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Objective To understand the molecular epidemiological characteristics of Norovirus outbreaks and the genome evolution of Norovirus epidemic strains in Hainan Province from 2020 to 2022.Methods The information and samples have been collected from the norovirus outbreaks from 2020 to 2022.Norovirus was detected by using the real-time PCR in these samples,then the detected sequences were amplified the analyzed.The Norovirus se-quences of 8 strains had been amplified and analyzed.Results From 2020 to 2022,39 gastroenteritis outbreaks were reported,and 25 outbreaks caused by Norovirus which mainly occurred in childcare institutions and schools(20/25,80％).The Norovirus outbreaks were mainly concentrated in counties around Haikou(northeast),which including Ding'an(5 cases),Wenchang(4 cases),Chengmai(4 cases),and Lingao(3 cases);following by western regions which included Baisha(2 cases),Ledong(2 cases),and Dongfang(3 cases).1 case was in Wanning in the southeast.Among individuals aged 2-17,the positive proportion of Norovirus in males was higher than that in females.Among individuals aged over 55,the proportion of Norovirus positive in females was higher than that in males.The gender of positive samples among individuals aged 18-40 was related to their profession.According to RT-PCR typing and sequencing,GⅡ group Norovirus were classified in13 outbreaks.There were 4 genotypes detected.GⅡ.2[P1 6]was the main epidemic strain with 60％(9/13),and the other three genotypes were GⅡ.4 Sydney[P31](15.4％,2/13)GⅡ.4 Sydney[P16](7.7％,1/13)and GⅡ.3[P12](7.7％,1/13).Further genic analysis of 8 Norovirus strains showed that all of them were still in the same branch as the previ-ous strain,and all exhibited a certain amount of amino acid variation.Conclusion Norovirus is the main pathogen of gastroenteritis outbreaks in Hainan province,and the main epidemic strain is GⅡ.2[P16].It is necessary to continue to strengthen the monitoring that provides scientific evidence for the prevention and control of norovirus out-breaks in Hainan region.
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Objective:The predictive model of cardiac arrest in the emergency room was constructed and validated based on Logistic regression.Methods:This study was a retrospective cohort study. Patients admitted to the emergency room of the First Affiliated Hospital of Xinjiang Medical University from January 2020 to July 2021 were included. The general information, vital signs, clinical symptoms, and laboratory examination results of the patients were collected, and the outcome was cardiac arrest within 24 hours. The patients were randomly divided into modeling and validation group at a ratio of 7:3. LASSO regression and multivariable logistic regression were used to select predictive factors and construct a prediction model for cardiac arrest in the emergency room. The value of the prediction model was evaluated using the area under the receiver operator characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).Results:A total of 784 emergency room patients were included in the study, 384 patients occurred cardiac arrest. The 10 variables were ultimately selected to construct a risk prediction model for cardiac arrest: Logit( P)= -4.503+2.159×modified early warning score (MEWS score)+2.095×chest pain+1.670×abdominal pain+ 2.021×hematemesis+2.015×cold extremities+5.521×endotracheal intubation+0.388×venous blood lactate-0.100×albumin+0.768×K ++0.001×D-dimer. The AUC of the model group was 0.984 (95% CI: 0.976-0.993) and that of the validation group was 0.972 (95% CI: 0.951-0.993). This prediction model demonstrates good calibration, discrimination, and clinical applicability. Conclusions:Based on the MEWS score, chest pain, abdominal pain, hematemesis, cold extremities, tracheal intubation, venous blood lactate, albumin, K +, and D-dimer, a predictive model for cardiac arrest in the in-hospital emergency room was constructed to predict the probability of cardiac arrest in emergency room patients and adjust the treatment strategy in time.
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which is manifested by symptoms such as difficulties in social interaction and communication, stereotypical repetitive behaviors, and narrow areas of interests.At present, the intervention methods for ASD mainly include behavioral intervention, pharmacological intervention, physical intervention, exercise intervention, complementary and alternative medicine intervention.With the progress of science and technology and in-depth research, the intervention methods of ASD will develop in the direction of personalized intervention, deep learning technology, gene therapy and neurofeedback technology.These new intervention methods would hopefully improve the treatment effect and the quality of life of patients.
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ObjectiveTo explore the possible mechanisms of Shoutai Wan （寿胎丸） in treating recurrent miscarriage （RSA） from the perspective of immune tolerance under the acidic microenvironment at the maternal-fetal interface. MethodsFemale CBA/J mice were randomly divided into normal group， model group， progesterone group， and Shoutai Wan group， with 15 mice in each group. The mice in the normal group and model group were given 0.2 ml distilled water by gavage each day， the Shoutai Wan group given Shoutai Wan decoction 0.15 g/（10 g·d） by gavage， the progesterone group given progesterone tablets 0.44 mg/（10 g·d） by gavage. After gavage for 14 days， the mice were cohabited. Female CBA/J mice in the normal group were mated with male BALB/c mice at a ratio of 2∶1， and female CBA/J mice in the other groups were mated with male DBA/2 mice at a ratio of 2∶1 to establish the RSA mouse model. Vaginal smears were taken from the female mice the next morning， and the appearance of a large number of spermatozoa and the presence of a vaginal plug were considered as the first day of pregnancy. After the appearance of the plug， the mice were continued to be administered according to the previous method until the 10th day of pregnancy. On the 10th day of pregnancy， maternal-fetal interface tissues were collected from each group of mice， and lactate dehydrogenase colorimetric method was used to detect lactate （LA） content； qPCR method and Western blot method were used to detect the expression of immune-related factors interleukin-4 （IL-4）， interferon-gamma （IFN-γ）， transforming growth factor beta 1 （TGF-β1）， and forkhead box protein 3 （Foxp3） mRNA and protein； flow cytometry was used to detect the numbers of helper T lymphocyte 1 （Th1）， helper T lymphocyte 2 （Th2）， regulatory T cell （Treg）， classical macrophage （M1）， and alternative macrophage （M2）. The bivariate Pearson test was used to analyze the correlation between LA content and the numbers of Th1， Th2， Treg， M1， and M2 cells， as well as the correlation between LA content and the expression of IL-4， IFN-γ， TGF-β1， Foxp3 protein， and mRNA. ResultsOn the 10th day of pregnancy， compared with the normal group， the LA content decreased in the model group， and the expression of IL-4， TGF-β1， Foxp3 protein and mRNA in the maternal-fetal interface tissues decreased， while the expression of IFN-γ protein and mRNA increased. The numbers of Th1 and M1 cells increased， while the numbers of Th2， Treg， and M2 cells decreased （P＜0.05 or P＜0.01）. Compared with the model group， the LA content increased in the Shoutai Wan group and progesterone group. The expression of IL-4， TGF-β1， Foxp3 protein and mRNA in the maternal-fetal interface tissues increased， while the expression of IFN-γ protein and mRNA decreased. The numbers of Th1 and M1 cells decreased， while the numbers of Th2， Treg， and M2 cells increased （P＜0.05 or P＜0.01）. The LA content was positively correlated with the numbers of Th2， Treg， and M2 cells， and the expression of IL-4， TGF-β1， Foxp3 protein， and mRNA （P＜0.05 or P＜0.01）； the LA content was negatively correlated with the numbers of Th1， M1 cells， and the expression of IFN-γ protein and mRNA （P＜0.05 or P＜0.01）. ConclusionShoutai Wan may improve immune tolerance by regulating the expression of immune-related factors in the acidic microenvironment at the maternal-fetal interface of RSA model mice， thereby exerting its role in preventing miscarriage.
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ObjectiveTo assess the impact of intraoperative plasma infusion dose and coagulation test value INR on the clinical prognosis of patients undergoing cardiac surgery， providing a basis for guiding rational blood use during cardiac surgery. MethodsThe clinical data of 305 surgical patients who received fresh frozen plasma transfusion during cardiac surgery were collected in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022. The patients were divided into low-dose group （plasma infusion dose <15 mL/kg， n = 214） and high-dose group （plasma infusion dose ≥15 mL/kg， n = 91） based on the intraoperative plasma dose. Univariate analysis， correlation analysis and logistic multivariate regression analysis were used to analyze the relationship between plasma infusion dose， changes in INR before and after plasma transfusion， and the clinical prognosis of patients undergoing cardiac surgery. ResultsThe median plasma infusion dose for all patients was 11.11 （8.17-19.05） mL/kg， while the median plasma infusion dose in the high-dose group and the low-dose group was 17.78 （15.69-20.91） mL/kg and 9.52 （7.77-11.43） mL/kg， respectively， with a statistically significant difference （P <0.001）. The median INR decrease in the high-dose and low-dose groups was 0.98 （0.60-1.26） and 0.50 （0.35-0.76）， respectively， with a statistically significant difference （P<0.001）. Logistic multivariate regression analysis revealed that abnormally elevated preoperative INR values increased the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P<0.001）， with an OR 95%CI of 6.757（3.068， 14.822）. Additionally， it also increased the risk of postoperative in-hospital mortality （P< 0.001）， with an OR 95%CI of 5.441 （2.193， 13.499）. INR decrease reduced the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P=0.001）， with an OR 95%CI of 0.244（0.107， 0.558）. Correlation analysis showed positive correlation between plasma infusion dose and postoperative ICU days （rs=0.569， P<0.001） and hospital days （rs=0.302， P<0.001） in cardiac surgery patients. ConclusionAmong patients undergoing cardiac surgery who receive intraoperative plasma transfusion， high plasma infusion dose and abnormally elevated preoperative INR values are associated with poorer clinical outcomes， while patients who show a greater degree of INR correction after plasma transfusion exhibit better clinical results.
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【Objective】 To explore the relationship between the intraoperative plasma transfusion volume, the changes of blood coagulation test values and the clinical prognosis of surgical patients, so as to provide a theoretical basis for guiding the rational use of blood during the operation. 【Methods】 The clinical data of 556 surgical patients who received plasma infusion from January 2017 to December 2020 in Sun Yat-sen Memorial Hospital were collected. Patients were divided into low plasma dose group (<15 mL/kg) and high plasma dose group (≥15 mL/kg). The univariate regression analysis, logistic multivariate regression analysis and linear regression analysis were used to explore the relationship of plasma dose, the changes of coagulation indicators and the clinical prognosis. 【Results】 A total of 556 surgical patients were included in the study and the median (interquartile range) of plasma transfusion volume for all patients during the operation was 10.5 (8.5~14.0) mL/kg. In multivariate regression analysis, an increase of 1 mL/kg of intraoperative plasma dose resulted in an increased risk of red blood cell infusion within 24 hours after surgery[OR(95% CI) 1.16(1.01, 1.33), P<0.05], an increase in the ICU stays[Mean(95%CI) 0.19(0.03, 0.35), P<0.05] and an increase in the hospitalization days[Mean(95%CI) 0.55(0.27, 0.81), P<0.05]. The preoperative INR value increased the risk of red blood cell infusion within 24 hours after surgery[OR(95% CI) 1.82(1.33, 2.50), P<0.05], and increased the hospital mortality of postoperative patients[OR (95% CI) 2.15 (1.09, 4.24), P<0.05]; the decrease in INR reduced the risk of red blood cell infusion in patients 24 hours after surgery[OR(95% CI) 0.47(0.27, 0.84), P<0.05]and reduced hospital mortality[OR(95% CI) 0.23(0.13, 0.50), P<0.05]. 【Conclusion】 In surgical patients undergoing intraoperative plasma infusion, abnormal preoperative INR value and high intraoperative plasma infusion are related to poor clinical prognosis, while INR decrease (preoperative-postoperative) was related to better clinical results.
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Objective@#To observe the association between puberty development and thyroid function among school-aged girls in Minhang District of Shanghai, in order to explore the effect of puberty development on thyroid function. @*Methods@#The study was based on a cohort of adolescent girls recruited in iodine-suitable areas of Minhang District, and the baseline and follow-up survey have been carried out from January to March 2019. The method of phased cluster sampling was used to select one junior high school in the east, south, north and middle of Minhang District, Shanghai, respectively. Finally, 464 new junior high school girls were included in the Cohort study for physical examination, and girls were followed up from January to March 2021. The Puberty Development Scale (PDS) was used to assess the stage of puberty. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were determined for each participant. Thyroid homeostasis structure parameters (THSPs) was calculated. Changes of Thyroid hormones at baseline and follow-up were compared by Wilcoxon signed rank sum test. Multiple linear regression analyses were used to evaluate the associations of thyroid hormones (THs) and THSPs changes with pubertal develepment.@*Results@#Serum TSH levels of female studentds decreased significantly, while their FT3 and FT4 levels increased significantly during the study period ( Z=-10.53, -4.71, -12.46, P <0.01). In multiple linear regression analysis after adjustment for co-variables (including baseline age, change of BMI and waist circumference), FT4 and thyroid feedback quantile-based index (TFQI) in the higher puberty category scores changes (△PCS) group were further reduced compared with those in the low △PCS group ( β =-0.66, -0.55 ). Compared to the late puberty at baseline and follow-up (BLFL) group, FT4 and TFQI showed higher decline in the pre-puberty at baseline and late puberty at follow-up (BPFL) group with the pre-puberty at baseline and end of puberty at follow-up (BPFT) group ( β =-0.55, -0.44)( P <0.05). There were no association of △TSH, △FT3, △FT4/FT3 and TSH index changes (△TSHI) with △PCS or the puberty pattern.@*Conclusion@#Serum TSH decreases while serum FT3 and FT4 increase among girls during puberty. Both the initial stage and the velocity of pubertal development are related to thyroid hormone fluctuations.
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Objective:To analyze the global epidemic data of Corona virus disease 2019 (COVID-19) and the prevention and control measures, learn about the epidemic characteristics, development trend and the main factors affecting the prevention and control effect, and provide reference for scientific prevention and control of COVID-19.Methods:The data of COVID-19 mainly came from the WHO website and the websites of the United States, European and other Centers for Disease Control and Prevention (the statistical time was from the beginning of the epidemic in each country to March 31, 2022). The epidemiological characteristics and trends in the world and major countries were analyzed, and the main factors affecting the prevention and control of the epidemic were studied. SPSS19.0 software was used to collate data and statistical analysis.Results:The worldwide cumulative confirmed cases of COVID-19 reached 1 million on April 2, 2020, 10 million cases on June 28, 2020, 100 million cases on January 25, 2021, 200 million cases on August 3, 2021, 300 million cases on January 6, 2022, 400 million cases on February 8, 2022, 489 million cases on March 31, 2022. From January 2020 to March 31, 2022, the interval between each additional 100 million cases was gradually shortened (about 360 days from the beginning of the epidemic to the increase to 100 million, the average time to increase from 100 million to 200 million, from 200 million to 300 million was 170 days, and the number of confirmed cases increased from 300 million to 400 million was only 33 days), the epidemic had accelerated. The worldwide cumulative number of death case was 100 000 on April 9, 2020, 1 million on September 19, 2020, 5 million on October 31, 2021, and 6.14 million on March 31, 2022. From January to October 2021, the average time interval for an increase of 1 million deaths was 97 days. After October, the growth rate decreased, averaging 121 days. At the end of 2021, affected by the Omicron mutation, the number of infected people worldwide increased sharply. By March 31, 2022, the cumulative number of confirmed cases in all continents was Europe (181 million), Asia (141 million), North America (94.67 million), South America (56.09 million), Africa (11.55 million) and Oceania (5.58 million) from high to low. The cumulative deaths from high to low was Europe (1.77 million), North America (1.42 million), Asia (1.41 million), South America (1.28 million), Africa (0.25 million) and Oceania (8 900). The top 5 countries with cumulative confirmed cases of COVID-19 were the United States (80.14 million), India (43.03 million), Brazil (29.98 million), France (25.82 million) and the United Kingdom (21.28 million). The top five countries with accumulated deaths were the United States (980 000), Brazil (660 000), India (520 000), the United Kingdom (160 000) and France (140 000).Conclusions:COVID-19 is a global public health emergency. The epidemic has spread worldwide with strong infectivity, rapid transmission and great harm. It is suggested to focus on the prevention and control of key links, strengthen the early warning mechanism, continue to take scientific public health prevention and control measures such as vaccination, reduce severe case and death and deal with an ongoing challenge.
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Objective:To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.Methods:A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.Results:A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of lactate, albumin, and L/A were 0.794 (95% CI was 0.741-0.840), 0.589 (95% CI was 0.528-0.647), 0.807 (95% CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve. Conclusion:The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.
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Objective:To analyze the changes in plasma endothelin-1 (ET-1) concentrations in the patients with acute respiratory distress syndrome (ARDS).Methods:Fourteen patients with ARDS induced by trauma, 8 males and 6 females, aged 19-80 yr, were studied. The severity of ARDS was graded according to the Berlin definition of ARDS after admission to intensive care unit (ICU). Venous blood samples were obtained on 1st, 3rd and 5th days after admission to ICU, the plasma ET-1 concentrations were measured by radioimmunoassay, the pulmonary vascular permeability index (PVPI) was determined by PiCCO technique, and multiple organ dysfunction (MOD) score and lung injury score (LIS) were assessed. Spearman correlation of plasma ET-1 concentrations with MOD score, LIS and PVPI was analyzed.Results:MOD score, LIS, PVPI and plasma ET-1 concentrations were significantly decreased in mild ARDS patients ( n=5) as compared with moderate ARDS patients ( n=9, P<0.05). The plasma ET-1 concentration was positively correlated with MOD score, LIS and PVPI ( r=0.69, 0.76, 0.62, P<0.001). Conclusions:Plasma ET-1 concentrations can reflect the pulmonary vascular permeability and even the severity of the disease in the early stage of ARDS, so it is necessary to carry out dynamic monitoring in the patients.
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Objective:To evaluate the role of aryl hydrocarbon receptor (AhR) in the down-regulation of Clara cell secretory protein (CCSP) expression during endotoxin-induced lung injury in rats.Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8 weeks, weighing 200-250 g, were divided into 4 groups ( n=6 each) using a random number table method: normal control group (group C), acute lung injury (ALI) group, ALI+ AhR antagonist group, and ALI+ vehicle group. Lipopolysaccharide(LPS) 1 mg/kg was intratracheally instilled to develop the model of lung injury, while the equal volume of normal saline was given instead in group C. At 2 h before LPS injection, AhR antagonist 6, 2′, 4′-trimethoxyflavone solution 5 mg/kg (diluted to 1 ml in dimethyl sulfoxide solution) was intraperitoneally injected in ALI+ AhR antagonist group, while dimethyl sulfoxide solution 1 ml was given in ALI+ vehicle group. The rats were sacrificed under anesthesia at 48 h after LPS administration. The left lung was lavaged and the broncho-alveolar lavage fluid (BALF) was collected for determination of the concentrations of CCSP by enzyme-linked immunosorbent assay, and the expression of CCSP in the bronchial epithelium in right lung tissues was determined by immunohistochemistry. Results:Compared with group C, the expression of CCSP in the bronchial epithelium was significantly down-regulated, and the concentrations of CCSP in BALF were decreased in the other three groups ( P<0.05 or 0.01). Compared with ALI group and ALI+ vehicle group, the histopathological injury was significantly reduced, the expression of CCSP in the bronchial epithelium was up-regulated, and the concentrations of CCSP in BALF were increased in ALI+ AhR antagonist group ( P<0.01). Conclusions:AhR partially mediates the down-regulation of CCSP expression during endotoxin-induced lung injury in rats.
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Objective:To investigate the diagnostic value of diffusion kurtosis imaging (DKI) quantitative parameters in lymph node metastasis of rectal cancer.Methods:The clinicopathological data of 79 patients with rectal cancers in Shanxi Province Cancer Hospital from November 2016 to March 2017 were retrospectively analyzed. All patients underwent routine magnetic resonance image (MRI) sequence and DKI sequence examinations before the operation. The tumor region of interest (ROI) was delineated by two radiologists. Matlab software was applied to calculate DKI quantitative parameters including apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) in two groups, respectively; and the consistency analysis was performed by using the interclass correlation coefficients (ICC). According to the results of postoperative pathology, all patients were divided into lymph node metastasis group and lymph node non-metastasis group; ADC, MD, MK of both groups were compared. The pathological diagnosis results were taken as the gold standard, receiver operating characteristic (ROC) curves of DKI quantitative parameters in the diagnosis of lymph node metastasis of rectal cancer were plotted, the area under the curve (AUC) was calculated, the optimal diagnostic threshold was determined based on the Yoden index, and the sensitivity and specificity were calculated.Results:The ICC of ADC, MD and MK calculated by two physicians were 0.934 (0.833-0.975), 0.963 (0.905-0.981) and 0.971 (0.949-0.991), respectively, showing a good inter-observer consistency. Among the 79 patients with rectal adenocarcinoma, 36 cases were in lymph node metastasis group and 43 cases were in lymph node non-metastasis group. MK value in lymph node metastasis group was higher than that in lymph node non-metastasis group, and the difference was statistically significant (0.97±0.08 vs. 0.89±0.09; t = -4.07, P < 0.001), while the ADC and MD values in lymph node metastasis group were lower than those in lymph node non-metastasis group, and the differences were not statistically significant (all P > 0.05). The AUC of MK value in the diagnosis of lymph node metastasis of rectal cancer was 0.735, and the corresponding sensitivity and specificity were 55.56% and 88.37%, respectively. Conclusions:DKI quantitative parameter MK has a certain diagnostic value in predicting lymph node metastasis of rectal cancer.
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【Objective】 To investigate the incidence of clinical massive blood transfusion in hospitals, the proportion of departments conducted massive blood transfusion and the current situation of component transfusion, so as to provide a theoretical basis for medical decision-making and further research on massive blood transfusion. 【Methods】 The basic clinical data and transfusion of blood components were retrospectively collected from 489 patients (514 occasions) who received massive blood transfusion at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from Jan. 1 2014 to Dec. 31 2018. 【Results】 The incidence of massive blood transfusion during the 5-year period was 1.2/1 000 inpatients (95%CI: 1.1-1.3), and the 30-day all-cause mortality was 21.88%; in the departments where massive blood transfusion occurred, the mortality rate was the highest in the trauma emergency department (60%), followed by intensive care unit (56.25%) and other surgery department (46.67%), while there was no death in the obstetric department. All patients received red blood cells [median 14 U (11.5-19.13)] and plasma [median 1 600 mL (1 200-2 200)], of which 47% received platelet [median 0 U (0-10)] and 32.68% received cryoprecipitate [0 U (0-10)]. The results of logistics regression analysis of all-cause mortality risk showed that compared with the youth group, the risk of all-cause death at 30 days of elderly patients over 65 years old (65 80 years old: OR=7.563, 95%CI=[1.587, 36.049], P<0.05) and 24-hour RBC infusion volume greater than 18 U (18≤RBC<27: OR=2.948 95%CI=[1.592, 5.462], P<0.05; RBC≥28: OR=3.992, 95%CI=[1.178, 13.536], P<0.05) was higher. 【Conclusion】 A dynamic definition should be included in massive transfusion studies. If only a 24-hour RBC infusion volume ≥18 U was used as the mass transfusion definition, about 68% of cases would be lost. The mortality rate of patients with massive blood transfusion was higher, and the incidence of massive blood transfusion was higher in the departments of cardiac surgery, general surgery and orthopedics surgery. More attention should be paid to the increasing number of female patients with massive blood transfusion. In addition, the risk of 30-day all-cause death was highest in elderly patients over 65 years of age and those with a 24-hour erythrocyte transfusion level of ≥18 U.
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Objective To observe the value of multimodal imaging for diagnosis of cardiac space-occupying lesions.Methods Data of 70 patients with cardiac space-occupying lesions who underwent echocardiography and cardiac CT(CCT)were retrospectively analyzed,among them 35 also underwent cardiac MRI(CMRI).The value of multimodal imaging for diagnosis of cardiac space-occupying lesions were explored according to the results of surgical pathology or clinical diagnosis.Results Among 70 cases,benign tumors were confirmed by surgical pathology in 43 cases,while malignant tumors were confirmed by surgical pathology in 3 cases and clinically diagnosed in 1 case.Meanwhile,non-tumor-occupying lesions were clinically diagnosed in 23 cases,all obviously shrunken after treatments.Among 70 cases,echocardiography correctly diagnosed 57 cases,misdiagnosed 8 cases and unclearly diagnosed 5 cases,with diagnostic accuracy rate of 81.43%(57/70).CCT correctly diagnosed 63 cases,misdiagnosed 4 cases but missed 3 cases,with diagnostic accuracy rate of 90.00%(63/70).CMRI outcomes in all 35 cases were consistent with surgical pathologic results,with diagnostic accuracy rate of 100%(35/35).Conclusion Multimodal imaging might provide objective evidences for diagnosis and treatment of cardiac space-occupying lesions.
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Objective:To investigate the effect of serum 25 hydroxyvitamin D (25OHD) levels in early pregnancy on glucose and lipid metabolism indicators and pregnancy outcomes in women with polycystic ovary syndrome (PCOS).Methods:A prospective study was conducted on 132 pregnant women with PCOS admitted to the Yanda Hospital in Hebei from January 2021 to June 2022. They were divided into four groups based on serum 25OHD levels: severe vitamin D deficiency group (12 cases with 25OHD<10 ng/ml), vitamin D deficiency group (28 cases with 25OHD: 10-<20 ng/ml), vitamin D deficiency group (55 cases with 25OHD: 20-<30 ng/ml), and vitamin D sufficient group (37 cases with 25OHD≥30 ng/ml). Four groups of serum glucose and lipid metabolism indicators [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), fasting insulin (FINS), insulin resistance index (HOMA-IR)] and poor pregnancy outcomes were compared.Results:As the degree of vitamin D deficiency worsens in early pregnancy, serum levels of TC, TG, LDL-C, FPG, FINS, and HOMA-IR gradually increased (all P<0.05), while serum levels of HDL-C gradually decreased (all P<0.05). The serum 25OHD level in early pregnancy of PCOS pregnant women was negatively correlated with serum TG, FINS levels, and HOMA-IR levels ( r=-0.523, -0.612, -0.354, all P<0.05), and positively correlated with serum HDL-C levels ( r=0.484, P<0.05). There was no significant correlation with serum TC, LDL-C, and FPG levels (all P>0.05). The incidence of adverse pregnancy outcomes in the vitamin D sufficient group was significantly lower than the other three groups [8.11%(3/37) vs 34.55%(19/55), 46.43%(13/28), 8/12, P<0.05], while the incidence of adverse pregnancy outcomes in the vitamin D insufficient group was significantly lower than that in the vitamin D severely deficient group (34.55% vs 8/12, P<0.05). Conclusions:With the decrease of serum 25OHD levels in early pregnancy, the disorder of glucose and lipid metabolism in PCOS pregnant women gradually worsens, and the incidence of adverse pregnancy outcomes gradually increases.
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Objective:To explore the effect of electroencephalographic (EEG) biofeedback combined with buspirone on patients with schizophrenia with anxiety, in order to provide evidence-based reference for clinical treatment.Methods:From January 2018 to January 2020, 80 patients with schizophrenia and anxiety in Jinzhou Kangning Hospital were prospectively selected and divided into the study group and the control group by simple randomization, each group with 40 patients. The control group was given buspirone, and the study group was given EEG biofeedback combined with buspirone. Both were treated for 8 weeks. The efficacy, adverse reactions and the Positive and Negative Symptoms Scale (PANSS) and Hamilton Anxiety Scale (HAMA), the Pittsburgh Sleep Quality Scale (PSQI), Scale of Social Function in Psychosis Inpatients (SSPI), Barthel Index (BI) score, and serum neuroendocrine index thyroid stimulating hormone (TSH), cortisol (Cor) levels before treatment, 4 weeks and 8 weeks after treatment were compared between the two groups.Results:After 8 weeks of treatment, the total effective rate in the study group was higher than that in the control group: 95.0% (38/40) vs. 77.5% (31/40), the difference was statistically significant (χ 2 = 5.16, P<0.05). After 4, 8 weeks of treatment, the PANSS scores in the study group were lower than those in the control group: (49.57 ± 5.65) scores vs. (57.96 ± 6.48) scores, (37.69 ± 4.35) scores vs.(45.07 ± 5.74) scores, the differences were statistically significant ( P<0.05). After 4, 8 weeks of treatment, the HAMA and PSQI scores in the study group were lower than those in the control group, while the SSPI and BI scores were higher than those in the control group, the differences were statistically significant ( P<0.05). After 4, 8 weeks of treatment, the serum TSH and Cor levels in the study group were lower than those in the control group: after 4 weeks of treatment: (2.74 ± 0.84) mU/L vs. (3.35 ± 0.97) mU/L, (276.51 ± 45.96) μg/L vs. (346.42 ± 50.34) μg/L; after 8 weeks of treatment: (2.46 ± 0.72) mU/L vs. (2.82 ± 0.86) mU/L, (197.26 ± 36.84) μg/L vs. (264.19 ± 42.46) μg/L, the differences were statistically significant ( P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during treatment ( P>0.05). Conclusions:EEG biofeedback combined with buspirone can enhance the therapeutic effect by regulating neuroendocrine, reduce the mental symptoms, anxiety and sleep disorders ofschizophrenia patients with anxiety. It can also improve social function and daily life ability, and have high safety.
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Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders.Impaired social functioning is a core characteristic of individuals with ASD.Social attention deficits are important manifestation of their impaired social functioning.And it mainly reflected in the gaze on faces and social interactions.Eye movement technology is an objective and sensitive non-invasive measurement tool.Its application makes the measurement of individual core characteristics of ASD more accurate and objective.A review of recent studies revealed that the type of eye-movement stimuli for social attention in patients with AD gradually shifted from face image processing to social interaction scenes, and developed from static presentation to dynamic presentation.Dimensional embodiment of the progress of eye-movement studies of social attention in individuals with ASD.These studies suggest that individuals with ASD are less likely to gaze at the face region and the eye region of the face.More studies are currently using eye-tracking technology, and the analysis of emotional face gaze reveals that, the reduction in eye gaze in individuals with ASD is due to the discomfort associated with threatening faces.These findings validate the " gaze aversion" hypothesis regarding impaired social attention in individuals with ASD.Related neural mechanism studies have found a general lack of attention to social cues in the environment in individuals with ASD.Brain regions such as the amygdala, cingulate gyrus, superior temporal sulcus and anterior insula are associated with social attention in individuals with ASD.Especially with the superior temporal sulcus, the dorsal and ventral sides of the anterior insula, and so on.Future research should explore the cognitive neural mechanisms of social attention deficits in ASD, and the application of advanced information technology, such as eye-tracking technology, in the rehabilitation of patients with ASD.
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The cases of paradoxical brain embolism (PBE) due to venous aneurysms and patent foramen ovale (PFO) are extremely scarce, with only 5 cases caused by popliteal venous aneurysm reported in the literature to date, while PBE caused by deep femoral venous aneurysm (DFVA) and PFO has not been reported. Herein, an unusual case of PBE in a 15-year-old girl with PFO who still had cerebral infarction and pulmonary embolism after transcatheter closure was present. She was finally diagnosed as PFO with DFVA by angiography. Furthermore, clinical characteristics of 6 cases were summarized to improve the clinicians′ recognition of the rare risk factor of stroke-venous aneurysms of the lower extremity deep veins.
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Objective:To investigate the gaze characteristics of children with autism spectrum disorder (ASD) on dynamic threatening (fear, anger) and non-threatening emotional (sadness, happiness) faces, and to explore the correlation between their eye-tracking data and autism symptomatology scores to provide a basis for the treatment and rehabilitation of children with ASD.Methods:From November 2020 to June 2021, 26 children with ASD and 30 age-and sex-matched normally developing children (typical developmental, TD) who met the enrollment criteria were included, and children with ASD were assessed for symptoms by the childhood autism rating scale (CARS). The SMI-red portable eye-tracking recording system was used to record the eye-movement gaze characteristics of children in both groups during free viewing of dynamic threatening and non-threatening emotional face segments.Statistical processing was performed by SPSS 21.0 software.The independent sample t-test and chi square test were used for the data conforming to the normal distribution, and the non parametric test was used for the data not conforming to the normal distribution, and Pearson correlation analysis was used to analyze the correlation between eye-tracking data and symptomatology scores. Results:The total CARS score of the ASD group was (32.64±7.42). The eye tracking data for children with ASD showed gaze aversion characteristics.Children with ASD spent significantly less time gazing at the eye area of threatening emotional faces in fear (2.41(0.26, 10.65)s) and anger (2.17(0.13, 6.13)s) than children with TD (8.81(2.54, 12.11)s, 5.21(3.80, 12.49)s), with statistically significant differences (fear: Z=-2.252, P<0.05.anger: Z=-2.793, P<0.01). Children with ASD spent significantly less time gazing at the mouth area of all four emotional faces (sad: 3.56(0.44, 7.16)s, fear: 2.68(0.42, 4.78)s, anger: 2.13(0.35, 4.20)s, happiness: 2.93(0.46, 5.71)s) than children with TD (sad: 11.43(6.97, 14.22) s, fear: 6.73(3.65, 10.10)s, anger: 6.86(4.55, 12.33)s, happiness: 11.72(7.22, 14.39)s), with statistically significant differences (sad: Z=-4.502, P<0.01.fear: Z=-3.493, P<0.01.anger: Z=-4.025, P<0.01.happiness: Z=-4.699, P<0.01). Correlation analysis revealed that the time spent gazing at emotional faces in children with ASD was negatively correlated with the total CARS score ( r=-0.476, P<0.05), and further analysis of different emotional faces revealed that the time spent gazing at fearful faces in children with ASD was negatively correlated with the total CARS score ( r=-0.455, P<0.05). Conclusions:Eye tracking in children with ASD show a gaze profile with less gaze time to threatening emotional faces compared with TD children, and the more severe the symptoms in children with ASD, the less gaze time to fearful faces.
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Objective:To explore the influence of tomoxetine hydrochloride on the cognitive processing of children with attention deficit hyperactivity disorder (ADHD).Methods:From January 2018 to July 2021, 62 ADHD children who were treated with tomoxetine hydrochloride for the first time for(8±4) weeks were selected as the ADHD group.And 62 healthy children matched with age and sex were selected as the healthy control group.Pre-test and post-test by the Das-Naglieri: Cognitive Assessment System(DN: CAS) were performed to evaluate the cognitive function of all individuals.The differences of cognitive processing in pre-treatment and post-treatment of ADHD group were compared with those in healthy control group.The difference between before and after treatment of ADHD group was also compared.SPSS 26.0 statistical software was adopted for statistical analysis.The scores of ADHD group pre-treatment and post-treatment were compared by paired sample t-test, and the scores of ADHD group pre-treatment and post-treatment were compared with those of healthy control group by independent sample t-test. Results:Compared with healthy control group, there were lower of planning score((18.77±5.92) vs (28.56±5.55)), attention score((22.24±5.93) vs (29.56±6.16)), simultaneous processing ((34.21±7.75) vs (37.61±6.29)), successive processing((30.37±7.12) vs (33.74±5.43)), and the total scores((105.60±21.29) vs (134.84±22.87)) in ADHD group before treatment, and there were significant differences( t=9.49, 6.74, 2.68, 2.96, 7.36, all P<0.05). Compared with healthy control group, there were lower of planning score ((22.13±5.99)s), attention score((25.26±7.11) with significant difference( t=6.20, 3.60, both P<0.05) in ADHD group after treatment.And there was no significant difference in the simultaneous processing test and the successive processing test after treatment compared with the healthy control group(both P>0.05). In ADHD group, the scores of planning, simultaneous processing, attention, successive processing and the total score were significantly higher after treatment than those before treatment and there were significant differences( t=-6.03, -4.13, -4.77, -5.48, -8.59, all P<0.05). (2) Compared with the healthy control group, there were lower of matching number score and other 8 sub-test scales in DN: CAS test in ADHD group before treatment, and the differences were statistically significant (all P<0.05). Meanwhile, there were still lower of matching number score and other 4 sub-test scales in DN: CAS test in ADHD group after treatment, and the differences were statistically significant (all P<0.05). The matching number score and other 10 sub-test scales in DN: CAS test in ADHD group after treatment were all higher than those of before treatment(all P<0.05). Conclusion:The planning, attention, simultaneous processing, successive processing and total cognitive function of ADHD children were significantly improved after treatment with tomoxetine hydrochloride, special for simultaneous processing and successive processing.