Portal vein thrombosis in liver cirrhosis： Risk factors and protection strategies / 临床肝胆病杂志

Portal vein thrombosis （PVT） is one of the common complications during the natural course of liver cirrhosis and has an important influence on the progression of liver cirrhosis. This article mainly summarizes the research advances in the risk factors for PVT. There are many risk factors for PVT， and Virchow’s triad， namely venous stasis， hypercoagulability， and vascular endothelial injury and systemic inflammation caused by surgery or trauma， are considered the main reasons for the development and progression of PVT. At present， more prospective studies are still needed to validate the predictive models for the risk of PVT that have certain application prospects in clinical practice. Cirrhotic patients with PVT tend to have a poor prognosis， and complete obstructive PVT is associated with increased mortality after liver transplantation. Recent studies have shown that prophylactic anticoagulant therapy is safe and effective in patients with liver cirrhosis and can thus help with the prevention and treatment of PVT.

Mediating effects of self-perceptions of aging between frailty and cognitive function in community-dwelling older adults / 中华行为医学与脑科学杂志

Objective:To explore the mediating role of self-perceptions of aging between frailty and cognitive function in community-dwelling older adults.Methods:From February to July 2021, a total of 528 elderly people in Xinxiang community were investigated with the frailty phenotype, the brief self-perceptions ageing questionnaire and the Mini-mental state examination(MMSE) scale.According to the MMSE total score and education level, the subjects were divided into cognitive impairment group (illiteracy≤17, primary school≤20, junior high school and above≤24, n=74) and cognitive normal group( n=454). SPSS 25.0 software was used for common method deviation test, descriptive statistics and correlation analysis, while AMOS 24.0 software was used to build structural equation model and Bootstrap method was used for intermediary effect test. Results:(1)The prevalence of cognitive impairment among the elderly in the community was 14.1%. The differences between the cognitively normal group and cognitively impaired group were statistically significant in terms of age, education, number of chronic diseases suffered and depression ( χ2=59.21, 6.53, 9.84, 25.47, all P<0.05). The differences were statistically significant in terms of frailty( χ2=75.65, P<0.001) and self-perceptions of aging ( t=77.67, P<0.001). (2)Self-perceptions of aging in the cognitively impaired group (47.39±8.66) was higher than that in the cognitively normal group (38.22±8.24) ( t=77.67, P<0.001) .Frailty score in cognitively impaired group (2.00 (1.00, 3.00)) was higher than that in the cognitively normal group (0.00 (0.00, 1.00))( Z=-8.63, P<0.001) . (3)Frailty was negatively correlated with cognitive function ( r=-0.492, P<0.01), and positively correlated with self-perceptions of aging ( r=0.540, P<0.01). Self-perceptions of aging was negatively correlated with cognitive function ( r=-0.541, P<0.01) . After controlling the influencing factors such as age, education level, chronic diseases and depression, the correlation was still significant (all P<0.01) . (4) Self-perceptions of aging played a partially mediating role in the relationship between frailty and cognitive function, the mediating effect accounted for 58.5% of the total effect. Conclusion:Frailty and self-perceptions of aging have a significant impact on the cognitive function of the elderly in the community, and self-perceptions of aging plays a partial intermediary role between the frailty and cognitive function of the elderly in the community.

Advancement in the relationship between gut microbiota and coronary artery disease / 中国胸心血管外科临床杂志

@#Including gut microbiota and oral microbiota, various microorganisms in different human ecosystem constitute the human microbiota, which play an important role in human metabolism, immunity and maintaining microecological homeostasis. Abnormal changes in gut microbiota known as dysbiosis may lead to metabolic abnormalities and inflammatory changes, which are closely related to disease states including hypertension, diabetes, inflammatory bowel disease, and autoimmune diseases. The main cause of coronary artery disease is coronary atherosclerosis, a chronic and progressive inflammatory disease. Many evidences have shown that there is a correlation between gut microbiota and coronary artery disease. Therefore, we aim to review the relationship between gut microbiota and coronary artery disease, and discuss the possible research directions and application prospects.

Relationship between adolescents sense of life purpose and depression：the moderating role of grade / 中国学校卫生

Objective@#Exploring the relationship between adolescents sense of life purpose and depression as well as the moderating effect of grade, in order to provide evidence for the situation of sense of life purpose among Chinese adolescents.@*Methods@#A total of 1 627 adolescents from grade 4 to 9 in Hebei and Yunnan provinces were selected as the research subjects by using convenient cluster sampling method. The survey was conducted by using the Depression Self Rating Scale for Children and the Revised Youth Purpose Survey, and stratified regression was used for moderating effect analysis with a simple slope test.@*Results@#There were statistically significant differences in the score of depression among adolescents of different genders, mother s education level, father s education level, family economy and academic performances( t/F=-2.70, 3.62, 2.82, 13.67, 13.81, P <0.01). There were statistically significant differences in the score of sense of life purpose among adolescents of different mother s education level, father s education level, family economy and academic performances( F=3.24, 4.27, 7.50, 9.39, P <0.01). Correlation analysis showed that adolescents sense of life purpose was significantly negatively correlated with depression( r=-0.38, P <0.01). Hierarchical regression model results showed that adolescents sense of life purpose significantly negatively predicted depression (β=-0.19, t= -5.93, P <0.01). Grade played a moderating role between adolescents sense of life purpose and depression( β=-0.34, t= -7.54 , P <0.01). The simple slope test showed that depression decreased as the sense of life purpose increased in primary school students(grades 4-6) and in middle school students(grades 7-9), and the decrease of the middle school students was greater( β=-0.19, -0.53, t=-5.93, -16.15, P <0.01).@*Conclusion@#The sense of life purpose negatively predicted depression of adolescents, and grade moderated the relationship between the sense of life purpose and depression. Compared with students in grades 4-6, the improvement of life purpose of middle school students have a more significant protective effect on depression.

Effect of LncRNA GHET1 on Proliferation, Apoptosis, and Metastasis of Gallbladder Cancer Cells by Targeting miR-27b / 肿瘤防治研究

Objective To investigate the effect of GHET1 on the biological behavior of gallbladder cancer cells and the regulatory mechanism of GHET1 on miR-27b. Methods The expression of GHET1 and miR-27b in 50 samples of gallbladder cancer was detected by real-time quantitative PCR. The si-NC vector, si-GHET1 vector, miR-27b inhibitor, and si-GHET1 vector+miR-27b inhibitor were transfected into SGC-996 cells and set as the control group, GHET1 interference group, miR-27b interference group, and GHET1+miR-27b interference group. Cell proliferation, apoptosis, and metastasis in each group were detected by MTT, flow cytometry, and Transwell assays. The regulatory effect of GHET1 on miR-27b was validated by luciferase reporter gene assay. Results GHET1 expression was higher in cancer tissues than that in paracancerous ones. miR-27b expression was lower in cancer tissues than that in paracancerous tissues. GHET1 was negatively correlated with miR-27b expression (P<0.05), and GHET1 expression was associated with TNM staging and lymph node metastasis (P<0.05). High GHET1 expression was associated with poor prognosis of patients with gallbladder cancer (P<0.05). Compared with the control group, the GHET1 interference group showed decreased cell-proliferation ability, increased apoptosis rate, and reduced number of cell metastasis. The miR-27b interference group showed increased cell-proliferation ability, decreased apoptosis rate, and increased number of cell metastasis (P<0.05). Compared with the GHET1 interference group, the GHET1+miR-27b interference group showed increased cell-proliferation ability, decreased apoptosis rate, and increased number of cell metastasis (P<0.05). GHET1 inhibited miR-27b expression by acting as a sponge of miR-27b. Conclusion GHET1 promotes the proliferation and metastasis and inhibits the apoptosis of gallbladder cancer cells by targeting miR-27b, suggesting that GHET1/miR-27b axis plays a role in gallbladder cancer progression.

Establishment of early warning indicators of SARS-CoV-2 Omicron variant in Tianjin / 中华预防医学杂志

In this study, Delphi method was used to conduct a questionnaire survey on 12 experts to determine the indicators system and the corresponding weight for early warning features of SARS-CoV-2 Omicron in Tianjin.The positive indexes of experts in three rounds of consultations were both 100%. The experts' authority coefficient was 0.79. The Kendall's W coordination coefficients were 0.375, 0.356 and 0.385 respectively (all P<0.05). The indicators system for early warning features of 2019-nCoV Omicron variant had 5 first-level indicators, 10 second-level indicators and 52 third-level indicators. The weight of each indicator was also determined.

Analysis on the application of infectious diseases automated-alert and response system in Tianjin during the 13th Five-Year Plan period / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of automatic warning signals of infectious diseases received in Tianjin during the 13th Five-Year Plan period, and to provide reference for the function optimization of automatic warning system of infectious diseases during the 14th Five-year Plan period． Methods The data of infectious disease automatic early warning signals in Tianjin from 2016 to 2020 were downloaded from the China infectious diseases automated-alert and response system (CIDARS). The characteristics and response of early warning signals were analyzed by descriptive method. Results During the 13th Five-Year Plan period, 23,660 early warning signals were received in Tianjin, involving 39 kinds of infectious diseases, with 100% response rate and 1.10% positive rate of early warning signals. The median response time of warning signal was 0.53 hours (P25-P75: 0.19-1.17h). 95.74% of signals were responded within 2 hours and 98.47% of signals were responded within 24 hours. COVID-19, other infectious diarrhea diseases, dysentery, measles, and scarlet fever were the top five diseases with early warning signals. Conclusion During the 13th Five-Year, the automatic early warning system of infectious diseases in Tianjin runs well and has a high response rate, but the positive rate of early warning signal is low. During the 14th Five-Year，further research is needed to improve the early warning threshold according to the prevention and control needs and epidemic characteristics of different diseases, and to improve early warning positive rate.

HIV infection status in male outpatients in sexually transmitted disease clinics in Tianjin, 2016-2020 / 中华流行病学杂志

Objective: To understand the HIV infection status in male outpatients in sexually transmitted disease (STD) clinics in Tianjin from 2016 to 2020. Methods: According to the sentinel surveillance protocol, continuous cross-sectional studies were conducted between April and June during 2016-2020 to collect the information about the awareness of AIDS related knowledge, related sex behaviors, HIV infection, syphilis prevalence and HCV infection of male STD outpatients in Tianjin with a sample seize of 400 in each sentinel clinic. Results: From 2016 to 2020, a total of 4 000 male STD outpatients were surveyed. The HIV positive rate increased from 1.13% (9/800) to 2.25% (18/800) (trend χ2=14.22, P<0.001), the positive rate of syphilis increased from 9.38% (75/800) to 13.00% (104/800) (trend χ2=7.30, P=0.007) in this population during this period. The overall HCV positive rate was 0.45% (18/4 000). Multivariate logistic regression analysis showed that compared with those who were unmarried, had registered residence in Tianjin, had no temporary sexual behavior in the past 3 months, had no anal sex and had negative syphilis test result, the risk factors of HIV infection in the male STD outpatients included cohabitation (aOR=7.53, 95%CI:2.13-26.62), being from other provinces (aOR=3.64,95%CI:1.58-8.38), having temporary sexual behavior in the past 3 months (aOR=2.24,95%CI:1.03-4.89), having homosexual anal sex (aOR=85.99,95%CI:38.76-190.74) and suffering from syphilis (aOR=6.06,95%CI:3.18-11.56). Conclusion: The detection rates of HIV infection and syphilis in male STD outpatients in Tianjin showed upward trends from 2016 to 2020. Having temporary sexual behavior and anal sex, and suffering from syphilis were the main risk factors of HIV infection in male STD outpatients.

Peripheral blood circular RNA circ_0141633 and circ_0008234 as potential diagnostic and prognostic biomarkers in pancreatic cancer / 中国医师杂志

Objective:To clarify the clinical significance, diagnostic and prognostic values of circular RNA circ_0141633 and circ_0008234 in peripheral blood of pancreatic cancer, and analyze their impact on the biological function of pancreatic cancer cells.Methods:The peripheral blood samples of 97 pancreatic cancer patients and 71 healthy controls were collected, and the expression of circ_0141633 and circ_0008234 was analyzed by real-time quantitative polymerase chain reaction (qRT-PCR). The relationships between the expression of circ_0141633 and circ_0008234 and clinicopathological characteristics and prognosis of pancreatic cancer were analyzed by chi-square test, K-M survival curves and Cox proportional hazards regression model. The area under curve (AUC), sensitivity and specificity of circ_0141633 and circ_0008234 in the diagnosis of pancreatic cancer were analyzed by receiver operating characteristic (ROC) curve. The effects of circ_0141633 and circ_0008234 on the proliferation, migration, invasion and epithelial mesenchymal transformation (EMT) of Bxpc-3 cells were analyzed by methyl thiazolyl tetrazolium (MTT) method, cell scratch test, Transwell invasion and Western blot.Results:The expression of circ_0141633 and circ_0008234 in peripheral blood of pancreatic cancer patients was higher than those of healthy controls (all P<0.05). High expression of circ_0141633 and circ_0008234 was associated with higher clinical stage, lymph node metastasis and venous invasion, and were independent risk factors for poor prognosis in pancreatic cancer (all P<0.05). The overall survival rate of patients with high expression of circ_0141633 and circ_0008234 was significantly lower than that of patients with low expression of circ_0141633 and circ_0008234 (all P<0.05). The AUC of circ_0141633, circ_0008234, the combination of circ_0141633 and circ_0008234, CA19-9 in the diagnosis of pancreatic cancer was 0.70, 0.67, 0.88 and 0.82, with sensitivity of 64.32%, 60.79%, 78.22% and 73.97%, respectively. The specificity was 68.54%, 65.46%, 81.65% and 79.41%, respectively. The diagnostic efficiency of combination was superior to CA19-9, circ_0141633 and circ_0008234 alone (all P<0.05). Interfering with circ_0141633 and circ_0008234 alone could inhibit the proliferation, migration, invasion and EMT of Bxpc-3 cells, and the above inhibitory effect was more obvious after interfering with both of circ_0141633 and circ_0008234 (all P<0.05). Conclusions:The high expression of circ_0141633 and circ_0008234 in peripheral blood could be used as potential diagnostic and prognostic biomarkers of pancreatic cancer, and could promote the progression of pancreatic cancer.

Preimplantation Genetic Diagnosis of α/β Complex Thalassemia by Next Generation Sequencing / 中国实验血液学杂志

OBJECTIVE@#To explore the application value of next generation sequencing (NGS) in preimplantation genetic diagnosis of α/β complex thalassemia couple.@*METHODS@#The coding regions of α-globin genes (HBA1, HBA2) and β-globin gene (HBB) were selected as the target regions. The high-density and closely linked single nucleotide polymorphism (SNP) sites were selected as the genetic linkage markers in the upstream and downstream 2M regions of the gene. After NGS, the effective SNP sites were selected to construct the haplotype of the couple, and the risk chromosome of the mutation carried by the couple was determined. The NGS technology was used to sequence the variations of HBA1, HBA2 and HBB directly and construct haplotype linkage analysis for preimplantation genetic diagnosis.@*RESULTS@#Direct sequencing and haplotype linkage analysis of HBA1, HBA2 and HBB showed that two of the six blastocysts were α/β complex thalassemia, one was β-thalassemia heterozygote, two were α-thalassemias heterozygotes, and one was intermediate α-thalassemia. A well-developed embryo underwent preimplantation genetic diagnosis was implanted into the mother's uterus, and a healthy infant was born at term.@*CONCLUSION@#Preimplantation genetic diagnosis can be carried out by NGS technology in α/β complex thalassemia couples, and abortion caused by aneuploid embryo selection can be avoided.

Analysis of driver gene mutations in colorectal cancer by using next-generation sequencing / 中华老年医学杂志

Objective:To investigate the characteristics of gene mutations in colorectal cancer(CRC)patients by using next-generation generation sequencing(NGS).Methods:Blood and tissue samples were collected from 90 CRC patients admitted to Beijing Hospital between August 5, 2016 and December 29, 2020.Analysis of driver gene mutations was performed by using a 1021-gene NGS panel.Results:There were 43 tissue samples and 83 blood samples.Also, 36 patients had both tissue and blood samples.The frequency rates of KRAS and BRAF mutations were 51.2%(22/43)and 20.9%(9/43)in tissue samples, and 3 rare concomitant KRAS/ BRAF mutations were detected.The frequency rates of KRAS and BRAF mutations were 26.5%(22/83)and 10.8%(9/83)in blood samples.In patients with tissue and blood samples, the rates of KRAS and BRAF mutations were 52.8%(19/36)and 10.8%(8/36). Conclusions:The rate of KRAS mutations in tissue samples from colorectal cancer patients is similar to rates reported in the literature, but the rate of BRAF mutation and the rate of rare KRAS and BRAF co-mutations are higher than those reported from other countries.

Changes of multimodality therapeutic patterns of care study for resectable gastric cancer / 中华放射肿瘤学杂志

Objective:To investigate and analyze the current status of multimodality therapy for resectable gastric cancer, aiming to provide reference for optimizing the multimodality treatment strategy for gastric cancer.Methods:Clinical data of patients diagnosed with gastric adenocarcinoma undergoing radical gastrectomy in the Second Affiliated Hospital of Soochow University were retrospectively analyzed. Clinical characteristics, preoperative medical comorbidities, pathological features, surgical and perioperative status and clinical efficacy were recorded. The gap between the diagnosis and treatment procedures and the standard guidelines was analyzed. The changes in the multimodality treatment patterns for gastric cancer were understood.Results:A total of 265 patients were included in this study. All patients were divided into two cohorts: early[2008] and late[2013] cohorts. In the early cohort, 127 patients were assigned, and 138 cases in the late cohort. In the early cohort, 67 patients (52.8%) underwent D 2 lymph node dissection, significantly less than 83 patients (60.1%) in the late cohort ( P<0.01). In the early and late cohorts, the proportion of patients with the number of lymph node dissection of ≥15 was 5.5% and 52.8%( P<0.01). The median number of lymph node dissection was increased from 6 to 16. The proportion of patients receiving neoadjuvant chemotherapy in the early and late cohorts was 2.4% and 3.6%( P=0.55). In the early cohort, the proportion of patients treated with postoperative chemotherapy and postoperative adjuvant chemoradiotherapy was 62.6% and 2.4%, significantly higher compared with 58.0% and 8.0% in the late cohort ( P=0.04). In addition, the proportion of patients receiving postoperative chemotherapy in the early cohort was 62.2%( n=79) and 58.0%( n=80) in the late cohort ( P=0.48). Conclusions:Although the level of radical gastrectomy has been continuously improved and standardized in China, which still lags behind the standard D 2 radical gastrectomy in Japan and South Korea. Adjuvant therapies including postoperative adjuvant radiotherapy can bring clinical benefits. However, the proportion of patients receiving adjuvant therapy is still low, and the multimodality therapy of gastric cancer should be widely applied.

Monitoring results of individual doses to medical radiation workers in Jiangxi province from 2014 to 2018 / 中华放射医学与防护杂志

Objective:To analyze the levels of individual doses to radiation workers receiving medical radiation exposure in hospitals in Jiangxi province, so as to provide reference for radiation protection.Methods:The radiation workers of different types in medical institutions in Jiangxi were investigated from 2014 to 2018, involving diagnostic radiology, radiotherapy, nuclear medicine and interventional radiology. Statistical analyses were made of the individual doses to medical radiation workers in the province.Results:The total number of monitored workers were 23 833 with average annual individual effective dose of 0.316 mSv. NR1 and NR5, the ratios of the number of workers receiving annual individual doses exceeding 1 and 5 mSv to the total monitored workers were 4.32% and 0.10%, respectively. During the five-year period, the average annual individual effective dose showed a upward and then downward trend, with peak appearing in 2017. A total of 17 909 diagnostic radiologists were monitored, accounting for 75.14% of the total number of monitored workers. The average annual individual effective dose received by workers was 0.329 mSv, the highest, in interventional radiology, followed by diagnostic radiology 0.318 mSv, nuclear medicine 0.283 mSv, and radiotherapy 0.269 mSv, respectively. There were statistically significant differences among radiation workers of different types ( χ2=489.39, P<0.001). Conclusions:The average annual individual effective dose to the radiation workers in medical institutions in Jiangxi province meets the relevant national standards, but with an upward trend in nuclear medicine. The higher levels of individual doses to radiation workers are seen in primary and secondary hospitals. It should be strengthen the oversight of radiation workers in nuclear medicine and in primary and secondary hospitals.

Early detection of subclinical myocardial dysfunction assessed by cardiac MR feature tracking in hypertensive heart disease patients / 中华放射学杂志

Objective:To evaluate the value of cardiac MR feature tracking (CMR-FT) on the early assessment of left ventricular subclinical myocardial dysfunction in patients of hypertensive heart disease (HHD).Methods:From October 2018 to November 2019, 16 HHD patients with left ventricular hypertrophy (HHD-LVH), 24 HHD patients without left ventricular hypertrophy (HHD-nonLVH) and 24 age-and gender-matched normotensive controls who underwent 3.0 T CMR examination were retrospectively enrolled. Imaging protocol included cine sequence and late gadolinium enhancement. Left ventricular function variables were measured using Argus software, mainly including left ventricular end-diastolic volume index (LVEDVI), left ventricular mass index (LVMI), left ventricular maximal wall thickness (LVMWT), the ratio of left ventricular mass to left ventricular end-diastolic volume (M/V). CMR-FT was performed using commercial software CVI 42, with parameters including global radial, circumferential, longitudinal strains (GRS, GCS, GLS), peak systolic radial, circumferential, longitudinal strain rate (SRSR peak, SCSR peak, SLSR peak) and peak diastolic radial, circumferential, longitudinal strain rate (DRSR peak, DCSR peak, DLSR peak) derived. One-way analysis of variance with scheffe correction or Kruskal-Wallis test was performed for multiple comparisons. Pearson or Spearman analysis was used for linear or monotonic nonlinear correlations. Results:HHD-LVH group had higher LVEDVI, LVMI, LVMWT and M/V than HHD-nonLVH group and control group ( P<0.05). Compared with control group, GRS, GCS and GLS were statistically impaired in HHD-LVH group, and DRSR peak, DCSR peak and DLSR peak were statistically reduced in HHD-LVH group and HHD-nonLVH group(all P<0.05). Correlation analysis showed that LVMI correlated linearly with GRS ( r=-0.384, P=0.002), GCS ( r=0.392, P=0.001) and GLS ( r=0.491, P<0.0001),LVMWT correlated nonlinearly with GRS ( r=-0.362, P=0.003), GCS ( r=0.384, P=0.002) and GLS ( r=0.422, P=0.001), LVEDVI correlated nonlinearly with GRS ( r=-0.295, P=0.018) and GCS ( r=0.264, P=0.035). Conclusion:CMR-FT derived left ventricular strain parameters could be served as early indicators for the assessment of subclinical myocardial dysfunction in HHD patients, which have great potential in guiding appropriate intervention therapy and improving cardiac remodeling.

Analysis on individual dose reaching survey level of occupational external exposure in Jiangxi Province in 2018 / 中国辐射卫生

Objective To investigate the reasons why the routine monitoring of personal dose of occupational external exposure of some radiological workers in our province reached the investigation level in 2018, so as to provide technical support for the correct decision making of administrative departments. Methods The registration forms for monitoring and verifying the personal dose of occupational external exposure were issued to radiation workers whose periodic dose reached or exceeded 1.25 mSv/ cycle. Results A total of 102 person-times were sent out in 53 verification forms, and 95 person-times were collected in 47 copies. The recovery rate was 88.68%, and 7 person-times did not feedback the verification forms. There were 15 cases of actual exposure, accounting for 15.79%, including 5 cases of radiological diagnostic staff, who did not close the protective door when operating exposure. Among them, the other 80 cases, accouting for 84.21% didn't receive actual exposure. Conclusion The vast majority of radiological workers who reached the survey level didn't receive actual exposure. 5 person-time radiological diagnostic staff, during the work did not close the protective door, subjected to abnormal radiation. Interventional medicine, nuclear medicine and industrial mobile flaw detection workers are at higher risk of abnormal exposures during their work. The suspicious results of the questionnaires without feedback were all less than the annual dose limit and the requirements of audit management. We will strengthen supervision of radiation health protection, raise the awareness of radiation protection among radiation workers, and improve radiation protection management and protection conditions for radiation workers in interventional medicine, nuclear medicine and industrial mobile flaw detection furtherly.

Regulation of Cued Fear Expression via Corticotropin-Releasing-Factor Neurons in the Ventral Anteromedial Thalamic Nucleus / 神经科学通报·英文版

The ventral part of the anteromedial thalamic nucleus (AMv) is in a position to convey information to the cortico-hippocampal-amygdalar circuit involved in the processing of fear memory. Corticotropin-releasing-factor (CRF) neurons are closely associated with the regulation of stress and fear. However, few studies have focused on the role of thalamic CRF neurons in fear memory. In the present study, using a conditioned fear paradigm in CRF transgenic mice, we found that the c-Fos protein in the AMv CRF neurons was significantly increased after cued fear expression. Chemogenetic activation of AMv CRF neurons enhanced cued fear expression, whereas inhibition had the opposite effect on the cued fear response. Moreover, chemogenetic manipulation of AMv CRF neurons did not affect fear acquisition or contextual fear expression. In addition, anterograde tracing of projections revealed that AMv CRF neurons project to wide areas of the cerebral cortex and the limbic system. These results uncover a critical role of AMv CRF neurons in the regulation of conditioned fear memory.

Expert consensus on emergency medicine procedure optimization guided by routine prevention and control strategy for COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety.

Pelvic membrane anatomy and surgery with network preservation of autonomic nervous system for rectal cancer / 中华胃肠外科杂志

The principle of total mesorectal excision (TME) standardizes the resection range and surgical dissection plane in radical rectal cancer surgery, reduces the local recurrence rate and improves the long-term survival. TME is the "gold standard" in radical rectal cancer surgery. However, with the progress of laparoscopic surgical instruments and techniques in recent years, further understanding of pelvic membrane anatomy and autonomic nervous system has been gained, which makes the surgical plane of TME more accurate and the autonomic nervous system better preserved. According to anatomical discovery and histological confirmation, there is a fascia between the mesorectal fascia and pelvic parietal fascia, called pre-hypogastric nerve sheath, in which autonomic nervous system courses, including the superior hypogastric plexus, left and right hypogastric nerves, pelvic plexus and the neurovascular bundles, from the abdominal to the pelvic cavity behind the mesorectal fascia. It fuses with the end of the mesorectum at the superior border of musculi puborectalis, and goes around the mesorectum to join with Denonvillier fascia. On the basis of anatomical studies and empirical anatomical observations, we put forward the concept of network preservation of the autonomic nervous system: the main trunk as well as the nerve branches of the pelvic autonomic nervous system and accompanying blood vessels should be preserved to ensure the integrity of the nerve reflex arc. The concept allows the radical resection of rectal cancer to follow the principle of TME, and meanwhile, protect patient's urination function and sexual function to the greatest extent, improving the quality of life of patients after surgery.

Investigation and analysis on characteristics of a cluster of COVID-19 associated with exposure in a department store in Tianjin / 中华流行病学杂志

Objective@#To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development.@* Methods@#The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed.@* Results@#A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19(47.50%) were customers and 15(37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days.@* Conclusion@#This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.

Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19 / 中华心血管病杂志

Objective@#To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin-I (cTnI) with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated.@*Methods@#A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January to February in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD) , as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients.@*Results@#Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909, 95%CI 4.086-177.226, P=0.001) and CHD (OR=16.609, 95%CI 2.288-120.577, P=0.005) were the independent risk factors of critical disease status.@*Conclusions@#COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are two independent determinants of clinical disease status in patients with COVID-19.