) were invited to compare the rate of correctness of judgement and detection of image discrepancies. The ultrasound features of thyroid nodules (solid composition, microcalcifications, markedly hypoechoic, ill-defined or irregular margins, or extrathyroidal extensions, vertical orientation and comet-tail artifact) were extracted according to the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). The consistency of ultrasound features of thyroid nodules before and after restoration were compared.Results:The mean squared error of the images before and after restoration ranged from 0.274 to 0.522, and there were significant differences in the rate of correctness of judgement and detection of image discrepancies between physicians of different groups(all P<0.001). The overall accuracy rate was 51.95%, the overall detection rate was 1.79%, there were significant differences also within the chief physicians and resident groups (all P<0.001). The agreement rate of all ultrasound features of the nodules before and after image restoration was higher than 70%, over 90% agreement rate for features such as solid composition and comet-tail artifact. Conclusions:The algorithm can effectively repair obscured thyroid ultrasound images while preserving image features, which is expected to expand the deep learning image database, and promote the development of deep learning in the field of ultrasound images.

The distribution of total IgE in patients with allergic and their correlation with allergens and peripheral blood eosinophils / 中国医师进修杂志

Objective:To investigate the distribution of the total IgE, and their relationship with allergens and peripheral blood eosinophils in patients with allergic.Methods:The cross-sectional study was used, and 1 417 patients with allergic in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were selected. The serum total IgE was detected by enzyme-linked immunosorbent assay (ELISA), and the total IgE>60 kU/L was increased. The blood routine was detected by automated hematology analyzer. Using inhalant allergens and food allergens specific IgE antibody detection kits, the serum or plasma allergen-specific IgE antibodies were detected by Oumeng imprinting in vitro semi quantitative method.Results:Among 1 417 patients with allergic, elevated total IgE was in 617 cases (43.54%), normal total IgE in 800 cases (56.46%); 749 cases (52.86%) were allergic, the most common inhalation allergen was dust mite (38.72%, 218/563), and the most common food allergen was peanut (24.01%, 109/454). The rate of normal total IgE, eosinophils and non allergic was 19.20% (272/1 417). The male proportion, ratio of eosinophils, eosinophils count, total index of inhaled allergens, total index of non inhaled allergens, number of positive allergens, total positive index and average positive index in patients with elevated total IgE were significantly higher than those in patient with normal total IgE, the age was significantly lower than that in patients with normal total IgE, and there were statistical differences ( P<0.01). The total IgE<60 kU/L (normal total IgE) was in 800 cases, total IgE from 60 to 499 kU/L (mild elevation of total IgE) in 487 cases, total IgE from 500 to 999 kU/L (moderate elevation of total IgE) in 78 cases, total IgE≥1 000 kU/L (severe elevation of total IgE) in 52 cases. The male proportion and age in patients with sever elevation of total IgE and moderate elevation of total IgE were significantly higher than those in patients with mild elevation of total IgE and normal total IgE, and there were statistical differences ( P<0.05). The compound allergy rate in patients with severe elevation of total IgE was significantly higher than that in patients with moderate elevation of total IgE, mild elevation of total IgE and normal total IgE: 73.08% (38/52) vs. 60.26% (47/78), 38.40% (187/487), 17.00% (136/800), and there was statistical difference ( P<0.05). The ratio of eosinophils, eosinophils count and number of positive allergens increased with increasing total IgE level, and there was statistical difference ( P<0.05). The number of dermatophagoides/dermatophagoides culinae allergic in patients with moderate elevation of total IgE was significantly more than that in patients with sever elevation of total IgE, mild elevation of total IgE and normal total IgE, and there was statistical difference ( P<0.05). Conclusions:Allergic disease may show a normal level of total IgE. Males are more likely to be troubled with high level of IgE. Patients with total IgE ≥1 000 kU/L should be alert to the possibility of poly-sensitization. Total IgE was no longer correlated with individual allergy severity in patients with total IgE≥500 kU/L.

Effects of extrafine-particle versus fine-particle inhaled corticosteroids combined with formoterol on large and small airway function in patients with bronchial asthma / 中国医师进修杂志

Objective:To compare the effects of extrafine-particle versus fine-particle inhaled corticosteroids (ICS) combined with formoterol on clinical symptoms, airway inflammation and airway function in patients with bronchial asthma (referred to as asthma).Methods:This prospective, randomized controlled clinical trial enrolled a total of 111 patients diagnose of asthma and cough variant asthma with forced expired volume in one second (FEV 1) percentage of predicted (FEV 1%pred) >70% in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from November 2020 to October 2022. The patients were divided into observation group (57 cases) and control group (54 cases) by random digits table method. The patients in observation group were treated with extrafine-particle ICS combined with formoterol, while the patients in control group were treated with fine-particle ICS combined with formoterol. Both groups were treated for 4 weeks. During treatment 10 patients lost follow up and a total of 101 patients complete the final study: 52 cases in observation group and 49 cases in control group. At baseline, the asthma control test (ACT) score was calculated to evaluate the clinical symptoms, fractional exhaled nitric oxide (FeNO) was applied to evaluate the airway inflammatory level, and the pulmonary function test and bronchodilation test were perfromed. The symptom relief time was record. After treatment, all of the parameters were reevaluated. Results:The FEV 1, peak expiratory flow (PEF), forced expired flow at 50% of forced vital capacity (MEF 50), forced expired flow at 25% of forced vital capacity (MEF 25), maximal expiratory flow-volume curve (MMEF) and ACT score after treatment in both groups were significantly improved compared to baseline, and there were statistical differences ( P<0.01). The improvement of ACT score in observation group was significantly higher than that in control group: (5.90 ± 2.25) scores vs. (4.10 ± 2.18) scores, and there was statistical difference ( P<0.01); there were no statistical differences in the symptom relief time and the improvement rates of FEV 1, PEF, MEF 50, MEF 25, MMEF between the two groups ( P>0.05). Further subgroup analysis was performed on 78 patients with small airway dysfunction, 39 patients were treated with extrafine-particle ICS combined with formoterol (observation subgroup), and 39 patients were treated with fine-particle ICS combined with formoterol (control subgroup). The improvement of ACT score in observation subgroup was significantly higher than that in control subgroup: (6.05 ± 2.22) scores vs. (3.95 ± 2.19) scores, and there was statistical difference ( P<0.01); there were no statistical differences in the symptom relief time and the improvement rates of FEV 1, PEF, MEF 50, MEF 25, MMEF between the two subgroups ( P>0.05). Spearman correlation analysis result showed that the improvement rates of MEF 50, MEF 25 and MMEF after treatment were positive correlated with baseline bronchodilator responses of FEV 1, FEV 1/FVC, MEF 50, MEF 25, MMEF ( r = 0.22 to 0.58, P<0.05), but not with baseline bronchodilator responses of PEF ( P>0.05). In terms of safety, neither of the two treatments had major adverse reactions that affect treatment. Conclusions:For asthma patients with baseline FEV 1%pred>70%, the extrafine-particle ICS combined with formoterol has more significantly improved of clinical symptoms compared to fine-particle ICS combined with formoterol, and potentially with better safety profile. The improvement ratio of small airway function parameters in baseline bronchodilation test could potentially predict treatment response.

Effects of vitamin D diet early in life on airway inflammation in different endotypes of asthma mice models / 中国医师进修杂志

Objective:To investigate the effects of different doses of vitamin D diet early in life on airway inflammation in different endotypes of asthma mice models.Methods:In the Animal House of Shanghai General Hospital of Nanjing Medical University in June 2022, the BALB/c mice with 14 d pregnant were selected, the offspring mice were divided into vitamin D sufficient group and vitamin D deficient group by random number table method with 12 each. The mice in the vitamin D sufficient group were given a feed with sufficient vitamin D content, while the mice in the vitamin D deficient group were given a feed without vitamin D. At the age of 8 weeks, the mice were sensitized and stimulated with ovalbumin to establish a T2 type asthma model, while the mice were sensitized and stimulated with ovalbumin combined with ozone exposure to establish a non-T2 type asthma model, with 6 mice in each model. The level of serum 25 hydroxy vitamin D 3 was detected by enzyme-linked immunosorbent assay (ELISA) method. The lung tissue was stained with HE to evaluate the inflammatory response score and calculate the eosinophils density and neutrophils density. In bronchoalveolar lavage fluid (BALF), the expression levels of interleukin (IL)-4, IL-6, IL-10 and IL-17A, the inflammatory cell count (total cell count, neutrophil count and eosinophil count) were detected. Results:The 25 hydroxy vitamin D 3 in T2 type asthma mice and non-T2 type asthma mice of vitamin D deficient group were significantly lower than that in vitamin D sufficient group: (8.12 ± 1.72) μg/L vs. (26.63 ± 2.54) μg/L and (6.86 ± 1.65) μg/L vs. (23.81 ± 3.09) μg/L, and there was statistical difference ( P<0.01). The inflammatory response score in non-T2 type asthma mice of vitamin D deficient group was significantly higher than that in non-T2 type asthma mice of vitamin D sufficient group: (2.58 ± 0.49) scores vs. (1.83 ± 0.21) scores, and there was statistical difference ( P<0.05), there was no statistical differences in inflammatory response score in T2 type asthma mice between two groups ( P>0.05). The neutrophils density and eosinophils density in T2 type asthma mice and non-T2 type asthma mice of vitamin D deficient group were significantly higher than those in vitamin D sufficient group, T2 type asthma mice: (20.30 ± 1.95) cells/100 μm vs. (12.58 ± 1.04) cells/100 μm and (5.25 ± 0.62) cells/100 μm vs. (3.15 ± 0.35) cells/100 μm; non-T2 type asthma mice: (53.48±5.19) cells/100 μm vs. (33.80 ± 2.74) cells/100 μm and (3.00 ± 0.29) cells/100 μm vs. (2.17 ± 0.21) cells/100 μm, and there were statistical differences ( P<0.01 or <0.05). The BALF total cell count in T2 type asthma mice and non-T2 type asthma mice of vitamin D deficient group was significantly higher than that in vitamin D sufficient group, the BALF eosinophil count in T2 type asthma mice of vitamin D deficient group was significantly higher than that in T2 type asthma mice of vitamin D sufficient group, the BALF neutrophil count in non-T2 type asthma mice of vitamin D deficient group was significantly higher than that in T2 type asthma mice of vitamin D sufficient group, and there were statistical differences ( P<0.01); there was no statistical difference in BALF neutrophil count in T2 type asthma mice between two groups ( P>0.05); there was no statistical difference in BALF eosinophil count in non-T2 type asthma mice between two groups ( P>0.05). The BALF total cell count and neutrophil count in non-T2 type asthma mice of both groups were significantly higher than those in T2 type asthma mice, but the BALF eosinophil count in T2 type asthma mice was significantly higher non-T2 type asthma mice, and there were statistical differences ( P<0.05). The BALF IL-4, IL-6 and IL-17A in T2 type asthma mice and non-T2 type asthma mice of vitamin D deficient group were significantly higher than those in vitamin D sufficient group, the BALF IL-10 was significantly lower than those in vitamin D sufficient group, and there were statistical differences ( P<0.01 or <0.05). In vitamin D deficient group, the BALF IL-4 in non-T2 type asthma mice was significantly lower than that in T2 type asthma mice, the BALF IL-6 and IL-17A were significantly higher than those in T2 type asthma mice, and there were statistical differences ( P<0.05); in vitamin D sufficient group, the BALF IL-6 and IL-17A in non-T2 type asthma mice were significantly higher than those in T2 type asthma mice, and there were statistical differences ( P<0.05). Conclusions:Vitamin D deficiency is involved in different mechanisms of airway inflammation in T2 type asthma and non-T2 type asthma, and this effect may be more obvious for non-T2 type asthma.

Correlation study between early neurological deterioration and cerebral microbleeds in patients with acute small artery occlusion / 中国医师进修杂志

Objective:To investigate the relationship between the degree and location of cerebral microbleeds (CMBs) and the early neurological deterioration (END) within 72 h after admissionin in patients with acute small artery occlusive stroke (SAO).Methods:Patients with first-onset SAO hospitalized in Changzhou Second People′s Hospital from July 2020 to January 2021 were retrospectively enrolled. All patients completed the head magnetic resonance imaging including susceptibility weighted imaging. Collected baseline data, and evaluated the National Institutes of Health Stroke Scale (NHISS) scores before admission and within 72 h after onset. Patients were divided into END group and no END group according to whether NIHSS scores increased by ≥3 within 72 h after admission. The baseline characteristics were compared between these two groups. Moreover, the correlation between the degree and location of CMBs and END were analyzed by multivariate Logistic regression.Results:A total of 163 first-episode SAO patients were enrolled. There were 47 patients (28.83%) with END. In END group, there were 35 patients (74.47%) with CMBs which was higher than those in non-END group [42 patients (36.21%)]. In END group, there were 21 patients (44.68%) with severe CMBs, 11 patients (23.41%) with basal ganglia CMBs, 16 patients (34.04%) with mixed CMBs, which were all higher than those in non-END group [5 patients (4.31%) with severe CMBs, 9 patients (7.76%) with basal ganglia CMBs, and 13 patients (11.21%) with mixed CMBs]. The difference was statistically significant ( P<0.05). After adjusting for triglyceride, location of infarcated lesions, and the degree of WMHs, further Logistic regression analysis revealed that severe CMBs ( OR = 6.139, 95% CI 1.377 - 27.375, P = 0.017), basal ganglia CMBs ( OR = 5.253, 95% CI 1.105 - 24.975, P = 0.037) and mixed CMBS ( OR = 5.098, 95% CI 1.197 - 21.704, P = 0.028) were independent risk factors of END in SAO patients. Conclusions:The location and degree of CMBs are closely related to the occurrence of END in patients with SAO. Severe CMBs, basal ganglia CMBs and mixed CMBs may be the effective predictors of END in patients with SAO.

Clinical characteristics of neonatal gastric perforation and risk factors of mortality / 中国新生儿科杂志

Objective:To study the clinical characteristics of neonatal gastric perforation (NGP) and risk factors of mortality.Methods:From January 2015 to May 2022, infants with NGP admitted to NICU of our hospital were retrospectively studied. They were assigned into the survival group and the death group. Clinical manifestations, laboratory and imaging results, surgical treatments and prognosis were compared and risk factors of mortality were determined.Results:A total of 27 infants with NGP were enrolled, including 17 males and 10 females. 24 were premature infants and 3 were term infants. 26 infants had low birth weight. 3 infants had neonatal resuscitation due to asphyxia, 10 received positive pressure ventilation before the onset of perforation symptoms, 2 showed gastrointestinal malformations and 3 with septic shock before surgery. The median age of onset was 2.0 d. The main presenting symptom was abdominal distension, with most perforations occurring at the greater curvature of the stomach. 20 cases had congenital gastric muscular layer defects. 21 cases survived and 6 cases died. Age of onset was later in the death group than the survival group [2.5 (2.0, 7.8) days vs. 1.9 (1.4, 3.0) days]. The survival group had higher preoperative platelet count than the death group [(218±80) ×10 9/L vs. (126±73)×10 9/L]. The incidences of thrombocytopenia, septic shock and multi-organ dysfunction syndrome before surgery in the survival group were significantly lower than the death group ( P<0.05). Logistic regression analysis showed that preoperative thrombocytopenia was a risk factor for NGP mortality ( OR=19.000, 95% CI 2.029-177.932, P=0.010). Conclusions:NGP is more common in male infants, premature infants and low birth weight infants. The most common etiology is congenital gastric muscular layer defects. The mortality rate is high and preoperative thrombocytopenia is a risk factor for mortality.

Cerebral small vessel disease and autonomic dysfunction / 国际脑血管病杂志

Cerebral small vessel disease (CSVD) is one of the main causes of cognitive impairment and decreased the quality of daily life in the elderly. Researches have shown that CSVD is closely associated with autonomic nervous function. Patients with CSVD may be accompanied by cardiovascular, endocrine, gastrointestinal, urination, sleep disorders and other autonomic dysfunction.

Application strategy of the Principles and Guidelines for Human Factors/Ergonomics (HFE) Design and Management of Work Systems in China / 中国职业医学

To provide in-depth information and guidance on ergonomics, the International Labour Organization (ILO) had issued a series of conventions, recommendations, and resolutions on human factors/ergonomics (HFE) and had published HFE guides and toolkits. In 2021, the ILO and the International Ergonomics Association released an international guideline on HFE entitled Principles and Guidelines for Human Factors/Ergonomics (HFE) Design and Management of Work Systems (hereinafter referred to as the HEF Guidelines), aiming to improve the occupational safety, health, and the well-being of workers from the perspective of work system sustainability. There are currently 112 national health standards in China related to HFE, of which 79 (accounting for 71%) are equivalent to relevant standards from the International Organization for Standardization. Most of the recommended standards do not meet the applicability requirements of HFE for the Chinese workforce, as they are different from the national occupational health standard system. At present, China's HFE capability cannot meet the needs of the workforce, and there is still a gap between occupational diseases related to HFE included in the Occupational Disease List of China and those compared to the ILO. In the future, China needs to pay attention to the application of the HEF Guidelines, further improve the technical services for occupational health, include diseases caused by poor ergonomics in the national occupational disease list, strengthen the HFE standard system in the national occupational health standard system, actively promote the application of action-oriented HFE tools, enhance “human-machine coordination” and “person-job matching”, and focus on physical and cognitive HFE design to promote equality in workplace and reduce the occurrence of occupational and work-related diseases.

Application of pulmonary circulation single-blocking method in intersegmental plane identification during segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To introduce a new method for identifying intersegmental planes during thoracoscopic segmentectomy using pulmonary circulation single-blocking in the target segment. Methods    To retrospectively analyze the clinical data of 83 patients who underwent thoracoscopic pulmonary segmentectomy from January 2019 to March 2020 using the pulmonary circulation single-blocking method. There were 33 males and 50 females, with a median age of 54 (46-65) years, and they were divided into a single vein group (SVG, n=31) and a single artery group (SAG, n=52), and the clinical data of two groups were compared. Results    The intersegmental planes were identified successfully in both groups and there were no statistically significant differences between the two groups in terms of intersegmental plane management (P=0.823), operating time (P=0.786), intraoperative blood loss (P=0.775), chest drainage time (P=0.659), postoperative hospital stay (P=0.824) or the incidence of postoperative complications (P=1.000). Conclusion    The use of pulmonary circulation single-blocking for intersegmental plane identification during thoracoscopic segmentectomy is safe and feasible, and the intersegmental plane can be satisfactorily identified by the single-blocking of arteries or veins.