Efficacy and safety of switching to flumatinib in patients with chronic myeloid leukemia who have not achieved optimal response or are intolerant to TKI treatment / 陆军军医大学学报

Objective To observe the efficacy and safety of flumatinib conversion in chronic myelogenous leukemia-chronicphase(CML-CP)patients with suboptimal TKI response or intolerance.Methods Patients who did not have the best response or intolerance to first-line imatinib,dasatinib,and nilotinib and switched to flumatinib(600 mg/d)from February 2020 to August 2022 were collected from 5 hospitals from Chongqing and affiliated hospitals of North Sichuan Medical College.The efficacy and safety of flumatinib were observed.The optimal response rate,major molecular response(MMR),cumulative complete cytogenetic response(CCyR)rate,cumulative MMR rate,cumulative deep molecular response(DMR),progression-free survival(PFS),event-free survival(EFS)and adverse reactions in 3,6 and 12 months after treatment were observed and analyzed.Results A total of 100 patients with CML-CP were enrolled,with a median follow-up of 18(3～36)months.The optimal response rate was 92.6％(88/95),94.4％(85/90)and 92.9％(79/85)respectively,at 3,6 and 12 months after treatment.Till August 20,2023,the cumulative CCyR and MMR rate was 98.0％(98/100)and 81.9％(77/94),respectively,the median time to reach CCyR and MMR was 3 months,and cumulative DMR rate was 51.0％(51/100).PFS rate was 100.0％(100/100)and 1-year EFS rate was 85.6％(75/90).The most common non-hematologic adverse reactions of flumatinib were diarrhea and abdominal pain(7.0％),followed by renal dysfunction(6.0％)and musculoskeletal pain(2.0％).The main hematologic adverse reactions were thrombocytopenia(12.0％),anemia(6.0％)and leukopenia(2.0％).Conclusion Flumatinib has better MMR and DMR and is well tolerated in CML-CP patients with TKI resistance or intolerance.

Preparation and Recognition Features of Molecularly Imprinted Polymer Membrane for Lamotrigine in Plasma / 分析化学

The molecularly imprinted polymers membranes(MIPMs)were prepared for selective adsorption of lamotrigine(LTG)in plasma by surface molecular imprinting technology with polyvinylidenefluoride(PVDF)membranes as supporter,lamotrigine as template molecule,methyl methacrylate as functional monomer,ethylene glycol dimethacrylate as cross-linking agent,azodiisobutyronitrile as initiator and acetonitrile-dimethylformamide(1∶1.5,V/V)as pore-forming agent.The prepared MIPMs were characterized by scanning electron microscope,Fourier transform infrared spectroscopy,Brunaner-emmet-teller measurements,X-ray photoelectron spectroscopy,and thermogravimetric analysis.The adsorption properties of the materials were investigated by kinetic adsorption,isothermal adsorption,selective adsorption,adsorption-desorption and reusability experiments.The results showed that the imprinted layer of LTG was successfully coated on the surface of PVDF,and the materials had uniform particle size.The adsorption capacity and imprinting factor of the MIPMs towards LTG were 3.77 mg/g and 8.97,respectively.The nanomaterials showed fast mass transfer rate(30 min)and good reusability(the adsorption efficiency was 86.66%after 6 cycles),and could be used for the adsorption of LTG in plasma with low matrix interference,recoveries of 86.54%-90.48%and RSD of 1.51%-3.15%(n=5).The proposed LTG MIPMs were demonstrated to be simple and environment friendly,and had high selectivity in rapid separation and extraction of LTG in plasma.

Exploration of Correlation Between Psoraleae Fructus and Precocious Puberty in Children Based on Network Pharmacology / 广州中医药大学学报

Objective The network pharmacological methods and molecular docking technology were used for investigating the possibility of Psoraleae Fructus in promoting precocious puberty in children and its potential mechanism.Methods The main active ingredients of Psoraleae Fructus and their therapeutic targets were obtained from BATMAN-TCM online platform.The disease targets related with precocious puberty were obtained from GeneCards database.A visualized network of active ingredients-disease targets was constructed by Cytoscape 3.7.1 software.Protein-protein interaction(PPI)network diagrams were constructed based on the STRING online database.Gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis were conducted using Metascape online tool.The structures of the main active ingredients were obtained from PubChem database,the structures of core targets were obtained from RCSB PDB database,and then the structures were imported into Autodock for molecular docking.Finally,the mimic diagrams of the molecular docking were drawn using PYMOL software.Results A total of 12 active ingredients of Psoraleae Fructus were obtained,involving 274 targets.And there were 11 active ingredients and 98 targets associated with precocious puberty.The main active compounds were stigmasterol,bakuchiol,angelicin,bavachalcone,isobavachalcone,and xanthotoxin.The main targets were estrogen receptor 1(ESR1),estrogen receptor 2(ESR2),insulin-like growth factor 1(IGF1),and progesterone receptor(PGR),which were mainly involved in the ovarian steroidogenic pathway and Hippo signaling pathway.The molecular docking results showed that the active compounds were well binded to the targets.Conclusion It is possible that Psoraleae Fructus can promote the sexual development in children and has its potential pharmacological mechanism.The results will provide theoretical references for the clinical prevention and treatment of precocious puberty and early pubertal development in children.

Comparison of the predictive value of new simplified insulin resistance assessment indexes in identifying left ventricular subclinical dysfunction in T2DM patients / 解放军医学杂志

Objective To investigate the predictive value of new simplified insulin resistance(IR)assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction(LVEF≥50%)who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed.All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain(GLS).According to GLS value,the subjects were divided into the normal group(GLS≥18%group,n=80)and the impaired group(GLS<18%group,n=70).Some new simplified IR assessment indicators were calculated and compared between the two groups,including body mass index(BMI),TG/HDL-C ratio,triglyceride-glucose(TyG)index,TyG-BMI index,TyG-WHR and metabolic score for IR(METS-IR).Correlation between the GLS and the new simplified IR assessment indexes was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes,with the area under the curve(AUC)calculated.Furthermore,according to whether the subjects were complicated with hypertension,binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS<18%.Results Total 150 were included with aged(54.5±13.7)years with 96(64.0%)men and 54(36.0%)women.Compared with the GLS≥18%group,the TG/HDL-C ratio,TyG index,TyG-BMI,and METS-IR of subjects in the GLS<18%group were significantly increased(P<0.05).Pearson correlation analysis showed that TG/HDL-C ratio,TyG index,TyG-BMI,TyG-WHR,and METS-IR were negatively correlated with GLS(P<0.05).ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18%(AUC=0.678,95%CI 0.591-0.765,P<0.001).Stratification based on hypertension and further adjusting for confounding factors,TyG index remains significantly associated with GLS<18%(OR=3.249,95%CI 1.045-10.103,P=0.042).Conclusions The novel simplified insulin resistance evaluation indexes are closely associated with left ventricular subclinical systolic dysfunction in T2DM patients with preserved ejection fraction.TyG index is an effective index to identify left ventricular subclinical dysfunction in these populations.

Alteration of cognitive function in overweight and obese adolescents and its relationship with serum FGF21 levels / 上海交通大学学报（医学版）

Objective·To evaluate the changes in cognitive function in overweight and obese adolescents,and explore the association between cognitive function and fibroblast growth factor 21(FGF21).Methods·A total of 175 adolescents from a senior high school in Shanghai were divided into normal weight group(n=50),overweight group(n=50)and obese group(n=75)based on their body mass index(BMI).General information,anthropometric data and laboratory testing indicators of the adolescents were collected and compared.The cognitive function of the three groups of adolescents was assessed by using the accuracy(ACC)and reaction time of Flanker task and n-back task.Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum FGF21 level of the three groups of adolescents.Partial correlation analysis and multiple linear regression model were used to evaluate the correlation between cognitive task performance and anthropometric data and laboratory testing indicators.Results·Compared with the normal weight group,systolic blood pressure,diastolic blood pressure,and the levels of fasting plasma glucose,glycosylated hemoglobin and triacylglycerol in the obese group were higher(all P<0.05).Under congruent or incongruent stimulus conditions in the Flanker task,there was no significant difference in ACC between any two groups;compared with the normal weight and overweight groups,the reaction time of the adolescents in the obese group was prolonged(all P<0.05).In the n-back task,there were no significant differences in ACC between any two groups,while the obese group had longer reaction time in the 1-back and 2-back tasks compared to the normal weight and overweight groups(all P<0.05).Compared with the normal weight group,serum FGF21 levels of the adolescents in the obese group were higher(P=0.000).Partial correlation analysis showed that the reaction time of the adolescents in Flanker and n-back tasks was correlated with their BMI,body fat mass,waist circumference,waist-to-hip ratio and FGF21 level(all P<0.05).Multiple linear regression analysis further confirmed that BMI was associated with prolonged reaction time in cognitive-related behavioral tasks in the adolescents(all P<0.05),and FGF21 level was associated with ACC in the 2-back task(P=0.000)and reaction time in the incongruent stimulus condition(P=0.048).Conclusion·Overweight and obese adolescents have cognitive impairments,and BMI and serum FGF21 levels are associated with changes in their cognitive function.

Guiding recommendations for fertility preservation of female patients of reproductive age based on modified Delphi method / 复旦学报（医学版）

Objective To obtain guiding recommendations for the development of fertility preservation in female patients of reproductive age,so as to promote the scientific,standardized and orderly implementation of fertility preservation work.Methods A previous questionnaire survey was used to determine the preliminary recommendations,a modified Delphi method was used to invite 18 domestic experts of fertility preservation to conduct two rounds of expert consultation.Then we adjusted and summarized recommendations according to the results of the consultation.Results Finally,14 guiding recommendations for the development of fertility preservation in female patients of reproductive age were obtained according to the results of the Delphi consultation,including 5 recommendations at technical level,5 recommendations at political level and 4 recommendations at educational level.At technical level,it was proposed to establish a standardized operation process;at political level,it was proposed to improve the relevant legislation of fertility preservation in China to protect the safety and interests of patients;at educational level,it was suggested to take various forms to promote the mass dissemination of fertility preservation knowledge.Conclusion Guiding recommendations for fertility preservation in female patients of reproductive age can provide detailed and comprehensive guidance for promoting fertility preservation in female patients of reproductive age in Shanghai,and provide reference for carrying out fertility preservation in other regions.

Feasibility study on automatic segmentation of pelvic intestinal tube for radiotherapy images based on deep learning / 复旦学报（医学版）

Objective To study the feasibility on automatic contouring of pelvic intestinal tube based on deep learning for radiotherapy images.Methods A total of 100 patients with diagnosis of rectal cancer,received radiotherapy in Zhongshan Hospital,Fudan University from 2019 to 2021,were randomly selected.Sixty cases were randomly enrolled to train the models,and the other 40 cases were applied to test.Based on the original small intestine model in automatic segmentation software AccuContour,60,40 and 20(2 groups)cases in the model cases were used to train the models Rec60,Rec40,Rec20A and Rec20B with manual contouring as ground truth.Other 40 cases for test were applied to evaluate the Dice similarity coefficient(DSC),95%Hausdorff distance(HD95)and average symmetric surface distance(ASSD)between the manual contouring and original model along with model Rec60.The DSC of the 5 groups of auto-segmentations were compared as well.The paired t tests were performed for each pair of the original model and 4 trained models.Results The small bowel contoured by trained models were more similar to the manual contouring.They could distinguish the boundary of the intestinal tube better and distinguish the small bowel from the colon.The average DSC,HD95 and ASSD of Rec60 were 0.16 higher(P＜0.001),12.4 lower(P＜0.001)and 5.14 lower(P＜0.001)than the original model respectively.According to the paired t tests,there were no statistical differences in DSC between the 4 training models and the original model.No statistical difference was observed between Rec60 and Rec40,while they were both significantly different from the two Rec20 models.There was no statistical difference between Rec20B and Rec20B.Conclusion For radiotherapy images,model training can effectively improve the accuracy of intestinal tube delineation.Forty cases were enough for training an optimal model of automatic segmentation for pelvic intestinal tube in AccuContour software.

Investigation on the application and improvement of PAD class in Epidemiology teaching / 沈阳医学院学报

Objective:To analyze the application effect of PAD teaching mode in Epidemiology teaching,and to investigate students'suggestions for improving PAD class,so as to provide some thoughts and basis for improving teaching reform.Methods:PAD class was introduced into Epidemiology teaching.Two cross-sectional surveys were conducted after class,and questionnaires about PAD learning interests and suggestions for improvement were anonymously collected.The teaching effect was analyzed and suggestions for rectification were put forward.Results:Among the 134 students majoring in medical laboratory science,the score rate of each learning interest survey item of PAD teaching mode was more than 80% .And 57.46% of the students thought that discussion sessions should be added.The scores of chapter test in PAD mode class was higher than that in traditional mode class(t=2.938,P＜0.01).Conclusions:PAD class can enhance learning interest and knowledge mastery.The time schedule of teaching and discussion should be adjusted in time according to students'wishes,and after-school exercises and counseling should be appropriately increased to promote the application of PAD class in Epidemiology teaching.

The association between C-reactive protein/albumin ratio and the risk of cardiovascular events in mainte-nance hemodialysis patients / 实用医学杂志

Objective To explore the association between C-reactive protein/albumin ratio(CAR)and the risk of cardiovascular events in maintenance hemodialysis(MHD)patients.Methods This study enrolled MHD patients who were treated in the blood purification center of the Second Affiliated Hospital of Guangzhou Medical University between August 2016 to December 2019,and the follow-up deadline was March 31,2021.Collected the clinical data of patients who conform to the inclusion criteria,including demographic,complications,primary basic disease,biochemical indicators of the patients who underwent 3 months regular dialysis treatment and the occurrence of cardiovascular events during the follow-up period.The Kaplan-Meier method was used to estimate the probability of cardiovascular incidents in MHD patients.The Cox proportional hazards model based on generalized propensity score weighting(GPSW)was used to estimate the relationship between CAR and cardiovas-cular events in MHD patients.Results A total of 170 eligible objects were included in this study,64 patients with cardiovascular events(37.6%).The Cox proportional hazards model which based on GPSW(HRCAR = 2.087,95%CI:1.085～4.015,P = 0.028),indicated that the hazard ratio of cardiovascular events was 2.087 when the CAR each additional a unit in MHD patients.Conclusion CAR and the risk of cardiovascular events in MHD patients have a significant positive correlation,which can help clinical workers recognize the MHD patients who have high risk of cardiovascular events and intervene in time.

Characterization of temporal and intensity parameters of early postural adjustment phase during gait initiation in stroke patients / 中国组织工程研究

BACKGROUND:Early postural adjustments serve as preparatory measures for forthcoming actions or potential disruptions in posture,thereby facilitating improved movement execution and mitigating destabilizing effects caused by posture interference. OBJECTIVE:To investigate the characteristics of temporal and intensity parameters of key lower limb muscles during early postural adjustment phase when stroke patients with varying levels of balance initiate walking at a self-selected comfortable pace. METHODS:The characteristics of early postural adjustments in 16 stroke patients were observed.Sixteen patients were divided into a non-fall group(n=8)and a fall group(n=8)based on the history of falls and Berg Balance Scale scores.Noraxon inertial sensors and Noraxon Ultium EMG wireless surface electromyography were utilized to collect body kinematic data and surface electromyography data during gait initiation.Muscle activation time and activation sequence of six key muscles in the lower limbs(tibialis anterior,medial and lateral gastrocnemius,rectus femoris,lateral femoris and biceps femoris muscles)during the early postural adjustment phase,as well as normalized electromyography integral values for the four time windows(each 150 ms)before gait initiation,were analyzed. RESULTS AND CONCLUSION:Stroke patients with a history of falls exhibited earlier activation times for the six key muscles in the lower limbs during gait initiation compared with those in the non-fall group.The fall group demonstrated significantly earlier activation times for tibialis anterior,lateral head of gastrocnemius,and vastus lateralis(P<0.01,P<0.05).In contrast,the non-fall group displayed a consistent pattern of activating extensor muscles before flexor muscles,with thigh muscle activation preceding calf muscle activation.However,in the fall group,calf extensor muscle activation occurred prior to thigh extensor muscle activation,and the vastus lateralis was activated even earlier.The tibialis anterior was the last activated muscle in both groups.Specifically during T3(>-300 to-150 ms),the tibialis anterior exhibited significantly higher activity in the fall group compared with the non-fall group(P<0.05),while the lateral head of gastrocnemius demonstrated significant inhibition during T3(P<0.05)and the medial head of gastrocnemius showed significant inhibition during both T3 and T4(>-150 to 0 ms)stages compared with the non-fall group(P<0.01,P<0.05).To conclude,stroke patients with varying balance abilities employ distinct early postural adjustment strategies prior to stepping,as evidenced by differences in muscle activation timing,recruitment order,and muscle activity amplitude.Patients at a high risk of falling exhibit prolonged duration of early postural adjustment and delayed initiation of gait,indicating earlier activation of the tibialis anterior muscle and inhibition of gastrocnemius muscle activity.These delays in gait initiation and variations in muscle recruitment strategies may contribute to unstable posture and an increased susceptibility to falls.

Mediating role of health education competency in the relationship between supportive communication and general self-efficacy among medical undergraduates / 中华医学教育探索杂志

Objective:To explore the factors influencing the supportive communication ability of medical undergraduates, and to propose strategies to improve supportive communication.Methods:By cluster sampling, we selected 388 medical undergraduates of grades 2017 and 2018 from Harbin Medical University for a questionnaire survey on supportive communication, general self-efficacy, and health education abilities. SPSS 22.0 was used for descriptive statistical analysis. AMOS 22.0 was used to construct a structural equation model to verify the relationship between the three variables. Mediating effects were also tested.Results:The students showed good supportive communication ability, with a total score of (74.28±10.84) points. The general self-efficacy score was (27.81±5.58) points, and the total score of health education ability was (25.50±4.76) points. General self-efficacy had direct positive effects on supportive communication and health education abilities ( β=0.75, 0.31, both P<0.001). Health education ability had a direct positive effect on supportive communication ability ( β=0.14, P<0.001). Health education ability played a significant mediating role in the influence of general self-efficacy on supportive communication ability (standardized mediating effect value=0.042, P<0.01), with the mediating effect accounting for 5.1%. Conclusions:The health education competency of medical undergraduates can mediate the effect of general self-efficacy on supportive communication ability. By strengthening medical humanities education to increase general self-efficacy and also emphasizing the cultivation of health education competency, the supportive communication ability of students can be improved.

Effect of adipose-derived stem cells with overexpression or silencing of lncRNA SNHG8 on vascular endothelial cell dysfunction / 中国病理生理杂志

AIM:To investigate the effects of adipose-derived stem cells(ADSCs)with overexpression or si-lencing of long noncoding RNA(lncRNA)SNHG8 on the viability,migration,angiogenesis,and the expression of vasoac-tive factors in human umbilical vein endothelial cells(HUVECs).METHODS:Identification of ADSCs derived from morbidly obese patients(O-ADSCs)was conducted using flow cytometry and induction of lipogenesis and osteogenesis.The expression of lncRNA SNHG8 in healthy human ADSCs(H-ADSCs)and O-ADSCs was detected by RT-qPCR.Tran-swell method was used to establish the indirect co-culture system of ADSCs and HUVECs for 48 h,and the cells were di-vided into O-ADSCs+HUVECs group,H-ADSCs+HUVECs group,and HUVECs alone group.The mRNA and protein ex-pression levels of angiotensin Ⅱ(Ang Ⅱ),endothelin-1(ET-1)and endothelial nitric oxide synthase(eNOS)in HUVECs were detected by RT-qPCR and Western blot.The lncRNA SNHG8 overexpression and silencing lentiviruses were con-structed and used to infect O-ADSCs.The indirect co-cultured ADSCs and HUVECs were divided into O-ADSCs-OE-SNHG8+ HUVECs group,O-ADSCs-OE-NC+HUVECs group,O-ADSCs-sh-SNHG8+HUVECs group,and O-ADSCs-sh-NC+HUVECs group.After co-culture for 48 h,the viability,migration and tubule formation of HUVECs were detected by CCK-8,scratch and angiogenesis assays,respectively.The mRNA and protein expression levels of Ang Ⅱ,ET-1 and eNOS in HU-VECs were detected by RT-qPCR and Western blot,respectively.The nitrate reductase method was used to detect the con-tent of NO in HUVECs.RESULTS:(1)The cultured cells were identified as ADSCs.(2)Compared with H-ADSCs,ln-cRNA SNHG8 expression was significantly up-regulated in O-ADSCs(P<0.01).(3)Compared with H-ADSCs+HUVECs group and HUVECs group,the mRNA and protein expression levels of Ang Ⅱ and ET-1 in HUVECs in O-ADSCs+HU-VECs group were up-regulated(P<0.01).(4)Overexpression of lncRNA SNHG8 in O-ADSCs enhanced the viability,mi-gration and tube formation ability of HUVECs,up-regulated the mRNA and protein expression levels of Ang Ⅱ and ET-1,down-regulated the mRNA and protein expression levels of eNOS,and decreased the content of NO in HUVECs(P<0.05).However,silencing of lncRNA SNHG8 in O-ADSCs exerted opposite results(P<0.05).CONCLUSION:(1)The O-ADSCs can promote endothelial cell viability,migration and tubule formation through paracrine effects.(2)The O-ADSCs with overexpression of lncRNA SNHG8 promote the imbalance of diastolic and contractile factors secreted by endo-thelial cells,and induce the dysfunction of vascular endothelial cells.

Key genes and related pathways of hepatic fibrosis based on bioinformatics analysis / 局解手术学杂志

Objective By screening key genes and related pathways for hepatic fibrosis treatment through bioinformatics analysis,the differentially expressed genes of hepatic fibrosis patients were mined to predict potential therapeutic targets for liver fibrosis.Methods Gene expression profiles GSE197112 were obtained from GEO database.Differentially expressed genes were screened by Limma.DAVID online database was used to conduct GO enrichment analysis and KEGG signaling pathway enrichment analysis of differentially expressed genes.The protein-protein interaction(PPI)network diagram of differentially expressed genes were obtained from STRING database and visualize by Cytoscape software.At the same time,the plug-in CytoHubba in Cytoscape software was used to screen the target genes of hepatic fibrosis.Results A total of 399 differentially expressed genes were screened(P<0.01,∣log2FC∣>1.5),including 300 down-regulated genes and 99 up-regulated genes.These genes were mainly involved in GO biological processes such as mitosis checkpoint,DNA replication,chromosome segregation,cell division,apoptosis,adaptive immune response and so on,and mainly regulated the intestinal immune network for IgA production,progesterone-mediated oocyte maturation,human T-cell leukemia virus 1 infection,cell cycle,antigen processing and presentation,p53 signaling pathway,cancer transcription disorder,cell adhesion molecules and so on.Five target genes were screened by Cytoscape software:TTK,KIF2C,ASPM,DLGAP5,PBK.Conclusion In this study,399 differentially expressed genes and 5 target genes in hepatic fibrosis were screened by bioinformatics methods,which play key roles in the biological processes related to hepatic fibrosis,and provide a new direction for the pharmacological treatment of liver fibrosis.

Risk factors for rod fracture after correction and internal fixation for adult spinal deformity and treatment strategy / 中国脊柱脊髓杂志

Objectives:To investigate the incidence,relative risk factors and treatment strategies of rod breakage after correction and internal fixation of adult spinal deformity(ASD).Methods:The clinical data of ASD patients treated with posterior corrective operation and internal fixation in the Department of Orthopedics of Xinqiao Hospital between January 2015 and December 2019 were analyzed retrospectively.A total of 79 patients aged 45-75 years(62.1±7.7 years)were included.The follow-up period was 24-59 months(30.6±9.2 months).According to whether the rod was broken during the follow-up period,the patients were divided into rod fracture group(RF group)and rod non-fracture group(NRF group).The sex,age,body mass index(BMI),bone mineral density(BMD)T value,complications and follow-up time of the two groups were recorded.The sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracic kyphosis(TK),lumbar lordosis(LL),LL-TK value,PI-LL value,and coronal Cobb angle were measured before and after operation.The operation-related information of the two groups was collected,including operative time,intraoperative blood loss,the number of fixed fusion segments,whether three-column osteotomy,whether the lower fixed ver-tebrae involved the sacrum or pelvis,and whether there was interbody fusion.The position,time and revision operation of the broken rod in the RF group were recorded.The data of the two groups were compared and analyzed by Spearman test,and the positive parameters were further analyzed by multivariate logistic regres-sion to find potential risk factors for rod fractures.Odds ratio(OR)and 95％confidence interval(CI)were cal-culated.Results:Among the 79 patients,rod fracture occurred in 14 patients(17.7％),with bilateral fracture in 11 cases and unilateral fractures in 3 cases.The time of rod fracture occurred at 6-31 months after oper-ation(averaged 16 months),which occurred at the early stage after operation(within 24 months)in 10 patients(71.4％)and at 24 months after operation in 4 patients(28.6％).The rod fracture occurred at the osteotomy site in 11 cases and at T10-12 level in 3 cases.Spearman test showed that younger age(P=0.038),more lev-els of fusion(P＜0.001),3-column osteotomy(P＜0.001)and bigger preoperative SV A(P＜0.00 1)were correlated with rod breakage.Multivariate logistic regression analysis showed that more levels of fusion(P=0.037,OR=2.043,95％CI=1.046-3.992),3-column osteotomy(P=0.044,OR=0.113,95％CI=0.014-0.941),and bigger preop-erative SVA(P=0.006,OR=1.1 19,95％CI=1.032-1.212)were the risk factors of rod breakage after corrective surgery for ASD patients.11 patients(78.6％)underwent revision surgery because of intractable low back pain or progression of spinal deformities,and were replaced the broken rods through posterior primary incision ap-proach,combined with satellite rod technique;And meanwhile,out of which,5 patients underwent one-stage retroperitoneal approach for anterior iliac bone graft fusion and received satisfactory results during follow-up.Conclusions:The incidence of rod breakage after correction and internal fixation in ASD patients is high.More levels of fusion,3-column osteotomy,and greater preoperative SVA were significantly associated with rod fracture.The"Multi-rod technique"and anterior bone graft fusion technique can be used in the revision operation of rod fracture.

Correlation between risky drinking and decision-making ability in offspring of fathers with alcohol dependence / 中国心理卫生杂志

Objective:To investigate the association of risky drinking and decision-making ability among off-spring of fathers with alcohol dependence(OFAD).Methods:A case-control study was conducted according to the cutoff of the Alcohol Use Disorder Identification Test(AUDIT)(delimited as 7).OFAD were divided into"risky drinking group"(n=29)and"non-risky drinking group"(n=43).The Iowa Gambling Task(IGT)was used to e-valuate the decision-making ability.Covariance analysis was used to compare differences of IGT between the two groups,and multivariate logistic regression was used to explore the association between risky drinking and decision making ability.Results:There was no significant difference in total scores of IGT between the risky drinking group and the non-risky drinking group(P＞0.05).Risky drinking group had less Selection 2 in block 5 of IGT[(3.8± 2.5)v.s.(5.7±3.1),P＜0.05]than non-risky drinking group.Selection 2 in block 5 was still associated with risky drinking after controlling the covariates(OR=0.72,95％CI:0.57～0.90,P＜0.05).Conclusion:This study indicates that risky drinking group in offspring of parents with alcohol dependence may have better decision-making ability.

Arrhythmia classification method based on genetic algorithm optimization of C-LSTM model / 中国医学物理学杂志

A GC-LSTM model is proposed based on the characteristics of global optimization of genetic algorithm.The model automatically and iteratively searches the optimal hyper-parameter configuration of the C-LSTM model through the genetic algorithm of a specific genetic strategy,and it is configured using the genetic iteration results and validated on the MIT-BIH arrhythmia database according to the classification criteria of the Association for the Advancement of Medical Instrumentation.The testing shows that the classification accuracy,sensitivity,accuracy and F1 value of GC-LSTM model are 99.37%,95.62%,95.17%and 95.39%,respectively,higher than those of the manually established model,and it is also advantageous over the existing mainstream methods.Experimental results demonstrate that the proposed method can achieve better classification performance while avoiding a large number of experimental parameters.

Association between Adverse Medical Events and Defensive Medicine:Evidence from A Physician Survey in 8 cities / 中国医院管理

Objective To investigate the prevalence of defensive medicine among physicians in public hospitals in China and the impact of physicians'adverse medical events experiences.Methods Data were collected from 15 secondary or tertiary public hospitals in the eight cities in 2019 using convenience sampling method.Descriptive and multiple linear regression analyses were performed to investigate physicians'characteristics and explore the associa-tions between characteristics,adverse medical events experiences and the frequencies of defensive medicine.Re-sults Physicians who are male(β2=-0.59),low income(β2=-1.47)and work in acute care units(β1=3.84,β2=1.84),pediatrics(β1=3.01,β2=2.16)and surgery(β1=2.64,β2=1.67)were more likely to engage in defensive medical behavior(P＜0.05).Physicians who experienced adverse medical events practiced more frequent defensive medicine.Conclusion Adverse medical events experiences significantly increase physicians'defensive medicine prac-tice.Joint efforts should be made to improve physician-patint relationship and focus on prevention at source and im-proving dispute resolution mechanisms.

Cases analysis and etiology discussion of thymoma with alopecia areata / 中华胸心血管外科杂志

Objective:Analyzed the clinicopathological features of thymoma with alopecia areata, and discussed the pathogenesis and treatment methods.Methods:The clinicopathologic data of patients with thymoma who underwent surgery from August 1, 2015 to July 31, 2020 in Beijing Tongren Hospital, Capital Medical University were reviewed. Transversally analyzed the patients of thymoma with alopecia areata and longitudinally compared with the patients of thymoma without alopecia areata after 1﹕10 matched by propensity score matching.Results:A total of 252 patients of thymoma were enrolled, including 6 patients with alopecia areata, accounting for 2.38%. The anti-AchR antibody, CD4 + /CD8 + T inversion in serum and myasthenia gravis were present in the all 6 thymoma patients with alopecia areata, which were significantly higher than those in the group of thymoma without alopecia areata. Besides myasthenia gravis, the proportion of complicated with other autoimmune diseases in thymoma patients with alopecia areata was significantly higher than that of thymoma patients without alopecia areata[83.33%(5/6) vs. 20.00%(12/60), P=0.003]. After operation, 5 patients’ alopecia areata were improved in 6 thymoma patients with alopecia areata(83.33%, 5/6). Conclusion:The thymoma patients with alopecia areata always complicated with myasthenia gravis and other autoimmune diseases. The pathogenesis may be associated with autoimmune CD8 + T lymphocytes produced by thymoma. At present, surgery is still the most effective way to improve thymoma-associated alopecia areata.

Evaluation and application of automated quality control of automatic pipeline in clinical biochemical and immunological detection / 中华检验医学杂志

Objective:To assess the applicability of fully automatic pipeline automated testing for internal quality control (automated quality control).Methods:Stability, assay efficiency and implementation costs of 18 biochemical tests, 5 immunoturbidimetric tests and 11 chemical illuminescent tests in the Department of Laboratory Medicine of Peking Union Hospital from January 2019 to July 2022 were evaluated using automated quality control implementation methods. The detailed method is as follows: quality control materials for biochemical, immunoturbidimetric and chemiluminescent tests were stored in the refrigerator in the pipeline which was controlled by the intermediate software, and were automatically retrieved and tested as pre-set followed by documenting and storing. The quality control setup for the biochemical tests included refreshing quality control materials daily and weekly,both of which were paralleled for 3 months. The on-line storage stability of quality control materials in the pipeline was evaluated by comparing the coefficients of variation ( CV) of the quality control results between the two patterns. Effect of automated quality control application was evaluated using 6 indicators, including the results′ variation of automatically performed and manually performed quality controls, the out-of-controlled rate, the consumption of quality control materials, the change of staff workload, the impact on the testing time of the first sample, and the failure rate of automated quality control. Results:(1) Storage stability of quality control materials in the pipeline: under the pattern of weekly refresh of the biochemical quality control materials, except for total carbon dioxide (TCO 2) (the CVs of low and high level quality control were respectively 20.24% and 21.82%) and sodium (the CV of low level quality control was 1.51%) that were greater than the allowable variation set by the laboratory, the CVs of the rest tests meet the lab requirements on the allowable variations. (2) The results′ variation of quality control in automatically performed and manually performed control patterns: in the patterns of daily refresh of biochemical quality control materials and weekly refresh of immunoturbidimetric and chemiluminescent quality control materials, the CVs of both low and high levels of quality control were lower in the automatically performed control pattern than that in manually performed pattern for 8 chemiluminescent items of dehydroepiandrosterone sulfate, estradiol, follicle stimulating hormone, luteinizing hormone, serum ferritin, serum folic acid, vitamin B12 and testosterone, 3 immunologic items of complement 3, C reactive protein and immunoglobulin G, and 10 biochemical items of alkaline phosphatase, glucose, calcium, chloride, potassium, lactate dehydrogenase, sodium, urea, low density lipoprotein cholesterol, and adenosine deaminase. The out-of-control rates of biochemistry, immunoturbidimetric and chemiluminescence tests in both quality control patterns conformed with the clinical routine work requirements. (3) Comparison of quality control materials′ consumption: compared with manually performed quality control, weekly consumption of automatically performed chemiluminescent quality control materials decreased 37.5% (from 8 ml to 5 ml); weekly consumption of automatically performed immunoturbidimetric quality control materials decreased 33.3% (from 3 ml to 2 ml). (4)Comparison of staff workload and first sample testing time: compared with manually performed quality control, automatical quality control reduced manual work by about 156 steps per week, and the daily initial testing time was earlier by 15 min on average. The failure rate was 54.5% (37/64) during the early-stage application of the automated quality control which dropped to 10.2% (13/128) in the late-stage. Conclusion:The results of automated quality control detected in the pipeline system meet the quality indicators′ requirements of the laboratory, and the application of automated quality control can improve the quality control, save costs, reduce workload, and improve work efficiency.

Postoperative Treatment and Rehabilitation of Malignant Tumor Based on the Theory of Qi Sinking in Traditional Chinese Medicine / 中医杂志

As an important concept in Chinese medicine theory， "qi sinking" is the inheritance and extension of the thought core of sinking of qi in whole body. This article explored the concept of sinking of pectoral qi， center qi， and kidney qi in the theory of qi sinking， and believed that sinking of pectoral qi， stagnation and sinking of center qi， deficiency and sinking of kidney qi were the core pathogenesis of postoperative injury in malignant tumours. Anchored to the method of reinforcing healthy qi and lifting the sunken， this article recommended to identify pattern and treat by guiding supplement and lifting the sunken. For lung gold impairment， heart yang depletion， and pectoral qi sinking， the treatment is to warm and supplement heart and lung， lift pectoral qi， and restore the respiratory function by modified Shengxian Decoction （升陷汤） plus Guizhi Decoction （桂枝汤）； for spleen depletion and pathways blockage， liver failing to act freely， and center qi stagnation and sinking， the treatment is to warm and supplement center qi， raise yang and lift the sunken， and restore the digestive function by modified Buzhong Yiqi Decoction （补中益气汤）； for source exhausted and essence deficiency， liver qi hiding， and kidney qi deficiency to inward invasion， the treatment is to nourish the kidney and astringe the liver， consolidate the original qi and lift qi， improve the pelvic floor dysfunction， and protect the kidney function by modified Liuwei Dihuang Pill （六味地黄丸） plus Shengma Chaihu Decoction （升麻柴胡汤）. Modification need base on different disease patterns and stages， and new ideas for postoperative traditional Chinese medicine treatment and rehabilitation of malignant tumours were provided.