Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine（Part 5）： Retrieval and Synthesis of Key Information on Rational Drug Use / 中医杂志

Recommendations for Chinese patent medicine （CPM） based on key information on rational drug use are one of the important conditions for enhancing guideline enforceability as well as facilitating guideline implementation. In this study， we discussed in detail of the key information on the rational use of CPM in five aspects， which are dosage， drug discontinuation， drug-drug and drug-food interactions， safety and economy. Following the process of multi-source search， synthesis and prioritization， it is suggested to collect key information on the rational use of CPM from a multi-source search of drug instructions， policy documents， literature， and clinical experts' experiences. Then the searched information should be summarized and prioritized with the principle that taking drug instructions as the basis and other-sources information for check and supplementation. Finally， methodological recommendations for the retrieval and synthesis of key information on rational drug use in guideline recommendations has been formed.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine： 2.Establishment of Guideline Working Group and Management of Conflict of Interests / 中医杂志

This paper summarized the key points and methods in terms of the establishment of the guideline working group and the management of conflict of interests， trying to provide reference for the development of clinical practice guidelines for Chinese patent medicine （CPM）. The establishment of the working group is the first important step for developing CPM guidelines. Considering the characteristics of the clinical practice guidelines for CPM， this study suggests that the three key elements of ‘multidisciplinarity’， ‘clinical relevance’ and ‘geographical representativeness’ should be put focus on when forming the working group. The guideline advisory committee， clinical expert group， evidence systematic evaluation group， secretary group and the external review group should be established. All group members should clarify the conflict of interest， and the process and management method of the conflict of interest should be clearly reported.

Etiology and prognostic factors of necrotizing enterocolitis in infants after neonatal period with hematochezia / 中国小儿急救医学

Objective:To analyze the etiology and prognostic factors of necrotizing enterocolitis(NEC) in infants after neonatal period with hematochezia.Methods:The clinical data of 62 infants older than 28 days with NEC and hematochezia diagnosed at Beijing Children′s Hospital, Capital Medical University from January 2016 to December 2021 were retrospectively analyzed, summarizing the etiology of NEC in this age group and analyze the factors affecting the prognosis of NEC.According to IgE detection results of food allergens, the infants were divided into milk protein positive group and milk protein negative group.According to the absolute value level of peripheral blood eosinophils, they were divided into increased eosinophils group(≥0.5×10 9/L) and normal eosinophils group(<0.5×10 9/L). They were divided into three groups according to co-infection: NEC group(no co-infection), NEC+ clostridium difficile associated diarrhea(CDAD) group, and NEC+ other infection group(salmonella infection or sepsis). According to different feeding methods, they were divided into normal amino acid group(osmotic pressure 310 mOsm/L), diluted amino acid group(osmotic pressure 233 mOsm/L), and deep hydrolysis group(osmotic pressure 185 mOsm/L). The relief time of clinical symptoms, the recovery time of intestinal gas accumulation, feeding time to achieve physiological requirements, and the length of hospital stay in each group were compared. Results:Among 62 cases, there were 27 males and 35 females.The median age of onset was 1.4(1.2, 2.3) months.The median birth weight was 3.2(2.9, 3.4)kg.Full-term infants accounted for 87.1%.Cesarean accounted for 62.9%.Fifty-three patients(85.5%)had allergic symptoms.Thirteen patients(21.0%)had family history of allergy.Cow milk protein allergy was diagnosed in 29 cases.Thirty-two cases(51.6%) had elevated peripheral blood eosinophils.The hospitalization time of milk protein positive group was longer than that of negative group( P=0.047). The clinical remission rate after hypoallergenic formula feeding for 1 day of increased eosinophils group was higher than that of normal eosinophil group(100.0% vs.65.0%, P=0.002). Ten patients(16.1%)were complicated with clostridium difficile infection, two patients(3.2%) with salmonella enteritis, and four patients(6.5%) with sepsis.Both the hospital stay and feeding time to achieve physiological requirements of NEC+ other infection group were longer than the other two groups( P<0.05). NEC+ CDAD group had a higher rate of repeated hospitalizations(40.0%, P=0.004). The mean recovery time of intestinal gas accumulation was(4.5±2.9)days.After(3.9±3.0)days, hypoallergenic formula feeding started.After one day of feeding, the clinical remission rate was 79.0%.The average time to achieve physiological requirements was(5.8±3.2)days.The clinical symptom relief time of diluted amino acid group was shorter( P=0.006), but there was no statistical difference in feeding time to achieve physiological requirements and hospitalization time between each group( P>0.05). Conclusion:Cow′s milk protein allergy and infection(especially CDAD)are closely related to the occurrence and development of NEC after neonatal period with hematochezia.The administration of diluted amino acid-based formulae close to the osmotic pressure of breast milk and targeted anti-infective therapy could shorten the clinical remission time of NEC and reduce the risk of repeated hospitalization.

Analysis of influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on two models / 中国实用护理杂志

Objective:To analyze the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization based on Logistic regression model and decision tree model.Methods:This was a cross-sectional study. A total of 236 patients with primary liver cancer after transarterial chemoembolization in The Second Affiliated Hospital of Air Force Military Medical University from March 2021 to June 2022 were conveniently selected as the research subjects. The factors related to delayed nausea and vomiting were collected, and Logistic regression and decision tree models were established, respectively, and the differences between the two models were compared.Results:The incidence of delayed nausea and vomiting of patients with primary liver cancer after transarterial chemoembolization was 45.34% (107/236). Logistic regression model showed that age, anxiety, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization(all P<0.05). Decision tree model showed that age, sleep disorder, emetic risk level of chemotherapeutic drugs, embolic agent type, and pain 24 hours after surgery were the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization (all P<0.05). The classification accuracy rates of Logistic regression, decision tree model and combined diagnosis of two models were 72.9%, 71.2% and 72.0% respectively; the areas under the ROC curve were 0.778, 0.781 and 0.806 respectively, with no significant difference (all P>0.05). Conclusions:The analysis results of Logistic regression and decision tree model on the influencing factors of delayed nausea and vomiting in patients with primary liver cancer after transarterial chemoembolization are highly consistent, which can be combined to provide a more comprehensive reference for the evaluation and intervention of medical staff.

Multidisciplinary management and follow-up study of Alagille syndrome / 国际儿科学杂志

Objective:To explore the multidisciplinary management that centred on gastroenterology department, and follow-up study of children with Alagille syndrome(ALGS).Methods:The clinical data of 19 children diagnosed with ALGS in Pediatric Gastroenterology Department, Shengjing Hospital of China Medical University since June 2013 to December 2022 was retrospectively analyzed, and the clinical manifestations of various systems of the body were followed up and evaluated, and then developed the personalised management strategies.Results:Among the 19 confirmed patients, 18 cases were confirmed by genetic testing.Eighteen cases(94.7%) had characteristic facial features.To follow-up node, 8 cases(42.1%) had cholestasis, with alanine aminotransferase(210.20±110.50)U/L, aspartate aminotransferase(187.86±96.70)U/L, and direct bilirubin(110.93±108.15)μmol/L.Eighteen cases(94.7%) had pruritus.Eighteen cases(94.7%) of the patients had a high risk of malnutrition, and the level of total bilirubin[(76.17±107.34)μmol/L] and total bile acid[(100.18±83.78)μmol/L] were significantly increased in the children with obvious growth retardation.Thirteen cases(68.42%) had diffuse liver injury.The clinical opinions on genetic counseling, application of new drugs, liver transplantation, cardiac medicine and surgery follow-up, spine and oral surgery orthodontics were given by multiple disciplines.Conclusion:ALGS children have a high risk of long-term malnutrition and are associated with the severity of liver injury, and pruritus and jaundice are the main clinical manifestations.The management of ALGS patients should be centered around liver disease doctors, combined with multiple disciplines, paying attention to changes in various related organs of ALGS patients, and improving their quality of life.

Analysis on influencing factors on loneliness in the elderly aged 60 and above in China / 中华流行病学杂志

Objective: To analyze the influential factors of loneliness in the elderly aged ≥60 years in China. Methods: Data used in this study were obtained from participants aged ≥60 years from the China Longitudinal Aging Social Survey, with a sample size of 7 593. Loneliness was measured with loneliness scale, and the influence of subjective and objective factors on loneliness and their interaction were analyzed with stepwise linear regression model and simple slope test. SPSS 25.0 was used for statistical analysis. PROCESS 3.3 macro program was used for simple slope test. Results: A total of 8 926 participants were included. Among the objective factors, the elderly with poor family network have a higher level of loneliness (P<0.05), and community provision of elderly care services could reduce the loneliness of the elderly (P<0.05). Elderly people with subjective aging age ≤60 years old and poor social adaptation and emotional perception have higher levels of loneliness (all P<0.05). Subjective aging age plays a negative regulatory role in the impact of community elderly care services on loneliness (P<0.05), Social adaptation and emotional perception play a negative regulatory role in the impact of family network on loneliness (P<0.05). Conclusions: Elderly people aged ≥60 years of feeling of loneliness was affected by both subjective and objective factors and subjective factors play an important regulatory role in the influence of objective factors on elderly people's feeling of loneliness in China. Therefore, while creating a good aging environment to provide strong external support for the elderly, the subjective initiative of the elderly should also be fully mobilized, to alleviate the loneliness of the elderly from these two aspects.

Application of four intraocular lens calculation formulas in patients with super-high myopia complicated with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the accuracy of SRK/T, Haigis, Barrett Universal II and Wang-Koch modified SRK/T formula in the operation of cataract complicated by super-high myopia.METHODS: A total of 44 cases(52 eyes)with super-high myopia complicated with cataract who underwent phacoemulsification with tension ring implantation combined with intraocular lens implantation in our hospital from January 2020 to June 2021 were collected. SRK/T, Haigis, Barrett Universal Ⅱ formula and Wang-Koch modified SRK/T formula were used to calculate the postoperative reserved diopter before surgery, and the actual diopter was measured by comprehensive optometry at 3mo after surgery. The mean absolute refractive error(MAE)of four formulas was obtained to evaluate the accuracy of the calculation formula.RESULTS: The MAE of SRK/T formula, Haigis formula, Barrett Universal Ⅱ formula and Wang-Koch modified SRK/T formula were 0.86(0.56, 1.20), 0.79(0.56, 1.16), 0.68(0.30, 0.87), 0.65(0.43, 0.75)D, respectively, and MAE of SRK/T formula and Haigis formula were significantly higher than those of Barrett Universal Ⅱ formula and Wang-Koch modified SRK/T formula(P<0.01). According to preoperative corneal curvature(K), enrolled patients were divided into K >46D group(12 eyes), 44D< K ≤46D group(24 eyes), and K ≤44D group(16 eyes). The MAE of SRK/T formula and Haigis formula were significantly higher than those of Barrett Universal Ⅱ formula and Wang-Koch modified SRK/T formula in the three groups(P<0.01). According to preoperative axial length(AL), patients were divided into AL ≤30 mm group(24 eyes)and AL >30mm group(28 eyes). The MAE of SRK/T formula and Haigis formula in two groups were significantly higher than those of Barrett Universal Ⅱ formula and Wang-Koch modified SRK/T formula(P<0.05).CONCLUSIONS: Wang-Koch modified SRK/T formula and Barrett Universal Ⅱ formula are more accurate in predicting the degree of intraocular lens in patients with super-high myopia complicated with cataract.

Acupuncture-Neuroimaging Research Trends over Past Two Decades: A Bibliometric Analysis / 中国结合医学杂志

OBJECTIVE@#To identify topics attracting growing research attention as well as frontier trends of acupuncture-neuroimaging research over the past two decades.@*METHODS@#This paper reviewed data in the published literature on acupuncture neuroimaging from 2000 to 2020, which was retrieved from the Web of Science database. CiteSpace was used to analyze the publication years, countries, institutions, authors, keywords, co-citation of authors, journals, and references.@*RESULTS@#A total of 981 publications were included in the final review. The number of publications has increased in the recent 20 years accompanied by some fluctuations. Notably, the most productive country was China, while Harvard University ranked first among institutions in this field. The most productive author was Tian J with the highest number of articles (50), whereas the most co-cited author was Hui KKS (325). Evidence-Based Complementary and Alternative Medicine (92) was the most prolific journal, while Neuroimage was the most co-cited journal (538). An article written by Hui KKS (2005) exhibited the highest co-citation number (112). The keywords "acupuncture" (475) and "electroacupuncture" (0.10) had the highest frequency and centrality, respectively. Functional magnetic resonance imaging (fMRI) ranked first with the highest citation burst (6.76).@*CONCLUSION@#The most active research topics in the field of acupuncture-neuroimaging over the past two decades included research type, acupoint specificity, neuroimaging methods, brain regions, acupuncture modality, acupoint specificity, diseases and symptoms treated, and research type. Whilst research frontier topics were "nerve regeneration", "functional connectivity", "neural regeneration", "brain network", "fMRI" and "manual acupuncture".

Pathological features and immune microenvironment in HER-2 intratumoral heterogeneous breast cancers / 中华肿瘤杂志

Objective: To observe the clinical pathology features, and immune microenvironment of HER-2 intratumoral heterogeneity breast cancer. Methods: Thirty cases of HER-2 intratumoral heterogeneous breast cancer were retrospectively analyzed in Tianjin Medical University Cancer Institute and Hospital from November 2017 to June 2020. HER-2 expression was detected by immunohistochemistry and verified by dual color silver-enhanced in-situ hybridization (D-SISH). HER-2 intratumoral positive and negative regions were divided. The pathological characteristics, subtype, and the level of tumor infiltrating lymphocytes (TILs) and the expression of programmed cell death-ligand 1 (PD-L1) were evaluated respectively. Results: The proportion of HER-2 positive cells of the breast cancer ranged from 10% to 90%. The pathological type was mainly invasive non-special typecarcinoma. Six cases presented different pathological types between HER-2 positive and negative regions. The HER-2-positive areas included 2 cases of carcinoma with apocrine differentiation, and the negative areas included 2 cases of invasive micropapillary carcinoma, 1 case of invasive papillary carcinoma, and 1 case of carcinoma with apocrine differentiation. In HER-2 positive regions, 17 cases were Luminal B and 13 cases were HER-2 overexpressed types. There were 22 cases of Luminal B and 8 cases of triple negative tumors in the HER-2 negative areas. The levels of TILs in HER-2 positive and negative areas accounted for 53.3% (16/30) and 26.7% (8/30), respectively, with a statistically significant difference (P=0.035). The positive expression of PD-L1 in HER-2 positive area and HER-2 negative area were 6 cases and 9 cases, respectively. Among 8 cases with HER-2 negative regions containing triple negative components, 4 cases were positive for PD-L1 expression. Conclusions: In the case of HER-2 intratumoral heterogeneity, it is necessary to pay attention to both HER-2 positive and negative regions, and evaluate subtype separately as far as possible. For HER-2 intratumoral heterogeneous breast cancer containing triple negative components, the treatment mode can be optimized by refining the intratumoral expression of PD-L1.

Advances on associations of exposure to air pollutants during pregnancy with congenital heart disease in offspring / 环境与职业医学

Congenital heart disease (CHD) is the most common birth defect and one of the major causes of neonatal death, with an average prevalence of 9.4‰ worldwide. We reviewed recent epidemiological studies and found that exposure to air pollutants is associated with increased CHD risks, but the associations are inconsistent between exposure to air pollutants and different subtypes of CHD due to developmental and etiological heterogeneity among different subtypes of CHD. It has been reported that air pollutants are associated with increased risks of ventricular septal defect, patent ductus arteriosus, pulmonary stenosis, tetralogy of Fallot, and transposition of the great arteries. However, associations between maternal exposure to air pollutants and atrial septal defect (ASD) are contradictory, with significantly positive associations of inhalable particulate matter and nitrogen dioxide exposure, negative associations of fine particulate matter and carbon monoxide, and mixed associations of sulfur dioxide. Adverse effects of air pollutant on cardiac development cover a wide time window beyond 3-8 weeks during gestation; particulate matter and nitrogen oxide are more likely to affect fetal heart in early pregnancy, while the association strength of carbon monoxide shows a trough in early pregnancy, and sulfur dioxide and ozone affect cardiac health throughout pregnancy. In addition, we discussed the limitations of previous studies on the associations between maternal air pollutant exposure and CHD, and highlighted the application of precise assessment on exposure to air pollutants, the performance of prospective cohort studies and longitudinal studies, and the necessity of studies on CHD subtypes, in order to provide scientific evidence to control exposure to environmental pollutants and CHD occurrence.

Mechanism of Xuanfu Daizhetang in Alleviating Allergic Asthma by Inhibiting Secretion of Inflammatory Factors / 中国实验方剂学杂志

ObjectiveTo investigate the regulatory effects of Xuanfu Daizhetang on a mouse model of allergic asthma induced by ovalbumin （OVA）. MethodSixty female BALB/c mice （6-8 weeks old， SPF） were randomly divided into groups. Ten mice were assigned to the normal group and given 0.2 mL of saline， while the remaining groups received intraperitoneal injections of Al（OH）3 at 5 g·L-1 and OVA at 1 g·L-1. The mice were divided into normal group （10 mL·kg-1 saline）， OVA model group （10 mL·kg-1 saline）， dexamethasone group （OVA+DEX， 1 mg·kg-1）， OVA+ low-dose Xuanfu Daizhetang group （OVA+XL， 7.065 g·kg-1）， OVA+ medium-dose Xuanfu Daizhetang group （OVA+XM， 14.13 g·kg-1）， and OVA+ high-dose Xuanfu Daizhetang group （OVA+XH， 28.26 g·kg-1）. An OVA-induced asthma model was established in mice. Hematoxylin-eosin （HE） and periodic acid-Schiff （PAS） staining methods were used to observe bronchial tissue pathological changes. Enzyme-linked immunosorbent assay （ELISA） was performed to measure the levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， IL-5， IL-13， IL-17A， and γ interferon （IFN-γ） in bronchoalveolar lavage fluid. Western blot was used to detect the phosphorylation of extracellular signal-regulated kinase （ERK）， p38 mitogen-activated protein kinase （MAPK）， and c-Jun N-terminal kinase （JNK） proteins in lung tissue. ResultCompared with the normal group， the OVA model group showed increased inflammatory cell infiltration in mouse alveoli， elevated levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and promoted phosphorylation of MAPK signaling pathway-related proteins. Compared with the model group， the OVA+XL， OVA+XM， and OVA+XH groups showed reduced inflammatory cell infiltration in mouse alveoli， decreased levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and inhibited phosphorylation of MAPK signaling pathway-related proteins. ConclusionThe results of this study suggest that Xuanfu Daizhetang has potential anti-allergic asthma activity， providing a theoretical basis for its future clinical application.

Application of the “virtual-real combination” experimental teaching model in Human Parasitology teaching: a case study of comprehensive schistosome experiments / 中国血吸虫病防治杂志

Information technology has become an important driver to facilitate higher education developments in the context of new medical sciences. A new “virtual-real combination” experimental teaching model was designed and created through integrating information technology with experimental teaching by Experimental Teaching Center of Basic Medical Sciences and Department of Pathogen Biology, Nanjing Medical University and was applied in Human Parasitology teaching, which achieved satisfactory teaching effectiveness. This new model showed effective to deepen the understanding of the basic human parasitology knowledge, improve the operative skills, and cultivate the moral literacy and comprehensive capability among medical students. This report presents the teaching protocols and implementation, teaching effectiveness and evaluation, and experiences of comprehensive schistosome experiments.

Relationship between rs128912 single nucleotide polymorphism in promoter region of Toll-like receptor 3 gene and cataract in Chinese Han population / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the relationship between rs128912 single nucleotide polymorphism(SNP)in the promoter region of Toll-like receptor 3(TLR3)gene and cataract in Chinese Han population.METHODS: A total of 263 patients with cataract admitted to our hospital from June 2019 to June 2021 were selected as study group, and 150 patients with lens dislocation were included in control group. Western blotting was used to detect the expression of TLR3 protein in the anterior capsular tissues of lens in the two groups, and direct sequencing method was applied to analyze the polymorphism of rs128912 locus in the promoter region of TLR3 gene. The expression of peripheral blood TLR3 mRNA of patients with different genotypes was detected by real-time quantitative polymerase chain reaction(RT-qPCR).RESULTS: The expression level of TLR3 protein in the anterior capsular tissues in the study group was higher than that in the control group(P&#x003C;0.05). The frequencies of genotypes(AA, AT, TT)at rs128912 locus in the TLR3 gene promoter region in the study group and the control group were in accordance with Hardy-Weinberg genetic equilibrium, and there were differences in the frequencies of genotypes(AA, AT, TT)and frequencies of alleles(A, T)at rs128912 locus in the TLR3 gene promoter region between both groups(P&#x003C;0.05). The relative expression level of peripheral blood TLR3 mRNA in patients with TT genotype in the study group was higher than that in patients with AA or AT genotypes(P&#x003C;0.05).CONCLUSION: The expression of TLR3 protein in anterior capsular tissues of lens of patients with cataract is significantly up-regulated, and rs128912 locus polymorphism in the TLR3 gene promoter region is related to the susceptibility of cataract in Chinese Han population, and people with TT genotype are more prone to cataract.

Analysis of clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease stage 3-4 / 中华肾脏病杂志

Objective:To explore the clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease (CKD) stage 3-4.Methods:It was a single-center, retrospective observational study. CKD stage 3-4 patients aged ≥60 years old from March 2019 to March 2022 in the Geriatrics Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the study. General data of the patients were collected, and laboratory indicators, muscle strength, physical function and appendicular muscle mass index (ASMI) were measured. According to the diagnostic criteria of sarcopenia, the patients were divided into no sarcopenia CKD group and sarcopenia CKD group. Baseline data between these two groups were compared. Logistic regression analysis was used to analyze the related factors of sarcopenia in elderly CKD stage 3-4 patients.Results:A total of 162 CKD stage 3-4 patients were enrolled in this study, with 89 males (54.9%) and a median age of 75 (69, 82) years. Sarcopenia was diagnosed in 40 cases, and the prevalence was 24.7% (95% CI 18.1%-31.3%). Compared with no sarcopenia CKD group, age, proportion of dementia, cystatin C, urea nitrogen, C-reactive protein (CRP) and ratio of urine protein to creatinine were higher (all P<0.05), while body mass index (BMI), hemoglobin, carbon dioxide combining power, estimated glomerular filtration rate (eGFR), serum albumin and the proportion of regular exercise and using α-ketones were lower in sarcopenia CKD group (all P<0.05). Meanwhile, grip strength, walking speed, short physical performance battery score and ASMI were lower in sarcopenia CKD group (all P<0.05). Multivariable logistic regression analysis results showed that low eGFR ( OR=0.824, 95% CI 0.687-0.987, P=0.036), low BMI ( OR=0.463, 95% CI 0.304-0.704, P<0.001), low serum albumin ( OR=0.459, 95% CI 0.263-0.802, P=0.006) and high CRP ( OR=2.754, 95% CI 1.708-4.439, P<0.001) were the independent related factors of sarcopenia in elderly CKD patients. Conclusions:The prevalence of sarcopenia in elderly CKD stage 3-4 patients is high. Low eGFR, low BMI, low serum albumin and high CRP are the independent risk factors for sarcopenia in elderly CKD stage 3-4 patients.

Influencing factors of learned helplessness in patients with primary liver cancer treated by interventional therapy / 中国实用护理杂志

Objective:To investigate the influencing factors of learned helplessness in patients with primary liver cancer treated by interventional therapy.Methods:This study was a cross-sectional study. The 221 patients with primary liver cancer treated by interventional therapy in the Second Affiliated Hospital of Air Force Military Medical University from August 2020 to October 2021 were selected as the subjects. General data statistics, Learned Helplessness Scale and Support in Intimate Relationships Rating Scale were used for questionnaire survey.Results:The total score of learned helplessness in the 221 patients with primary liver cancer treated by interventional therapy was 74.12 ± 6.55. Gender, education level, family per capita monthly income, number of interventions and perceived spouse support were the main influencing factors of learned helplessness in patients with primary liver cancer treated by interventional therapy (adjusted R2=0.891, F=65.65, P<0.05). Conclusions:The sense of learned helplessness of patients with primary liver cancer treated by interventional therapy is at a high level. According to patients with features of male, lower education level, lower family per capita monthly income, more number of interventional therapy or lower perceived spouse support, medical staff can use dialectical behavior therapy, symptom group intervention, spouse support intervention and other methods to reduce learned helplessness of patients.

Impact of activities of daily living on depression in the elderly aged 60 and above in China / 中华流行病学杂志

Objective: To explore the impact of activities of daily living (ADL) on depression in the elderly and the role of social networks and children's support. Methods: Data used in this study were obtained as participants aged 60 and above from the "China Longitudinal Aging Social Survey 2018",with a sample size of 10 215. ADL, social network and depression were measured on scales. The moderated mediation model was used to analyze the role of social networks and children's support. The SPSS 25.0 software was used for statistical analysis, the PROCESS 3.3 macro program was used to test the moderated mediation effect. Results: A total of 10 760 participants aged 60 and above were included. Activities of daily living showed a direct impact on depression in the elderly (β=-0.090, P<0.01), with social network playing a mediating role (β=0.035, P<0.01; β=-0.064, P<0.05) and children's support played a moderating role (β=-0.029, P<0.05) in the relationship between the elderly's ADL and depression. Conclusions: The social network is an essential buffer to declining ADL's negative impact on depression of older adults. Children's support is a powerful supplement to enhance social networks' positive role and reduce the risk of elderly depression. Exerting the combined advantages of social networks and children's support are important ways to maintain the elderly's mental health.

The clinical value of fluorescence quantitative assay and G6PD/6PGD ratio method in the diagnosis of glucose-6-phosphate dehydrogenase deficiency and gene mutation / 中华检验医学杂志

Objective:To investigate the diagnostic value of fluorescence quantitative method and G6PD/6PGD ratio method in glucose-6-phosphate dehydrogenase (G6PD) deficiency and the type of gene mutation.Methods:A total of 1 201 patients (711 males and 490 females) with suspected G6PD deficiency in Shanghai Children′s Hospital were collected from June 2018 to March 2021. Fluorescence quantification method, G6PD/6PGD ratio method and multicolor melting curve were used to detects enzyme activity, ratio and gene mutation type. Comparison of each index and evaluation of its diagnostic efficiency were performed.Results:Among 1 201 suspicious samples, 163 cases (135 males and 28 females) were finally diagnosed. 156 cases were diagnosed by fluorescence quantitative method with a detection rate of 95.71%, and 140 cases were diagnosed by G6PD/6PGD ratio method with a detection rate of 85.89%. enzymatic activity of G6PD and ratio of G6PD/6PGD in male were significantly lower than female, and the differences were statistically significant ( U=642.5, 734.5, P<0.001). 112 cases received G6PD gene mutation detection and 92 cases were diagnosed, 74 were hemizygous mutations, 1 were homozygous mutations, 15 were heterozygous mutations, and 2 were compound heterozygous mutations. Among 15 cases of heterozygous mutations, 11 cases were diagnosed by fluorescence quantitative method, the diagnosed rate was 73.33%, 4 cases were diagnosed by G6PD/6PGD ratio method, and the diagnosed rate was 26.67%. A total of 7 mutation sites were detected and the proportions were c.1388G>A (32.22%), c.1376G>T (30.00%), c.871G>A (13.33%), c.1024C>T (11.11%). c.95A>G (7.78%), c.487G>A (4.44%), c.392G>T (1.11%). The enzymatic activities of c.1376G>T and c.1024C>T, c.487G>A were statistically significant ( P<0.001,0.015); the G6PD/6PGD ratios of c.1024C>T and c.1388G>A, c.1376G>T were statistically significant ( P=0.017,0.002,0.011,0.013). Fluorescence quantitative method had sensitivity of 100%, specificity of 95.65%, and the area under the curve (AUC) is 0.972. The sensitivity of the G6PD/6PGD ratio method was 100%, the specificity was 94.57%, and the AUC was 0.979. The sensitivity of fluorescence quantitative method combined with G6PD/6PGD ratio was 96.7%, the specificity was 100%, and the AUC was 0.992. Conclusions:Compared with fluorescence quantification, the G6PD/6PGD ratio method might not be able to diagnose female heterozygotes effectively; The panel of G6PD fluorescence quantification and G6PD/6PGD ratio was helpful to reduce the missed diagnosis. Combined with gene mutation analysis, it could improve the diagnosis rate of G6PD deficiency in the children.

Fulminant myocarditis with multiple organ dysfunction treated by extracorporeal life support in ICU: report of 9 adult cases / 中华全科医师杂志

Objective:To summarize the clinical experience in the treatment of fulminant myocarditis with multiple organ dysfunction using extracorporeal life support in the ICU.Methods:Clinical data of 9 adult cases of fulminant myocarditis complicated with multiple organ dysfunction admitted in ICU from January 2019 to October 2020 were retrospectively analyzed.Results:All patients received immunoregulatory and antiviral therapy; mechanical ventilation and renal replacement treatment were performed. Extracorporeal life support was also applied, including 1 case receiving intra-aortic balloon pump (IABP) support, and 6 cases receiving IABP and venous-arterial extracorporeal membrane oxygenation (VA-ECMO). In 6 cases with ECMO, the SpO 2(100.0±0)%, ScvO 2(78.7±3.9)%, hsTnI [10.0(2.2,31.8)mg/ml], oxygenation index[437.0(326.5,450.8)], lactic acid [(1.5±0.5)mmol/L], BE(-1.1±1.9)and LVEF(53.5±12.6)% were significantly improved 5 days after treatment compared with before [(98.0±1.4)%,(61.9±4.3)%,27.1(16.6,50.0)mg/ml,159.7(70.3,190.9),(6.4±3.4)mmol/L,(-10.3±4.6),(29.0±11.1)%]( t=-3.46, -9.74; Z=-1.99, -4.89; t=3.63, -5.84, -3.33; P<0.05). Eight patients were discovered and discharged, and one patient died. Conclusion:Fulminant myocarditis develops rapidly, integrated treatment based on extracorporeal mechanical life support and immunomodulatory therapy can improve the outcome of patients in the ICU.

Efficacy of long-pulsed 1 064-nm Nd:YAG laser combined with a topical emulsion containing Camellia reticulata and Radix Notoginseng in the treatment of melasma / 中华皮肤科杂志

Objective:To evaluate the efficacy of long-pulsed 1 064-nm Nd:YAG laser combined with a topical emulsion containing Camellia reticulata and Radix Notoginseng in the treatment of melasma. Methods:A total of 80 patients with melasma were enrolled from Department of Dermatology, People′s Hospital of Ningxia Hui Autonomous Region from June 2019 to June 2020, and randomly and equally divided into control group and observation group by using a random number table: 40 patients in the control group were treated with long-pulsed 1 064-nm Nd:YAG laser once every 2 weeks for 6 sessions as a course of treatment; another 40 in the observation group were treated with the same laser therapy as the control group and a topical emulsion containing Camellia reticulata and Radix Notoginseng twice a day for 3 months as a course of treatment. Melasma area and severity index (MASI), clinical efficacy, patient satisfaction rate and safety were compared between the 2 groups before and/or after treatment. Results:After 4- and 8-week treatment, there was no significant difference in the MASI score between the observation group (14.57 ± 3.22 points, 10.00 ± 2.94 points, respectively) and control group (14.74 ± 3.11 points, 11.31 ± 3.00 points, respectively; both P>0.05). After 12-week treatment, the MASI score was significantly lower in the observation group (4.80 ± 2.78 points) than in the control group (7.07 ± 3.22 points, t = -3.38, P<0.01). After 3-month treatment, the response rate was significantly higher in the observation group (36 cases, 90%) than in the control group (31 cases, 77.5%; χ2 = 4.58, P < 0.001) ; however, there was no significant difference in the patient satisfaction rate between the observation group (87.5%) and control group (72.5%, χ2 = 7.26, P = 0.06). In addition, no significant difference in the occurrence of adverse reactions was observed between the observation group (5 cases, 12.5%) and control group (7 cases, 17.5%; P > 0.05) . Conclusion:Compared with the long-pulsed 1 064-nm Nd:YAG laser alone, the topical emulsion containing Camellia reticulata and Radix Notoginseng in combination with the long-pulsed 1 064-nm Nd:YAG laser is more effective for the treatment of melasma, with higher patient satisfaction and less adverse reactions.

The regional nerve block technique for anesthesia in elderly patients with traumatic tibia and fibula fractures / 中华老年医学杂志

Objective:To explore the effect of regional nerve block anesthesia for elderly patients with traumatic tibia and fibula fractures.Methods:Ninety-three elderly patients with tibia and fibula fractures undergone surgical treatment were randomly divided into an observation group and a control group, with 47 and 46 patients, respectively, in each group.The control group received general anesthesia and the observation group received a regional nerve block.Results:There was no difference in operative time between the two groups[(42.2±5.4)min and(43.3±5.7)min, t=0.953, P=0.343].The time to recovery of consciousness[(11.2±2.6)min and(14.5±2.8)min, t=5.714, P<0.001]and the volume of intraoperative infusion[(415.6±27.5)ml/L and(686.6±36.3)ml/L, t=40.626, P<0.001]were lower and patients' blood pressure and respiratory rate were also lower at skin incision, fracture fixation, end of surgery and 30 min after surgery in the observation group than in the control group.The levels of Glu, IL-6 and COR were higher than those in the control group(all P<0.05).The incidence of complications was 2.13% in the observation group and 15.22% in the control group( χ2=5.07, P<0.05). Conclusions:Elderly patients with traumatic tibia and fibula fractures receive beneficial anesthetic effects with the regional nerve block technique, with stable hemodynamics, mild stress response and minor adverse reactions.