Study of the urban-impact on microbial communities and their virulence factors and antibiotic resistance genomes in the Nandu River, Haikou / 中华流行病学杂志

Objective: To explore the changes in bacterial community structure, antibiotic resistance genome, and pathogen virulence genome in river water before and after the river flowing through Haikou City and their transmission and dispersal patterns and to reveal anthropogenic disturbance's effects on microorganisms and resistance genes in the aquatic environment. Methods: The Nandu River was divided into three study areas: the front, middle and rear sections from the upstream before it flowed through Haikou City to the estuary. Three sampling sites were selected in each area, and six copies of the sample were collected in parallel at each site and mixed for 3 L per sample. Microbial community structure, antibiotic resistance, virulence factors, and mobile genetic elements were analyzed through bioinformatic data obtained by metagenomic sequencing and full-length sequencing of 16S rRNA genes. Variations in the distribution of bacterial communities between samples and correlation of transmission patterns were analyzed by principal co-ordinates analysis, procrustes analysis, and Mantel test. Results: As the river flowed through Haikou City, microbes' alpha diversity gradually decreased. Among them, Proteobacteria dominates in the bacterial community in the front, middle, and rear sections, and the relative abundance of Proteobacteria in the middle and rear sections was higher than that in the front segment. The diversity and abundance of antibiotic resistance genes, virulence factors, and mobile genetic elements were all at low levels in the front section and all increased significantly after flow through Haikou City. At the same time, horizontal transmission mediated by mobile genetic elements played a more significant role in the spread of antibiotic-resistance genes and virulence factors. Conclusions: Urbanization significantly impacts river bacteria and the resistance genes, virulence factors, and mobile genetic elements they carry. The Nandu River in Haikou flows through the city, receiving antibiotic-resistant and pathogen-associated bacteria excreted by the population. In contrast, antibiotic-resistant genes and virulence factors are enriched in bacteria, which indicates a threat to environmental health and public health. Comparison of river microbiomes and antibiotic resistance genomes before and after flow through cities is a valuable early warning indicator for monitoring the spread of antibiotic resistance.

Analysis on the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors / 中华预防医学杂志

Objective: To evaluate the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors. Methods: A COVID-19 outbreak caused by the Delta variant occurred in Nanjing in July 2021. A total of 235 cases with current addresses in Nanjing were reported from 171 households. The subjects in this study were selected from household close contact(s) of infected cases. The information on household index cases and their contacts were collected, and the household secondary attack rate (HSAR) and the risk factors were analyzed by the multi-factor logistic regression model. Results: A total of 234 cases of household close contacts and 64 household secondary cases were reported from 103 households, and the HSAR was 27.4% (64/234, 95%CI:22.0% to 33.4%). The proportions of household size for 2 to 3, 4 to 5, and 6 to 9 were 64.1% (66), 26.2% (27) and 9.7% (10), respectively. A total of 35 cases of household cluster outbreaks were reported (35/103, 34.0%). The number of the first case in the household (FCH) was 103 and males accounted for 27.2% (28 cases), with the median age (Q1, Q3) of 49 (9, 56). The number of household close contacts was 234 and males accounted for 59.0% (138 cases), with the median age (Q1, Q3) of 42 (20, 55) and the median exposure period (Q1, Q3) of 3 (1, 3) days. The multi-factor logistic regression model showed that the higher HSAR was observed in the FCH with the features of airport staff (OR=2.913, 95%CI:1.469-5.774), detection from home quarantine screening (OR=6.795, 95%CI:1.761-26.219) and detection from mass screening (OR=4.239, 95%CI:1.098-16.368). Meanwhile, higher HSAR was observed in cases with longer household exposure (OR=1.221, 95%CI:1.040-1.432), non-vaccination (OR=2.963, 95%CI:1.288-6.813) and incomplete vaccinations (OR=2.842, 95%CI:0.925-8.731). Conclusion: The generation interval of the Delta variant is shortened, and the ability of transmission within the household is enhanced. In the outbreak in Nanjing, the associated factors of HSAR are occupation, detection route, vaccination and exposure period.

Research Progress of Upadacitinib in the Treatment of Crohn’s Disease / 中山大学学报(医学科学版)

Crohn’s Disease （CD） is a destructive， relapsing and remitting chronic inflammatory bowel disease that usually progresses to irreversible intestinal structural and functional changes， such as intestinal lumen stenosis， fistula formation and perianal lesions， severely affecting the quality of life of patients. This review summarized the research progress on the mechanism， clinical application and safety of upadacitinib in the treatment of CD. Upadacitinib can increase the clinical remission and endoscopic response rates in patients with CD， improve the long-term outcome of CD patients and provide a new idea for the treatment of CD patients by using biological agents.

Efficacy and Safety of the Safe Triangular Working Zone Approach in Percutaneous Vertebroplasty for Spinal Metastasis

Objective@#This study aimed to assess the technical feasibility, efficacy, and safety of the safe triangular working zone (STWZ) approach applied in percutaneous vertebroplasty (PV) for spinal metastases involving the posterior part of the vertebral body. @*Materials and Methods@#We prospectively enrolled 87 patients who underwent PV for spinal metastasis involving the posterior part of the vertebral body, with or without the STWZ approach, from January 2019 to April 2022. Forty-nine patients (27 females and 22 males; mean age ± standard deviation [SD], 57.2 ± 11.6 years; age range, 31–76 years) were included in group A (with STWZ approach), accounting for 54 vertebrae. Thirty-eight patients (18 females and 20 males; 59.1 ± 10.9 years; 29–81 years) were included in group B (without STWZ approach), accounting for 57 vertebrae. Patient demographics, procedure-related variables, and pain relief as assessed using the visual analog scale (VAS) were collected at different time points. Tumor recurrence in the vertebrae after PV was analyzed using Kaplan–Meier curves. @*Results@#The STWZ approach was successful from T1 to L5 without severe complications. Cement filling was satisfactory in 47/54 (87.0%) and 25/57 (43.9%) vertebrae in groups A and B, respectively (v< 0.001). Cement leakage was not significantly different between groups A and B (p= 1.000). Mean VAS score ± SD before and 1 week and 1, 3, 6, 9, and 12 months after PV were 7.6 ± 1.8, 4.2 ± 2.0, 2.7 ± 1.9, 1.9 ± 1.5, 1.7 ± 1.4, 1.7 ± 1.1, and 1.6 ± 1.3, respectively, in group A and 7.2 ± 1.7, 4.0 ± 1.3, 3.4 ± 1.6, 2.4 ± 1.2, 1.8 ± 1.0, 1.4 ± 0.5, and 1.7 ± 0.9, respectively, in group B. Kaplan–Meier analysis showed a lower tumor recurrence rate in group A than in group B (p = 0.001). @*Conclusion@#The STWZ approach may represent a new, safe, alternative/auxiliary approach to target the posterior part of the vertebral body in the PV for spinal metastases.

T lymphocyte subsets combined with inflammatory indicators for auxiliary diagnosis and prognosis evaluation of sepsis / 中华预防医学杂志

Objective: To explore the application value of T lymphocyte subsets combined with procalcitonin (PCT), C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR) and white blood cell count (WBC) in the auxiliary diagnosis and prognosis evaluation of sepsis. Methods: In a retrospective study, seventy-two patients with sepsis diagnosed and treated in Tianjin First Central Hospital from June 2018 to April 2021 were selected as the research objects, and included in the sepsis group were 46 males and 26 females, aged 68 (57.3, 80.3) years. In addition, 111 patients with local infection admitted to hospital during the same period were included in the local infection group, including 62 males and 49 females, aged 68 (51, 77) years. Sepsis patients were divided into survival group (43 cases) and death group (29 cases) according to the 28-day outcome. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry within 24 h after admission, PCT was detected by ELISA, CRP was detected by immunoturbidimetry, blood routine examination, blood lactic acid (Lac) and oxygen partial pressure (PO2) were detected by instrumental method. Multivariate Logistic regression analysis was used to evaluate the correlation between each indicator and sepsis, and receiver operating characteristic curve (ROC) was drawn to evaluate the diagnostic value of each indicator for sepsis. Multivariate Logistic regression analysis and Kaplan Meier survival analysis were used to evaluate the prognostic value of each index for patients with sepsis. Results: Peripheral blood CD3+, CD4+, CD8+, CD4+/CD8+ ratio and PLT in sepsis group were significantly lower than those in local infection group(Z=-8.184,P<0.001;Z=-7.210,P<0.001;Z=-5.936,P<0.001;Z=-2.700,P=0.007;Z=-6.381,P<0.001); PCT, CRP, NLR and Lac levels were significantly higher than those in local infection group(Z=-8.262,P<0.001;Z=-3.094,P=0.002;Z=-9.004,P<0.001;Z=-4.770,P<0.001). Multivariate Logistic regression model showed that PCT, NLR, CD3+, CD8+, CD4+/CD8+ were independent risk factors for sepsis. According to ROC curve analysis, AUC of sepsis patients diagnosed by each indicator were 0.862, 0.894, 0.858, 0.760 and 0.618, respectively. The cut-off values were 3.075 ng/ml, 10.715, 44.935×109/L, 27.463×109/L and 0.750, respectively. The NLR sensitivity was 80.6%, and the CD3+ specificity was 94.6%. The AUC of combined detection of PCT and NLR was 0.947, sensitivity was 87.5% and specificity was 91.9%. The combined detection AUC of PCT, NLR, CD3+, CD4+/CD8+ was 0.958, the sensitivity and specificity were 90.3% and 91.0% respectively(P<0.001). PCT and Lac in death group were significantly higher than those in survival group(Z=-2.302,P=0.021;Z=-3.095,P=0.002);Peripheral blood CD4+/CD8+ levels were significantly lower than those in survival group(Z=-3.691,P<0.001),Multivariate Logistic regression model showed that CD4+/CD8+ ratio was an independent risk factor for 28 d mortality in patients with sepsis (P<0.001). The ROC curve showed that the AUC was 0.758, and the Youden index reached the maximum when the cut-off value was 1.27, the sensitivity and specificity were 79.3% and 60.5%, respectively. Compared with patients with CD4+/CD8+ ≥1.27, 28-day mortality was significantly increased in patients with CD4+/CD8+<1.27 (P=0.032). Conclusion: The combined detection of PCT, NLR, CD3+ and CD4+/CD8+ can improve the auxiliary diagnostic efficiency of sepsis, and the ratio of CD4+/CD8+ in peripheral blood may have certain predictive value for the prognosis of sepsis.

Perioperative nebulization of ipratropium bromide in patients with chronic obstructive pulmonary disease under thoracic surgery: A randomized, double-blind, placebo-controlled, parallel-group, multi-centre trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of perioperative nebulization of ipratropium bromide on preoperative pulmonary function and incidence of postoperative pulmonary complications as well as safety in chronic obstructive pulmonary disease (COPD) patients who underwent lung resection in thoracic surgery. Methods    During November 18, 2013 to August 12, 2015, 192 COPD patients with a necessity of selective surgical procedures of lobectomy or right bilobectomy or segmentectomy under general anaesthesia in 10 centers were 1 : 1 randomized to an ipratropium bromide group (96 patients) and a placebo group (96 patients), to compare the effect on preoperative pulmonary function and incidence of postoperative pulmonary complications. The average age of treated patients was 62.90±6.50 years, with 168 male patients and 22 female patients. Results     The demographic and baseline characteristics were well-balanced between the two groups. The adjusted mean increase of forced expiratory volume in one second (FEV1) in the ipratropium bromide group was significantly higher than that in the placebo group (169.90±29.07 mL vs. 15.00±29.35 mL, P<0.05). The perioperative use of ipratropium bromide significantly decreased incidence of postoperative pneumonia (2.6% vs. 14.1%, P<0.05). There was no ipratropium bromide related adverse event (AE) observed in this trial. Conclusion    This trial indicates that perioperative nebulization of ipratropium bromide significantly improves preoperative lung function and reduces postoperative pneumonia in COPD patients undergoing lung resection in thoracic surgery, and has good safety profile.

Study on the health and self-efficacy of pregnant women in delivery with music analgesia and labor doula / Estudo sobre a saúde e autoeficácia de gestantes no parto com analgesia induzida por música e apoio de doula / Efectos del parto en la salud y la autoestima de la mujer embarazada

ABSTRACT To explore the effect of delivery supported by a labor doula combined with music therapy on stabilizing maternal psychology and improving delivery quality, and to find out the predictors of delivery self-efficacy. Statistical processing showed that P<0.05, which was statistically significant. Group was superior in numerical value, followed by the B group. Using the rank sum test, the pain grade of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P<0.05). T test or χ2 test showed that the total labor time of the experimental group was shorter than that of the control group. Vaginal delivery rate was higher than that of the control group, and the cesarean section rate was lower than that of the control group, and the difference was statistically significant (P<0.05). Conclusion: Doula delivery combined with music therapy is effective in parturient delivery, which can alleviate parturient pain, speed up labor progress and improve delivery quality, and is worthy of popularization and application. At the same time, increasing pregnant women's understanding of delivery strategies and techniques and improving their psychological state will help improve the level of delivery self-efficacy of pregnant women.

RESUMO Explorar o efeito do parto apoiado por doulas combinado com a terapia musical em estabilizar o estado psicológico materno e melhorar a qualidade do parto, e descobrir os indicadores de autoeficácia do parto. O processamento estatístico mostrou que P<0.05, o que foi estatisticamente significativo. O Grupo foi superior em valor numérico, seguido pelo Grupo B. Por meio do teste da soma dos ranks, o grau de dor do grupo experimental foi significativamente menor do que o do grupo controle, e a diferença foi estatisticamente significativa (P<0.05). O teste de T ou teste de χ2 mostrou que o tempo de trabalho de parto total do grupo experimental foi mais curto do que o do grupo controle. A taxa de parto normal foi maior do que a do grupo, e a taxa de cesariana foi menor do que a do grupo controle, e a diferença foi estatisticamente significativa (P<0.05). Conclusão: O parto feito com doulas combinado com a terapia musical é eficaz para a parturiente, podendo aliviar a dor do parto, acelerar o trabalho de parto e melhorar a qualidade do parto, merecendo maior popularização e aplicação. Ao mesmo tempo, aumentar a compreensão das gestantes sobre estratégias e técnicas de parto e melhorar seu estado psicológico ajudará a melhorar o nível de autoeficácia do parto dessas mulheres.

RESUMEN Explorar el efecto del parto apoyado por una doula combinado con musicoterapia para estabilizar el estado psicológico materno, mejorar la calidad del parto, y descubrir los predictores de la autoeficacia del mismo. El procesamiento estadístico mostró P <0.05, lo que fue estadísticamente significativo. El grupo fue superior en valor numérico, seguido por el grupo B. Usando la prueba de la suma de rangos, el grado de dolor del grupo experimental fue significativamente más bajo que el del grupo de control, y la diferencia fue estadísticamente significativa (P <0.05). La prueba T o la prueba χ2 mostraron que el tiempo total de trabajo del grupo experimental fue más corto que el del grupo de control. La tasa de parto vaginal fue mayor que la del grupo de control, y la tasa de cesáreas fue menor que la del grupo de control, y la diferencia fue estadísticamente significativa (P <0.05). Conclusión: El parto con doulas combinado con musicoterapia es eficaz, puede aliviar el dolor de las parturientas, acelerar el progreso del parto y mejorar la calidad del mismo, y es digno de popularización y aplicación. Al mismo tiempo, aumentar la comprensión de las mujeres embarazadas sobre las estrategias y técnicas de parto y mejorar su estado psicológico ayudará a mejorar el nivel de autoeficacia del parto de las mujeres embarazadas.

A Human Case of Lumbosacral Canal Sparganosis in China

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People’s Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1-S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1-S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study.

Determination of seven polycyclic aromatic hydrocarbons in water by dispersive liquid-liquid microextraction based on solidification of floating organic droplet with gas chromatography-mass spectrometry / 上海预防医学

Objective To develop a new method for the simultaneous determination of seven polycyclic aromatic hydrocarbons(PAHs)in water by dispersive liquid-liquid microextraction based on solidification of floating organic droplet(DLLME-SFO)with gas chromatography-mass spectrometry(GC-MS). Methods The experimental conditions of DLLME-SFO were determined with dodecanol as extractant solvent, methanol as dispersive solvent, inonic strength increased by adding 8% NaCl. After vortexed for 1 min and centrifuged at 4 000 r/min for 5 min, the water sample was cooled down in an ice bath till dodecanol became solid and formed a small ball. Then the solidified dodecanol phase was transferred, and directly detected by GC-MS method after it melted. Results Good linearities were obtained for the seven polycyclic aromatic hydrocarbons within the range of 5 μg/L-200 μg/L. The correlation coefficients were above 0.996. The detection limits ranged from 1.6 ng/L to 3.2 ng/L. The average recoveries ranged from 86.2% to 105% and the RSDs from 3.8% to 9.4%. Conclusion The method is sensitive, fast and simple. It has the advantage of little organic solvent consumption, which is friendly to environment and suitable for the detection of seven PAHs in water.

Research progress on Er: YAG lasers applied for tooth bleaching / 口腔疾病防治

@#Er: YAG laser bleaching is a new tooth bleaching method compared with traditional bleaching technology. The Er: YAG laser significantly improves the bleaching efficiency, has the advantages of high safety, short treatment time and excellent bleaching effect and is widely used in clinical operations. This paper summarizes the working principle and bleaching characteristics of Er: YAG laser bleaching technology and its effect on tooth structure. The existing literature suggests that the high absorption of water and hydroxyapatite by the Er: YAG laser makes it work well on water-bearing tissues and dental tissues. When it is absorbed by the bleaching agent on the tooth surface, it accelerates the catalytic oxidation-reduction reaction and selectively acts on the pigment particles deposited on the tooth, thereby achieving the effect of tooth bleaching. Er: YAG laser bleaching can be applied to most discolored teeth. The bleaching process is rapid and effective. During the bleaching process, for the dental pulp tissue, the temperature of the pulp cavity is lower than the critical value of 5.6 ℃, causing no pathological damage to the dental pulp tissue. For the hard tissues of the teeth, laser irradiation will cause changes in the chemical composition of calcium and phosphorus. The enamel presents a unique lava-like shape, and the bonding strength of the tooth increases after bleaching. Compared with other lasers, the Er: YAG laser has a wavelength close to the peak of water, and adding other ingredients to the bleaching agent is not required. Almost all the energy is used for the bleaching agent, with no damage to the surrounding tissues.

GLGZD improves cerebral ischemia-reperfusion injury in rats by inhibiting microglial activation / 中国药理学通报

Aim To study whether GLGZD exerts brain protection by affecting the activation of cortical microglia in cerebral ischemia-reperfusion rats. Methods The nylon thread plug was used to establish the MCAO model. After GLGZD treatment for seven days, mNSS was used to evaluate the neurological function of each group of rats, MRI to detect cerebral infarction volume in rats, TUNEL to detect the apoptotic rate of nerve cells, immunohistochemistry to detect TNF-α protein expression in ischemic cortical brain tissues, and RT-qPCR to detect mRNA expression of neuron-microglia interaction-related factors TWEAK, Fnl4, NIK, Rel B, CCL21, CXCR3 and microglial activation marker IBA-1 in ischemic cortical brain tissues. Results GL-GZD could significantly improve the neurological function of MCAO rats, and markedly reduce the infarct volume and apoptosis of ischemic cortical neurons in MCAO rats. It also could significantly down-regulate the expressions of TNF-a protein and TWEAK, Fnl4, NIK, Rel B, CCL21, CXCR3 and IBA-1 mRNA in ischemic cortex of MCAO rats. Conclusions GLGZD can significantly improve cerebral ischemia-reperfusion injury in rats, which may be related to inhibition of microglial cell activation by affecting TWEAK/Fn14/ CCL21/CXCR3 signaling pathway.

Advances in Studies on Plants of Trollius / 中国实验方剂学杂志

There are 16 species and 7 varieties of medicinal plants of Trollius in China, with effects in clearing heat, detoxification and swelling, they are used for the treatment of acute and chronic tonsillitis, acute otitis media, chronic bronchitis and urinary tract infections. Through retrieval of literatures on nasturtium from 1972 to 2019 in a number of databases, such as CNKI, Wanfang Database, Baidu Academic and PubMed, the cultivation and quality control methods, extraction and purification processes, chemical composition, pharmacological effects, pharmacokinetics and metabolism of medicinal plants of the genus nasturtium were summarized. The researches of cultivation mainly focus on the establishment of seed treatment and tissue culture system. Quality control is mainly based on orientin and flavonoids. Research on extraction and purification technology mainly focused on the extraction and purification of total flavonoids. In terms of chemical composition, there are currently more than 100 major compounds isolated from this genus, including flavonoids, organic acids, alkaloids, coumarins and styrenes. Among them, there are 80 flavonoids, 12 organic acid monomers, 3 alkaloid monomers, 4 coumarin monomers and 14 styrene monomers. In terms of pharmacological action, there are mainly in vitro experiments of crude extracts of medicinal materials. The data of pharmacokinetics and metabolism mainly focus on the study of flavone monomers.

Persistence of rabies antibody 3 years after postexposure prophylaxis with 2-1-1 regimen of Vero-cell rabies vaccine for human use and antibody response to two booster doses / 中华疾病控制杂志

Objective To evaluate the antibody persistence following rabies postexposure prophylaxis (PEP) with 2-1-1 regimen and antibody response to two booster doses. Methods A total of 314 healthy volunteers at year 1, year 2, year 3 who had received a complete rabies PEP using 2-1-1 regimen were recruited. Two booster doses of rabies vaccine were inoculated, and blood samples were obtained before and 14 days after two booster doses. Human rabies virus IgG antibody was evaluated by ELISA, and the antibody levels and antibody positive rates were analyzed. Results The antibody GMC of 303 people at year 1, year 2, year 3 after a complete immunization was 1.33 IU/mL, 1.04 IU/mL and 0.72 IU/mL, with an antibody positive rate of 77.78%, 66.67% and 55.56%, respectively. Among 282 people who received 2 doses for booster immunization, the antibody GMC at day 14 of 1 year, 2 year and 3 year immunization group was 16.83 IU/mL, 19.37 IU/mL and 21.05 IU/mL respectively, which was higher than that before booster immunization (t=16.54, P<0.001; t=13.85, P<0.001; t=16.02, P<0.001). The antibody positive rate was 100.00%, 99.00% and 100.00%, respectively. Conclusions The immune persistence of rabies antibody after PEP with antirabies vaccine using the 2-1-1 regimen is good so as to the immune response after 2 doses of booster immunization in 3 years is effective.

needling technique for diabetic fundus hemorrhage / 中国针灸

OBJECTIVE@#To observe the clinical effect of ' -- needling technique for diabetic fundus hemorrhage.@*METHODS@#With before-after study design, 34 patients with diabetic eyeground hemorrhage were treated with basic treatment (oral administration of antidiabetic medication or insulin injections to ensure blood glucose in the normal range); in addition, acupuncture was given at bilateral Fengchi (GB 20), Taiyang (EX-HN 5), Jingming (BL 1), Cuanzhu (BL 2), Sanyinjiao (SP 6) and Hegu (LI 4). The ' -- needling technique was applied at Fengchi (GB 20); the heat reinforcing needling technique was applied at Taiyang (EX-HN 5); the slow needle insertion technique was applied at Jingming (BL 1); and the - needling technique was applied at Cuanzhu (BL 2); the neutral supplementation and draining method was applied at remaining acupoints. The acupuncture was given once a day, 6 times as one course, and totally 4 courses were given with an interval of 1 day between courses. The follow-up visit was 6 months after treatment. The TCM symptom scores, fundus examination results and vision improvement were observed before and after treatment, and the effect was observed.@*RESULTS@#Compared before treatment, the visual acuity, TCM symptom scores, fundus microaneurysm and hemorrhage points in 34 patients (68 eyes) were significantly improved after treatment (0.05).@*CONCLUSION@#' -- needling technique could improve symptoms, promote the absorption of fundus hemorrhage, and improve vision in patients with diabetic fundus hemorrhage.

Group B streptococcus colonization in pregnant women and group B streptococcus infection in their preterm infants / 中国当代儿科杂志

OBJECTIVE@#To study the incidences of group B streptococcus (GBS) colonization in pregnant women and GBS infection in their preterm infants, and to investigate the risk factors for GBS colonization in preterm infants.@*METHODS@#A total of 859 women who delivered before term from January 2017 to January 2018 were enrolled in this prospective cohort study. Bacterial culture was performed for GBS using the swabs collected from the rectum and the lower 1/3 of the vagina of the pregnant women on admission. A total of 515 of the above cases underwent real-time PCR assay for testing of GBS DNA. Bacterial culture was performed for GBS using the oropharyngeal secretion, gastric fluid or blood samples in preterm infants born to the 859 pregnant women. Peripheral blood samples from the pregnant women and umbilical cord blood samples from their preterm infants were collected to determine the level of anti-GBS capsular polysaccharide antibody. The incidence of GBS infection and perinatal risk factors for GBS colonization in the preterm infants were examined.@*RESULTS@#The positive rate for GBS in the rectal and vaginal cultures was 14.8% (127/859) among the 859 pregnant women, and the positive rate in the GBS DNA testing was 15.1% (78/515). There were 976 live-birth preterm infants delivered by 859 pregnant women, and 4.4% (43/976) of whom were GBS positive. Four preterm infants had early-onset GBS diseases, including pneumonia in two cases and sepsis in two cases. In 127 preterm infants delivered by 127 GBS-positive pregnant women, the preterm infant group with a gestational age between 34 and 37 weeks had a significantly lower GBS positive rate and a significantly higher level of anti-GBS capsular polysaccharide antibody compared with the preterm infant group with a gestational age of less than 34 weeks (P=0.013 and 0.001 respectively). A multivariate logistic regression analysis revealed that premature rupture of membranes time >18 hours and chorioamnionitis were independent risk factors for GBS colonization in preterm infants (OR=6.556 and 6.160 respectively; P18 hours and chorioamnionitis may increase the risk of GBS colonization in preterm infants.

Application of standardized patient combined with formative assessment in pediatric teaching / 中国实用儿科杂志

Due to pediatric patients,there are the absence of clinical cases and the conflict between physicians and patients during teaching. Formative assessment(FA)is a teaching method to provide feedback and correctives at each stage in the teaching-learning process,which has been applied in clinical training for medical students and resident standardizing training recent years. Standardized patient(SP)is a simulated teaching tool,and when SPs are introduced in formative assessment by applied to history taking,patient education and counseling and communication skills. The combination not only solves the scarcity of clinical cases,but avoids doctor-patient contradiction. Therefore,SPs provide a broader application prospect for formative assessment. In fact,the combination offers new ideas for pediatric teaching.

Bone Metabolic Markers in Patients with Obstructive Sleep Apnea Syndrome / 中华医学杂志(英文版)

Background@#Obstructive sleep apnea syndrome (OSAS) is prevalent in obesity and is associated with many metabolic abnormalities. The relationship between OSAS and bone metabolism is still unclear. The aim of this study was to investigate the relationship between the severity of OSAS and bone metabolic markers.@*Methods@#A total of 119 obese males were enrolled in this study in spring months from 2015 to 2017. All candidates underwent polysomnography, and their bone mineral density (BMD) and the serum levels of total procollagen type 1 N-terminal propeptide (t-P1NP), N-terminal midfragment of osteocalcin (N-MID), β-C-terminal telopeptide of type 1 collagen (β-CTX), vitamin D (VD), and parathyroid hormone (PTH) were measured. The analysis of variance and Pearson correlation analysis were performed for data analyses.@*Results@#No significant differences in the mean values of BMD were observed among the obesity, mild-to-moderate OSAS, and severe OSAS groups; and the serum levels of t-P1NP and β-CTX in the severe OSAS group were significantly higher than those in the obesity group (48.42 ± 23.78 ng/ml vs. 31.98 ± 9.85 ng/ml, P < 0.001; 0.53 ± 0.24 ng/ml vs. 0.41 ± 0.13 ng/ml, P = 0.011, respectively). The serum level of VD in the obesity group was significantly higher than those in the mild-to-moderate and severe OSAS groups (both P < 0.001), and decreased as the severity of OSAS increased (P < 0.001). The serum level of PTH in the severe OSAS group was significantly higher than those in the obesity and mild-to-moderate OSAS groups (both P < 0.001). The results of correlation analysis indicated that the level of apnea-hypopnea index (AHI) was correlated with the levels of t-P1NP (r = 0.396, P < 0.001), VD (r = -0.404, P < 0.001), and PTH (r = 0.400, P < 0.001), whereas the level of minimum Osaturation (SaOmin) was correlated with the levels of VD (r = 0.258, P = 0.016) and PTH (r = -0.376, P < 0.001).@*Conclusions@#The levels of bone resorption and formation markers in patients with severe OSAS were significantly increased compared to obese men, and the severity of OSAS was correlated with the serum levels of t-P1NP, VD, and PTH.

Three-dimensional finite element analysis on stress distribution after greater trochanter bone flap for treating osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND: Three-dimensional finite element analysis has been used by many scholars from department of orthopedics, but the results of postoperative evaluation of hip preserving treatment for osteonecrosis of femoral head are different. OBJECTIVE: To study the biomechanical changes of the femoral head and the biomechanical changes of the proximal femur after greater trochanter bone flap for the treatment of femoral head necrosis using three-dimensional finite element method, and to verify the mechanical safety and effectiveness. METHODS: One case of unilateral femoral head necrosis in ARCOIII stage undergoing parallel vascularized greater trochanter bone flap transplantation was selected. Computed Tomography data of proximal femur were collected before and 6 months after the operation, and preserved in DICOM format. With the aid of computer technology, professional medical modeling software, MIMICS and HYPERMESH, were used to establish the three-dimensional geometric models of the proximal femur. These models were divided into normal group, necrosis group and repair group. Finite element analysis software ANSYS was utilized to simulate human body standing and movement in different situations. The model was divided by free mesh, and given material parameters to establish normal proximal femur, femoral head necrosis and bone defect. Greater trochanter bone flap was applied in repairing three-dimensional finite element model of bone defect. Loads were loaded on different finite element models. The maximum displacement of the femoral head and the stress distribution in the proximal femur of the three groups were observed under different loading models. RESULTS AND CONCLUSION: (1) Under the same load, the maximum displacement of the three sets of models was 0.61 mm in the normal group, 0.66 mm in the necrosis group, and 0.61 mm in the repair group, respectively. Maximum Von Mises stress was greater in necrosis model than in the normal molding. The maximum Von Mises stress gradually decreased in the repair model, and was close to normal value. (2) Three groups of models showed stress concentration above the rotor in femoral neck region. The maximum stress in the trochanteric position was higher in necrosis models than in normal models. The maximum stress in this region gradually increased after repair, but was still lower than the failure stress of bone. (3) The results confirm that the maximum stress and the maximum displacement are closer to the normal value after greater trochanter bone flap for treatment of osteonecrosis of the femoral head. The greater trochanter is safe and reliable for repairing bone defect of femoral head.

Design for a phase Ⅳ study on perioperative intervention with nebulized ipratropium bromide in Chinese patients with chronic obstructive pulmonary disease / 中华胸心血管外科杂志

Owing to the increasing morbidity and pulmonary infection,management of pulmonary function has become an important problem for COPD patients who undergo surgery.Surgical patient with respiratory disease such as COPD has declined lung function before operation,then increased the risk of post-operative pulmonary complications.Ipratropium bromide can significantly improve pulmonary function.Therefore,we hypothesis the treatment with nebulized ipratropium bromide will benefit the perioperative patients with COPD.A randomized,double-blind,placebo-controlled,parallel-group,multi-center trial (Ipratropium bromide in Peri-Operative COPD study,IPO-COPD study)has been conducted to evaluate the efficacy and safety of nebulized ipratropium bromide in Chinese perioperative patients with COPD under general anaesthesia.A total of 192 COPD patients who satisfied the eligibility criteria were randomly assigned(1∶1) to one of the two treatment groups(ipratropium bromide 500 μg or normal saline 4 ml) for 11 days.Measurements will include the change of the forced expiratory volume in 1 second(FEV1),the forced vital capacity(FVC),blood gas analyses and main post-operative pulmonary complications.

Scleral buckling surgery for the repair of binocular combined retinoschisis and retinal detachment: a case report

Congenital retinoschisis is an uncommon ocular disorder, and combined retinoschisis and retinal detachment is rarer. Here, we report a case of binocular combined retinoschisis and retinal detachment in a 34-year-old male. We reattached the detached retina through scleral buckling. No recurrence of retinal detachment was found in each follow-up visit until the present. The satisfactory results of scleral buckling surgery for the repair of combined retinoschisis and retinal detachment indicate that this kind of patients can have the same surgery as those with ordinary rhegmatogenous retinal detachment