The formula for orogastric tube insertion length in preterm infants based on growth indicators and gestational age / 中国新生儿科杂志

Objective:To develop a formula for estimating the insertion length of orogastric (OG) tube for preterm infants based on growth indicators and gestational age (GA).Methods:From January 2020 to December 2021, preterm infants admitted to the neonatal intensive care unit of our hospital were retrospectively reviewed. OG tubes were inserted within 24 h of admission and the lengths of OG tubes were adjusted according to chest and abdominal X-ray results. The formula for OG tube placement was developed using stepwise regression analysis method with GA, body weight (BW) and body length (BL) as the independent variables and the corrected length of OG tube as the dependent variable. The weight-based formula developed by Freeman et al. were compared.Results:A total of 180 preterm infants were included, with 90 cases GA<32 weeks, 84 cases GA 32~35 weeks and 6 cases GA 36 weeks. No significant differences ( P>0.05) existed in the incidences of misplacement of OG tube and the specific types of misplacement among GA groups. For infants with GA≤35 weeks, the insertion length of OG tube was positively correlated with BW and BL and for preterm infants with GA 36 weeks, the insertion length of OG tube was positively correlated with BW only. Stepwise regression analysis showed the formula as OG tube length (cm)=11.8+2.1×BW (kg) or OG tube length (cm)=9.5+1.6×BW (kg)+0.091×GA (week). Comparing with the formula developed by Freeman et al., the differences of OG tube length estimated using our formula were more prominent as BW increased. Conclusions:The length of OG tube is positively correlated with BW and GA with BW shows more influence.

Comparison of the diagnostic effect on different machine learning predictive model of imipenem sensitivity of Klebsiella pneumoniae based on MALDI-TOF MS / 中华检验医学杂志

Objective:Machine learning is not only an important branch of artificial intelligence, but also supporting technologies for bioinformatics analysis. In the presence work, four machine-learning-predictive model for the drug-sensitivity of Klebsiella pneumoniae to imipenem were established based on matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and the diagnostic effect of these methods was exmained. Methods:A retrospective study was performed and the data of MALDI-TOF-MS and imipenem sensitivity of a total number of 684 cases Klebsiella pneumoniae isolated from clinical specimens in the laboratory of microbiology department of Tianjin Haihe Hospital from 2019 January to 2020 December were collected. The mass spectrometry and imipenem sensitivity data of 70 cases identified as imipenem-sensitive and 70 resistant cases were simple randomly selected to establish the training set model; whereas 30 cases of sensitive and 30 cases of resistant cases were randomly selected to establish the test set model. Mass spectral peak data were subjected to Orthogonal Partial least squares Discriminant Analysis (OPLS-DA). The training set data model was established by machine learning least absolute shrinkage and selection operator (LASSO) algorithm, Logistic Regression (LR) algorithm, Support vector machines (SVM) algorithm, neural network (NN) algorithm. The area under the curve (AUC) and confusion matrix of training set and test set model were calculated and selected by Grid search and 10-fold Cross-validation respectively, the accuracy of the prediction model was verified by test set confusion matrix. Results:The R2Y and Q2 of OPLS-DA were 0.546 3 and 0.017 8. The AUC of the best training set and test set models were 1.000 0 and 0.858 1, 1.000 0 and 0.820 1, 0.940 8 and 0.756 1, 1.000 0 and 0.697 2 evaluated by LASSO, LR, SVM and NN model respectively. The accuracy of the model were 99% (69/70), 100% (70/70), 91% (64/70) and 100% (70/70) for prediction of drug resistance, 100% (70/70), 100% (70/70), 90% (63/70) and 100% (70/70) for drug sensitivity prediction, the correct rate were 99% (139/140), 100% (140/140), 91% (127/140) and 100% (140/140) in training set, the test set showed that the accuracy were 93% (28/30), 87% (26/30), 60% (18/30) and 60% (18/30) for prediction of drug resistance, 100% (30/30), 80% (24/30), 93% (28/30) and 67% (20/30) for drug sensitivity prediction, the correct rate were 97% (58/60), 83% (50/60), 77% (46/60) and 63% (38/60) by LASSO, LR, SVM and NN model respectively.Conclusion:The LASSO prediction model of Klebsiella pneumoniae sensitivity to imipenem established in this study has a high accuracy rate and has potential clinical decision support ability.

BRICS report of 2021: The distribution and antimicrobial resistance profile of clinical bacterial isolates from blood stream infections in China / 中华临床感染病杂志

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2021 to December 2021. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 11 013 bacterial strains were collected from 51 hospitals, of which 2 782 (25.3%) were Gram-positive bacteria and 8 231 (74.7%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.6%), Klebsiella pneumoniae (18.9%), Staphylococcus aureus (9.8%), coagulase-negative Staphylococci (6.3%), Pseudomonas aeruginosa (3.6%), Enterococcus faecium (3.6%), Acinetobacter baumannii (2.8%), Enterococcus faecalis (2.7%), Enterobacter cloacae (2.5%) and Klebsiella spp (2.1%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3% and 76.8%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci was detected; more than 95.0% of Staphylococcus aureus were sensitive to ceftobiprole. No vancomycin-resistant Enterococci strains were detected. The rates of extended spectrum B-lactamase (ESBL)-producing isolated in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 49.6%, 25.5% and 39.0%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2% and 15.8%, respectively; 7.9% of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination. Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae. Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii (5.5% and 4.5%). The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%. Conclusions:The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria, in which Escherichia coli is the most common. The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low. The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level, but the trend is downwards.

Safety and Efficacy of Irreversible Electroporation Combined with Neoadjuvant Chemotherapy for Locally Advanced Pancreatic Cancer: A Meta-analysis / 肿瘤防治研究

Objective To evaluate the safety and efficacy of irreversible electroporation (IRE) combined with neoadjuvant chemotherapy in patients with locally advanced pancreatic cancer. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, China Biomedical Literature Database, CNKI, Wanfang, and VIP databases for articles dated from the establishment of each database to March 2022. Meta-analysis was performed using RevMan5.4 software. Results A total of 3970 patients with locally advanced pancreatic cancer were enrolled in eight studies, including one randomized controlled trial, four retrospective studies, and three prospective studies. The patients were divided into the combined therapy group with 344 patients and the chemotherapy-only group with 3626 patients. Meta-analysis showed that the overall survival of patients in the combined therapy group was significantly higher than that in the chemotherapy-only group (OR=4.52; 95%CI: 2.63-7.77; P < 0.00001). However, no significant difference existed in the disease control rate between the combined therapy group and the chemotherapy-only group (OR=0.58; 95%CI: 0.02-18.74; P=0.76). Moreover, no significant difference existed in the disease progression between the two groups (OR=0.49; 95%CI: 0.23-1.02; P=0.06). The combination of neoadjuvant chemotherapy and IRE had no significant effect on the incidence of adverse reactions of gastrointestinal reaction (OR=0.37; 95%CI: 0.10-1.34; P=0.13) and bone marrow suppression (OR=0.61; 95%CI: 0.26-1.40; P=0.24). Conclusion IRE combined with neoadjuvant chemotherapy can remarkably improve the prognosis of patients with locally advanced pancreatic cancer, and significantly prolong the overall survival.

Perinatal outcome and risk factors of precipitate labor in term primipara: an analysis of 381 cases / 浙江大学学报·医学版

OBJECTIVE@#To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.@*METHODS@#A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women's Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled, among whom 381 cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group. The perinatal outcomes of the two groups were compared, and the risk factors of precipitate labor were analyzed by multivariate logistic regression.@*RESULTS@#The incidence of precipitate labor in full-term, singleton pregnancy and cephalic primiparas was 5.48% (381/6951). The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group ( P<0.01); while there was no significant difference in the duration of the third stage of labor between the two groups ( P>0.05). Compared with the control group, the incidence of soft birth canal laceration in the precipitate labor group was increased ( P<0.01). However, there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups (all P>0.05). Multivariate logistic regression analysis showed that maternal height ( OR=1.038, 95% CI: 1.010-1.067, P<0.01), gestational age at delivery ( OR=0.716, 95% CI: 0.618-0.829, P<0.01), late miscarriage ( OR=1.986, 95% CI: 1.065-3.702, P<0.05), membrane rupture before labor ( OR=1.802, 95% CI: 1.350-2.406, P<0.01), labor induction by transcervical balloon ( OR=3.230, 95% CI: 2.027-5.147, P<0.01), labor induction by propess ( OR=2.332, 95% CI: 1.632-3.334, P<0.01) and labor induction by oxytocin ( OR=0.291, 95% CI: 0.219-0.386, P<0.01) were independently associated with precipitate labor.@*CONCLUSIONS@#The incidence of precipitate labor in full-term, singleton pregnancy was not low. Precipitate labor could lead to a significant increase in perineal laceration. Maternal height, history of late miscarriage, membrane rupture before labor and labor induction by transcervical balloon, labor induction by propess are risk factors, while labor induction by oxytocin and late gestational time of delivery are protective factors for precipitate labor in term primipara.

The influence of mindfulness cognitive therapy on the early maladaptive schema in patients with depression / 中华行为医学与脑科学杂志

Objective:To evaluate the effect of mindfulness-base cognitive therapy (MBCT) in improving patients with depression, and to explore its effect on patients early maladaptive schemas (EMSs).Methods:Sixty patients with depressive disorder were included in the pre- and post-control design, and MBCT treatment was carried out for 8 weeks. The Hamilton depression scale-17 (HAMD-17), Hamilton anxiety scale (HAMA), five facet mindfulness questionnaire (FFMQ), and Young schema questionnaire-short form (YSQ-SF) were used for evaluation. The scores of the three time points were compared by one-way repeated measure ANOVA and Kruskal Wallis test. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between the improvement degree of depression and anxiety symptoms, as well as the changes of mindfulness level and schema.Results:There were significant differences in the total scores of HAMD-17, HAMA and FFMQ at baseline((15.4±5.0), (21.0±9.6), (115.8±11.7)), 4 weeks after intervention((11.4±6.7), (15.9±10.1), (121.9±14.2)) and 8 weeks((11.0±6.2), (15.4±8.7), (122.6±15.5)) after intervention ( F=25.22, 20.95, 14.02, all P<0.01). Further pairwise comparison, compared with baseline, the total scores of HAMD-17 and HAMA in patients with depression decreased (all P<0.05), and the total scores of FFMQ increased (all P<0.05) in 8 weeks and 4 weeks after treatment.There were no significant differences in the total scores of HAMD-17, HAMA and FFMQ between 8 weeks and 4 weeks after treatment (all P>0.05). There were significant differences on the scores of the emotional deprivation, abandonment/instability, failure, vulner ability to harm or illness, enmeshment/undeveloped self, unrelenting standards/hypercriticalness, and entitlement/grandiosity subscales in the YSQ-SF( H=2.00-17.11, all P<0.05). Regression analysis showed that the FFMQ total score difference has a linear relationship with the HAMA total score difference ( β=-0.363). There was a linear relationship between the emotional deprivation scale score difference and the HAMD-17 total score difference ( β=-0.292). Dependence/incompetence and submission scale score difference showed a linear relationship with the HAMA total score difference ( β=0.334, 0.278). Conclusion:MBCT can improve the anxiety and depression symptoms of patients with depression, and the improvement of some EMSs may be the mechanism of MBCT in the treatment of depression.

The evaluation value of antithrombin Ⅲ in decompensated stage of hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding / 中华消化杂志

Objective:To investigate the value of antithrombin Ⅲ (AT-Ⅲ) in evaluating patients with decompensated hepatitis B liver cirrhosis and complicated with esophagogastric variceal bleeding (EVB).Methods:From January 1, 2018 to December 31, 2021, clinical data of 193 hospitalized patients with hepatitis B liver cirrhosis diagnosed in the Second Hospital of Shanxi Medical University were retrospectively analyzed, which included coagulation indicator (AT-Ⅲ), liver function indicators (total bilirubin, etc.), abdominal ultrasound results (portal vein diameter, portal vein blood flow velocity), and the occurrence of esophagogastric varices. According to the presence or absence of main complications, 193 patients with hepatitis B liver cirrhosis were divided into compensated group (60 cases) and decompensated group (133 cases). According to the presence or absence of EVB, 133 patients of decompensated group were divided into non-bleeding subgroup (96 cases) and bleeding subgroup (37 cases). The above indicators were compared among compensated group, decompensated group and their subgroups. The independent related factors of decompensated hepatitis B liver cirrhosis and EVB were analyzed. The level of AT-Ⅲ of each group were compared, and the relationship between AT-Ⅲ and Child-Pugh score was analyzed. The diagnostic capability of AT-Ⅲ in decompensated hepatitis B liver cirrhosis and complicated with EVB were analyzed. Mann-Whitney U test, independent sample t test, chi-square test, multiple logistic regression analysis, Pearson correlation analysis and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Results:The total bilirubin level of the decompensated group was higher than that of the compensated group, the portal vein diameter was larger than that of the compensated group, and the portal vein blood flow velocity was lower than that of the compensated group (31.50 μmol/L (21.90 μmol/L, 48.80 μmol/L) vs. 19.40 μmol/L (15.00 μmol/L, 25.50 μmol/L); (14.31±3.53) mm vs. (12.57±3.83) mm; (13.39±3.49) cm/s vs. (15.08±4.28) cm/s), and the differences were statistically significant ( Z=-5.76, t=-2.78 and 2.40; P<0.001, =0.006 and 0.018). The incidence of esophagogastric varices of the compensated group and the decompensated group was compared (40.0%, 24/60 vs. 87.2%, 116/133), and the difference was statistically significant ( χ2=64.06, P<0.001). The diameter of portal vein of the bleeding subgroup was larger than that of the non-bleeding subgroup, and the portal vein blood flow velocity was lower than that of the non-bleeding subgroup ((15.54±4.23) mm vs. (13.87±3.16) mm; (12.05±3.12) cm/s vs. (13.85±3.51) cm/s), and the differences were statistically significant ( t=-2.15 and 2.23, P=0.034 and 0.028). The AT-Ⅲ levels gradually decreased in the non-bleeding subgroup and bleeding subgroup of the compensated group and decompensated group, which were (79.52±16.02)%, (63.91±19.96)% and (35.92±13.69)%, respectively, the difference was statistically significant ( F=5.71, P=0.018). The AT-Ⅲ level of the compensated group was higher than that of the non-bleeding subgroup and the bleeding subgroup of the decompensated group, and the AT-Ⅲ level of the non-bleeding subgroup of the decompensated group was higher than that of the bleeding subgroup, and the differences were statistically significant ( t=5.11, 13.74 and 7.84, all P<0.001). The results of multivariate logistic regression analysis showed that total bilirubin and AT-Ⅲ were independent related factors of decompensation of hepatitis B liver cirrhosis ( OR (95% confidence interval (95% CI) 1.060 (1.018 to 1.104) and 0.945 (0.922 to 0.970), P=0.005 and <0.001). AT-Ⅲ was an independent related factor of decompensation of hepatitis B liver cirrhosis and complicated with EVB ( OR(95% CI) 0.902 (0.856 to 0.950, P<0.001). AT-Ⅲ was negatively correlated with Child-Pugh score ( r=-0.559, P<0.001). ROC analysis showed that the cut-off values of AT-Ⅲ in the diagnosis of decompensated stage of hepatitis B liver cirrhosis and complicated with EVB were 62.5% and 61.5%, the sensitivity was 88.3% and 89.2%, the specificity was 70.7% and 61.5%, and the area under the curve (95% CI) was 0.815 (0.755 to 0.874, P<0.001) and 0.899 (0.828 to 0.971, P<0.001), respectively. Conclusion:AT-Ⅲ is an important indicator in evaluating the severity of disease progression in patients with hepatitis B liver cirrhosis, and it has a certain clinical value in evaluating the bleeding tendency of patients with decompensated hepatitis B liver cirrhosis and complicated with esophagogastric varices.

Comparison of the performance of SCORTEN and ABCD-10 in evaluating the prognosis of Stevens-Johnson syndrome/toxic epidermal necrolysis / 中华皮肤科杂志

Objective:To compare the performance of the severity-of-illness score for toxic epidermal necrolysis (SCORTEN) and ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area) scoring systems in predicting death in patients with Stevens-Johnson syndrome (SJS) /toxic epidermal necrolysis (TEN) .Methods:Clinical data were collected from 85 patients with SJS/TEN who were hospitalized in Sichuan Provincial People′s Hospital from January 2010 to April 2021, and retrospectively analyzed. The predicted mortality and actual mortality were compared at each score level of SCORTEN and ABCD-10. The receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the predictive power and calibration of SCORTEN and ABCD-10 on mortality.Results:Among the 85 patients, 37 were males and 48 were females, and their ages were 52.36 ± 19.31 years (range, 14 - 88 years) . There were 61 cases of SJS, 6 of SJS/TEN overlap, and 18 of TEN. Ten patients died in hospital and the fatality rate was 11.76%. Among the SCORTEN and ABCD-10 components, age > 40 years or ≥ 50 years, epidermal exfoliation > 10% body surface area on the 1st day after admission, heart rate > 120 beats per minute, serum urea nitrogen level > 10 mmol/L and serum bicarbonate level < 20 mmol/L were significantly correlated with death ( χ2 = 4.46, 6.18, 25.50, 15.13, 7.59, 8.38, respectively, all P < 0.05) , while malignancies, serum glucose level > 14 mmol/L, and pre-hospital dialysis were not significantly correlated with death ( χ2 = 0.35, 0.10, 1.38, respectively, all P > 0.05) . There were no significant differences between the predicted mortality and actual mortality at every score level of SCORTEN and ABCD-10 (all P > 0.05) . The ROC curve showed that both SCORTEN and ABCD-10 had good predictive power for death (areas under the curve: 0.874 and 0.867, 95% CI: 0.758 - 0.990, 0.773 - 0.962, respectively) , but the model goodness-of-fit of SCORTEN was superior to that of ABCD-10 ( P = 0.944, 0.048, respectively) . Conclusion:Both SCORTEN and ABCD-10 scoring systems could accurately predict mortality of SJS/TEN patients at early stage, but SCORTEN showed more favourable predictive power and calibration.

Preliminary study on the expression of MIF in HCC tissues and its relationship with ERK1/2 signaling pathway / 中华内科杂志

Objective:To investigate the expression of Macrophage migration-inhibitory factors (MIF) in hepatocellular carcinoma (HCC) tissues and its interaction with ERK1/2 signaling pathway, so as to establish a theoretical basis for further studying the molecular mechanism of MIF promoting HCC.Methods:From February 2020 to August 2021, 52 cases of hepatocellular carcinoma (HCC) tissues based on hepatitis B cirrhosis (HBV-LC) and 52 cases of adjacent tissues in Tianjin Medical University Cancer Hospital and 940th Hospital of Joint Logistic Support Force of PLA were collected as the experimental group, including 39 males and 13 females, aged 35-65 years. And 20 cases of normal liver tissue were selected as the control group. Immunohistochemistry was used to detect the expression of MIF, ERK1/2 and p-ERK1/2 proteins in liver tissues of the two groups, and in situ hybridization was used to detect the expression of ERK1/2 nucleic acid in liver tissues of the two groups.HepG2 HCC cells and L-02 normal hepatocytes were co-cultured with different concentrations of rMIF, the expression and phosphorylation levels of ERK1/2 and JNK1 proteins in the two kinds of liver cells were detected by Western-blot, and the expression levels of ERK1/2 nucleic acids in the two kinds of liver cells were detected by RT-PCR. One-way ANOVA was used for measurement data and χ 2 test was used for counting data. Results:The expressions of MIF, ERK1/2, p-ERK1/2 and ERK1/2 mRNA were significantly increased in HCC and para-cancer tissues (the expression of MIF in HCC group was 78.8%, and that in adjacent group was 75.0%; ERK1/2 80.8% in HCC group and ERK1/2 71.8% in paracancerous group. The expression of p-ERK1/2 75.0 % in HCC group and 46.2% in paracancerous group were respectively detected. ERK1/2 mRNA was expressed in HCC group 76.9%, ERK1/2 mRNA expression in paracancerous group 78.8%), and the differences were statistically significant compared with normal liver tissues ( P<0.05), but there was no significant difference between HCC and para-cancer tissues ( P>0.05). The expressions of ERK1/2, p-ERK1/2 and ERK1/2 mRNA in HepG2 HCC cells were significantly increased with the increase of rMIF concentration, and the increase was most obvious when rMIF concentration was 200 ng/ml, and the difference was statistically significant compared with L-02 normal hepatocytes ( P<0.05). Conclusion:MIF, ERK1/2 and p-ERK1/2 are highly expressed in HCC tissues and HepG2 HCC cells, suggesting that MIF promotes the occurrence and development of hepatocellular carcinoma through ERK1/2 signaling pathway.

Clinical characteristics of pregnancy and lactation-associated osteoporosis and literature review / 中华内分泌代谢杂志

Objective:To analyze nine cases of pregnancy and lactation-associated osteoporosis(PLO) along with a literature review to improve clinicians′ knowledge of the disease.Methods:We collected medical history, laboratory examination, bone mineral density(BMD) scan, treatment and follow-up data of 9 inpatients with PLO in the Endocrinology Department of the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2021.Results:The median age of onset of 9 patients with PLO was 30 years(22-37 years). All 9 patients presented low back pain, and the median time of low back pain after childbirth was 2.5 months(0.5-7 months). 89% of the patients presented vertebral compression fractures, and the mean number of vertebral fractures was 4.6. Eight patients with PLO showed osteoporosis by dual X-ray absorpiometry(DXA) scan, and one patient showed bone loss by quantitative CT scan. Osteoporosis predominated in the trabecular bone. After the diagnosis, nine patients with PLO stopped breastfeeding and were given calcium and vitamin D preparations. Seven patients were given bisphosphonates and one patient was treated with teriparatide followed by denosumab. The back pain of all patients was relieved, with the median of relief time being 3 months(7 d-6 m). After treatment initiation, BMD was increased in eight patients, especially obvious in the lumbar spine. No new clinical fractures occurred during the follow-up.Conclusions:For women with low back pain and shortened height in late pregnancy or breastfeeding, the possibility of PLO should be considered. Prompt diagnosis and early medical interventions are of utmost importance to reduce the risk of subsequent fractures and improve the prognosis.

The phenotypic and genetic spectrum of colony-stimulating factor 1 receptor gene-related leukoencephalopathy in China / 中华神经科杂志

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

Application of the method of judging small shadow intensity and CT reference film in the diagnosis of silicosis / 中华放射学杂志

Objective:To explore the application value of the method of judging the density of small shadows in the lung area by using CT and CT reference films for pneumoconiosis.Methods:The chest imaging data of 244 employees of a large copper company in Tongling City, Anhui Province who underwent occupational physical examination at Tongling Municipal Hospital in Anhui Province from January 2016 to December 2019 were retrospectively analyzed. Totally 244 cases underwent chest CT scan and chest DR radiography at the same time. The shape and size of the small shadows (the size of the circular and quasi-circular nodules in the lung area were represented by p, q, r, and the size of the irregular small shadows were represented by s, t, u), the overall density, the density of small shadows in each lung area, the large shadows, and the diagnosis stage were observed and compared. The small shadow density of each lung area was judged by the method of judging the small shadow density of CT lung area and the reference film, and other observation indicators were judged according to GBZ70-2015 Diagnosis of Occupational Pneumoconiosis. Results:There was a significant difference between CT and DR in judging s-shaped small shadows and no small shadows ( P<0.05), and there was no statistically significant difference in judging p, q, r, t, and u-shaped small shadows ( P>0.05). CT and DR had medium to high consistency in the judgment of the overall density of small shadows (Kappa=0.692, P=0.001), and the diagnostic coincidence rate was 82.38% (201/244). There was moderate to high agreement between CT and DR in the density of small shadows shown in the right upper, right lower, left upper, left middle, and left lower lung regions (Kappa ranged from 0.40 to 0.75, P<0.05), and the consistency in the right middle lung region was poor (Kappa=0.381, P=0.001). Eleven large shadows were detected in 8 cases by DR, 31 large shadows were detected in 23 cases by CT, and 20 (8.20%) large shadows were detected more frequently by CT than DR. The agreement between CT and DR for the diagnosis and staging of silicosis was excellent (Kappa=0.843, P=0.001), and the diagnostic coincidence rate was 91.80% (224/244). Conclusion:Applying the method of determining the density of small shadows in the lung area of pneumoconiosis and reference films, combined with GBZ70-2015 Diagnosis of Occupational Pneumoconiosis, can make a more accurate diagnosis of silicosis.

BRICS report of 2020: The bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China / 中华临床感染病杂志

Objective:To investigate the bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China.Methods:The clinical bacterial strains isolated from blood culture were collected during January 2020 to December 2020 in member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS). Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI, USA). WHONET 5.6 was used to analyze data.Results:During the study period, 10 043 bacterial strains were collected from 54 hospitals, of which 2 664 (26.5%) were Gram-positive bacteria and 7 379 (73.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (38.6%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (9.9%), coagulase-negative Staphylococci (7.5%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.3%), Enterobacter cloacae (2.8%), Enterococcus faecalis (2.6%), Acinetobacter baumannii (2.4%) and Klebsiella spp (1.8%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 27.6% and 74.4%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci were detected. More than 95% of Staphylococcus aureus were sensitive to rifampicin and SMZco. No vancomycin-resistant Enterococci strains were detected. Extended spectrum β-lactamase (ESBL) producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 48.4%, 23.6% and 36.1%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.3% and 16.1%, respectively; 9.6% of carbapenem-resistant Klebsiella pneumoniae strains were resistant to ceftazidime/avibactam combination. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii. The prevalence rate of carbapenem-resistance of Pseudomonas aeruginosa was 23.2%. Conclusions:The surveillance results in 2020 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen, and ESBL-producing strains declined while carbapenem-resistant Klebsiella pneumoniae kept on high level. The proportion and the prevalence of carbapenem-resistant Pseudomonas aeruginosa were on the rise slowly. On the other side, the MRSA incidence got lower in China, while the overall prevalence of vancomycin-resistant Enterococci was low.

Impact of pre-pregnancy body mass index, weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with gestational diabetes mellitus / 浙江大学学报·医学版

To explore the effects of pre-pregnancy body mass index (BMI), weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with and without gestational diabetes mellitus(GDM). A total of 12 650 singleton pregnant women without history of hypertension and diabetes who were admitted at Women's Hospital, Zhejiang University School of Medicine for delivery from January 2018 to April 2019 were enrolled in the study. There were 2381 cases complicated with gestational diabetes (GDM group) and 10 269 cases without GDM (non-GDM group). The pre-pregnancy BMI and weight gain during pregnancy were documented in two groups. The factors related to perinatal outcome were analyzed. In both GDM and non-GDM pregnant women, pre-pregnancy overweight and excessive weight gain during pregnancy were independent factors of large for gestational age infant (LGA), small for gestational age infant (SGA) and first cesarean section (<0.01 or <0.05). Excessive weight gain during pregnancy was also an independent risk factor of preeclampsia (<0.05). Triglyceride levels in the second trimester were independently associated with multiple adverse pregnancy outcomes, such as LGA, preeclampsia, initial cesarean delivery, premature delivery. Controlling excessive or insufficient weight gain during pregnancy can significantly reduce the incidence of LGA and SGA. And controlling BMI before pregnancy can effectively reduce the incidence of LGA, preeclampsia and the first cesarean section. For non-GDM pregnant women, abnormal blood lipid levels in the second trimester may be closely related to multiple adverse pregnancy outcomes, and active dietary guidance or treatment is also required.

Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus / 浙江大学学报·医学版

To investigate the impact of family history of diabetes (FHD) on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus (GDM). A total of 1265 GDM women who gave childbirth in Women's Hospital, Zhejiang University School of Medicine during January to December 2019 were enrolled in the study, including 253 women with FHD and 1012 women without FHD. The -test or test were used to compare the blood lipid, blood glucose levels and perinatal outcomes including large for gestational age infant, small for gestational age infant, macrosomia, cesarean delivery, preeclampsia, preterm labor, postpartum hemorrhage, fetal distress. The correlation between FHD and perinatal outcomes were estimated by Logistic regression analysis. The high density lipoprotein level at third-trimester was significantly lower in GDM women with FHD (<0.05); and the women with FHD also had higher fasting blood glucose oral glucose tolerance test (OGTT)1 h, OGTT 2 h and glycosylated hemoglobin level (all <0.01). In GDM women, FHD was an independent risk factor for preeclampsia (=3.27, 95%: 1.39-7.68). GDM women with FHD have lower high density lipoprotein and higher glucose levels. FHD is an independent risk factor for preeclampsia in GDM women.

Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus / 浙江大学学报·医学版

To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). A total of 2611 pregnant women with GDM who were examined and delivered in Women's Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all <0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (all <0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (all <0.017), and the incidence of LGA were higher than that in inadequate GWG patients (all <0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (all <0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (=1.66, 95%: 1.10-2.52; =2.20, 95%: 1.07-4.53), and protective factor for LGA (=0.40, 95%: 0.27-0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (=2.15, 95%: 1.35-3.41; =1.80, 95%: 1.20-2.72; =2.18, 95%: 1.10-4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (=0.24, 95%: 0.09-0.67; =0.54, 95%: 0.34-0.86), while excessive GWG was risk factor for premature delivery (=1.98, 95%: 1.23-3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.

BRICS report of 2018-2019: the distribution and antimicrobial resistance profile of clinical isolates from blood culture in China / 中华临床感染病杂志

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.

Application Management of Carbapenems in Tuberculosis Patients of Our Hospital Based on Multi-disciplinary Team / 中国药房

OBJECTIVE：To provide reference for the ra tional use of carbap enems in tuberculosis patients. METHODS ：Totally 12 576 tuberculosis inpatients were collected from our hospital. Multi-disciplinary team （MDT） model was adopted for carbapenems management in aspects of policy intervention ，technical support and staff training. Average hospitalization duration ， mortality，nosocomial infective rate ，use and drug resistance of carbapenems were compared before （Mar. 2016-Mar. 2017）and after management （Apr. 2017 to Mar. 2019）. Interrupted time series （ITS）analysis was used to analyze the utilization rate of carbapenems，DDDs，the proportion of carbapenems ’DDDs in the total antibiotics ’DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost before and after management. Pearson correlation analysis was conducted for DDDs of carbapenems with medical quality indicators and detection rate of carbapenems-resistant bacteria. RESULTS ：After the management ，average hospitalization stay ，the cost of antibiotics ，DDDs of carbapenems ，the proportion of carbapenems ’DDDs in the total antibiotics ’ DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost，the utilization rate of carbapenems ’，and the drug resistance rate of some bacteria to carbapenems were significantly lower than those before the management （P＜0.05）. ITS analysis results showed that after management ，the utilization rate of carbapenems ，DDDs，the proportion of com carbapenems’DDDs in the total antibiotics ’DDDs and the proportion of carbapenems ’cost in the total antibiotics ’cost hhyyzj@126.com were decrease d by 4.491％ ，220.276，6.535％ ，11.747％ ， with statistical significance （P＜0.05）. Co mpared with before management ，above indexes were decreased by 0.330％，17.625， 0.308％，0.304％ monthly，among which the utilization rate and DDDs of carbapenems were decreased significantly （P＜0.05）. Before management ，drug resistance rate of Pseudomonas aeruginosa to carbapenems was 21.80％，and those of Acinetobacter baumannii to meropenem and imipenem were both 4.60％；after management ，drug resistance rate of P. aeruginosa to imipenem was 13.00％，and those of A. baumannii to meropenem and imipenem were both 16.30％，with statistical significance before and after management （P＜0.05）. There was no statistical significance in drug resistance rate of Enterobacteriaceae （P＞0.05）. Pearson correlation analysis showed that carbapenems ’DDDs was significantly positively correlated with average hospitalization duration and antibiotics ’cost（P＜0.05）；imipenem’s DDDs was positively correlated with drug resistance rate of P. aeruginosa （P＜0.05）. CONCLUSIONS： MDT management can effectively standardize the use of carbapenem in tuberculosis patients ， shorten hospitalization duration ，and reduce drug cost ，DDDs and drug resistance rate of some bacteria.

Mediating effects of defense styles on the relationship between early maladaptive schemas and mental health in patients with depression / 中华行为医学与脑科学杂志

Objective:To explore the relationship between early maladaptive schemas, defense styles and mental health in patients with depression, and to investigate the mediating effects of defense styles between early maladaptive schemas and mental health.Methods:A total of 87 outpatients with depression were assessed with the Young schema questionnaire-short form 2(YSQ-SF2), defense style questionnaire(DSQ), symptom checklist-90(SCL-90) and Beck depression inventory(BDI). SPSS Process program and Bootstrap method were used to explore the mediating effect of defense styles.Results:The scores of abandonment/instability were higher in females than those in males (2(0.5, 4), 0(0, 1.25), Z=-2.963, P=0.003) while the score of emotional inhibition was higher in males than in females (1(0, 3), 0(0, 2), Z=-2.318, P=0.02). The total score of SCL-90 was positively predicted by vulnerability to harm or illness and emotional deprivation, with an explanatory variation rate of 27.7%.The number of SCL-90 positive items was positively predicted by social isolation/alienation and abandonment/instability, with an explanatory variation rate of 19.3%.Immature defense styles fully mediate the relationship between social isolation/alienation and mental health, as well as between abandonment/instability and mental health. Conclusion:Social isolation/alienation and abandonment/instability affect the mental health of patients with depression by the mediating effect of immature defense styles.

Experimental study of SPECT imaging with novel myocardial perfusion imaging tracer: 99Tcm-3SPboroxime / 中华核医学与分子影像杂志

Objective@#To assess the superiority of 99Tcm-3SPboroxime (99Tcm-3SP for short) as a fast-myocardial perfusion imaging (MPI) tracer in normal and acute myocardial infarction (AMI) mini-swine.@*Methods@#99Tcm-3SP and 99Tcm-Teboroxime (99Tcm-TEBO for short) were prepared. Approximately 370 MBq 99Tcm-3SP or 99Tcm-TEBO was injected intravenously in 2 healthy mini-swine separately. Dynamic planar images were acquired immediately after injection and continued for 20 min using a standard SPECT camera. The radioactivity uptakes in the heart, liver, and lungs were measured, and heart/liver and heart/lung ratios over time were calculated. Dynamic SPECT studies were performed in 4 normal swine and 1 AMI-swine using cadmium zinc telluride-SPECT (CZT-SPECT). List mode acquisitions were immediately started and continued for 15 min after intravenous injection of approximately 370 MBq 99Tcm-TEBO and 99Tcm-3SP. The injection of two radiotracers in the same swine was completed within 2 d. The radioactivity uptakes in heart and liver were measured, and heart/liver ratio was calculated. Image quality was also evaluated. Paired t test was used to analyze the data.@*Results@#The radiochemical purity of 99Tcm-TEBO or 99Tcm-3SP were both above 95%. The initial heart uptake of 99Tcm-3SP was very close to that of 99Tcm-TEBO (planar image, 2 min postinjection: 309.32×103 vs 314.13×103 counts/MBq; SPECT image, 2 min postinjection (corrected): 7.96±0.87 vs 8.24±1.53, t=0.277, P>0.05), but the myocardial retention time was much longer than that of 99Tcm-TEBO (planar image, 20 min postinjection: 218.67×103 vs 143.19×103 counts/MBq; SPECT image, 15 min postinjection (corrected): 6.76±0.45 vs 5.06±0.33, t=-12.412, P=0.001). The uptake of liver and heart/liver ratio between 99Tcm-TEBO and 99Tcm-3SP were similar (t values: -1.332-1.101, all P>0.05 within 15 min). SPECT MPI images demonstrated uniform tracer distribution with clearly visualizable myocardial boundary in normal myocardium and intense perfusion defect in infarct myocardium. High quality SPECT images could be obtained in any of the 5 min imaging windows over the first 15 min after injection of 99Tcm-3SP in normal swine and AMI-swine.@*Conclusion@#99Tcm-3SP is a promising 99Tcm-labeled radiotracer for fast-MPI considering its high heart uptake, long myocardial retention time (20 min postinjection) and superior SPECT image quality.