The value of the malignant subregion-based texture analysis in predicting the Ki-67 status in breast cancer.

Objective: To evaluate the value of the malignant subregion-based texture analysis in predicting Ki-67 status in breast cancer. Materials and methods: The dynamic contrast-enhanced magnetic resonance imaging data of 119 histopathologically confirmed breast cancer patients (81 patients with high Ki-67 expression status) from January 2018 to February 2023 in our hospital were retrospectively collected. According to the enhancement curve of each voxel within the tumor, three subregions were divided: washout subregion, plateau subregion, and persistent subregion. The washout subregion and the plateau subregion were merged as the malignant subregion. The texture features of the malignant subregion were extracted using Pyradiomics software for texture analysis. The differences in texture features were compared between the low and high Ki-67 expression cohorts and then the receiver operating characteristic (ROC) curve analysis to evaluate the predictive performance of texture features on Ki-67 expression. Finally, a support vector machine (SVM) classifier was constructed based on differential features to predict the expression level of Ki-67, the performance of the classifier was evaluated using ROC analysis and confirmed using 10-fold cross-validation. Results: Through comparative analysis, 51 features exhibited significant differences between the low and high Ki-67 expression cohorts. Following feature reduction, 5 features were selected to build the SVM classifier, which achieved an area under the ROC curve (AUC) of 0.77 (0.68-0.87) for predicting the Ki-67 expression status. The accuracy, sensitivity, and specificity were 0.76, 0.80, and 0.68, respectively. The average AUC from the 10-fold cross-validation was 0.72 ± 0.14. Conclusion: The texture features of the malignant subregion in breast cancer were potential biomarkers for predicting Ki-67 expression level in breast cancer, which might be used to precisely diagnose and guide the treatment of breast cancer.

Metabonomics analysis on Terra Flavausta in treating diarrhea with spleen yang deficiency based on UPLC-Q-Exactive MS / 国际中医中药杂志

Objective:To study the effects of Terra Flavausta on diarrhea mice with spleen yang deficiency based on metabonomics. Methods:Totally 30 mice were divided into normal group, model group and Terra Flavausta group according to random number table method. Mice in the model group and Terra Flavausta group were treated by the method of "diet disorder + clearing fire with herbs bitter in flavour and cold in property" to establish the diarrhea model of spleen yang deficiency. After successful modeling, Terra Flavausta group received Zaoxintu Decoction 12.0 g/kg for gavage, while normal group and model group were given equal volume of distilled water for gavage, for consecutive 7 d. The serum metabolites of each mouse were analyzed and identified based on UPLC-Q-Exective-MS. The differential metabolites were characterized by principal component analysis and orthogonal partial least squares discriminant analysis, and the potential biomakers were screened, and the KEGG pathway enrichment analysis was performed. Results:Totally 110 different metabolites were screened under the positive and negative ion mode. Terra Flavausta can effectively reverse the disorder of serum metabolism in diarrhea mice with spleen yang deficiency, and has a significant callback effect on 12 potential biomarkers related to diarrhea with spleen yang deficiency. KEGG pathway enrichment mainly involved HIF-1 signaling pathway, ascorbate and aldarate metabolism, platelet activation, etc. Conclusion:Terra Flavausta may play the effect of warming spleen and relieving diarrhea through down-regulation of L-ascorbic acid affecting HIF-1 signal pathway, ascorbic acid and aldose metabolism pathway, vitamin digestion and absorption pathway, up-regulation of prostaglandins G2 and H2 affecting platelet activation pathway, and down-regulation of jasmonic acid α linolenic acid metabolic pathway.

Curative effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy-Comparisons of different approaches at different time point.

Pelvic floor muscle exercise (PFME) is widely applied for urinary incontinence (UI) after radical prostatectomy (RP). This research aimed to explore the relationship between PFME and UI after RP. We searched databases for studies that met our requirements until 17/4/2021. The UI symptoms of the PFME group and the control group were compared at 1, 3, 6 and 12 months after the operation. Subgroup analysis based on surgical approach (open radical prostatectomy vs laparoscopy & robotics radical prostatectomy) and UI definition (questionnaire vs. pad weight) were also conducted. The UI rate in PFME group is significantly lower when compared with control group at each time point. According to subgroup analysis, PFME is more effective to alleviate UI after laparoscopy & robotics radical prostatectomy when compared with open RP at mid-term (3s and 6 months) whereas no significant difference was detected between two groups at short (1 month) or long (12 months) term. According to this meta-analysis, post-operation PFME treatment can effectively alleviate the symptoms of UI after RP at any time point; pre-operation PFME alone was not sufficient to relieve UI. Compared with open prostatectomy, PFME is more effective for the UI after laparoscopy & robotics radical prostatectomy.

The diagnosis and treatment of primary vitreoretinal lymphoma: 10 years of experience / 中华眼底病杂志

Objective:To investigate the clinical characteristics, treatment and prognosis of primary vitreoretinal lymphoma (PVRL) diagnosed and treated in our hospital during the past 10 years.Methods:A retrospective clinical study. From 2011 to 2021, 126 eyes of 67 patients with PVRL who were diagnosed and treated in Department of Ophthalmology, Eye-ENT Hospital, Fudan University were included in the study. Among them, there were 23 males (34.3%, 23/67) and 44 females (65.7%, 44/67); the average age was 57.1 years. There were 59 cases with both eyes (88.1%, 59/67) and 8 cases with one eye (11.9%, 8/67). At the initial eye diagnosis, 22 cases had a clear history of primary central nervous system lymphoma (PCNSL); 5 cases were found to have intracranial lesions by head imaging examination; 40 cases had no central nervous system involvement. Twenty cases were treated with glucocorticoids due to misdiagnosed uveitis. All patients received intravitreal injection of methotrexate (IVM) treatment. The treatment regimen was twice a week in the induction period for 2 weeks, once a week in the consolidation period for 1 month, and once a month in the maintenance period. Patients with PCNSL or both eyes received concurrent systemic chemotherapy (chemotherapy), and some in combination with radiation therapy to the brain (radiotherapy). The mean follow-up time was 39.3 months. The clinical manifestations, treatment and prognosis of the patients were retrospectively analyzed. The visual acuity before and after treatment was compared by t test. Results:Among the 22 cases with a clear history of PCNSL at the initial eye diagnosis, the average time from intracranial diagnosis to eye diagnosis was 22.9 months. Among the 40 cases without central nervous system involvement at first, 14 cases (20.9%, 14/67) developed central nervous system lesions during follow-up period. The mean time from ocular diagnosis to intracranial diagnosis was 9.9 months. Among the 126 eyes, 42 eyes (33.3%, 42/126) had anterior segment inflammation. vitreous inflammation type, retinal type, and vitreous retinal type were 58 (46.0%, 58/126), 7 (5.6%, 7/126), and 61 (48.4%, 61/126) eyes, and 9 of them (7.1%, 9/126) had optic nerve involvement at the same time. Patients received an average of 12 IVM treatments. IVM combined with systemic chemotherapy in 59 cases (88.1%, 59/67), of which 16 cases were combined with brain radiotherapy. All patients achieved complete remission after completing the treatment cycle (100.0%, 67/67). After treatment, 21 eyes (16.7%, 21/126) had ocular recurrence; 22 (32.8%, 22/67) had intracranial recurrence; 8 cases (11.9%, 8/67) died. The mean progression-free survival of patients was 23.7 months; the mean survival time was 43.6 months; the 5-year overall survival rate was 72.5%.Conclusions:The manifestations of PVRL are complex and diverse, and most of them are accompanied by involvement of the central nervous system. It can be divided into vitreitis type, retinal type and vitreoretinal type, and the optic nerve can be involved at the same time; IVM combined with systemic treatment can completely relieve the disease.

Progress on management of periviable extremely premature infants / 中华围产医学杂志

Periviable extremely preterm infant (PEPI) refers to preterm infants born on the border of viability, mainly those with gestational age less than 24 weeks or birth weight less than 500 g. PEPI has increased in the past decades, and about half of the survivors live without severe neurodevelopmental impairment. The management of PEPI remains one of the most complex fields in perinatal-neonatal medicine. Active interventions can reduce the risk of morbidity and mortality in PEPI during early life and short-term follow-up after discharge without increasing the risk of neurodevelopmental impairment. Clinical decision-making about PEPI should not be restricted to population-based prenatal data but should mainly be based on postnatal individual characteristics and conditions. Parents should make an informed choice after detailed consultation with their physician. When the prognosis is uncertain, resuscitation and intensive care could be given and reassessed subsequently. Current interventions or treatments of PEPI refer to strategies for infants born at 24-27 gestational weeks, which need to be refined in practice.

The hemodynamic assessment in ischemic stroke patients with intracranial artery stenosis by using 4D flow magnetic resonance imaging / 中华神经科杂志

Objective:To investigate the feasibility and clinical value of 4D flow magnetic resonance imaging (MRI) in evaluating hemodynamics of ischemic stroke patients with intracranial artery stenosis.Methods:Ischemic stroke patients with unilateral middle cerebral artery stenosis admitted from March 2017 to June 2018 in Beijing Tsinghua Changgung Hospital Stroke Center were prospectively enrolled. Time of flight magnetic resonance angiography was used to evaluate vascular stenosis, 4D flow MRI was used to measure net forward flow at the proximal of stenosis, and brain tissue perfusion was acquired simultaneously to validate flow.Results:A total of 33 patients with symptomatic middle cerebral artery stenosis were included [mean age: 56 years; male: 63.6% ( n=21)]. The flow rates among patients with stenosis of <30%, 30%-49%, 50%-69% and ≥70% were (3.56±1.08), (2.96±0.94), (3.72±0.60) and (2.50±1.03) ml/s individually, demonstrating a decreased flow in subjects with severe (≥70%) stenosis ( F=4.34, P=0.008). Further analysis about forward flow and brain tissue perfusion showed that the significant negative correlation between absolute flow rate or relative flow rate and relative time to peak could only be established in subjects with poor collateral (collateral score: 0-2), with r=-0.76 and -0.61 individually, both P<0.05. Conclusion:4D flow MRI could be used as a quantitative flow assessment in subjects with intracranial artery stenosis, and its association with distal brain tissue perfusion depends on collateral status.

SARS-CoV-2 causes human BBB injury and neuroinflammation indirectly in a linked organ chip platform

COVID-19 is a multi-system disease affecting many organs outside of the lungs, and patients generally develop varying degrees of neurological symptoms. Whereas, the pathogenesis underlying these neurological manifestations remains elusive. Although in vitro models and animal models are widely used in studies of SARS-CoV-2 infection, human organ models that can reflect the pathological alterations in a multi-organ context are still lacking. In this study, we propose a new strategy to probe the effects of SARS-CoV-2 on human brains in a linked alveolus-BBB organ chip platform. The new multi-organ platform allows to recapitulate the essential features of human alveolar-capillary barrier and blood-brain barrier in a microfluidic condition by co-culturing the organ-specific cells. The results reveal direct SARS-CoV-2 exposure has no obvious effects on BBB chip alone. While, infusion of endothelial medium from infected alveolus chips can cause BBB dysfunction and neuroinflammation on the linked chip platform, including brain endothelium disruption, glial cell activation and inflammatory cytokines release. These new findings suggest that SARS-CoV-2 could induce neuropathological alterations, which might not result from direct viral infection through hematogenous route, but rather likely from systemic inflammation following lung infection. This work provides a new strategy to study the virus-host interaction and neuropathology at an organ-organ context, which is not easily obtained by other in vitro models. This will facilitate to understand the neurological pathogenesis in SARS-CoV-2 and accelerate the development of new therapeutics. SUMMARYO_LIA linked human alveolus-BBB chip platform is established to explore the influences of SARS-CoV-2 on human brains in an organ-organ context. C_LIO_LISARS-CoV-2 infection could induce BBB injury and neuroinflammation. C_LIO_LIThe neuropathological changes are caused by SARS-CoV-2 indirectly, which might be mediated by systemic inflammation following lung infection, but probably not by direct viral neuroinvasion. C_LI

Genetic predisposition to psychiatric disorders and risk of COVID-19

BackgroundPre-pandemic psychiatric disorders have been associated with an increased risk of COVID-19. However, the underlying mechanisms remain unknown, e.g. to what extent genetic predisposition to psychiatric disorders contributes to the observed association. MethodsThe analytic sample consisted of white British participants of UK Biobank registered in England, with available genetic data, and alive on Jan 31, 2020 (i.e., the start of the COVID-19 outbreak in the UK) (n=346,554). We assessed individuals genetic predisposition to different psychiatric disorders, including substance misuse, depression, anxiety, and psychotic disorder, using polygenic risk score (PRS). Diagnoses of psychiatric disorders were identified through the UK Biobank hospital inpatient data. We performed a GWAS analysis for each psychiatric disorder in a randomly selected half of the study population who were free of COVID-19 (i.e., the base dataset). For the other half (i.e., the target dataset), PRS was calculated for each psychiatric disorder using the discovered genetic variants from the base dataset. We then examined the association between PRS of each psychiatric disorder and risk of COVID-19, or severe COVID-19 (i.e., hospitalization and death), using logistic regression models. The ascertainment of COVID-19 was through the Public Health England dataset, the UK Biobank hospital inpatient data and death registers, updated until July 26, 2020. For validation, we repeated the PRS analyses based on publicly available GWAS summary statistics. Results155,988 participants (including 1,451 COVID-19 cases), with a mean age of 68.50 years at COVID-19 outbreak, were included for PRS analysis. Higher genetic liability forwards psychiatric disorders was associated with increased risk of both any COVID-19 and severe COVID-19, especially genetic risk for substance misuse and depression. The adjusted odds ratios (ORs) for any COVID-19 were 1.15 (95% confidence interval [CI] 1.02-1.31) and 1.26 (1.11-1.42) among individuals with a high genetic risk (above the upper tertile of PRS) for substance misuse and depression, respectively, compared with individuals with a low genetic risk (below the lower tertile). Largely similar ORs were noted for severe COVID-19 and similar albeit slightly lower estimates using PRSs generated from GWAS summary statistics from independent samples. ConclusionIn the UK Biobank, genetic predisposition to psychiatric disorders was associated with an increased risk of COVID-19, including severe course of the disease. These findings suggest the potential role of genetic factors in the observed phenotypic association between psychiatric disorders and COVID-19, underscoring the need of increased medical surveillance of for this vulnerable population during the pandemic.

Effectiveness，Safety and Economy of Evolocumab in the Treatment of Hypercholesterolemia ：A Rapid Health Technology Assessment / 中国药房

OBJECTIVE：To rapidly evaluate the effectiveness ，safety and economy of evolocumab in the treatment of hypercholesterolemia so as to provide evidence-based reference for clinical drug selection and decision. METHODS ：Retrieved from PubMed，Cochrane Library ，CNKI，Wanfang database and HTA relative official website ，HTA reports ，systematic evaluation/ Meta-analysis and pharmacoeconomic studies about evolocumab alone or combined with standard plan versus standard plan or placebo or ezetimibe in the treatment of hypercholesterolemia were collected during the inception to Jan. 2020. Based on literature screening and data extraction ，HTA checklist ，system evaluation measurement tool AMSTAR- 2 scale，comprehensive healthy economic evaluation report standard scale were used to evaluate the quality of included HTA reports ，systematic evaluation/ Meta-analysis and pharmacoeconomic literatures. Quantitative description was performed for effectiveness and safety results ，and qualitative description was performed for economic evaluation results. RESULTS ：A total of 13 literatures were included ，involving 6 Meta-analysis and 7 economic studies. The quality of Meta-analysis literatures was low ，and the quality of economic research was good. In terms of effectiveness ，compared with placebo or ezetimibe ，evolocumab significantly reduced the levels of LDL-C ，TC， TG and VLDL-C ，the incidence of cardiovascular events ，myocardial infarction ，coronary ischemia and stroke ，while increased the level of HDL-C （P＜0.05）. There was no statisti cal significance in the risk of hospitalizatio n，cardiac mortality or cardiovascular disease mortality in patients with unstable angina pectoris between placebo and evolocumab （P＞0.05）. In terms ofsafety，there was no significant difference in the incidence of 6237545。E-mail：zhangxu1130@163.com any adverse events ，any treatment emergency adverse events and back pain ，musculoskeletal and connective tissue diseases between evolocumab and placebo （P＞0.05）. In terms of economy，additional use of evolocumab ，based on standard plan ，had a cost-effectiveness advantage for patients with high-risk atherosclerotic cardiovascular disease （ASCVD）whose blood lipids were still not up to standard. CONCLUSIONS ：Evolocumab has good effectiveness and safety in the treatment of hypercholesterolemia. For high-risk patients with ASCVD whose blood lipids are still not up to standard after standard plan ，evolocumab has certain economy and can be used as an alternative.

Effects of parental feeding practices on children s anemia in plateau area / 中国学校卫生

Objective@#To investigate the effects of parental feeding practices on anemia in children aged 0-6 years in the minority area of the plateau, and to provide evidence for anemia intervention.@*Methods@#A total of 1 726 children aged 0-6 years in 4 counties of Gannan Tibetan Autonomous Prefecture were selected by stratified random cluster sampling to measure hemoglobin level. Parental feeding practices were evaluated.@*Results@#The anemia prevalence rate among children aged 0-6 years was 50.3%. The prevalence of anemia was higher in those with younger age, Tibetan ethnic, rural residence, low parents education level and family income(χ2=156.95，899.51，148.17，8.18，16.36，11.03，P<0.05). Parentl awareness rates on feeding knowledge were 10.0%-53.7%. The report rates of distraction and force-feeding were 51.4% and 36.1%, respectively. Logistic regression analysis showed that parents incorrect feeding knowledge and compulsive feeding behaviors were positively associated with anemia in children(P<0.05).@*Conclusion@#Improvement of parents health literacy and feeding behavior is an important intervention to reduce anemia in children aged 0-6 years.

Experimental study of magnetic anchoring and traction device assisting thoracoscopic esophagectomy / 中国胸心血管外科临床杂志

@#Objective    To verify the feasibility of a self-designed magnetic anchoring and traction device (MATD) for assisting two-port video-assisted thoracoscopic esophagectomy. Methods    Three Beagle dogs were selected as animal models with age ranging from 1-6 years and weight ranging from 8-12 kg, and they underwent two-port video-assisted thoracoscopic esophagectomy after general anesthesia. We used the MATD to retract the esophagus to different directions, which assisted mobilizing esophagus, detecting the nerves along esophagus and dissecting paraesophagus lymph nodes. The operation time, blood loss and feasibility of the MATD were recorded. Results    With the aid of the MATD, we successfully retracted and mobilized the esophagus, detected the nerves and dissected the lymph nodes in three Beagle dog models. During the operation, the MATD provided sufficient and steady traction of esophagus to achieve a good exposure of the operative field, effectively decreasing the interference between working instruments. The MATD worked well. The mean operation time was 30 min, and the mean intraoperative blood loss was about 10 mL. Conclusion    It is effective to use the MATD to assist retracting esophagus during video-assisted thoracoscopic esophagectomy. The magnetic anchoring and traction technique can assist to expose the surgical field, decrease the interference between the working instruments and have the potential clinical application.

Association of plasma irisin concentration with obesity among children:a cohort study / 中国学校卫生

Objective@#To explore the longitudinal association of the levels of plasma irisin among children with changes in obesity related parameters and newly onset obesity, and to explore whether physical activity (PA) and sedentary behavior(SB) have regulatory effects, to provide a scientific basis for the prevention and control of childhood obesity work.@*Methods@#Cluster random sampling method was used to select 521 children from five schools in Guangzhou in 2017 at baseline and were followed up in 2019. A based on baseline PA and SB, children who meet the following criterion were selected:moderate vigorous intensity PA≥60 min/d or <150 min/week; and gender , age specific SB≥ P 75 or SB < P 25 . Plasma irisin concentration was measured in all the selected children. Multiple linear regression and Logistic regression were conducted to analyze the association.@*Results@#The two year cumulative incidence of obesity, overweight and obesity, and central obesity was 2.82%, 6.57%, and 6.81%, respectively. There was no statistically significant association between plasma irisin levels and changes in obesity related parameters, newly onset overweight obesity or central obesity among children ( P >0.05). After stratified by PA, the irisin concentration in the low PA group was positively associated with weight change ( B=0.229, P =0.03). After stratified by SB, the irisin concentration in the low SB group was positively associated with the height change ( B=0.210, P <0.05). In addition, PA level and SB level both had a moderating effect on the association between plasma irisin levels and the weight change ( P PA=0.01, P SB =0.05).@*Conclusion@#PA and SB show moderating effect on plasma irisin concentration and weight gain. No association of irisin concentration with newly onset overweight or obesity among children has been found.

Modeling SARS-CoV-2 infection in vitro with a human intestine-on-chip device

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has given rise to a global pandemic. The gastrointestinal symptoms of some COVID-19 patients are underestimated. There is an urgent need to develop physiologically relevant model that can accurately reflect human response to viral infection. Here, we report the creation of a biomimetic human intestine infection model on a chip system that allows to recapitulate the intestinal injury and immune response induced by SARS-CoV-2, for the first time. The microengineered intestine-on-chip device contains human intestinal epithelium (co-cultured human intestinal epithelial Caco-2 cells and mucin secreting HT-29 cells) lined in upper channel and vascular endothelium (human umbilical vein endothelial cells, HUVECs) in a parallel lower channel under fluidic flow condition, sandwiched by a porous PDMS membrane coated with extracellular matrix (ECM). At day 3 post-infection of SARS-CoV-2, the intestine epithelium showed high susceptibility to viral infection and obvious morphological changes with destruction of intestinal villus, dispersed distribution of mucus secreting cells and reduced expression of tight junction (E-cadherin), indicating the destruction of mucous layer and the integrity of intestinal barrier caused by virus. Moreover, the endothelium exhibited abnormal cell morphology with disrupted expression of adherent junction protein (VE-cadherin). Transcriptional analysis revealed the abnormal RNA and protein metabolism, as well as activated immune responses in both epithelial and endothelial cells after viral infection (e.g., up-regulated cytokine genes, TNF signaling and NF-kappa B signaling-related genes). This bioengineered in vitro model system can mirror the human relevant pathophysiology and response to viral infection at the organ level, which is not possible in existing in vitro culture systems. It may provide a promising tool to accelerate our understanding of COVID-19 and devising novel therapies.

Pre-pandemic psychiatric disorders and risk of COVID-19: a cohort analysis in the UK Biobank

ObjectiveTo determine the association between pre-pandemic psychiatric disorders and the risk of COVID-19. DesignCommunity-based prospective cohort study. SettingUK Biobank population. Participants421,048 participants who were recruited in England and alive by January 31st 2020, i.e., the start of COVID-19 outbreak in the UK. 50,815 individuals with psychiatric disorders recorded in the UK Biobank inpatient hospital data before the outbreak were included in the exposed group, while 370,233 participants without such conditions were in the unexposed group. MeasurementsWe obtained information on positive results of COVID-19 test as registered in the Public Health England, COVID-19 related hospitalizations in the UK Biobank inpatient hospital data, and COIVD-19 related deaths from the death registers. We also identified individuals who was hospitalized for infections other than COVID-19 during the follow-up. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), controlling for multiple confounders. ResultsThe mean age at outbreak was 67.8 years and around 43% of the study participants were male. We observed an elevated risk of COVID-19 among individuals with pre-pandemic psychiatric disorder, compared with those without such diagnoses. The fully adjusted ORs were 1.44 (95%CI 1.27 to 1.64), 1.67 (1.42 to 1.98), and 2.03 (1.56 to 2.63) for any COVID-19, inpatient COVID-19, COVID-19 related death, respectively. The excess risk was observed across all levels of somatic comorbidities and subtypes of pre-pandemic psychiatric disorders, while further increased with greater number of pre-pandemic psychiatric disorders. We also observed an association between pre-pandemic psychiatric disorders and increased risk of hospitalization for other infections (1.85 [1.65 to 2.07]). ConclusionsPre-pandemic psychiatric disorders are associated with increased risk of COVID-19, especially severe and fatal COVID-19. The similar association observed for hospitalization for other infections suggests a shared pathway between psychiatric disorders and different infections, including altered immune responses. Summary boxO_ST_ABSWhat is already known on this topic?C_ST_ABSPsychiatric morbidities have been associated with risks of severe infections through compromised immunity and/or health-behaviors. While recent studies showed that unhealthy lifestyle and psychosocial factors (including self-reported psychological distress) increased the risk of COVID-19 hospitalization, data on the role of clinically confirmed psychiatric disorders in COVID-19 susceptibility are to date absent. What this study adds?Using the large community-based data in UK Biobank, our analysis is the first to demonstrate an increase in the risk of COVID-19, especially severe and fatal COVID-19, among individuals with pre-pandemic psychiatric disorders, independently of many important confounders. A similar association was also observed between pre-pandemic psychiatric disorder and hospitalization due to other infections during the COVID-19 outbreak, suggesting a shared pathway between psychiatric disorders and different infections, including altered immune responses. This finding underscores the need of surveillance and care in vulnerable populations with history of psychiatric disorders during the COVID-19 outbreak.

A human disease model of SARS-CoV-2-induced lung injury and immune responses with a microengineered organ chip

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that seriously endangers human health. There is an urgent need to build physiological relevant human models for deep understanding the complex organ-level disease processes and facilitating effective therapeutics for COVID-19. Here, we first report the use of microengineered alveolus chip to create a human disease model of lung injury and immune responses induced by native SARS-CoV-2 at organ-level. This biomimetic system is able to reconstitute the key features of human alveolar-capillary barrier by co-culture of alveolar epithelial and microvascular endothelial cells under microfluidic flow. The epithelial cells on chip showed higher susceptibility to SARS-CoV-2 infection than endothelial cells identified by viral spike protein expression. Transcriptional analysis showed distinct responses of two cell types to SARS-CoV-2 infection, including activated type I interferon (IFN-I) signaling pathway in epithelium and activated JAK-STAT signaling pathway in endothelium. Notably, in the presence of circulating immune cells, a series of alveolar pathological changes were observed, including the detachment of endothelial cells, recruitment of immune cells, and increased production of inflammatory cytokines (IL-6, IL-8, IL-1{beta} and TNF-). These new findings revealed a crucial role of immune cells in mediating lung injury and exacerbated inflammation. Treatment with antiviral compound remdesivir could suppress viral copy and alleviate the disruption of alveolar barrier integrity induced by viral infection. This bioengineered human organ chip system can closely mirror human-relevant lung pathogenesis and immune responses to SARS-CoV-2 infection, not possible by other in vitro models, which provides a promising and alternative platform for COVID-19 research and preclinical trials.

Risk factor analysis of pneumonia in maintenance hemodialysis patients / 中华肾脏病杂志

Objective To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, oruntil the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results (1) A total of 311 patients were enrolled in the study, in which 178 (57.2％) of the patients were male, and 75(24.1％) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69 ± 9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95％ CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4％ (OR=0.936, 95％CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant ( 60.6％ vs 84.4％, χ2=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95％CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95％CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95％CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.

Risk factor analysis of pneumonia in maintenance hemodialysis patients / 中华肾脏病杂志

Objective@#To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients.@*Methods@#The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non-pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death.@*Results@#(1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P<0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P<0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95% CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95% CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant (60.6% vs 84.4%, χ2=16.647, P<0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95% CI 0.832-0.909, P<0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95% CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients.@*Conclusions@#Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.

The treatment effect of eustachian tube atresia with laser and connical plastic tube after radiotherapy for nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the method in treatment of Eustschian tube atresia caused by radiotherapy.@*Methods@#Two cases diagnosed of Eustschian tube atresia following radiotherapy were retrospectively analyzed in Department of Otorhinolaryngology, Divided Hospital of Shanghai University Communication Affiliated First People Hospital in Apr. 2014 and Oct. 2015. Both cases were female, 65 and 64 years old, and accepted radiotherapy six and 20 years ago respectively. The pharyngeal orifices of Eustschian tube were found to be totally closed under endoscope. The closed Eustschian tubes were re-opened by laser and re-shaped by a slim and conical plastic tube for more than six months. They were followed up and evaluated over 12 months.@*Results@#At six and 12 months after treatment, round mouths were formed in the pharyngeal orifice of Eustachian tube, and the patients had no resistance in Valsalva′s test. No shrink or abnormal opening of orifice was found at follow-up of 20 and 12 months.@*Conclusion@#The method of re-opening by laser and re-shaping by a slim and conical plastic tube is recommended to treat Eustschian tube occlusion caused by radiotherapy.

Investigation and Analysis of Medication Compliance of Patients with Nonvalvular Atrial Fibrillation to Warfarin and Its Influential Factors / 中国药房

OBJECTIVE:To improve medication compliance of patients with nonvalvular atrial fibrillation (NVAF) to warfarin and its influential factors,and to provide reference for guaranteeing the safety and effectiveness of therapy.METHODS:A questionnaire survey was conducted among NVAF patients receiving warfarin anticoagulation in our hospital,MMAS-8 and WRKS were adopted to evaluate medication compliance of patients to warfarin and the understanding of patients to the knowledge of anticoagulation treatment.Related influential factors for medication compliance of patients to warfarin were investigated by x2 test,t test and Logistic multiple regression analysis.RESULTS:Totally 129 questionnaires were sent out,and 112 were effectively received with effective recovery of 86.82％.The mean score of MMAS was (6.54 ± 1.61),and 42.86％ patients had good medication compliance.The mean score of WRKS was (7.95 ± 1.65);that of patients with good medication compliance was (9.31 ± 0.83),and that of patients with poor medication compliance was (6.92 ± 1.34).Single factor analysis showed that there was statistical significance in gender,age,occupation,educational level,the number of compliance,WRKS score between patients with good medication compliance and those with poor medication compliance (P＜0.05).Multivariate Logistic regression analysis showed that WRKS score,gender,educational level and the number of compliance were significantly correlated with medication compliance (P＜0.05).CONCLUSIONS:Poor medication compliance of NVAF patients to warfarin is related to multiple influential factors.The knowledge of warfarin anticoagulation is an important factor.

Investigation and Analysis of Medication Compliance of Patients with Nonvalvular Atrial Fibrillation to Warfarin and Its Influential Factors / 中国药房

OBJECTIVE:To improve medication compliance of patients with nonvalvular atrial fibrillation (NVAF) to warfarin and its influential factors,and to provide reference for guaranteeing the safety and effectiveness of therapy.METHODS:A questionnaire survey was conducted among NVAF patients receiving warfarin anticoagulation in our hospital,MMAS-8 and WRKS were adopted to evaluate medication compliance of patients to warfarin and the understanding of patients to the knowledge of anticoagulation treatment.Related influential factors for medication compliance of patients to warfarin were investigated by x2 test,t test and Logistic multiple regression analysis.RESULTS:Totally 129 questionnaires were sent out,and 112 were effectively received with effective recovery of 86.82％.The mean score of MMAS was (6.54 ± 1.61),and 42.86％ patients had good medication compliance.The mean score of WRKS was (7.95 ± 1.65);that of patients with good medication compliance was (9.31 ± 0.83),and that of patients with poor medication compliance was (6.92 ± 1.34).Single factor analysis showed that there was statistical significance in gender,age,occupation,educational level,the number of compliance,WRKS score between patients with good medication compliance and those with poor medication compliance (P＜0.05).Multivariate Logistic regression analysis showed that WRKS score,gender,educational level and the number of compliance were significantly correlated with medication compliance (P＜0.05).CONCLUSIONS:Poor medication compliance of NVAF patients to warfarin is related to multiple influential factors.The knowledge of warfarin anticoagulation is an important factor.