Summary report of a national survey of Kashin-Beck disease prevalence in 2020 / 中华地方病学杂志

Objective:To investigate the dynamic prevalence of Kashin-Beck disease (KBD) in 2020, and to provide the basis for assessment of KBD control and elimination.Methods:According to the "Kashin-Beck Disease Monitoring Plan (2019 Edition)", collection of basic information of endemic areas and children KBD examination were executed in all endemic areas from every endemic county (city, district, banner) of 13 endemic provinces. All children aged 7 - 12 years in endemic areas underwent clinical examination, X-ray examination was performed for clinically positive children. According to the criteria of "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010), KBD cases were diagnosed by both clinical examination and X-ray check.Results:In monitoring of 827 986 children of 7 - 12 years old, a total of 703 children with similar clinical signs of KBD were suspected positive cases. X-ray results showed that 703 children were normal, with no X-ray positive change, they were not children KBD cases.Conclusions:In 2020, no cases of Kashin-Beck disease are detected in children nationwide, and the condition of Kashin-Beck disease in children nationwide continues to be at a level of elimination.

Left Ventricle Longitudinal Strain Parameters Are Effective for Differentiating Cardiac Amyloidosis from Primary Hypertensive Left Ventricular Hypertrophy / 中山大学学报(医学科学版)

ObjectiveTo clarify the value of the left ventricular longitudinal strain（LVLS）parameters in patients with cardiac amyloidosis （CA） and primary hypertension with left ventricular hypertrophy （HLVH）. MethodsForty-one patients confirmed with CA were selected and assigned to CA with hypertension group （n =14） and pure CA group （n=27） based on the initial diagnosis with or without hypertension. Twenty patients with primary hypertension-induced left ventricular hypertrophy （HLVH group） and twenty healthy controls were also selected， matching for gender， age， and body surface area. Clinical data， conventional echocardiography parameters were collected and LVLS parameters were measured. Within-group variations were compared among the four groups， and pairwise comparisons were conducted between groups. The sensitivity and specificity of each parameter in predicting CA were judged by the receiver operator characteristic （ROC） curvy in CA and HLVH patients with left ventricular ejection fraction （LVEF） preserved. ResultsAmong the conventional echocardiography parameters， LVEF and left ventricular end-diastolic diameter （LVEDD） were lower in the CA with hypertension group and pure CA group compared with the higher values in the HLVH group and control group. Whereas， left ventricular posterior wall thickness （LVPWT）， relative wall thickness （RWT）， and average E/e' were higher in the two CA groups compared with the HLVH group （all P＜0.05）.Among the LVLS parameters， Global longitudinal strain （GLS） was the worst in the CA with hypertension group so as pure CA group， modest in the HLVH group， and highest in the control group. On the contrary， relative longitudinal strain and ejection fraction strain ratio （EFSR） were the highest in the CA with hypertension group so as to pure CA group， modest in the HLVH group， and lowest in the control group （all P＜0.05）. ROC analysis showed that when LVEF was preserved， the absolute value of GLS less than 14.35% and EFSR higher than 4.28 could effectively distinguish CA from HLVH （all AUCs＞0.9，all P＜0.05）； meanwhile GLS showed high sensitivity（100%） and EFSR showed great specificity（95%）. There were not statistically significance in any parameter between CA with hypertension group and pure CA group（all P＞0.05）. ConclusionWhether CA was complicated with hypertension or not， there were statistically significance among routine echocardiography and LVLS parameters compared with HLVH. In particular， GLS and EFSR are accurate in predicting CA in patients with myocardial hypertrophy and preserved LVEF.

Cardiovascular health status of Chinese adults based on "Life's Essential 8" score / 中华流行病学杂志

Objective: To assess the cardiovascular health status of adults in China by using the "Life's Essential 8" score, and provide reference for the development and improvement of cardiovascular disease prevention and control policies and measures. Methods: Chronic Disease and Nutrition Surveillance was conducted in 298 counties/districts in 2015 in 31 provinces (autonomous regions, municipalities) across China, multi-stage stratified cluster random sampling was used to select 45 households in each village or neighborhood, and 20 households were further selected to conduct dietary surveys. In this study, a total of 70 093 adults aged ≥20 years who completed the dietary survey and had complete information were included, their cardiovascular health status were assessed by using the "Life's Essential 8" score, a cardiovascular health scoring standard released by the American Heart Association in 2022. All results were adjusted using complex design-based sampling weights to achieve a better estimate of the population. Results: In 2015, the overall cardiovascular health score of Chinese adults aged ≥20 years was 73.3±12.6, the score was significantly higher in women (77.9±11.6) than in men (68.7±11.8), and higher in urban area (74.5±12.8) than in rural area (71.9±12.2), the differences were significant (P<0.001). It was estimated that about 0.25% (95%CI: 0.16%-0.33%) of adults in China had cardiovascular health score of 100, and 33.0% (95%CI: 31.6%-34.3%), 63.2% (95%CI: 62.1%-64.3%), and 3.9% (95%CI: 3.5%-4.2%) of adults had high, moderate and low cardiovascular health scores, respectively. The proportion of those with high cardiovascular health scores was relatively low in men, those with low education level, those with low income, those living in rural areas, and those living in southwest China (P<0.001). Of the eight factors, diet had the lowest mean score (46.0, 95%CI: 44.7-47.3), followed by blood pressure (59.4, 95%CI: 58.2-60.6) and tobacco exposure (61.4, 95%CI: 60.6-62.2). Conclusions: The cardiovascular health status of two-thirds of adult population in China needs to be improved. Diet, tobacco exposure, and blood pressure are the factors affecting the cardiovascular health of Chinese population, to which close attention needs to be paid, and men, rural residents, and those with lower socioeconomic status are key groups in cardiovascular health promotion.

Associations between 24-hour urinary sodium excretion and all-cause mortality in adults living in north China / 中华心血管病杂志

Objective: To investigate the associations between 24-hour urinary sodium excretion (24hUNaE) and all-cause mortality in adult Northern Chinese population. Methods: Data from this study were derived from the prospective urban and rural epidemiology (PURE) study in north China. Baseline information of all participants were obtained by face to face interview through trained research staffs based on questionnaires, and morning fasting urine samples of participants were collected to estimate 24hUNaE and 24-hour potassium excretion (24hUKE). Multivariable frailty Cox regression models were used to explore the association between 24hUNaE (<3.00, 3.00-3.99, 4.00-4.99, 5.00-5.99 and ≥6 g/d) and all-cause death. Results: A total of 27 310 participants were included in this study. The mean 24hUNaE was (5.84±1.73) g/d. After a median follow-up of 8.8 years, 1 024 participants died (3.7%), including 390 cardiovascular related deaths and 591 non-cardiovascular related deaths. The cause of death of the remaining patients could not be determined. Using 24hUNaE level of 4.00-4.99 g/d as the reference group, after fully adjustment, 24hUNaE ≥6.00 g/d was associated with an increased risk of all-cause death (HR=1.24, 95%CI: 1.02-1.49) and cardiovascular related death (HR=1.39, 95%CI: 1.02-1.88). 24hUNaE<3.00 g/d was associated with increased risk of all-cause mortality (HR=1.38, 95%CI: 0.96-1.99). There was no significant association between 24hUNaE and non-cardiovascular related death. Furthermore, using the combination of 24hUNaE 4.00-4.99 g/d and 24hUKE≥2.11 g/d as the reference group, the highest risk occurred in participants with the combination of low sodium (<3.00 g/d) and low potassium (<2.11 g/d). Conclusion: 24hUNaE equal or higher than 6 g/d or lower than 3 g/d is associated with increased risk of all-cause mortality and cardiovascular related death in Northern Chinese population. Besides, moderate sodium intake in combination with increased potassium intake might reduce the risk of all-cause death.

Willingness to pay for treatment of rosacea and its influencing factors: a survey of patients in Changsha region / 中华皮肤科杂志

Objective:To investigate the willingness to pay (WTP) for treatment and its influencing factors, to evaluate the correlation between the disease burden (quality of life) index and dermatology life quality index (DLQI) in patients with rosacea, and to provide a basis for individualized diagnosis and treatment.Methods:Patients with rosacea were enrolled via a WeChat platform at Department of Dermatology, Xiangya Hospital from August 2019 to February 2020. An online questionnaire survey was performed to investigate the WTP for a single session of treatment by which rosacea is assumed to be cured, and general information as well as data about clinical characteristics and DLQI scores were collected. Factors influencing high WTP were analyzed by using a logistic regression model.Results:Among the 435 respondents, 397 (91.3%) were females and 38 (8.7%) were males, with an age of 28.46 ± 8.33 years (range, 18- 63 years) . The respondents spent 10 474.95 ± 834.19 ( M[ P25, P75], 5 000 [1 000, 10 000]) RMB Yuan on previous medical treatment; the WTP was 12 510.86 ± 990.84 ( M[ P25, P75], 5 000[2 000, 10 000]) RMB Yuan; the DLQI score was 11.2 ± 0.38. Logistic regression analysis showed that lesions on the cheeks ( OR= 1.89, P= 0.041) , annual household income of > 100 000 RMB Yuan ( OR= 1.63, P= 0.029) , disease duration of > 1 year ( OR= 2.82, P < 0.001) , high number of visits in the past 1 year ( OR= 1.62, P < 0.001) , high self-rated rosacea severity score ( OR= 1.16, P= 0.002) and high DLQI score ( OR= 1.52, P < 0.001) were associated high WTP for treatment. Spearman correlation analysis showed that the DLQI score was positively correlated with WTP ( rs= 0.27, P < 0.05) and relative WTP (the proportion of WTP to monthly income, rs= 0.133, P < 0.05) . Conclusions:Among the patients with rosacea in Changsha, the WTP was at a moderate to high level, reflecting a serious impact on the quality of life. The WTP value can indirectly reflect the quality of life and help to rapidly understand the burden of disease in patients with rosacea.

Application of ultrasound bionic 3D printing combined with PBL method in individualized teaching of standardized residency training of cardiac ultrasound / 中华医学教育探索杂志

Objective:To meet the individualized needs of residents in standardized residency training of cardiac intervention specialty for cardiac ultrasound teaching, to construct a bionic 3D printing model of ultrasound source, and to discuss its application value in ultrasound teaching and simulation exercises.Methods:Sixty residents majored in cardiovascular medicine receiving standardized residency training of ultrasound in ultrasound imaging department of Renmin Hospital of Wuhan University were randomized into experimental group and control group in average. The experimental group adopted ultrasound bionic 3D printing heart model combined with problem-based learning (PBL) teaching method, and the control group adopted traditional multimedia PPT combined with PBL teaching method. At the end of teaching activities, theoretical examination, operation assessment and questionnaire survey were conducted to evaluate and compare the teaching effect between the two groups. SPSS 21.0 software was performed for t test. Results:The theoretical examination scores of the experimental group and the control group were (81.4±8.2) points and (74.8±9.4) points, respectively, P=0.002, and the operation assessment scores were (89.1±5.6) points and (71.5±8.8) points, respectively, P<0.001. The questionnaire survey showed that the experimental group had better feedbacks than the control group in the aspects of mastery of heart anatomy knowledge, learning experience, learning interest, learning efficiency, understanding of interventional heart disease, clinical skills of interventional operation and overall satisfaction (all P<0.05). Conclusions:Ultrasound bionic 3D printing combined with PBL teaching method can help strengthen the mastery of cardiac anatomy knowledge, promote the learning experience of cardiac ultrasound and improve the skills of interventional operation. The teaching effect is significant and the students' satisfaction is high.

Chinese Medicine Shensong Yangxin Capsule () Ameliorates Myocardial Microcirculation Dysfunction in Rabbits with Chronic Myocardial Infarction / 中国结合医学杂志

OBJECTIVE@#To investigate the effect of Chinese compound Shensong Yangxin Capsule ( , SSYX) on myocardial microcirculation in myocardial-infarcted rabbits.@*METHODS@#Myocardial infarction (MI) was established in rabbits by ligation of the left circumflex coronary. Thirty rabbits were randomly divided into the control group, the MI group (model), and the MI treated with SSYX group (MI+SSYX) by a random number table method. After 4 weeks of administration, low-energy real-time myocardial contrast echocardiography (RT-MCE) was conducted to assess the microcirculatory perfusion. Immunofluorescence double staining was used to detect the capillary density. The endothelial ultrastructure was observed with a transmission electron microscope. The mRNA expression levels of vascular endothelial growth factor (VEGF), endothelin 1 (ET-1), prostaglandin I2 (PGI2) and endothelial nitric oxide synthase (eNOS) were measured by real-time quantitative polymerase chain reaction (Real-time PCR). The plasmic levels of ET-1, thromboxane A2 (TXA2), nitric oxide (NO) and von willebrand factor (vWF) were examined with enzyme-linked immunosorbent assays (ELISA).@*RESULTS@#SSYX significantly improved the myocardial blood volume, myocardial micro bubble velocity, and myocardial inflow according to the examination of RT-MCE, and it visibly ameliorated the capillary endothelial structure. Furthermore, compared with the MI group, the plasma levels of TXA2, ET-1 and vWF contents significantly decreased in the MI+SSYX group, and the ET-1 mRNA expression levels of myocardium in the border zone significantly decreased, and the VEGF, PGI2 and eNOS mRNA expression levels significantly increased (all P<0.05).@*CONCLUSIONS@#SSYX has favorable advantages in ameliorating the impaired myocardial microcirculation following MI. The mechanisms of the effect are related to the ability of SSYX in balancing the endothelial-derived vasodilators and vasoconstrictors, and up-regulating the expression of VEGF and eNOS.

The value of ultrasound quantitative parameters in early evaluation of neoadjuvant chemotherapy for breast cancer / 中华超声影像学杂志

Objective:To investigate the predictive value of quantitative parameters of ultrasound on early neoadjuvant chemotherapy (NAC) in breast cancer.Methods:Between March 2018 and October 2020, breast cancer patients who underwent surgery after NAC treatment in Renmin Hospital of Wuhan University were collected. Multimodal ultrasound examinations were performed before chemotherapy and after NAC in the second cycle. The quantitative parameters of ultrasound included diameter (D), peak enhancement (PE), time to peak (TTP), maximum shear wave velocity (Vmax) and mean shear wave velocity (Vmean). The change rates of corresponding parameters (ΔD, ΔPE, ΔTTP, ΔVmax, ΔVmean) were calculated. According to Miller & Payne (MP) pathological reaction classification, 93 patients were divided into effective group (37 cases) and ineffective group (56 cases). The differences of quantitative parameters between the two groups were compared. Multivariate logistic regression was used to analyze the effective quantitative parameters of NAC response, and ROC curve was plotted to analyze the predictive effect of quantitative parameters on NAC efficacy.Results:Before NAC, there were no significant differences in clinical data and pathological features between the two groups except age (all P>0.05). After the second cycle of chemotherapy, ΔPE and ΔVmax were significantly correlated with the efficacy of NAC ( t=-3.417, P=0.001; Z=-5.173, P<0.001). Multivariate regression analysis showed ΔPE and ΔVmax were effective predictors of NAC ( OR=1.105, 95% CI=1.032-1.184, P=0.004; OR=1.232, 95% CI=1.125-1.349, P<0.001). The cutoff values of ΔPE and ΔVmax in evaluating the efficacy of NAC were 16.37% and 28.52%. ΔPE>16.37%, and ΔVmax>28.52% suggested the pathologically effective response of NAC. The sensitivity and specificity of ΔPE, ΔVmax and ΔPE+ ΔVmax were 83.78%, 57.14%; 78.38%, 85.71%; 75.68%, 91.07%, respectively. Conclusions:The quantitative ultrasound parameters have certain clinical value in early prediction of NAC efficacy of breast cancer, and the combined application of parameters can help to improve the prediction efficiency.

Summary report of a national survey of Kashin-Beck disease prevalence in 2019 / 中华地方病学杂志

Objective:To master the status of Kashin-Beck disease (KBD) in 2019, to provide the basis for assessment of KBD control and elimination.Methods:Data of endemic areas basic information collection and children KBD examination were executed in all endemic villages from every endemic county (city, district, banner) of 13 endemic provinces. All children aged 7 - 12 years in endemic villages underwent clinical examination, and X-ray examination was performed for clinically positive children. When both the clinical examination and X-ray reexamination were positive, the diagnosis was KBD.Results:In monitoring of 823 365 7 - 12 years old children, a total of 3 057 children with similar clinical signs of KBD were suspected positive cases. The results of X-ray reexamination showed that the X-ray manifestations of 3 057 children were normal, and no X-ray positive changes were found, that is, there was no case of KBD in children. A total of 16 559 endemic villages in 13 endemic provinces were monitored, and all reached the criteria for KBD elimination. Surveillance of all endemic villages was completed except Tibet Autonomous Region, the KBD elimination rates of endemic villages were 100.00% in 12 endemic provinces and 99.01% (16 559/16 725) in all 13 endemic provinces.Conclusions:No children KBD case is detected in 2019, children KBD stays at its eliminating level throughout the country. And 100.00% endemic villages meet the criteria for KBD elimination in the remaining 12 endemic provinces except Tibet Autonomous Region.

Effect of Astragaloside Ⅳ Combined with Notoginseng Total Saponins on Angiogenesis After Transplantation of BMSCs in Rats with Cerebral Ischemia / 中国实验方剂学杂志

Objective:To investigate the effect of astragaloside Ⅳ（AST Ⅳ）and Notoginseng total saponins （NTS） combined with bone marrow mesenchymal stem cell （BMSC） transplantation on neural repair and angiogenesis in rats with cerebral ischemia. Method:The rats were randomly divided into a sham operation group， a model group， low- and high-dose AST Ⅳ + NTS groups， a BMSC infusion group， and low- and high-dose BMSC infusion+AST Ⅳ （10 and 20 mg·kg^-1） + NTS group （25， 50 mg·kg^-1）. BMSCs were isolated and purified by whole bone marrow adherent culture. The positive expression of surface markers of BMSCs （CD29， CD90， CD34， and CD45） was detected by flow cytometry. The focal cerebral ischemia model was established by middle cerebral artery occlusion （MCAO）. The PKH26-labeled BMSCs were injected into the tail vein of rats in the BMSC infusion group， once a day. The rats in the combination groups received BMSC injection once a day and intragastric administration of drugs twice a day. Other groups were administered twice a day by gavage. The sham operation group and the model group received the same amount of normal saline. Symptoms and signs of neurological deficits were assessed by the Longa method and the cerebral infarction rate was determined by TTC staining. The survival and vascularization ［double positive expression of PKH26/vascular endothelial growth factor （VEGF）］ after transplantation of BMSCs were observed by the immunofluorescence method. The protein expression of Ang1 and TGF-<italic>β</italic>₁ was measured by Western blot. Result:BMSCs were properly isolated and cultured. The identification of surface markers CD29， CD90， CD34， and CD45 was consistent with the characteristics of BMSCs. The neurological deficit score and cerebral infarction rate of the model group were significantly increased （<italic>P</italic><0.01）. All drugs and cell transplantation could alleviate the above pathological changes in varying degrees. The strongest effect was observed in high-dose BMSC infusion+AST Ⅳ+NTS group （<italic>P</italic><0.01）， which was superior to those in the AST Ⅳ+NTS groups or the BMSC infusion group. BMSC injection helped cells survive in the ischemic brain tissues and promoted angiogenesis， and this effect could be enhanced by the combination with drugs. After cerebral ischemia， the expression of Ang1 and TGF-<italic>β</italic>₁ was increased， and the effect in the BMSC infusion+AST Ⅳ+NTS groups was the strongest （<italic>P</italic><0.01）. Conclusion:AST Ⅳ combined with NTS can promote the survival of transplanted BMSCs and facilitate angiogenesis after target repair of damaged blood vessels after cerebral ischemia. The mechanism may be related to the improvement of the local microenvironment in the brain after cerebral ischemia and the promotion of the survival and differentiation of transplanted stem cells.

Dynamic distribution of Kappa angle in myopic patients undergoing FS-LASIK and its correlation analysis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the dynamic distribution of pupil size and center, the eccentricity distribution of corneal light reflection, and its correlation analysis about suitable for femtosecond laser combined with excimer laser <i>in situ</i> keratomileusis.<p>METHODS: Randomly selected 225 patients(407 eyes)who underwent femtosecond laser combined with excimer laser <i>in situ</i> keratomileusis at Yanbian University Hospital in 2019 from January to May, preoperative use of Wavelight Allegro Topolyzer Corneal Topography to measure the pupil size and center position, the German Wavelight EX500 excimer Laser(500Hz)records the deviation between the pupil center and the coaxially sighted corneal light reflex when the patient is supine. <p>RESULTS:The average displacement distribution between the center of the cornea and the center of the pupil is 0.322±0.194mm, and 64% of the eyes are ≤0.40mm. The average displacement distribution of P-Dist(the eccentricity between the pupil center and the coaxially sighted corneal light reflex point)is 0.225±0.102mm, and 80% of the eyes are ≤0.30mm. The coaxially sighted corneal light reflex point is mainly deviated to the superior temporal side of the corneal center(34%). The X-axis of the left eye in low light conditions: -0.061±0.084mm, and the X-axis of the right eye: -0.016±0.059mm(<i>P</i>=0.002)(the left eye shifted to the temporal side in the dark light). The corneal transverse diameter(WTW)was positively correlated with changes in pupil diameter(dark pupil diameter-bright pupil diameter)(<i>r</i>=0.270, <i>P</i><0.001).<p>CONCLUSION: The left eye should be adjusted to a position of the machining center within 0.061mm. If the cornea is too large, try to maintain a dark light environment during the operation to improve the efficiency of pupil matching. This study further confirms the necessity of rationally positioning the cutting center under different angle kappa states.

Feasibility study of three-dimensional printing combined with mock circulatory system to make compliant mitral valve model for hemodynamic testing in vitro based on ultrasound image data / 中华超声影像学杂志

Objective:To explore the feasibility of three-dimensional(3D) printing combined with mock circulatory system of flexible mitral valve model for hemodynamic testing in vitro based on ultrasound image data, making the transformation of 3D printing valve model from static to dynamic and from anatomical to functional, as well as assisting surgical plan for mitral valve diseases. Methods:A total of 10 subjects underwent three-dimensional transesophageal echocardiography (3D-TEE) and proved to be without mitral diseases were collected as mitral normal group from February 2017 to December 2018 in Renmin Hospital of Wuhan University, 10 mitral stenosis patients were collected as mitral stenosis group, and 10 mitral regurgitation patients were collected as mitral regurgitation group. Hemodynamic parameters of velocity (peak E), pressure gradient were obtained by two-dimensional transthoracic echocardiography in three groups, and the degree of mitral valve stenosis and regurgitation were also evaluated. Then 3D-TEE was performed to obtain the 3D volume image of mitral valve. After image post-processing and 3D modeling, the valve mold was printed with soluble material polyvinyl alcohol (PVA). The mixture of human skin silicone, silicone oil, starch and curing agent were poured into the mitral valve mold in a certain proportion to make flexible silicone mitral valve model. Then, the compliant valve model was placed in mock circulatory system (MCS), regularly opening and closing as it in vivo in the heart cycle. The hemodynamic parameters of mitral valve were measured again in vitro and the degree of stenosis and regurgitation was also evaluated respectively. Paired t test was used for statistical analysis of in vivo and in vitro measurements in two groups, and the consistency test was performed. Results:The mitral valve 3D-TEE images of all patients were successfully post-processed, mitral valve molds were printed and flexible models were made. In vitro hemodynamic tests were all completed. The opening and closing state of the valve model in vitro was similar to that in vivo. Mitral valve regurgitation was detected in mitral regurgitation group in vitro, with degree to that in vivo. There were no statistically significant differences in hemodynamic parameters measured in vivo and in vitro models (all P>0.05), with a high consistency ( r=0.76). Among the 10 patients with mitral stenosis and 10 patients with mitral regurgitation, 18 patients were evaluated as same degree as in vivo. Conclusions:3D printing of compliant mitral valve model based on ultrasound image is feasible, which reproduced hemodynamic features of mitral valve in vitro, setting foundation for further surgery simulation and clinical decision-making.

Investigation of physical disability in adults patients with Kashin-Beck disease / 中华地方病学杂志

Objective:To investigate the degree of limb dysfunction in adult patients with Kashin-Beck disease (KBD), and the correlation between clinical grade of KBD and physical disability classification.Methods:Based on the monitoring data, using typical survey methods, 10 natural villages were selected as survey sites in the historical critical area of KBD in Heilongjiang Province in 2015. Patients over 40 years old with KBD were investigated by questionnaire, joint range of motion(ROM) examination, and X-ray film were performed. The degree of physical disability of the surveyed patients was evaluated according to the national standard of "Classification and Grading of Disability of the Disabled" (GB/T 26341-2010). The correlation between clinical classification of KBD and limb disability classification was analyzed.Results:A total of 137 adult patients with KBD were investigated, the age was (57.4 ± 9.9) years old. Among them, 84 were males and 53 were females; 95 were grade Ⅰ, 30 were grade Ⅱ and 12 were grade Ⅲ. The most common joint pain of upper limb was interphalangeal joint(126 cases, 126/137), followed by elbow joint (116 cases, 116/137); the lower limbs were mainly ankle joint (118 cases, 118/137) and knee joint (107 cases, 107/137). There were significant differences of detection rates in elbow, knee, ankle, hip and wrist joints dysfunction among different age groups ( P < 0.05). The detection rate increased with age. There was no correlation between the clinical grade of KBD and the classification of physical disability ( rs = - 0.142, P > 0.05). KBD patients accounted for the highest proportion of tertiary disability (60 cases, 60/137). The physical disability of male patients was more serious than that of female patients (χ 2 = 22.610, P < 0.01). Conclusions:In adults with KBD, interphalangeal joint pain is the most common in the upper limbs, and the ankle and knee joints are the most common in the lower limbs. There is no correlation between clinical grade of KBD and the level of physical disability. The degree of physical disability in male patients is higher than that in female patients.

Negative fluid balance can reduce the 30-day mortality after entering ICU of severe pneumonia patients: a retrospective cohort study / 中华急诊医学杂志

Objective:To study the effects of different fluid balance strategies on severe pneumonia patients and explore the possible influence path in order to optimize fluid treatment for severe pneumonia patients.Methods:A total of 89 adult patients with severe pneumonia admitted to EICU and RICU of Jiangsu Provincial Hospital from January 2017 to August 2019 were retrospectively analyzed . The differences of clinical data between the death group ( n=35) and the survival group ( n=54) were analyzed. Multivariate logistic regression analysis was used to identify predictors of 30-day mortality after entering ICU of severe pneumonia patients. Patients were divided into a positive fluid balance (PFB) group ( n=48) and a negative fluid balance (NFB) group ( n=41). Kaplan-Meier survival curve was used to analyze the difference of 30-day survival rate between the PFB and NFB groups. Results:Age ( OR=1.060, 95% CI: 1.018-1.104, P=0.005), ventilator dependency ( OR=6.679, 95% CI: 1.218-36.620, P=0.029), vasoactive agents ( OR=21.068, 95% CI: 4.654-95.376, P<0.001), and new hyperchloremia occurred within 24 h after admission to the ICU ( OR=21.714, 95% CI: 1.059-445.008, P=0.046) were the risk factors for severe pneumonia patients' 30-day mortality after entering ICU. The concentrations of creatinine, urea nitrogen, sodium and chlorine of the NFB patients were lower than those of the PFB patients within 5 days after admission to ICU (day 1-day 5) ( P<0.05). The serum calcium concentrations of the NFB patients were higher than those of the PFB patients on day 3-5 ( P<0.05). The 30-day survival rate was significantly higher in the NFB patients than in the PFB patients ( P<0.001). Conclusions:The strategy of negative fluid balance can reduce serum chlorine concentration, improve renal function and reduce mortality in patients with severe pneumonia.

A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China / 中国当代儿科杂志

OBJECTIVE@#To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China.@*METHODS@#According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017.@*RESULTS@#A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66).@*CONCLUSIONS@#Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.

Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation / 中华超声影像学杂志

Objective To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n =20) and no weaning group (n =8).The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.Results Age,the peak of creatine kinase-MB levels(CK-MB),cardiac troponin Ⅰ levels (cTnⅠ),and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR =0.064,95％CI:0.008-0.527,P =0.011;OR =1.004,95％CI:1.002-1.108,P =0.039;OR =3.635,95％CI:1.320-9.740,P =0.020;OR =1.075,95％CI:1.045-1.286,P =0.013).In the weaning group,compared with pre-ECMO,mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2)were significantly increased at maximum flow on the first day during ECMO (all P ＜0.05),while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P ＜0.05).The values of MAP,StO2,left ventricular ejection fraction (LVEF),velocity-time integral of left ventricular outflow tract (LVOT-VTI),velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P＜0.05).Compared with the no weaning group,MAP,StO2,LVEF,LVO-TVTI and LatSa increased significantly in the weaning group (all P ＜0.05),and the left ventricular end diastolic volume (LVEDV)decreased obviously after ECMO weaning(P ＜0.05).Conclusions Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.

Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation / 中华超声影像学杂志

Objective@#To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).@*Methods@#A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.@*Results@#Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05).@*Conclusions@#Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.

The value of contrast-enhanced ultrasonography in differential diagnosis of orbit tumors in extraconal compartment / 中华超声影像学杂志

Objective@#To provide a reference for differential diagnosis of orbit tumors in extraconal compartment by analyzing the parameters of contrast-enhanced ultrasonography (CEUS).@*Methods@#A total of 76 patients with orbit tumors in extraconal compartment who underwent CEUS examination were retrospectively analyzed. These patients were divided into two groups depending on histological diagnosis including 27 cases with malignant tumor and 49 cases with benign tumor. CEUS images were analyzed using Sonoliver software. The time-intensity curve (TIC) and dynamic vascular pattern curve (DVPC) were acquired and the characteristics of the arterial flow infusion of these were analyzed. The related parameters such as time of arrival time(AT), rise time (RT), time to peak(TTP), mean transit time(mTT), slope of rise(K1), the absolute value for slope of down (K2) were also obtained. The differences of DVPC, TIC and quantitative parameters between the two groups were compared. Receiver operating curve analysis was used to acquire the cut-off values of these parameters for differential diagnosis.@*Results@#①TICs of the benign tumors were mainly fast rise and slow drop and DVPCs were mainly positive biphasic, while TICs of the malignant tumors were mainly fast rise and fast drop and DVPCs were mainly biphasic. ②The differences of quantitative parameters IMAX, K1, K2, mTT and RT of TICs were statistically significant between the two groups (P<0.05), while those of AT and TTP were not (P>0.05). ③IMAX=456.2%, K1=109.6, K2=35.2, RT=7.9 s, mTT=28.1 s were the best cut-off values for differential diagnosis. Among these parameters, mTT with 28.1 s had the highest diagnostic value(sensitivity: 81%, specificity: 77%).@*Conclusions@#The quantitative CEUS parameters can provide effective reference for differential diagnosis of orbit tumors in extraconal compartment.

Astragaloside IV attenuates cerebral ischemia and reperfusion injury and reduces activation of NLRP3 inflammasome and NF-κB phosphorylation in rats following a transient middle cerebral artery occlusion / 生理学报

The present study was aimed to investigate the protective effect and anti-inflammation mechanism of astragaloside IV (AST-IV) on cerebral ischemia and reperfusion injury. Following the establishment of cerebral ischemia and reperfusion model in rats by modified suture method, neurological deficit scores and cerebral infarct volume were used to evaluate the pharmacological effect of AST-IV against cerebral ischemia-reperfusion injury. Western blot was used to detect the expression levels of NLRP3, pro-Caspase-1, Caspase-1, pro-IL-1β, IL-1β, pro-IL-18, IL-18, phosphorylated and total nuclear factor kappa B (NF-κB)/p65 protein in the brain tissue. The results showed that compared with model group, the intervention of AST-IV decreased the neurological deficit scores, reduced the cerebral infarct volume, decreased the levels of NLRP3, Caspase-1, pro-IL-1β, IL-1β, pro-IL-18 and IL-18, and inhibited the expression of phosphorylated NF-κB in brain tissue. The results suggest that AST-IV has a protective effect against cerebral ischemia and reperfusion injury, and its mechanism is related to inhibiting the phosphorylation of NF-κB and NLRP3 inflammasome activation.

The value of contrast‐enhanced ultrasonography in differential diagnosis of orbit tumors in extraconal compartment / 中华超声影像学杂志

Objective To provide a reference for differential diagnosis of orbit tumors in extraconal compartment by analyzing the parameters of contrast‐enhanced ultrasonography ( CEUS) . Methods A total of 76 patients with orbit tumors in extraconal compartment w ho underwent CEUS examination were retrospectively analyzed . T hese patients were divided into two groups depending on histological diagnosis including 27 cases with malignant tumor and 49 cases with benign tumor . CEUS images were analyzed using Sonoliver software . T he time‐intensity curve ( T IC ) and dynamic vascular pattern curve ( DVPC ) were acquired and the characteristics of the arterial flow infusion of these were analyzed . T he related parameters such as time of arrival time( AT ) ,rise time ( RT ) ,time to peak( T T P) ,mean transit time( mT T ) ,slope of rise( K1 ) ,the absolute value for slope of down ( K 2 ) were also obtained . T he differences of DVPC ,TIC and quantitative parameters between the two groups were compared . Receiver operating curve analysis was used to acquire the cut‐off values of these parameters for differential diagnosis . Results ① T ICs of the benign tumors were mainly fast rise and slow drop and DVPCs were mainly positive biphasic ,w hile T ICs of the malignant tumors were mainly fast rise and fast drop and DVPCs were mainly biphasic . ② T he differences of quantitative parameters IM AX ,K 1 ,K2 ,mT T and RT of T ICs were statistically significant between the two groups ( P ＜0 .05) ,w hile those of A T and T T P were not ( P ＞ 0 .05 ) . ③ IM AX＝ 456 .2% ,K1 ＝109 .6 ,K2 ＝35 .2 ,RT＝7 .9 s ,mT T＝28 .1 s were the best cut‐off values for differential diagnosis . Among these parameters ,mT T with 28 .1 s had the highest diagnostic value ( sensitivity :81% ,specificity :77% ) . Conclusions The quantitative CEUS parameters can provide effective reference for differential diagnosis of orbit tumors in extraconal compartment .