Changing trend of the disease burden of liver cirrhosis in China from 1990 to 2019 / 临床肝胆病杂志

ObjectiveTo investigate the prevalence of liver cirrhosis and the changing trend of the disease burden of liver cirrhosis in the Chinese population from 1990 to 2019， and to provide a data reference for formulating the prevention and treatment strategies for liver cirrhosis in China. MethodsThe Global Burden of Disease Study 2019 was used to collect the data on the incidence rate， mortality rate， disability-adjusted life years （DALY）， years of life lost （YLL）， and years lived with disability （YLD） of liver cirrhosis. The Joinpoint regression model was used to analyze the changing trend of disease burden； the age-period-cohort （APC） model was used to evaluate age， period， and cohort effects； R software BAPC package was used to predict future changes in disease burden. ResultsFrom 1990 to 2019 in China， there were increases in the numbers of liver cirrhosis cases and prevalent cases in the general population， as well as in the male and female populations， while there was a reduction in the number of deaths. From 1990 to 2019， the standardized incidence rate， standardized prevalence rate， and standardized mortality rate of liver cirrhosis in the Chinese population showed a downward trend， with a mean annual reduction of 0.62% （95% confidence interval ［CI］： -0.74% to -0.50%， t=9.99， P<0.001）， 0.44% （95%CI： -0.53% to -0.35%， t=13.18， P<0.001）， and 3.02% （95%CI： -3.12% to -2.93%， t=7.58， P<0.001）， respectively. From 1990 to 2019， the standardized DALY， YLL， and YLD rates of liver cirrhosis in the Chinese population also showed a downward trend， with a mean annual reduction of 3.27% （95%CI： -3.37% to -3.18%， t=6.22， P<0.001）， 3.32% （95%CI： -3.42% to -3.22%， t=9.31， P<0.001）， and 1.42% （95%CI： -1.49% to -1.34%， t=4.93， P<0.001）， respectively. From 1990 to 2019， the incidence rate of liver cirrhosis in the Chinese population first increased and then decreased with age， while the mortality rate showed an increasing trend， and the risks of disease onset and death showed a decreasing trend with time and birth cohort. The predictive model showed that the standardized incidence rate， prevalence rate， mortality rate， and DALY rate of liver cirrhosis in China will show a decreasing trend from 2020 to 2030. Alcohol was the most important risk factor for both male and female populations， followed by medication. ConclusionThe disease burden of liver cirrhosis in China shows a decreasing trend from 1990 to 2019， with sex and age differences， especially in the middle-aged male population. Effective measures should be taken for intervention.

Role of Akkermansia muciniphila in nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease （NAFLD） has become the most common chronic liver disease in the world， and it is also one of the main causes of liver cirrhosis and hepatocellular carcinoma， so it is particularly important to curb the development and progression of NAFLD in a timely manner. However， due to its complex pathogeneses， there are currently no effective methods for radical treatment. As a new generation of probiotics， Akkermansia muciniphila （Akk bacteria） can improve metabolic disorders of the body， and more and more studies have shown that Akk bacteria have a potential therapeutic effect on metabolic diseases， especially NAFLD. Therefore， this article briefly reviews the mechanism of action of Akk bacteria in NAFLD， in order to provide new ideas for improving the treatment of NAFLD and creating new therapies.

Long-term auditory monitoring in children with Alport syndrome based on different degrees of renal injury / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate long-term auditory changes and characteristics of Alport syndrome（AS） patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33（25 males, 8 females, aged 3.4-27.8 years） were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease（ESRD）, predominantly males （6/7）. The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group（P=0.013）. There was no correlation between the progression of renal disease and long-term hearing level（P>0.05）. kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss（P=0.048）, and there was no correlation with the severity of hearing loss（P>0.05）. Among 11 cases, theCOL4A5mutationwas most common （8 out of 11）, but there was no significant correlation between the mutation type and hearing phenotype（P>0.05）. Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.

TRIB3 promotes pulmonary fibrosis through inhibiting SLUG degradation by physically interacting with MDM2

Pulmonary fibrosis (PF) is the pathological structure of incurable fibroproliferative lung diseases that are attributed to the repeated lung injury-caused failure of lung alveolar regeneration (LAR). Here, we report that repetitive lung damage results in a progressive accumulation of the transcriptional repressor SLUG in alveolar epithelial type II cells (AEC2s). The abnormal increased SLUG inhibits AEC2s from self-renewal and differentiation into alveolar epithelial type I cells (AEC1s). We found that the elevated SLUG represses the expression of the phosphate transporter SLC34A2 in AEC2s, which reduces intracellular phosphate and represses the phosphorylation of JNK and P38 MAPK, two critical kinases supporting LAR, leading to LAR failure. TRIB3, a stress sensor, interacts with the E3 ligase MDM2 to suppress SLUG degradation in AEC2s by impeding MDM2-catalyzed SLUG ubiquitination. Targeting SLUG degradation by disturbing the TRIB3/MDM2 interaction using a new synthetic staple peptide restores LAR capacity and exhibits potent therapeutic efficacy against experimental PF. Our study reveals a mechanism of the TRIB3-MDM2-SLUG-SLC34A2 axis causing the LAR failure in PF, which confers a potential strategy for treating patients with fibroproliferative lung diseases.

Discussion on the Authenticity Verification Method in the Verification of Medical Device Registration Quality Management System / 中国医疗器械杂志

Authenticity verification is a very important aspect of medical device registration quality management system verification of medical device. How to verify the authenticity of samples is a problem worth discussing. This study analyzes the methods of authenticity verification from the aspects of product retention sample, registration inspection report, traceability of records, hardware facilities and equipment. In order to provide reference for relevant supervisors and inspectors in the verification of registration quality management system.

Development and validation of interpersonal emotion regulation questionnaire for healthcare workers / 中华行为医学与脑科学杂志

Objective:To develop the interpersonal emotion regulation questionnaire for healthcare workers and examine its reliability and validity.Methods:Based on the theory of social regulatory cycle (SRC), literatures review and semi-structured interview were used to form the item pool of the scale.Through expert consultation, project analysis and the exploratory factor analysis, the scale items were screened, and the interpersonal emotion regulation questionnaire for healthcare workers was initially formed.The convenient sampling method was adopted to select 619 healthcare workers from multiple hospitals in Anhui province to conduct the formal survey to test the reliability and validity of the questionnaire and confirmatory factor analysis (CFA) using the SPSS 24.0 and Mplus 8.0 software.Results:There were 18 items and four dimensions including emotion identification, motivation, regulation strategy and implementation strategy process in the interpersonal emotion regulation questionnaire for healthcare workers.The results of CFA showed that the questionnaire fitted the data with well construct validity.The correlation coefficients between each dimension and the scale were 0.830-0.932.The Cronbach’s α coefficient of the overall questionnaire was 0.962, the split-half reliability was 0.880 and the test-retest reliability was 0.786.The score of total questionnaire was significantly positively correlated with the score of emotional intelligence ( r=0.680, P<0.001) and empathic ability ( r=0.554, P<0.001), and was significantly negatively correlated with the doctor-patient relationship ( r=-0.353, P<0.001). Conclusion:The interpersonal emotion regulation questionnaire for healthcare workers has satisfactory reliability and validity, which can be used to measure the ability of interpersonal emotion regulation in healthcare workers.

Practice and effect of construction of rational drug use mode of PIVAS by the activities of quality control circle / 药学实践杂志

Objective To establish a rational drug use model of PIVAS and promote the rational drug use in clinical practices by enhancing the quality of prescription review by pharmacists. Methods The PIVAS physician orders received from 2014 to 2021 were extracted through the hospital information management (HIS) system. The types of irrational physician orders were statistically analyzed, the improvements were made by the method of quality control circle (QCC). Results The model of PIVAS rational drug use formed a standardized process. The proficiency of physician order review was improved. From 2014 to 2021, the number and proportion of unreasonable physician orders in PIVAS decreased year by year. Every type of unreasonable physician orders was improved year by year. Conclusion The professional and technical levels of pharmacist for physician order review at our hospital were improved by the model of PIVAS rational drug use. The quality of pharmaceutical service was significantly improved which ensured the safety of patients' medication.

HMG20A was identified as a key enhancer driver associated with DNA damage repair in oral squamous cell carcinomas.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the main type of oral cancer. Disturbing DNA repair is an invaluable way to improve the effectiveness of tumor treatment. Here, we aimed to explore the key enhancer drivers associated with DNA damage repair in OSCC cells. METHODS: Gene Set Enrichment Analysis (GSEA), Gene Set Variation Analysis (GSVA) and Kaplan-Meier analysis were applied to explore the relationship among DNA repair-related genes expression and clinical phenotypes based on The Cancer Genome Atlas (TCGA) database. HOMER software and Integrative Genomics Viewer were applied to identify and visualize enhancers using GSE120634. Toolkit for Cistrome Data Browser was applied to predict transcription factors. Human Protein Atlas Database was used to analyze the protein levels of transcription factors in OSCC and control tissues. Seventy-two OSCC patients were included in this study. qRT-PCR was used to detect transcription factor expression in OSCC and adjacent control tissues collected in this study. qRT-PCR and ChIP-qPCR were used to verify the binding of transcription factors to enhancers, and regulation of target genes transcription. Transcription factor knockdown and control cells were treated with cisplatin. CCK8 was used to detect cell viability and proliferation. Western blotting was implemented to detect the levels of DNA repair-related proteins. Transwell assay was used to detect cell invasion. RESULTS: DNA repair was positively associated with the OSCC metastatic phenotype. Patients in the cluster with high expression of DNA repair-related genes had a worse prognosis and a higher proportion of advanced stage, low-differentiation, alcohol consumption and smoking compared to the cluster with low DNA repair-related gene expression. Seventeen metastasis-specific enhancer-controlled upregulated DNA repair-related genes, with the top two upregulated genes being ADRM1 26 S proteasome ubiquitin receptor (ADRM1) and solute carrier family 12 member 7 (SLC12A7) were screened. High mobility group 20 A (HMG20A) was the key prognostic enhancer driver regulating metastasis-specific DNA repair-related genes, with higher expression in OSCC tissues than normal control tissues, and higher expression in metastatic OSCC tissues than non-metastatic OSCC tissues. HMG20A bound to the metastasis-specific enhancers of ADRM1 and SLC12A7, thereby promoting ADRM1 and SLC12A7 expression. Knockdown of HMG20A enhanced cisplatin sensitivity of cells, and inhibited OSCC cells from repairing DNA damage caused by cisplatin, as well as proliferation and invasion of OSCC cells. CONCLUSION: HMG20A was identified as the key prognostic enhancer driver regulating DNA repair in OSCC cells, providing a new therapeutic target for OSCC.

Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: results from the IMPACC study

BackgroundBetter understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management. MethodsImmunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1,164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed. FindingsThe median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age [≥] 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63-4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC. InterpretationIntegration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19. FundingNIH RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSWe did a systematic search of the PubMed database from January 1st, 2020 until April 24th, 2022 using the search terms: "hospitalized" AND "SARS-CoV-2" OR "COVID-19" AND "Pro-spective" AND "Antibody" OR "PCR" OR "long term follow up" and applying the following filters: "Multicenter Study" AND "Observational Study". No language restrictions were applied. While clinical, laboratory, and radiographic features associated with severe COVID-19 in hospitalized adults have been described, description of the kinetics of SARS-CoV-2 specific assays available to clinicians (e.g. PCR and binding antibody) and their integration with other variables is scarce for both short and long term follow up. The current literature is comprised of several studies with small sample size, cross-sectional design with laboratory data typically only recorded at a single point in time (e.g., on admission), limited clinical characteristics, variable duration of follow up, single-center setting, retrospective analyses, kinetics of either PCR or antibody testing but not both, and outcomes such as death or, mechanical ventilation that do not allow delineation of variations in clinical course. Added value of this studyIn our large longitudinal multicenter cohort, the description of outcome severity, was not limited to survival versus death, but encompassed a clinical trajectory approach leveraging longitudinal data based on time in hospital, disease severity by ordinal scale based on degree of respiratory illness, and presence or absence of limitations at discharge. Fatal COVID-19 cases had the lowest ratio of antibody to viral load levels over time as compared to non-fatal cases. Integration of PCR cycle threshold and antibody values with demographics, baseline comorbidities, and laboratory/radiographic findings identified additional risk factors for outcome severity over the first 28 days. However, female sex was the only variable associated with persistence of symptoms over time. Persistence of symptoms was not associated with clinical trajectory over the first 28 days, nor with antibody/viral loads from the acute phase. Implications of all the available evidenceThe described calculated ratio (binding IgG/PCR Ct value) is unique compared to other studies, reflecting host pathogen interactions and representing an accessible approach for patient risk stratification. Integration of SARS-CoV-2 viral load and binding antibody kinetics with other laboratory as well as clinical characteristics in hospitalized COVID-19 patients can identify patients likely to have the most severe short-term outcomes, but is not predictive of symptom persistence at one year post-discharge.

Management of asthma in adolescents / 中华实用儿科临床杂志

Asthma is the most common chronic respiratory disease in children and requires long-term medical management.Adolescence has unique physical and psychological characteristics, which challenge the management of asthma in adolescents.A personalized transition strategy can achieve a successful asthma transition from childhood into adulthood and improve long-term outcomes of asthma.In this paper, the characteristics of adolescence, burden of adolescent asthma, challenges to adolescent asthma, adolescent asthma management system, and successful transition of adolescent asthma were reviewed.

Application of Westgard sigma rule in quality control laboratory of blood station / 中国输血杂志

【Objective】 To help quality control laboratory of blood station select suitable internal quality control rules using Westgard sigma rules. 【Methods】 The accumulated coefficient of variation of internal quality control was used as the measurement imprecision in quality control laboratory of blood station, and the bias of the results of EQA in 2020 was regarded as Bias. The allowable total error (TEa) of WS/T406-2012 was used as the evaluation index to calculate the σvalue of laboratory blood testing items to select reasonable and feasible quality control rules using the Westgard sigma rule. 【Results】 The average σvalues of total protein in the three national EQAS were 14.2, 8.7 and 9.6, respectively. The average σvalues of fibrinogen in two national EQAS were 3.6 and 4.1. The average σvalues of Plt counts and MCHC were <4 and >3, and those of other items were more than 6 in two national EQAS. 【Conclusion】 The rule of 13s, 13s/22s/R4s/41s/ and 13s/22s/R4s/41s/ should be used in total protein, fibrinogen and whole blood cell count testing, respectively, by Westgard sigma rule, which can effectively help the blood quality control laboratory select appropriate quality control rules.

Application of scenario-based learning in humanistic education of residents during rotation in department of geriatrics / 中华医学教育探索杂志

Objective:To explore the value of scenario-based learning (SBL) in humanistic education of residents during rotation in department of geriatrics.Methods:Residents who were trained in Department of Geriatrics of Peking University First Hospital from March 5, 2019 to April 6, 2020 were selected as research objects and they were randomly assigned to SBL group and traditional training (TT) group for 4 weeks of humanistic education including humanistic knowledge learning and humanistic spirit cultivation. For humanistic knowledge learning, 56 residents were taught together. For humanistic spirit cultivation, SBL training and traditional training were conducted in the two groups respectively. The SBL group trained the residents through the simulation of such 4 scenarios as daily diagnosis and treatment work, emergency and critical care, diagnosis and treatment of elderly patients with mental disorders and hospice care, while TT group adopted traditional lecturing. After 8 weeks of training, the effects of SBL on the humanistic education were evaluated through simulated doctor-patient consultation scenarios. SPSS 22.0 was used for t test and Mann-Whitney U test. Results:A total of 56 residents participated in the training and complete the assessment. There were no significant differences in gender, age and duration of standardized training, respectively. However, the SEGUE scores of doctor-patient communication ability in SBL group were significantly superior to those of the TT group[(115.80±5.46) points vs. (109.71 ± 5.82), P<0.001]. Further analysis showed that among the 25 items of SEGUE scale, there were significant difference in the scores of 10 items (3rd, 6th, 8th, 12th, 14th, 15th, 18th, 19th, 22nd, 24th) between the two groups ( P<0.05). Conclusion:In humanistic education, SBL plays an important role in improving humanistic qualities of rotation residents in department of geriatrics, which is deserved to promote.

Study on the application of continuous nursing led on the theory of interactive standard theory after heart transplantation / 中国实用护理杂志

Objective:To explore the application research of continuity nursing based on the interactive reaching standard theory after heart transplantation.Methods:The clinical data of 104 patients after heart transplantation in Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital) from June 2012 to June 2020 were collected for retrospective study. According to the file order, they were divided into the control group and the experimental group with 52 cases in each group. The control group took regular nursing care, and the experimental group took continuation nursing based on the interactive standard theory on the basis of the control group. The intervention continued for 24 weeks. The compliance behavior, psychological state and other indexes were compared between two groups.Results:The scove of Positive and Negative Affect Scale: after 12 weeks and 24 weeks of nursing, the experimental group′s positive emotion scores (27.71 ± 4.42, 35.11 ± 4.19) were higher than those of the control group (24.45 ± 4.03, 28.87 ± 4.36). The negative emotional scores (24.52 ± 3.71, 16.66 ± 2.28) were lower than those of the control group (28.84 ± 4.14, 23.31 ± 3.46), the differences were statistically significant ( t=5.60, 11.57, P<0.05). After 12-week and 24-week nursing, the experimental group′s health knowledge level score (44.12 ± 4.43, 53.64 ± 4.55) , self-care skills score(35.35 ± 4.01, 44.78 ± 4.22) , self-responsibility score (21.15 ± 2.38, 26.11 ± 1.44) , and self-concept score (18.56 ± 6.25, 23.58 ± 2.58) were higher than the control group (37.78 ± 4.52 and 45.56 ± 5.13, 31.11 ± 3.64 and 36.65 ± 3.91, 18.82 ± 2.46 and 22.35 ± 1.29, 15.96 ± 4.10 and 18.12 ± 3.10), the differences were statistically significant ( t values were 2.51-14.03, P<0.05). Conclusions:Continuing care led by the interactive standard theory can improve the health literacy of patients after heart transplantation, relieve negative emotions, promote post-traumatic growth, enhance self-management capabilities, establish compliance behaviors, and improve heart function.

Non-pharmaceutical interventions for respiratory virus infection in children and its effect / 中华实用儿科临床杂志

With the emergence of new respiratory virus, it is more apparent for the vulnerability of population to respiratory viral infection.Non-pharmaceutical interventions (NPIs) for respiratory virus infection have become the main way to prevent corona virus disease 2019.Some studies had proven its effectiveness.In addition, the NPIs also significantly reduced the incidence and hospitalization rate of other respiratory disease in children.NPIs for respiratory virus infection in children have its particularity and challenge.In daily life, it is important to guide children how to do the NPIs, so as to protect susceptible children and reduce the disease burden in children′s health system.Therefore, the aerosol transmission, the specificity of the NPIs in children, and the impact on childhood respiratory diseases are described in this article, to improve the prevention of common respiratory diseases in children.

IgD multiple myeloma: report of 1 case and review of literature / 白血病·淋巴瘤

Objective:To investigate the clinical features of IgD multiple myeloma (MM) and the effect and prognosis of daratumumab-based combination therapy.Methods:The clinicopathological data of a IgD MM patient with disease progression and extramedullary infiltration treated with daratumumab in the Affiliated Hospital of Qingdao University in December 2019 were retrospectively analyzed.Results:The 74-year-old woman was diagnosed as IgD MM by bone marrow aspiration and immunofixation electrophoresis. The patient was given VD (bortezomib, dexamethasone), RD (lenalidomide, dexamethasone) and ID (ixazomib, dexamethasone) regimens. In June 2020, the patient developed multiple subcutaneous nodules, and she was assessed as progressive disease with extensive extramedullary infiltration. After treated with daratumumab-PAD (liposomal doxorubicin, bortezomib, dexamethasone) regimen, the patient's subcutaneous nodules were significantly reduced and partially disappeared, and the general condition was significantly improved. But the patient was in a cachexia state and finally died of the irregular treatment and disease progression.Conclusions:IgD MM has a low incidence and a short survival period, and there is no uniform standard treatment. The early application of daratumumab combined with proteasome inhibitors, immunomodulators, cytotoxic drugs and hematopoietic stem cell transplantation may improve the overall survival of patients.

The cell cycle inhibitor P21 promotes the development of pulmonary fibrosis by suppressing lung alveolar regeneration

The cell cycle inhibitor P21 has been implicated in cell senescence and plays an important role in the injury-repair process following lung injury. Pulmonary fibrosis (PF) is a fibrotic lung disorder characterized by cell senescence in lung alveolar epithelial cells. In this study, we report that P21 expression was increased in alveolar epithelial type 2 cells (AEC2s) in a time-dependent manner following multiple bleomycin-induced PF. Repeated injury of AEC2s resulted in telomere shortening and triggered P21-dependent cell senescence. AEC2s with elevated expression of P21 lost their self-renewal and differentiation abilities. In particular, elevated P21 not only induced cell cycle arrest in AEC2s but also bound to P300 and β-catenin and inhibited AEC2 differentiation by disturbing the P300-β-catenin interaction. Meanwhile, senescent AEC2s triggered myofibroblast activation by releasing profibrotic cytokines. Knockdown of P21 restored AEC2-mediated lung alveolar regeneration in mice with chronic PF. The results of our study reveal a mechanism of P21-mediated lung regeneration failure during PF development, which suggests a potential strategy for the treatment of fibrotic lung diseases.

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.

Case Report and Literature Analysis of Antidepressants-induced Thrombocytopenia / 中国药房

OBJECTIVE：To investigate the clini cal features of thrombocytopenia induced by antidepressants ，and to provide reference for the rational use of clinical drugs. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，PubMed and Web of Science，during Jan. 1st in 1985 to Aug. 31st in 2020，case reports about antidepressants-induced thrombocytopenia was collected and analyzed descriptively in terms of demographic characteristics ，medication，clinical manifestations ，treatment and outcome. RESULTS：A total of 17 literatures were retrieved ，and 19 patients were included ，involving 10 male and 9 female，aged from 5 to 95 years old ，with an average of （48±24）years old. Nine kinds of drugs were involved ，including 4 cases of escitalopram ，3 cases of citalopram ，3 cases of fluoxetine ，3 cases of mirtazapine ，2 cases of amitriptyline ，1 case of sertraline ，1 case of paroxetine，1 case of mianserin and 1 case of imipramine. There were 9 cases of single drug and 10 cases of drug combination. All 19 patients suffered from thrombocytopenia at 3 d-10 years after medication ，14 of them had hemorrhage tendency. Main clinical manifestations included mucocutaneous hemorrhage ，gingival bleeding ，black stool ，hematochezia，vaginal bleeding ，ocular hemorrhage，alveolar hemorrhage. No bleeding was found in 5 cases. After drug withdrawal/changing drugs and other symptomatic treatment， platelet count of 19 patients recovered to normal ， and bleeding symptoms disappeared. CONCLUSIONS ： Thrombocytopenia caused by antidepressants has no obvious clinical features and is not easy to be found ，but it may lead to severe； bleeding symptoms if it is not found in time. The changes of platelet count should be closely monitored in clinical application of such drugs to ensure the safety of drug use.

Studies on the mechanism of inhibitory effect of lithium chloride on the proliferation of human Tenon capsule fibroblasts / 中华实验眼科杂志

Objective:To investigate the effect of lithium chloride (LiCl) on the gap junctional intercellular communication (GJIC) in human Tenon capsule fibroblasts (HTFs) and its underlying mechanism.Methods:The Tenon capsule tissue of a patient who underwent strabismus surgery in Dezhou People's Hospital in April 2019 was collected and cut into tissue blocks of dimensions 1 mm×1 mm×1 mm.Primary culture and subculture were carried out, and the 4th-generation HTFs were taken for experiment.HTFs were divided into the control group and LiCl treatment group and were cultured with cell medium without or with 80 mmol/L LiCl for another 48 hours according to grouping.The cell scratch and dye labeling technique were used to label the coupling index and evaluate the GJIC function.The expression and localization of Cx43 in HTFs were detected by immunofluorescence staining.The expression levels of Cx43 mRNA and protein were detected by real-time fluorescence quantitative PCR and Western blot, respectively.The study protocol was approved by an Ethics Committee of Dezhou People's Hospital (No.2019-023). Written informed consent was obtained from the subject.Results:The cultured spindle-shaped HTFs grew adhering to the wall showing radial monolayer or vortexlike, and the cytoplasm was vimentin positive.Results of dye tracer experiment of cell scratch showed that the cell coupling index of LiCl treatment group was 9.04±0.53, which was significantly higher than 4.94±0.39 of the control group ( t=-18.79, P<0.01). Immunofluorescence staining showed that the Cx43 fluorescence was dotted in the cell membrane between adjacent cells in the control group, and Cx43 staining was obviously enhanced in the LiCl treatment group.The results of real-time fluorescence quantitative PCR showed that with relative expression level of Cx43 mRNA in the control group set to 1, the relative expression level of Cx43 in the LiCl treatment group was significantly increased to 1.97±0.23, showing a statistical significance between them ( t=-14.426, P<0.01). Western blot showed that the relative expression level of Cx43 protein was 0.871±0.057 in the LiCl treatment group, which was significantly higher than 0.446±0.028 in the control group ( t=-11.682, P<0.01). Conclusions:LiCl can enhance the GJIC function between HTFs by upregulating the expression levels of Cx43 mRNA and protein, suggesting that the enhanced GJIC function by LiCl may be one of the mechanisms of its inhibition on HTFs proliferation.

Biotherapy trends in asthma: from the discovery of IgE to anti-IgE antibody production / 中华实用儿科临床杂志

Asthma is the most common chronic respiratory disease in children.Currently, asthma symptoms can be well controlled under initial treatment.For moderate and severe asthma that cannot be controlled by initial treatment, biological therapy is a new option.Among them, the anti-IgE antibody (Omalizumab) is the earliest biological agent to be marketed for the treatment of asthma, followed by a large number of novel monoclonal antibodies targeting different sites.In this paper, the immune mechanism, classification and the development history of biological therapy of asthma were summarized, and the trends of biological therapy of asthma were prospected.