Clinical effect of double plasma molecular adsorption system in treatment of patients with chronic liver failure in high-altitude areas / 临床肝胆病杂志

ObjectiveTo investigate the differences in clinical features and mortality rate between native patients with chronic liver failure （CHF） and migrated patients with CHF after treatment with double plasma molecular adsorption system （DPMAS） in high-altitude areas. MethodsA total of 63 patients with CHF who received DPMAS treatment in the intensive care unit of General Hospital of Tibet Military Command from January 2016 to December 2021 were enrolled， and according to their history of residence in high-altitude areas， they were divided into native group with 29 patients and migrated group with 34 patients. The two groups were compared in terms of baseline data and clinical features before and after DPMAS treatment. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the paired t-test was used for comparison before and after treatment within each group； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups， and the Wilcoxon signed rank sum test was used for comparison before and after treatment within each group； the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison of the risk of death. ResultsCompared with the native group， the migrated group had a significantly higher proportion of Chinese Han patients （χ2=41.729， P<0.001）， and compared with the migrated group， the native group had a significantly longer duration of the most recent continuous residence in high-altitude areas （Z=3.364， P<0.001）. Compared with the native group， the migrated group had significantly higher MELD score and incidence rates of hepatic encephalopathy， hepatorenal syndrome， and gastrointestinal bleeding （Z=2.318， χ2=6.903， 5.154， and 6.262， all P<0.05）. Both groups had significant changes in platelet count （PLT）， hemoglobin count （HGB）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， albumin， total bilirubin （TBil）， direct bilirubin （DBil）， lactate dehydrogenase （LDH）， creatinine （Cr）， and international normalized ratio （INR） after DPMAS treatment （all P<0.05）. Before DPMAS treatment， compared with the native group， the migrated group had significantly higher levels of ALT， AST， TBil， DBil， LDH， Cr， BUN， and INR （all P<0.05） and a significantly lower level of HGB （P<0.05）； after DPMAS treatment， compared with the native group， the migrated group had significantly greater reductions in PLT and HGB （both P<0.05） and still significantly higher levels of ALT， AST， TBil， DBil， LDH， BUN， and INR （all P<0.05）. The 60-day mortality rate of patients after DPMAS treatment was 52.5% （95% confidence interval ［CI］： 41.7 — 63.8） in the native group and 81.3% （95%CI： 77.9 — 85.6） in the migrated group. Compared with the native group （hazard ratio ［HR］=0.47， 95%CI： 0.23 — 0.95）， the migrated group had a significant increase in the risk of death on day 60 （HR=2.14， 95%CI： 1.06 — 4.32， P=0.039）. ConclusionCompared with the native patients with CHF in high-altitude areas， migrated patients have a higher degree of liver impairment， a lower degree of improvement in liver function after DPMAS treatment， and a higher mortality rate. Clinical medical staff need to pay more attention to migrated patients with CHF， so as to improve their survival rates.

Preliminary evaluation on the efficacy of emergency transcatheter aortic valve replacement: a multicenter study / 中华心血管病杂志

Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.

Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY) / 中华医学杂志(英文版)

BACKGROUND@#The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.@*METHODS@#CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.@*RESULTS@#The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).@*CONCLUSIONS@#TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.@*TRIAL REGISTRATION@#https://www.chictr.org.cn/ (No. ChiCTR2000038526).

Expression of cyclophilin A in oral squamous cell carcinoma and its effect on cell proliferation and invasion / 华西口腔医学杂志

OBJECTIVES@#To investigate the expression of cyclophilin A (CyPA) in oral squamous cell carcinoma (OSCC) and explore the effect of downregulating the expression of CyPA gene on the proliferation and invasion of SCC-25 cells.@*METHODS@#A total of 77 cases of patients with OSCC were selected. The expression levels of CyPA proteins in OSCC and adjacent normal tissues were evaluated. SCC-25 cells were cultured and divided into the CyPA interference sequence group, negative control group, and blank group. The expression levels of CyPA mRNA and protein in cells were detected by using real-time fluorescent quantitative polymerase chain reaction and Western blot, respectively. Cell proliferation was detected by using methyl thiazolyl tetrazolium and plate colony formation assays. Cell invasion was detected by using Transwell assay.@*RESULTS@#The positive expression rate of CyPA protein in OSCC tissues was 76.62%, which was higher than that in adjacent tissues (@*CONCLUSIONS@#The CyPA protein is highly expressed in OSCC tissues, and the downregulation of CyPA gene expression in SCC-25 cells can reduce cell proliferation and inhibit cell invasion.

Automated classification of ICD-O-3 morphology code from pathology reports using text-mining and support vector machine / 预防医学

Objective@#To evaluate the accuracy of automated classification of ICD-O-3 morphology code from pathology reports by text-mining and support vector machine ( SVM ) , in order to provide basis for automated tumor coding in Chinese. @*Methods@#The tumor report cards of Zhejiang residents from 2017 to 2019 were collected from Chronic Disease Surveillance Information Management System of Zhejiang Province. According to ICD-O-3, the keywords of the pathology reports were extracted, and SVM was used for automatic classification. The classification results were compared with those of 16 professionals with more than two years of experience in tumor coding, and the accuracy rate, recall rate and F-score were calculated for effect evaluation. @*Results@#Totally 83 082 cases from 2017 to 2019 were included and were categorized into 17 morphological classifications, with 52 877 ( 63.65% ) cases of adenocarcinoma, squamous carcinoma and transitional cell carcinoma. A total of 1 090 keywords were enrolled into main corpus. The total F-score, accuracy rate and recall rate are 85.69, 77.20% and 96.27%, respectively. @*Conclusion@#Text-mining combined with SVM can improve the efficiency of ICD-O-3 morphology coding; however, the accuracy needs to be further improved.

Investigation and analysis of work stress of medical staff in Shanghai during the period of normalized epidemic prevention and control / 中华医院管理杂志

Objective:To analyze the work stress of medical staff at different medical institutions in Shanghai under the background of normalized prevention and control of 2019 novel coronavirus diseases(COVID-19), for evidence of relieving the work stress of medical staff.Methods:From September to November 2020, two community health service centers, one secondary hospital and one tertiary hospital were selected from each district of Jing′an District, Jiading District and Pudong New Area of Shanghai, totaling 12 medical institutions. The medical staff were selected by stratified random sampling. A self-designed questionnaire was used to conduct an online questionnaire survey on the work stress of medical staff. The survey data were analysied by descriptive analysis, and different groups were compared with chi square test.Results:1 422 valid questionnaires were obtained. There was a significant difference in self-rated routine work stress of medical staff between community health service centers and secondary/tertiary hospitals( P<0.001). The proportions of medical staff whose self-rated routine work stress was " quite stressed" or " very stressed" at community health service centers and secondary/tertiary hospitals were 39.77%(317)and 55.36%(346)respectively. There was a significant difference in self-rated COVID-19 prevention stress of medical staff between community health service centers and secondary/tertiary hospitals( P<0.001), the proportions of medical staff who considered the COVID-19 prevention was " quite stressed" or " very stressed" were 86.45%(689)and 76.48%(478)respectively. Conclusions:The overall work stress of medical staff at medical institutions in Shanghai was high.The prevention and control of COVID-19 increased the pressure of medical staff at all levels of medical institutions.

Analysis on the appeals for rights and interests of medical staff in medical institutions at all levels in Shanghai / 中华医院管理杂志

Objective:To understand the current situation of appeals for rights and interests of medical staff in community health institutions and secondary/tertiary hospitals in Shanghai, for the suggestions on improving the job satisfaction and enthusiasm of medical staff.Methods:From September to November 2020, two community health service centers(stations), one secondary hospital and one tertiary hospital were selected from Jiading District, Pudong New Area and Jing′an District of Shanghai respectively. An online questionnaire survey was conducted among medical staff in medical institutions selected by stratified random sampling. The survey covered the main demographic information as well as 12 rights and interests demands, namely " salary promotion" among other. Descriptive analysis was performed on the data, and chi square test was used for comparison between groups.Results:1 759 valid questionnaires were recovered in this survey, and 1 654 medical employees(94.03%)reported a high degree of appeal for " salary promotion" . Compared with the medical staff in community health service centers(stations), the medical staff in secondary/tertiary hospitals reported higher demands for " training and study" " title appointment" and " academic promotion" , presenting a difference statistically significant( P<0.05). There were significant differences between doctors and nurses in " routine expense reimbursement" " staff recruitment" " professional title appointment" " children′s education" " cultural and recreational activities" and " opinion feedback channels" ( P<0.05). Conclusions:Salary promotion was the common demand of medical staff at all levels of medical institutions. Medical staff at secondary/tertiary hospitals had higher demands for career development. There were some differences in appeals for rights and interests between doctors and nurses. Medical institutions at all levels should continue to promote the reform of salary system, pay attention to the respective rights and interests of doctors and nurses, and improve their job satisfaction and enthusiasm.

Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China / 中华医学杂志(英文版)

BACKGROUND@#Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income.@*METHODS@#This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients' treatment satisfaction.@*RESULTS@#When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P 50% subgroup (all P 50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032).@*CONCLUSION@#Higher disease severity and higher financial burden were associated with lower patient satisfaction.

Comparison of heart failure and COVID-19 in chest CT features and clinical characteristics / 中华心血管病杂志

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and COVID-19. Methods: This study was a retrospective study. A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups(both P>0.05), but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 0, P<0.001; 12/12 vs. 4/7, P=0.013). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001；0 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of pulmonary veins was also higher (3/7 vs. 0，P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there were more cases with rounded morphology in COVID-19 group（9/12 vs. 2/7, P=0.048）. Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.

Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.@*METHODS@#We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.@*RESULTS@#A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803-55.938; P < 0.001).@*CONCLUSION@#As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.

Application of the "buddy-in-jail" technique during percutaneous coronary intervention:choice of wire and artery / 中国介入心脏病学杂志

Objective To evaluate the efficacy of the ' buddy-in-jail ' technique applied to complex coronary artery lesions during percutaneous coronary intervention.Methods A total of 12640 PCI cases from 4 different hospitals admitted between June 2014 to June 2017 were reviewed. Among them, the balloons or stents were unable to be delivered into the lesions in 25 cases. The "buddy-in-jail"technique was applied in 21 of these 25 cases. According to the guidewires used, the 21 cases were divided into the hydrophilic coated guidewire group(n=9) and non-hydrophilic coated guidewire group(n=21). The rates of procedural success and complications were compared between the 2 groups.Results 18 cases(18/21)were successfully treated with the "buddy-in-jail " technique. The success rates were similar between patients using the same artery(9/11) as the "buddy" vessel patients using other arteries(9/10) (P=0.593). Procedural success rates were also similar between patients using hydrophilic-coated guidewires (7/9) and non- hydrophilic coated guidewires(11/12)(P=0.386). All the wires were successfully taken out without complication.Conclusions "Buddy-in-jail" technique offers a potential alternative approach for patients with difflculty in delivering the balloon or stent to the target lesion.

Application and optimization of field psychological emergency rescue chest / 医疗卫生装备

Objective To optimize the design of the field psychological emergency rescue chest.Methods The deficiencies of the chest were summarized during the drilling and actual application of the psychological rescue unit,and some optimization countermeasures were put forward accordingly.Results The chest was optimized from the aspects of selection of chest body, internal and external layout as well as equipped devices.Conclusion The optimized chest can better meet the needs of the disaster emergency rescue.

Three-dimensional analysis of upper airway in the adolescents with different vertical skeletal patterns by Cone-Beam CT image / 实用口腔医学杂志

Objective: To study the difference of airway volume among the adolescent subjects with various vertical skeletal patterns. Methods: CBCT records of 88 adolescents with normal sagittal facial pattern were collected and divided into 3 groups according to their FH-MP angle. The subjects of the 3 groups were matched in age and sex. Airway volume and cross-sectional areas were compared among the 3 groups with Dolphin software. Correlation analyses of the airway dimensions with the maxillofacial variables was carried out. Results: There were statistical differences among the 3 groups in volumes of velopharynx,glossopharynx and oropharynx, minimal cross-section area of oropharynx and cross-section area on EP plane,and all the measurements decreased from low angle to normal angle to high angle groups(P ＜ 0. 05). Cross-section areas of HP plane and SP plane in low angle group were significantly larger than that of the normal angle and high angle groups(P ＜ 0. 05). The oropharyngeal airway dimensions showed negative correlation with FMA,and positive correlation with Co-Po,Ar-Gn (except cross-section area of HP). Conclusion: The pharyngeal airway volumes among different vertical skeletal patterns in adolescents are different.

Explore the effects of individualized interventions on drug compliance in patients with multidrug-resistant tuberculosis / 中国生化药物杂志

Objective To explore the effect of personalized intervention on drug compliance in patients with multidrug-resistant pulmonary tuberculosis. Methods A total of 80 patients with multidrug-resistant pulmonary tuberculosis were selected from March 22, 2016 to March 22, 2017, and randomized groups were randomly divided into the observation group and the control group,40 cases in each groups . The observation group and the control group Intervention and routine care. Results Observation group of patients satisfaction score (97.92±1.24), compliance score (95.42±3.14), the incidence of adverse events (5.00%), reasonable nutrition rate (100.00%), prescribed medication rate (100.00%), don't do STH without authorization (100.00%), rate of quitting cigarettes, alcohol and drug withdrawal rate (95.00%), and regularly review rate (95.00%), the psychological function (97.53±1.22) and body function (96.18 ± 1.42) points (95.31±2.41), material life, social function (94.82± 3.42mm) were better than control group (P<0.05).Conclusion Individualized intervention in multidrug-resistant tuberculosis patients can improve drug compliance.

Clinical observation of sertraline in the treatment of coronary heart disease complicated with depression after percutaneous coronary intervention / 中国基层医药

Objective To investigate the clinical effect of sertraline in the treatment of coronary heart disease (CHD) complicated with depression after percutaneous coronary intervention.Methods According to random number table,73 CHD patients complicated with depression after percutaneous coronary intervention were randomly divided into observation group(37 cases) and control group(36 cases).The control group was treated by CHD conventional therapy and shallow psychological intervention,and the observation group was treated with sertraline on the basis of the control group.The clinical efficacy,SDS and HAMD score,changes of SP-selectin,hs-CRP,IL-6,TNF-α,NO and ET-1 levels were compared.Results The total effective rate of the observation group was 97.30％,which was significantly higher than 88.89％ of the control group (Z =-5.541,P =0.000).The HAMD and SDS scores of the two groups were significantly decreased (tobservation group (HAMD) =10.600,P =0.000;tcontrol group (HAMD) =5.214,P =0.000;tobservation group(SDS) =14.844,P =0.000;tcontrol group(SDs) =6.863,P =0.000),and those of the observation group were significantly lower than the control group (tHAMD =--6.539,P =0.000;tSDs =--8.254,P =0.000).The levels of SP-selectin (t =3.759,P =0.000),hs-CRP (t =2.956,P =0.004) in the observation group and IL-6 (tob ion group =9.969,P =0.000;tcontrol group =5.059,P =0.000),TNF-α (tobservation group =10.596,P =0.000;tcontrol group =2.615,P =0.011),ET-1 (tobservation group =4.670,P =0.000;tcontrol group =2.264,P =0.027) in the two groups were significantly decreased,and the NO (tobservtion group =-5.482,P =0.000;tcontrol group =-4.027,P =0.000) increased.Also,the levels of SP-selectin (t =-2.715,P =0.008),hs-CRP (t =-2.089,P =0.040),IL-6 (t =-4.975,P =0.000) and TNF-α (t =-6.832,P =O.000) in the observa tion group were significantly lower than those in the control group.Conclusion Sertraline has significant clinical effi cacy in the treatment of CHD complicated with depression after percutaneous coronary intervention.It can effectively reduce the HAMD and SDS scores,improve the depressive symptoms,reduce the expression of SP-selectin and relat ed inflammatory factors.It is worthy of popularization and application.

Pathogens and antimicrobial resistance in maxillofacial infection / 中国感染控制杂志

Objective To investigate the distribution and antimicrobial susceptibility of pathogens causing maxillofacial infection in patients,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods Specimens of patients infected with oral and maxillofacial infection in a hospital between January 2012 and December 2016 were performed microbial culture,pathogens were identified and performed antimicrobial susceptibility testing,distribution of pathogens and antimicrobial resistance were analyzed.Results Of 882 patients with maxillofacial infection,male and female accounted for 32.20％ and 67.80％ respectively;35.38％ and 32.65％ of patients aged ～40 years and ～60 years respectively;a total of 145 strains were isolated,88(60.69 ％) of which were gram-negative bacteria,mainly Klebsiella pneumoniae and Pseudomonas aeruginosa;56 (38.62 ％) of which were gram-positive bacteria,mainly Staphylococcus aureus.Resistance rates of Klebsiella pneumoniae to 16 kinds of an timicrobial agents were a11＜50％,resistance rates to imipenem and meropenem were the lowest,both were 3.45％,1 1 strains were extended-spectrum β-lactamases-producing strains;resistance rates of Pseudomonas aeruginosa to 10 kinds of antimicrobial agents were all＜40％.Staphylococcus aureus was susceptible to tigecycline,linezolid,and vancomycin,resistance rate to penicillin was the highest (66.67％),resistance rate to oxacillin was 20.83％.Conclusion The main pathogens causing oral and maxillofacial infection are gram negative bacteria,different pathogens have different antimicrobial resistance,antimicrobial agents should be used rationally during clinical treatment according to antimicrobial susceptibility testing result.

E-26 Transformation-specific Related Gene Expression and Outcomes in Cytogenetically Normal Acute Myeloid Leukemia: A Meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The E-26 transformation-specific related gene (ERG) is frequently expressed in cytogenetically normal acute myeloid leukemia (CN-AML). Herein, we performed a meta-analysis to investigate the relationship between the prognostic significance of ERG expression and CN-AML.</p><p><b>METHODS</b>A systematic review of PubMed database and other search engines were used to identify the studies between January 2005 and November 2016. A total of 667 CN-AML patients were collected from seven published studies. Of the 667 patients underwent intensive chemotherapy, 429 had low expression of ERG and 238 had high expression of ERG. Summary odds ratio (OR) and the 95% confidence interval (CI) for the ERG expression and CN-AML were calculated using fixed- or random-effects models. Heterogeneity was assessed using Chi-squared-based Q- statistic test and I2 statistics. All statistical analyses were performed using R.3.3.1 software packages (R Foundation for Statistical Computing, Vienna, Austria) and RevMan5.3 (Cochrane Collaboration, Copenhagen, Denmark).</p><p><b>RESULTS</b>Overall, patients with high ERG expression had a worse relapse (OR = 2.5127, 95% CI: 1.5177-4.1601, P = 0.0003) and lower complete remission (OR = 0. 3495, 95% CI: 0.2418-0.5051, P< 0.0001). With regard to the known molecular markers, both internal tandem duplications of the fms-related tyrosine kinase 3 gene (OR = 3.8634, 95% CI: 1.8285-8.1626, P = 0.004) and brain and acute leukemia, cytoplasmic (OR = 3.1538, 95% CI: 2.0537-4.8432, P< 0.0001) were associated with the ERG expression. In addition, the results showed a statistical significance between French-American-British (FAB) classification subtype (minimally differentiated AML and AML without maturation, OR = 4.7902, 95% CI: 2.7772-8.2624, P< 0.0001; acute monocytic leukemia, OR = 0.2324, 95% CI: 0.0899-0.6006, P = 0.0026) and ERG expression.</p><p><b>CONCLUSION</b>High ERG expression might be used as a strong adverse prognostic factor in CN-AML.</p>

Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).</p><p><b>METHODS</b>A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.</p><p><b>RESULTS</b>During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.</p><p><b>CONCLUSION</b>High PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.</p>

Progress on mechanism of Tripterygium wilfordii-induced liver injury and detoxification mechanism of licorice / 中国中药杂志

Tripterygium wilfordii has exihibited multiple pharmacological activities, such as anti-inflammatory, immune modulation, anti-tumor and anti-fertility. T. wilfordii have been used for the therapy of inflammation and autoimmune diseases including rheumatoid arthritis, immune complex nephritis and systemic lupus erythematosus clinically. However, it is well known that T. wilfordii has small margin between the therapeutic and toxic doses and could cause serious injury on digestive, reproductive and urogenital systems. Among all the organs, liver is one of the most remarkable targets of T. wilfordii-induced toxicities, and the damage is more serious than others. It is generally accepted that T. wilfordii-induced liver injury is a result of the combined effects of toxic elements of T. wilfordii. It is reported in several studies that the mechanism of T. wilfordii-induced liver injury may be related to lipid peroxidation, cell apoptosis and immune damage, and so on. Licorice is one of the most commonly used Chinese herbal medicine, with effects of heat- clearing and detoxicating, anti-inflammatory and hepatoprotective, reconciling various drugs, and so on. Licorice often accompany T. wilfordii in clinical application which can significantly reduce the liver injury induced by T. wilfordii. The attenuated effect is exact, but the mechanism is still a lack of in-depth study. This paper reviews the studies on T. wilfordii-induced liver injury and the related mechanism as well as licorice and other traditional Chinese medicine accompany T. wilfordii to reduce the injury in recent years, so as to provide reference for related research in the future.

Synthesis of Resveratrol Dimer Induced by Pheophorbide and Its Enhancing Effects on Free Radical Elimination and Analgesic Activity / 浙江中医药大学学报

Objective] To explore a new method of synthesis of resveratrol oligmer induced by photosensitizers, further analyze its free radical scavenging activity and analgesic activity. [Method] Resveratrol was dispersed in pH 7.4 phosphate buffer solution, mixed with pheophorbide, then illuminated by laser at 630nm. The oligmers in the filtrate were analyzed by HPLC-MS and isolated by preparative liquid chromatography. Free radical scavenging activity was determined by DPPH and ABTS method, and the analgesic effect was measured by hot plate test and acetic acid writhing test in mice. [Result] A new peak occurred and reached stable in reactive solution after 20 min illumination. It was identified as the dimer of resveratrol with conversion of 35%. Its concentrations on inhibition of 50% DPPH and ABTS radical were respectively 230 μg·mL-1 and 273 μg·mL-1. It reached maximum pain threshold at 180 min, and the inhibition rate of writhing number was 62.6% with better effects than resveratrol. [Conclusion] Reseratrol can be polymerized to the dimer after pheophorbide excited by red light, the resveratrol and its dimer both have the ability of eliminating free radicals and analgesic effects, but the dimer has the stronger activity.