ZJU index and the risk of nonalcoholic fatty liver disease in the Uygur population in the rural area of Xinjiang Uygur Autonomous Region： A cohort study / 临床肝胆病杂志

ObjectiveTo investigate the association between ZJU index and the onset of nonalcoholic fatty liver disease （NAFLD） in the Uygur population and the value of ZJU index in predicting the risk of NAFLD. MethodsThe Uighur community of The 51st Regiment of The Third Division of Xinjiang Kashgar Corps was selected as the investigation site， and the Uygur residents who lived in this area and had an age of >18 years were selected as subjects. Follow-up studies were conducted in 2019， 2020， and 2021， and the investigation of outcomes was completed in June to August of 2021. Finally 10 597 subjects were enrolled for analysis. The Kruskal-Wallis H test was used for comparison of continuous variables between groups， and the chi-square test was used for comparison of categorical variables between groups. The subjects were divided into Q1-Q4 groups according to the level of ZJU index. The Kaplan-Meier curve was used to predict the incidence rate of NAFLD， and the Cox regression model was used to analyze the association between ZJU index and the risk of NAFLD； the area under the ROC curve （AUC） was used to evaluate the value of ZJU index in predicting the risk of NAFLD. ResultsDuring the median follow-up time of 4.92 years， the incidence rate of NAFLD was 9.4% （992/10 597） among the study population. After adjustment for multiple factors， there was a significant increase in the risk of NAFLD with the increase in ZJU index， with a hazard ratio of 2.55 （95% confidence interval ［CI］： 1.60‍ — ‍4.06）， 7.32 （95%CI： 4.78‍ — ‍11.20）， and 21.74 （95%CI： 14.32‍ — ‍33.00）， respectively （all Ptrend<0.001）. The ROC curve showed that ZJU index had a higher value in predicting NAFLD （AUC=0.816）， and the male subgroup had a significantly higher predictive accuracy of ZJU index than the female subgroup （AUC： 0.829 vs 0.809）. ConclusionZJU index is a predictive factor for the onset of NAFLD in the Uygur population in rural areas of Xinjiang and has a good value in predicting the risk of NAFLD.

The clinical characteristics of human pseudorabies virus infection: a case report and literature review / 中华神经科杂志

Objective:To explore the epidemiology, clinical features and prognosis of pseudorabies virus (PRV) infection in human.Methods:A case of human PRV encephalitis combined with acute retinal necrosis (ARN) in the First Affiliated Hospital of Zhengzhou University in May 2020 was reported. The epidemiology, clinical features, neuroimaging, cerebrospinal fluid (CSF), next-generation sequencing (NGS), treatment and prognosis of human PRV infection were summarized and analyzed with the previous published data.Results:The present case was a 38-year-old man who developed high fever, headache, cognitive decline, recurrent epileptic seizures after butchering a pig. Brain magnetic resonance imaging showed lesions in the insular lobes, temporal lobes, cingulate gyrus, frontal lobes, basal ganglia and hippocampus, with more significant signals on the left side. Afterwards, bilateral ARN occurred and resulted in his blindness. PRV DNA was detected from the aqueous humor. By literature review, a total of 20 cases (including this case) were analyzed. Most patients (95%, 19/20) had the history of direct contact with swine. The median incubation period was 7 days. The infection normally caused encephalitis (95%, 19/20), some cases with endophthalmitis (60%, 12/20). Based on the neuroimaging of the 19 patients, the lesions in neuroimaging were mainly in limbic system, especially in insular (17/19) and temporal lobes (17/19). The basal ganglia was often involved (9/19).The PRV-DNA was detected by NGS in CSF or intraocular fluid. Antiviral drugs and adjuvant treatment, including immunoglobulin and/or corticoid therapy, were effective to only few cases. Most patients (90%, 18/20) had the sequelae of severe impairment of daily living (modified Rankin Scale scores≥3).Conclusions:The cardinal clinical characteristics of human PRV infection are progressive panencephalitis and endophthalmitis, with an unfavorable outcome. The history of exposure to sick swine and typical neuroimaging suggest PRV infection. NGS of CSF and/or intraocular fluid is the dependable diagnostic method.

Effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of nasolacrimal duct packing combined with sodium hyaluronate gel injection in locating the nasal broken end in lacrimal canaliculus anastomosis which is difficult to find the broken end.METHODS:A total of 13 patients(13 eyes)with traumatic single lacrimal canaliculus rupture were treated in our hospital. RS lacrimal duct drainage tube was inserted into the lacrimal duct from intact lacrimal canaliculus to fill the nasolacrimal duct, then sodium hyaluronate gel was injected to make sodium hyaluronate gel overflow from the nasal broken end of fractured lacrimal canaliculus, which was used to locate the nasal broken end which was difficult to find and completed the lacrimal anastomosis operation.RESULTS: Among the patients with 13 eyes who were difficult to find the broken end, the nasolacrimal duct was filled with RS lacrimal duct drainage tube. After injection of sodium hyaluronate gel, the gel overflowed from the nasal broken end under direct vision of the microscope, and the lacrimal duct drainage tube was successfully inserted, and the success rate of finding the broken end was 100%. Thirteen eyes were extubated after being placed for 3mo, and then were followed up for 6mo. Among them, 9 eyes were cured, 3 eyes were markedly effective and 1 eye was ineffective. The cure rate was 69%, and the total effective rate was 92%.CONCLUSION: A new technique for rapid location of nasal broken end is proposed for patients in which are difficult to find the broken end. This method is simple to operate and requires a relatively low clinical experience. It is suitable for patients with different degrees of single lacrimal canaliculus rupture and can complete complex lacrimal canaliculus rupture anastomosis in a short time.

Comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma / 临床肝胆病杂志

Objective To investigate the comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma, and to lay a foundation for further research on the influence of hepatic cystic echinococcosis on HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma. Methods A retrospective analysis was performed for the data of 401 patients with hepatic cystic echinococcosis who were admitted to The First Affiliated Hospital of Shihezi University from 2003 to 2019, and the state of comorbidity of hepatic cystic echinococcosis with HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma was clarified. The patients with hepatic cystic echinococcosis and chronic HBV/HCV infection were selected as comorbidity group, and the patients with HBV/HCV infection alone were matched as control group. The chi-square test and the Fisher's exact test were used to analyze the state of viral infection and the disease composition of liver cirrhosis and hepatocellular carcinoma. Results Of all 401 patients, 38(9.5%) were included in the comorbidity group and 2(0.5%) had liver cirrhosis after HBV/HCV infection, while no patient had hepatocellular carcinoma after HBV/HCV infection. Among the patients with chronic hepatitis B virus infection in the comorbidity group, non-active HBsAg carriers accounted for 81%, HBeAg-positive chronic hepatitis B patients accounted for 9.5%, and HBeAg-negative chronic hepatitis B patients accounted for 9.5%; among the patients with hepatitis B virus infection in the control group, non-active HBsAg carriers accounted for 43%, HBeAg-positive chronic hepatitis B patients accounted for 33%, and HBeAg-negative chronic hepatitis B patients accounted for 19%, with a significant difference between the two groups ( P =0.033). There was a significant difference in the HBV RNA clearance rate of the patients with HCV infection between the comorbidity group and the control group ( χ 2 =4.447, P =0.035). In the comorbidity group, the patients with liver cirrhosis accounted for 5.2% and there were no patients with hepatocellular carcinoma, while in the control group, the patients with liver cirrhosis accounted for 18.4% and those with hepatocellular carcinoma accounted for 5.2%; the comorbidity group had significantly lower proportions than the control group ( P =0.048). Conclusion The proportion of liver cirrhosis patients with hepatic cystic echinococcosis and HBV/HCV infection is lower than that of liver cirrhosis patients with viral hepatitis alone, and there are no cases of hepatocellular carcinoma after HBV/HCV infection. Further multicenter studies are needed to investigate the influence of hepatic cystic echinococcosis on chronic HBV/HCV infection, liver cirrhosis, and hepatocellular carcinoma.

A study on the relationship between biomarkers and left ventricular myocardial native T 1 value in patients with lone atrial fibrillation / 中华放射学杂志

Objective:To investigate the relationship between serum procollagen Ⅲ amino terminal peptide (PIIINP), collagen I carboxyl terminal cross-linking peptide (CTXI), high-sensitivity C-reactive protein (hs-CRP) and cardiac magnetic resonance (CMR) T 1 mapping value in patients with lone atrial fibrillation (AF). Methods:Fifty-five patients with lone AF in Beijing Anzhen Hospital from July 2017 to June 2018 were prospectively enrolled. Another 20 healthy volunteers were examined at the same time to provide normal reference range. All patients completed PIIINP, CTXI, hs-CRP and CMR examination within one week. CMR examination including cine, pre-contrast T 1 mapping, and late gadolinium enhancement sequences. We used t test, Mann-Whitney U test or chi square test to compare the difference of the above indexes between AF patients and the control group. Spearman correlation analysis was used to determine the associations between left ventricular native T 1 value and blood biomarker in AF patients. Results:All the patients were paroxysmal AF with an average age of (48±10) years, of which 46 (83.6%) were male. The PIIINP, CTXI, hs-CRP, left ventricular native T 1 value of AF patients were 5.83 (3.52, 12.40) ng/ml, 4.63 (3.31, 6.82) μg/ml, 3.41 (1.72, 6.61) mg/L and (1 261±23) ms, respectively, which all significant higher than those in healthy subjects (all P<0.05). The native T 1 value of left ventricular myocardium was positively correlated with PIIINP ( r=0.492, P<0.05) and hs-CRP ( r=0.516, P<0.05), but not with CTXI ( r=0.021, P>0.05). Conclusions:The PIIINP, CTXI and hs-CRP increased in patients with lone AF, PIIINP and hs-CRP were correlated with elevated native T 1 value of left ventricular myocardium.

Clinical analysis of left atrial appendage occlusion for stroke prevention in elderly patients with atrial fibrillation / 中华内科杂志

To evaluate the efficacy and safety of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) over 75 years. A total of 82 patients with AF who underwent LAAO successfully in Beijing Anzhen Hospital from March 2014 to March 2019 were divided into two groups according to age: the elderly group (aged>75 years) and the young group (aged ≤75 years). Risk of perioperative complications and incidence of ischemic stroke and major bleeding during follow-up were retrospectively analyzed. The results showed that there were no significant differences in procedure-related ischemic stroke(0 vs.1.6%, P=0.768) and major bleeding (0 vs.1.6%, P=0.768) during perioperative period between the two groups. No complications as death or pericardial tamponade occurred in the two group. During a (25.9±15.9) months period of followed up, ischemic stroke event rate was 3.6/100 person-years in the elderly group and 4.9/100 person-years in the young group, respectively. Major bleeding event rate was 2.5/100 person-years in the elderly group and 0/100 person-years in the young group, respectively. Compared with the expected ones, the relative risk reduction (RRR) of stroke in the elderly group was more profound than that in the young group (32.0% vs. 25.0%), while the risk of major bleeding in the young group was significantly lower than that in the elderly group (RRR 100% vs. 56.9%). Therefore, LAAO might be suitable for stroke prevention in the elderly AF patients.

Effect of Canine-assisted Therapy on Family Function of Autism Spectrum Disorder / 中国康复理论与实践

Objective:To evaluate the effect of canine-assisted therapy on family function of autism spectrum disorder. Methods:The randomized controlled trials (RCT) about the effect of canine-assisted therapy on family function of autism spectrum disorder were retrieved from the Cochrane Library, PubMed, Web of Science, CNKI, CBM, VIP, and Wanfang Data from establishment to February, 2021. Brief Family Assessment Measure-III-General Scale (FAM-III-GS) was used to access the family function, and Children's Depression Inventory-Second Edition (CDI-2) and Spence Children's Anxiety Scale (SCAS) were used to access the psychological behavior. The quality of included studies was evaluated according to the method recommended by the Cochrane Collaboration and Joanna Briggs Institute Reviewers' manual. RevMan 5.4 software was used for meta-analysis. Results:Finally, four RCTs involving 190 patients were included. There were too less RCTs to do a meta-analysis. Two RCTs showed that the score of FAM-III-GS improved in the experimental group than in the control group. Conclusion:Canine-assisted therapy might improve the family function of patients with autism spectrum disorder.

Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes and attention deficit hyperactivity disorder: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the difference in cognitive impairment between the children with benign childhood epilepsy with centrotemporal spikes (BECT) and attention deficit hyperactivity disorder (ADHD) and those with BECT or ADHD alone.@*METHODS@#A prospective study was performed on 80 children with BECT and ADHD, 91 children with BECT, and 70 children with ADHD , who were diagnosed with the diseases for the first time. Seventy children of the same age who underwent physical examination were enrolled as the healthy control group. Event-related potential P300, Wechsler Intelligence Scale for Children, and integrated visual and auditory continuous performance test were used to measure and compare each index between groups.@*RESULTS@#Compared with the healthy control group, the BECT+ADHD group, the BECT group, and the ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ), auditory response control quotient (ARCQ), visual response control quotient, full response control quotient (FRCQ), auditory attention quotient (AAQ), visual attention quotient, and full attention quotient (@*CONCLUSIONS@#Compared with the children with BECT or ADHD alone, the children with both BECT and ADHD have basically the same fields of cognitive impairment but a higher degree of cognitive impairment in some fields.

Impact of iron deficiency on prognosis of heart failure patients with preserved ejection fraction / 中华心血管病杂志

Objective: To investigate the impact of iron deficiency (ID) on prognosis in heart failure patients with preserved ejection fraction (HFpEF). Methods: A total of 215 consecutive patients with HFpEF, who visited the cardiovascular outpatient department of Beijing Anzhen Hospital, were enrolled in this prospective study. The plasma ferritin level and transferin saturation were measured. Patients were divided into two groups: ID group and non-ID group. ID patients were further divided into absolute ID subgroup and functional ID subgroup. Patients were followed up to 1 year. The endpoints of the study were all-cause mortality and rehospitalization for heart failure (HF). The independent predictors of outcome were determined by Cox regression model. The quality of life of patients was evaluated at the end of the follow-up. Results: The age of this patient cohort was (67±8) years, 39.1% patients were male. The prevalence of ID was 54.4%. Within one year of follow-up, 37 patients (17.2%) died and 70 patients (32.6%) were rehospitalized for HF. Compared to non-ID group, patients in ID group were older, had higher heart rate, lower plasma hemoglobin level and estimated glomerular filtration rate (eGFR) value, had a higher prevalence of anemia and chronic kidney disease (P all<0.05). Kaplan-Meier curves showed that all-cause mortality and rehospitalization for HF in HFpEF patients with ID were higher than patients without ID, and prognosis was similar between patients with absolute ID and functional ID. Multivariable regression analysis showed that ID was an independent predictor for all-cause mortality and rehospitalization for HF in HFpEF patients. The of 6 minutes walking distance was shorter ((356.0±98.3)m vs. (389.2±94.3)m, P=0.023), and the value in Kansas city cardiomyopathy questionnaire was lower ((58.06±10.43) m vs. (61.51±11.64) m, P = 0.039) in patients with ID than patients without ID. Conclusion: In patients with chronic HFpEF, ID is an independent predictor for all-cause mortality and rehospitalization for HF at one year of follow-up, independent of the types of ID.

Efficacy and safety of catheter ablation in patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma / 中华心血管病杂志

Objective: To evaluate the safety and efficacy of catheter ablation in patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma. Methods: Nine patients with new onset atrial arrhythmia and a prior history of left atrial myxoma, who received surgical myxoma excision and catheter ablation between September 2014 and November 2019, were included in the present study. Baseline characteristics, procedural parameters during catheter ablation, severe perioperative adverse events, recurrence rate of arrhythmia and clinical prognosis were analyzed. Kaplan Meier survival analysis was used to define the maintenance rate of sinus rhythm after catheter ablation in this patient cohort. Results: Nine patients were included. The average age was (55.8 ± 9.1) years old (3 male), there were 3 patients (3/9) with paroxysmal atrial fibrillation (PAF) and 6 patients (6/9) with atrial flutter or atrial tachycardia (AFL or AT). Ablation was successful in all patients, there were no perioperative complications such as stroke, pericardial effusion, cardiac tamponade, vascular complications or massive hemorrhage. During a mean follow-up time of 40.0 (27.5, 55.5) months, sinus rhythm was maintained in six patients (6/9) after the initial catheter ablation. The overall sinus rhythm maintenance rate was 2/3. In addition, 1 out of the 3 AF patients (1/3) developed recurrence of AF at 3 month after ablation, and 2 out of the 6 AFL or AT patients (2/6) developed late recurrence of AF or AFL (19 months and 29 months after ablation), two out of three patients with recurrent AFs or AFL received repeated catheter ablation and one patient remained sinus rhythm post repeat ablation. Meanwhile, there was no recurrence of atrial myxoma, no death, stroke, acute myocardial infarction and other events during the entire follow-up period. Conclusions: Catheter ablation is a safe and feasible therapeutic option for patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma.

The thromboembolism risk of low-risk atrial fibrillation patients with different clinical characteristics / 中华心血管病杂志

Objective: This study explored the thromboembolism risk of low-risk atrial fibrillation (AF) patients (CHA2DS2-VASc score of 0 or 1 for male and 1 or 2 for female) with different clinical characteristics to provide the basis for anticoagulation decision-making in these patients. Methods: We prospectively enrolled consecutive 2 862 nonvalvular low-risk AF patients between August 2011 to December 2018 in China-AF (China Atrial Fibrillation Registry) Study, their CHA2DS2-VASc score was 0 or 1 for male and 1 or 2 for female. According to their age, sex, presence or absence of hypertension, diabetes mellitus, congestive heart failure, and vascular disease at the time of enrolling, patients were divided into CHA2DS2-VASc score 0 score group, 1 score group, and 2 score group. Patients were followed up every 6 months by outpatient clinic visit or telephone interview. The outcome was a thromboembolic event, including ischemic stroke and systemic embolism. Univariate Cox regression analysis was used to compare the thromboembolism risk between the patients with different risk factors and CHA2DS2-VASc score 0 group. Results: A total of 2 862 low-risk atrial fibrillation patients were enrolled in this study. 915 patients (32.0%) were female, and age was (55.0±10.7) years old. There were 933 patients (32.6%) in CHA2DS2-VASc score 0 group, 1 401 patients (49.0%) in score 1 group and 528 patients (18.5%) in score 2 group. During follow-up (median 1.5 years, 5 811.82 person-years), 33 cases of thromboembolic events were recorded, the annual rate of thromboembolism was 0.57% (95%CI 0.40%~0.80%). The number of thromboembolic events in patients with CHA2DS2-VASc score 0, 1 and 2 were 8, 11 and 14, respectively, and the annual thromboembolism event rates were 0.40% (95%CI 0.20%-0.81%), 0.39% (95%CI 0.22%-0.71%) and 1.34% (95%CI 0.80%-2.27%), respectively. The risk of thromboembolism of CHA2DS2-VASc score 2 group (HR=3.53, 95%CI 1.48-8.44; P=0.005), especially female patients aged 65-74 years in CHA2DS2-VASc score 2 group (HR=2.67, 95%CI 1.63-4.38; P<0.000) was significantly higher than that in patients of CHA2DS2-VASc score 0 group. Conclusion: Low-Risk Atrial Fibrillation patients with CHA2DS2-VASc score 2, especially female patients aged 65-74 years old with CHA2DS2-VASc score 2 are at higher risk of thromboembolism in low-risk AF patients. For such patients, intensified oral anticoagulant therapy might be helpful to reduce the risk of thrombolism.

Effect of Kinesio Taping on Chronic Nonspecific Low Back Pain: A Meta-analysis / 中国康复理论与实践

Objective:To evaluate the effect of Kinesio taping on chronic nonspecific low back pain (CNLBP). Methods:The Cochrane Library, PubMed, Web of Science, CNKI, CBM, VIP, and Wanfang Data were searched for the randomized controlled trials (RCT) about the effect of Kinesio taping on CNLBP from establishment to January, 2019. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. RevMan 5.3 software was used to analyze the extracted data. Results:Finally, nine RCTs involving 545 patients were included. Meta-analysis showed that the effect of Kinesio taping was significantly different in the improvement of pain compared with the non-stimulated group (MD = -0.76, 95%CI: -1.43 to -0.08, P = 0.03), the difference might be significant compared with the sham stimulation group (MD = -1.10, 95%CI: -2.22 to 0.02, P = 0.05); For improving dysfunction, the Oswestry Disability Index (ODI) scores were better in the Kinesio taping group than in the non-stimulation group (MD = -6.02, 95%CI: -8.63 to -3.41, P < 0.001) and the sham stimulation group (MD = -4.11, 95%CI: -5.82 to -2.41, P < 0.001), however, their was no significant difference in Roland Morris Disability Questionnaire (RMDQ) score between the Kinesio taping group and the non-stimulated group (MD = 0.69, 95%CI: -2.35 to 3.74, P = 0.66), and between the Kinesio taping group and the sham stimulation group (MD = -0.17, 95%CI: -1.43 to 1.08, P = 0.78). Conclusion:For the patients with CNLBP, the intervention of Kinesio taping could alleviate pain and improve function.

Association between weight control and recurrence of atrial fibrillation after catheter ablation in overweight and obese patients / 中华心血管病杂志

Objectives@#This study explored the relationship between weight control and atrial fibrillation (AF) recurrence after catheter ablation in overweight and obese patients.@*Methods@#We prospectively enrolled consecutive 333 overweight and obese patients aged 28 to 87 years old, who underwent catheter ablation for AF in Beijing Anzhen Hospital between October 2015 and February 2016. Data of patients′ characteristics, laboratory examination and treatment were collected at baseline. Each patient was followed up at 3, 6 and 12 months after ablation to collect information on weight, AF recurrence, stroke, major bleeding, hospitalization for cardiovascular reasons and death, etc. Patients were divided into weight controlled group (ΔBMI<-1 kg/m2) and weight uncontrolled group (ΔBMI≥-1 kg/m2), according to the changes in the most recent exposure BMI before AF recurrence in patients with recurrence or the BMI at 12 months′ follow-up in patients without recurrence and the BMI at baseline. Multivariate logistic regression was performed to adjust other known risk factors of AF recurrence and to explore the association between weight control and AF recurrence after catheter ablation.@*Results@#There were 54 patients in weight controlled group and 279 patients in weight uncontrolled group. There were no significant differences in age, gender, education level, left atrial size and history of hypertension between the two groups (all P>0.05). The proportion of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was higher in the weight controlled group (50.0%(27/54) vs. 34.8%(97/279), P=0.034). However, there was no significant difference in the proportion of patients with obesity (33.3% (18/54) vs. 29.7% (83/279)), paroxysmal AF (59.3% (32/54) vs. 56.6% (158/279)) and AF duration less than 5 years (76.9% (40/52) vs. 65.4% (178/272)) between the weight controlled group and the uncontrolled group. During 1-year follow-up after ablation, the recurrence rate of AF was significantly lower in the weight controlled group than that in the weight uncontrolled group (14.8% (8/54) vs. 32.6%(91/279), P=0.009). Multivariable logistic regression analysis shows that weight control is independently associated with a lower postoperative AF recurrence rate (OR=0.40, 95%CI 0.18-0.90, P=0.026).@*Conclusion@#Weight control is strongly associated with a lower AF recurrence rate after catheter ablation in overweight and obese patients.

Construction of artificial intelligence assisted diagnosis model for colonoscopy / 中华消化内镜杂志

Objective To establish an artificial intelligence deep learning model using clinical colonoscopy images and video to assist the diagnosis by colonoscopy. Methods More than 600000 colonoscopy images were collected in endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from 2014 to 2018, and endoscopic experts recorded a large number of high-quality operation video of colonoscopy as analysis data. After repeated discussion by six experts, the classified intestinal sites and pathological features were determined, and fuzzy and confusable images were deleted. The final selection result was approximately 1 out of 4. And then the features of images were marked using an independently developed software. The deep learning algorithm was developed using TensorFlow platform of Google. Results After repeated comparison and analysis of the results of machine training and judgment results combined with pathology from endoscopic experts, the sensitivity of the model for some diseases ( such as colon polyps) was 99％ under laboratory conditions. In the clinical colonoscopy test, the sensitivity, specificity, and overall accuracy of this model for diagnosis of colon polyps were 98. 30％(4187/4259), 88. 10％ (17620/20000), and 92. 92％ [2×98. 30％×88. 10％/(98. 30％+88. 10％)], respectively. The sensitivity and specificity for ulcerative colitis were 78. 32％ ( 2671/3410) , and 67. 06％(13412/20000), respectively. The diagnosis time spent on a single image was 0. 5±0. 03 s, and it was the real time for application, including system recognition, text prompt in video image, background record and storage. Conclusion The artificial intelligence assisted diagnosis model developed by our team can identify colonic polyps, colorectal cancer, colorectal eminence, colonic diverticulum, ulcerative colitis, etc. The auxiliary diagnosis model of colon disease can guide beginners to carry out colonoscopy, and can improve lesion detection rate, reduce misdiagnosis rate, and improve the overall operating efficiency of endoscopic center, which is conducive to the quality control of colonoscopy.

Risk factors and prognoses analysis of new-onset atrial fibrillation in patients with acute myocardial infarction / 中华内科杂志

Objective To explore the risk factors and prognoses of new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI).Methods A total of 468 patients with AMI were admitted into Beijing Anzhen Hospital for emergency pereutaneous coronary intervention (PCI).According to the NOAF occurred during hospitalization,the patients were divided into two groups:the NOAF (n=37) group and the non-NOAF (n=431) group.Parameters including general clinical conditions,coronary lesions,echocardiography,biochemical markers,C-reactive protein (CRP),N-terminal pro-brain natriuretic peptide (NT-pro-BNP),and myocardial markers were collected.In-hospital mortality and incidence of in-hospital main adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two groups.Logistic multivariate regression analyses were performed for the association between the risk factors and NOAF.Results The incidence of NOAF was 7.9％ in AMI patients undergoing emergency PCI.There were no significant differences in door-to-balloon time,weight,platelet counts,baseline serum creatinine (SCr),postoperative SCr,triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,uric acid,glycosylated hemoglobin A1c,preoperative medication,number of lesions,thrombus aspiration,location of myocardial infarction,and history of hypertension,diabetes,peripheral vascular disease and old myocardial infarction between the two groups.The percentage of women was in the NOAF group (32.4％ vs.16.7％,P＜0.05) and subjects in this group were significantly elder than those in the non-NOAF groups [(66±10) years vs.(571±11) years,P＜0.001].Moreover,the levels of no-reflow rate (40.5％ vs.12.6％,P＜0.001),CRP [25.2 (15.43,29.97)mg/L vs.5.21 (2.33,16.98) mg/L,P＜0.001],white blood cell counts [(11.19±3.44)× 109 vs.(9.91 ±3.23)× 109,p=0.022],NT-pro-BNP [(652.6± 108.8) ng/L vs.(258.3±105.9) ng/L,P＜0.001],and troponin I (TnI) [20.41(1.78,87.89) μg/L vs.7.72(1.29,36.39) μg/L,P=0.006] were significantly higher in the NOAF group than in the non-NOAF group,while left ventricular ejection fraction [(47.70± 7.34)％ vs.(53.35 ± 8.05)％,P＜0.001],and hemoglobin [137.0(125.5,146.0) g/L vs.144.0(133.0,156.0) g/L,P=0.042] were significantly lower in the NOAF group than the non-NOAF group.Patients in the NOAF group had significantly longer hospital stay than those in the non-NOAF group [(8.7± 5.6) d vs.(6.0± 2.3) d,P=0.007].The in-hospital mortality (8.1％ vs 1.4％ P=0.004) and the incidence of in-hospital MACCE (37.8％ vs.7.7％,P＜0.001) in the NOAF group were significantly higher than those in the non-NOAF group.Logistic multivariate regression analyses showed that age (HR 1.083,95％CI 1.028-1.141,P=0.003),CRP (HR 1.116,95％CI 1.049-1.187,P=0.001),NT-pro-BNP (HR 1.463,95％CI 1.001-4.064,P=0.001) and no-reflow (HR 4.388,95％CI 1.006-19.144,P=0.049) were independent predictors of NOAF after AMI.Conclusions Age,elevated levels of CRP,NT-pro-BNP,and the absence of no-reflow are risk factors for incident NOAF in patients with AMI in hospital.

Performance of interpreting the variants of long QT syndrome according ACMG guidelines by four clinical gene screening agencies from Beijing / 中华心血管病杂志

Objective@#To analyze the interpretation results on the pathogenic classification of KCNH2 variants and SCN5A variants of long QT syndrome (LQTS) based on American College of Medical Genetics and Genomics (ACMG) guidelines by 4 clinical gene screening agencies from Beijing.@*Methods@#Pathogenic classification of 16 variants in KCNH2 and SCN5A was made by 4 clinical gene screening agencies from Beijing based on ACMG guideline. Krippendorff's alpha was used to assess the inter-agency variation consistency.@*Results@#All 4 agencies made pathogenic assessment on all the variants and provided the interpretation results for the classification. For the eight variants from the patients with LQTS, the consistency of classification was only 1/8 and the alpha test value was - 0.01. For the eight variables from incidental findings, the consistency of classification was 4/8 and the alpha test value was 0.407. Evidence analysis of the 4 variants with large differences in classification among agencies showed that the main reasons for the discrepancies originated from the comprehensiveness of the literature search and the inconsistency of the subjective determination of the evidence grade.@*Conclusion@#The consistency of the pathogenic classification of LQTS gene variants based on ACMG guidelines among clinical gene screening agencies from Beijing is poor, which will result in great impact on the clinical treatment strategies of the patients with LQTS. The standardization of pathogenic evaluation of variants in clinical gene screening agencies needs to be improved urgently.

Investigation on Protective Effect of the Establishment of PIVAS on Occupational Exposure of Antineoplastic Drugs to Nursing Staff in Clinical Departments in Our Hospital / 中国药房

OBJECTIVE:To provide reference for confirming the protective effect of the establishment of PIVAS on antineoplastic drugs(ADs)occupational exposure to nursing staff in clinical departments,and to provide the basis for the formulation of ADs dispensing guideline and occupational exposure protection regulations. METHODS:By questionnaire survey and deriving data of lab examination index,the occurrence of abnormal menstruation,bad birth outcome,alopecia,blood toxicity, liver and renal toxicity in nursing staff of clinical departments with different ADs contact frequencies(non-exposure group as group A,low-exposure group as group B,high-exposure group as group C)were investigated and analyzed in our hospital before and after the establishment of PIVAS. The residual of ADs [methotrexate(MTX)and 5-Fluorouracil(5-FU)] in PIVAS environment were investigated by HPLC. RESULTS:A total of 160 questionnaires were sent out before the establishment of PIVAS,and 151 were effectively collected with effective recovery of 94.38%. After the establishment of PIVAS,150 questionnaires were sent out,and 144 were effectively collected with effective recovery of 96.00%. Questionnaire results showed that the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss in group C were significantly higher than group A,with statistical significance(P<0.05 or P<0.01). The incidence of above 6 conditions in group C were 5.14,6.10,3.81,4.04,6.15,8.08 times higher than in group A.At same time, the incidence of the offspring low birth weight and the severity of hair loss in group B were significantly higher than group A,with statistical significance(P<0.05 or P<0.01);the incidence of the former in group B was 6.21 times higher than in group A.After the establishment of PIVAS,the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss were decreased significantly in group C,with statistical significance(P<0.05). The severity of hair loss in group C was significantly higher than group A,and there was no statistical significance in above indexes,compared with group A(P>0.05). At the same time,there was no statistical significance in the incidence of the offspring low birth weight and the severity of hair loss between group B and A(P>0.05). Results of lab examination index investigation showed that before the establishment of PIVAS,WBC and PLT of group C were significantly lower than group A,and the incidence of abnormal liver function was significantly higher than group A,with statistical significance(P<0.05 or P<0.01). After the establishment PIVAS,WBC,PLT and RBC of group C,and PLT of group B were increased significantly compared to before the establishment PIVAS;the incidence of abnormal liver function in group C was decreased significantly compared to before the establishment PIVAS,with statistical significance(P<0.05 or P<0.01). There was no statistical significance in above indexes between group C and A(P>0.05),and PLT of group B was even significantly higher than group A(P<0.05). Results of investigation of ADs residues in PIVAS environment showed that there were different degrees of MTX and 5-FU residue on the surface of different objects. The residues of ADs from high to low were biological safety cabinet worktops,the floor just below biological safety cabinet,transfer box,transfer window and door handle and infusion bags. CONCLUSIONS:Nursing staff of clinical department with high ADs contact frequency face higher relevant health risks. The establishment of PIVAS can effectively protect the ADs occupational exposure of nursing staff in clinical departments,thereby reducing the above risks.At the same time,there are still different degrees of ADs residues on the surface of different objects in the PIVAS environment,and transshipment out of PIVAS is possible. It is suggested that the awareness of protection against occupational exposure risk caused by ADs residues in PIVAS environment should be improved;unified guideline for ADs dispensing and occupational exposure protection regulations should be formulated as soon as possible,so as to reduce occupational exposure risk associated with ADs for nursing staff in PIVAS and clinical departments.

Impact of body mass index on mortality in patients undergoing elective percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the influence of body mass index(BMI) on the prognosis of patients who had received elective PCI.Methods The study population consisted of 2964 consecutive patients with electivePCIs performed between July 2009 and September 2011. The patients were divided into three groups based on their preoperative BMI levels:the normal group( BMI<24.0 kg/m2,n=810); the overweight group( 24.0 kg/m2≤BMI<28.0 kg/m2,n=1454) and the obese group(BMI≥28.0 kg/m2,n=700). We examined the association between baseline BMI levels and postoperative mortality through a mean(571.5±130.8)days of follow up.Results Patients with high BMI had a higher percentage of comorbidities compared with the normal BMI group. The results of multivariate Cox regression analysis revealed that preoperative BMI was inversely associated with mortality after adjustment for other factors (HR 0.896,95％ CI 0.821-0.977,P=0.031). Compared with the obese group, the hazard ratios for risk of mortality in the overweight and the normal groups were 1.908(95％CI 0.689-5.291,P=0.213) and 2.241(95％CI 1.154-4.350,P=0.017).Conclusions For patients undergoing elective PCI, individuals with obesity and overweight had the better prognosis than those with normal BMI.

Simultaneous determination of six constituents in Yitai Capsules by HPLC / 中成药

AIM To establish an HPLC method for the simultaneous content determination of ginsenoside Re,ginsenoside Rg1,ginsenoide Rb1,specnuezhenide,calycosin-7-O-β-D-glucoside and oleanolic acid in Yitai Cap sules (Ginseng Radix et Rhizoma,Astragali Radix,Ligustri lucidi Fructus,etc.).METHODS The analysis of 70％ ethanol extract of this drug was performed on a 25 ℃ thermostatic Luna C18 column (4.6 mm ×250 mm,5 μm),with the mobile phase comprising of methanol-O.2％ phosphoric acid flowing at 1.0 mL/minin a gradient elution manner,and the detection wavelength was set at 203 nm.RESULTS Six constituents showed good linear relationships within their own ranges (r ＞ 0.999 0),whose average recoveries were 95.58％-102.12％ with the RSDs of 0.82％-1.73％.CONCLUSION This simple and stable method can be used for the rapid quality control of Yitai Capsules.

Different strategies for the ablation of atrial tachycardia in the redo ablation of persistent atrial fibrillation / 中国介入心脏病学杂志

Objective The recurrence of perimitral atrial tachycardia is common after initial ablation of persistent atrial fibrillation (AF). The aim of the study is to explore a preferable ablation approach for perimitral atrial tachycardia in the redo ablation of persistent AF. Methods Seventy-four patients with perimitral atrial tachycardia after initial ablation for persistent AF were included in our study. Patients were distinguished into either the group of having ablation during tachycardia (Group A) or the group having ablation after cardioversion to sinus rhythm (Group B) according to the different ablation strategies. The procedural endpoints were pulmonary vein isolation and bidirectional conduction block of all the ablated lines. The primary endpoint of the study was freedom from atrial tachyarrhythmia recurrence during the follow-up period. Results There were statistical differences in baseline clinical data between the 2 groups. During the redo procedure, conduction recovery rate across the mitral isthmus (MI),cavotricuspid isthmus and left atial roofline were 100％, 40.5％ and 48.6％ respectively. The procedural time, fluoroscopy time, mapping time were longer in the patients of group A. During a mean follow-up of (16.9±6.3) months, 31 (72.1％) patients in group A and 21(67.7％) patients in group B maintained in sinus rhythm in the absence of antiarrhythmic durgs (P =0.771) . Conclusion In patients with perimitral atrial tachycardia after initial ablation for persistent AF,ablation in sinus rhythm is a more simplified method and as effective as ablation during tachycardia.