Effect of pancreatic duct stenting in the treatment of severe acute pancreatitis: a retrospective study in a single center / 中华肝胆外科杂志

Objective:To evaluate the effect of pancreatic duct stenting in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 68 patients with SAP admitted to the Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University from January, 2019 to July, 2020 were retrospectively analyzed, including 38 males and 30 females, aged (44.85±8.51) years old. The patients were divided into two groups according to the treatment modality: the conservative group ( n=41) which received the conservative management, and the stent group ( n=27) which underwent pancreatic duct stent implantation and conservative management. The basic information, parenteral nutrition support time, fasting days, and other clinical data of patients were collected. Serum amylase, white blood cell count, acute physiology and chronic health (APACHE) II score and CT score were compared between the two groups at admission and 48 hours after treatment. Results:The serum amylase, white blood cell count, APACHE II score and CT score of the two groups were significantly lower after treatment (all P<0.05). Compared with the conservative group, the APACHE II score [(5.52±2.15) vs. (8.76±2.50)] and CT score [(4.85±1.96) vs. (6.18±1.07)] of patients were lower in the stent group after treatment (both P<0.05). Pancreatic duct stents were successfully implanted in all 27 patients of the stent group. Intubation to the main pancreatic duct failed in one patient, while the accessory pancreatic duct was alternatively intubated through the accessory nipple. No severe complications such as iatrogenic pancreatitis, bleeding, and perforation occurred after endoscopic retrograde cholangiopancreatography. The incidence of postoperative local complications was lower [18.52%(5/27) vs. 41.46%(17/41)], the proportion of antibiotic use>3 types [29.63%(8/27) vs. 56.10%(23/41)] decreased, and the analgesic episodes decreased [2(1, 3) vs. 4(3, 6)] in the stent group. The antibiotic usage duration [8(3, 11) d vs. 13(10, 19) d], the parenteral nutrition time [7(4, 15)d vs. 15(8, 18)d], the fasting time [5(3, 11) d vs. 11(6, 13)d] and the hospital stay [10(5, 16) d vs. 15(13, 23)d] were all shortened (all P<0.05). Conclusion:Both conservative management and pancreatic duct stenting can alleviate the clinical symptoms of SAP, and pancreatic duct stenting could help reduce local complications, relieve symptoms, and shorten hospital stay.

Analysis of investigation results of the prevalence of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region in 2019 / 中华地方病学杂志

Objective:To study the prevalence of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region (Inner Mongolia), and to provide reference for further prevention and treatment of skeletal fluorosis at this stage.Methods:From March to October 2019, a survey of skeletal fluorosis was carried out in all diseased villages of the eight diseased leagues (cities) in Inner Mongolia, including Alxa, Bayannur, Baotou, Ordos, Hohhot, Hulunbeier, Ulanqab and Xilingol. Permanent residents aged 18 years and above in the diseased villeges were investigated. Face to face questionnaires were used to collect the basic data of age, sex, epidemiological history, etc. of all subjects, and clinical examination of skeletal fluorosis was carried out. Drinking water samples were collected from residents for fluoride content testing.Results:A total of 123 166 residents aged 18 years and above were investigated, 1 781 cases of skeletal fluorosis were detected, and the detection rate was 1.45%. The degree of skeletal fluorosis was mild, accounting for 72.26% (1 287/1 781); the others were moderate and severe, accounting for 20.38% (363/1 781) and 7.36% (131/1 781), respectively. There were statistically significant differences in the detection rates of skeletal fluorosis among people of different water fluoride content, age, gender and regions (χ 2 = 565.96, 671.32, 4.38, 17 283.80, P < 0.05). Among them, the detection rates of skeletal fluorosis in water fluoride content > 4.0 mg/L, ≥56 years old and female population were relatively high, which were 5.21% (49/941), 2.26% (1 428/63 188) and 1.52% (905/59 555), respectively. The detection rates of skeletal fluorosis in Xilingol League and Baotou City were significantly higher, 25.48% (745/2 924) and 24.32% (225/925), respectively. Conclusion:The situation of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia has been effectively controlled, but there are still relatively many patients with skeletal fluorosis in some areas, and further targeted prevention and control work is needed.

Signal mining and analysis of adverse drug events of abatacept based on FAERS database / 中国药房

OBJECTIVE To provide a reference for the safe use of abatacept in clinic. METHODS Based on the United States FDA Adverse Event Reporting System （FAERS） database， the generic name of the drug “abatacept” and the trade name “Orencia” were used as the search keywords to retrieve drug adverse event （ADE） signal of abatacept as primary suspected drug. The reported odds ratio method and proportional reporting ratio method in the proportional imbalance method and Excel 2020 software were used to mine and analyze the signals. RESULTS A total of 93 189 abatacept-induced ADE reports were retrieved， mainly female cases （75.98%）， and the age was mainly concentrated in 18-64 years old （35.17%）； main countries reporting data were the United States （47.41%） and Canada （30.59%）， and the number of reports was generally increasing year by year. A total of 3 092 ADE signals were screened， of which the signals associated with the primary disease were similar to those described in the drug instruction of abatacept， such as rheumatoid arthritis， arthralgia， joint swelling， etc.； followed by ADE signals related to infusion reactions， including pain， fatigue， rash， etc. All selected ADE signals involved 27 system organ classes， mainly involved systemic diseases and drug site conditions， musculoskeletal and connective tissue diseases， injury， poisoning and surgical complications， infections and invasive diseases， gastrointestinal diseases， neurological diseases， respiratory， thoracic and mediastinal diseases， heart diseases， benign， malignant and unspecified tumors and reproductive system and breast diseases， etc. A total of 22 ADE signals were not included in the drug instructions of abatacept among the top 50 ADE signals in the number list of reported cases， including fatigue， drug intolerance， abdominal discomfort， swelling， lupus erythematosus， peripheral swelling， cell sores， diarrhea， elevated liver enzymes and lower respiratory tract infection， etc. CONCLUSIONS In the process of clinical use of abatacept， special attention should be paid to infection and its carcinogenicity， while assessing the risk of respiratory and cardiovascular system diseases in patients； when patients suffer from these two underlying diseases， the pros and cons should be weighed carefully before selecting drug； in addition， the drug-induced ADE in the neurological， gastrointestinal and reproductive system cannot be ignored.

Lycium barbarum Polysaccharide Regulates Activation of RAW264.7 Macrophages Through MGL/TLR Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the mechanism of Lycium barbarum polysaccharides （LBP） in promoting the activation of RAW264.7 macrophages. MethodRAW264.7 macrophages were stimulated with LBP at different concentrations （50， 100， 200 mg·L-1）， and those stimulated with lipopolysaccharide （LPS） at 100 μg·L-1 and galactose （Gal） at 100 mg·L-1 as positive controls. After 24 h of LBP stimulation， the cell counting kit-8 （CCK-8） was used to detect the survival rate of RAW264.7 macrophages treated with LBP （0， 50， 100， 200， 400， 800 mg·L-1）. The levels of interleukin-6 （IL-6） and interleukin-12 （IL-12） in cell culture supernatant were detected by enzyme-linked immunosorbent assay （ELISA）. The protein and mRNA expression of p38 mitogen-activated protein kinase （MAPK）， extracellular signal-regulated kinase （ERK）， c-Jun N-terminal kinase （JNK）， and nuclear factor κB （NF-κB） in Toll-like receptor 4 （TLR4）/Toll-like receptor 2 （TLR2）/macrophage galactose-type lectin （MGL） pathway of RAW264.7 macrophages was detected by Real-time fluorescence-based quantitative polymerase chain reaction （Real-time PCR） and Western blot. ResultCCK-8 results showed that compared with the results in the blank group， the survival rate of RAW264.7 macrophages decreased in the 400， 800 mg·L-1 LBP groups （P<0.05）. ELISA results showed that compared with the blank group， 50 mg·L-1 LBP could promote the secretion of IL-12 in RAW264.7 macrophages （P<0.01）. Compared with the blank group， 100 mg·L-1 LBP and 200 mg·L-1 LBP could promote the secretion of IL-6 in RAW264.7 macrophages （P<0.05， P<0.01）. Western blot results showed that compared with the blank group， the LBP groups （50， 100， 200 mg·L-1） enhanced protein expression levels of MAPK key molecules （p-p38 MAPK， p-ERK， p-NF-κB， and p-JNK） in TLR4， TLR2， and MGL pathways （P<0.05， P<0.01）. Compared with the model group， the 200 mg·L-1 LBP group could promote the expression level of p-NF-κB protein in RAW264.7 macrophages （P<0.01）. Real-time PCR results showed that compared with the blank group， the LBP groups （50， 100， and 200 mg·L-1） enhanced the mRNA expression levels of MAPK key molecules （p38 MAPK， ERK， NF-κB， and JNK） in TLR4 and TLR2 pathways （P<0.05， P<0.01）. Compared with the model group， the 50 and 200 mg·L-1 LBP groups could promote the mRNA expression levels of JNK and ERK2 in RAW264.7 macrophages （P<0.05， P<0.01）. ConclusionLBP can regulate the activation of RAW264.7 macrophages and participate in the immune response through the TLR2/TLR4/MGL pathway.

Effect of aluminum exposure on abnormal phosphorylationof tau protein in PC12 cells of rats / 预防医学

Objective @#To investigate the effect of aluminum exposure on expression of miR-497-5p, wingless murine breast cancer virus integration site family member 3a (Wnt3a), β-catenin protein, glycogen synthase kinase-3β (GSK-3β) protein and tau protein in rat adrenal pheochromocytoma PC12 cells, so as to provide insight into unraveling the mechanisms underlying aluminum exposure-induced abnormal phosphorylation of tau protein.@* Methods@# PC12 cells were exposed to Al(mal)3 at concentrations of 0, 100, 200, 400 μmol/L for 24 h. The viability of PC12 cells was measured using cell counting kit-8 (CCK-8) assay. The relative expression of miR-497-5p and Wnt3a was detected using a real-time fluorescent quantitative PCR (RT-qPCR) assay, and the expression of Wnt3a, β-catenin, GSK-3β, P-GSK-3β (Ser9), tau and p-tau (Ser396) proteins were determined using Western blotting. @*Results @#The viability of PC12 cells appeared a tendency towards a decline with the increase of aluminum dose (Ftrend=323.473, P=0.001). RT-qPCR assay detected that the relative miR-497-5p expression appeared a tendency towards a rise with the increase of aluminum dose (Ftrend=14.888, P=0.031), and the relative Wnt3a expression appeared a tendency towards a decline with the increase of aluminum dose (Ftrend=165.934, P<0.001). The miR-497-5p expression negatively correlated with the relative Wnt3a expression (r=-0.693, P=0.012). The expression of Wnt3a (Ftrend=357.656, P=0.001), β-catenin (Ftrend=208.750, P=0.001) and p-GSK-3β (Ser9) proteins (Ftrend=512.583, P<0.001) appeared a tendency towards a decline with the increase of aluminum dose, and the expression of GSK-3β (Ftrend=39.965, P<0.001), tau (Ftrend=277.929, P=0.006) and p-tau (Ser396) proteins (Ftrend=96.247, P=0.002) appeared a tendency towards a rise with the increase of aluminum dose. @*Conclusion@# Up-regulation of miR-497-5p and GSK-3β expression and down-regulation of Wnt3a and β-catenin expression may be a mechanism underlying aluminum exposure-induced abnormal phosphorylation of tau protein.

Characteristics and Research Progress of Traditional Chinese Medicine in Treatment of HER-2-Positive Breast Cancer： A Review / 中国实验方剂学杂志

Human epidermal growth factor receptor-2 （HER-2）-positive breast cancer has higher predilection to metastasize and invade other organs， leading to poor prognosis. The anti-HER-2 drugs， such as trastuzumab， pertuzumab， and trastuzumab emtansinehas， can remarkably prolong the disease free survival （DFS） of patients. However， frequent multidrug resistance， tumor recurrence and metastasis， and adverse reactions such as cardiotoxicity and gastrointestinal discomfort caused by adjuvant therapy are still challenges for the treatment of HER-2-positive breast cancer. The understanding of breast cancer in traditional Chinese medicine （TCM） has a long history. In thousands of years of inheritance and innovation， a standardized treatment system with TCM characteristics has been gradually formed， which shows unique advantages and significant curative effects in breast cancer treatment. The treatment principles of ''treatment based on syndrome differentiation''， ''treatment based on stages and types''， ''treatment according to individual conditions''， and ''treatment of different viscera and viscera based on the toxin and pathogen'' are closely related to the precise treatment concept. In view of the challenges in the treatment of HER-2-positive breast cancer， such as multidrug resistance， tumor recurrence and metastasis， cardiotoxicity， and gastrointestinal discomfort， this paper summarizes the characteristics of TCM in reversing the multidrug resistance， inhibiting tumor recurrence and metastasis， prolonging DFS， improving prognosis， reducing adverse reactions caused by adjuvant therapy， and improving the quality of life after breast cancer surgery according to the principles of reinforcing healthy Qi and eliminating pathogen， and treatment based on syndrome differentiation. This article is expected to serve as a reference for TCM treatment of HER-2 positive breast cancer.

Investigation on the prevalence of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region in 2020 / 中华地方病学杂志

Objective:To understand the prevalence of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region, and to provide a data basis for formulation of prevention and control measures.Methods:All administrative villages of 53 banners (counties) in 10 leagues (cities) of Inner Mongolia Autonomous Region were investigated for tea-drinking-borne fluorosis. The basic information and demographic information of each administrative village were collected, and 10 households were selected from each administrative village to investigate the basic information of family members and the drinking situation of brick tea, and collect household brick tea samples to determine the fluorine content. The prevalence of dental fluorosis in children aged 8 to 12 and skeletal fluorosis in adults over 16 years in the administrative villages were investigated.Results:There were 39 banners (counties) in Inner Mongolia Autonomous Region that had the habit of drinking brick tea, people who habitually drink brick tea a lot accounted for 70.22% of the total population (4.278 5 million/6.092 8 million). The per capita annual consumption of brick tea was 1.00 kg and the per capita daily intake of brick tea fluoride was 0.68 mg. A total of 24 282 brick tea samples were collected, and the samples with fluorine content exceeding the standard accounted for 74.77% (18 155/24 282). Except that the fluorine content of black brick tea was lower than the national health standard (300 mg/kg), other varieties of brick tea exceeded the standard. A total of 97 295 children aged 8 to 12 years were examined, and 6 558 cases of dental fluorosis were detected. The detection rate of dental fluorosis was 6.74%. Among them, 3 623 cases were very mild, 2 440 cases were mild, 489 cases were moderate and 6 cases were severe. There were significant differences in the detection rates of dental fluorosis in children of different regions and ages (χ 2 = 6 803.76, 30.82, P < 0.05). A total of 115 251 adults over 16 years old were examined, and 1 691 cases of skeletal fluorosis were detected. The detection rate of adult skeletal fluorosis was 1.47%; among them, 1 043 cases were mild, 481 cases were moderate and 167 cases were severe. There were statistically significant differences in the detection rates of skeletal fluorosis among adults of different regions and ages (χ 2 = 3 584.26, 562.67, P < 0.05). Conclusions:The fluoride content of brick tea consumed by residents in Inner Mongolia Autonomous Region seriously exceeds the standard. Moderate and severe patients with dental fluorosis in children aged 8 to 12 years and skeletal fluorosis in adults over 16 years old have been detected. The prevention and treatment of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region should be continuously strengthened.

Relationship between intestinal flora and intestinal barrier dysfunction in patients with sepsis / 中华急诊医学杂志

Objective:To explore the relationship between intestinal flora disorder and intestinal barrier dysfunction in patients with sepsis.Methods:A prospective observational study was conducted to include 10 patients with sepsis (sepsis group) admitted to the ICU of General Hospital of Ningxia Medical University from February 2017 to June 2017, 10 normal postoperative patients (non-sepsis group) admitted to the ICU of General Hospital of Ningxia Medical University in the same period, and 10 healthy persons (control group) were served as controls. General information was recorded. Fecal samples of the three groups of experimental subjects were detected and analyzed by using 16S rRNA gene sequencing technology. The venous blood of the sepsis and non-sepsis groups were collected and the levels of D-lactic acid and bacterial endotoxin in were measured by enzymatic method at the corresponding time points. The correlation between the levels of D-lactic acid and bacterial endotoxin and intestinal flora of patients with sepsis was analyzed.Results:The change consistency of pathogenic bacteria between clinical infection and intestinal pathogenic bacteria in patients with sepsis was observed and analyzed. Sputum culture of patients with sepsis was Acinetobacter baumannii (corresponding patient number: S5, S6, S8), Stenotrophomonas maltophilia (corresponding patient number: S6, S7), and Enterococcus (corresponding patient number: S7). In the intestinal flora of corresponding patients, the OUT abundance were increased. Patients with sepsis (corresponding patient number S7) showed E. coli in blood culture, and in his intestinal flora the OUT abundance was increased. Correlation analysis showed that the serum D-lactic acid level was negatively correlated with the proportion of Firmicutes in intestinal flora in the non-sepsis and sepsis groups, while was positively correlated with the proportion of Firmicutes (r value: -0.532, 0.468, respectively, P<0.05). Conclusions:The gut microbiota dysbiosis is correlated with intestinal barrier function in sepsis patients with sepsis. The spread of pathogenic bacteria between clinical infection and intestinal bacteria in sepsis patients has potential consistency.

Clinical study on simultaneous bacterial and fungal culture of bile and pancreatic juice in acute biliary pancreatitis / 中华肝胆外科杂志

Objective:To investigate the characteristics and clinical significance of distribution of bacteria and fungi in pancreatic fluid and bile in patients with acute biliary pancreatitis (ABP).Methods:The clinical data of patients with ABP who underwent endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct stenting with simultaneous bacterial and fungal culture of bile and pancreatic fluid at the Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University from January 1, 2019, to June 30, 2021 were retrospectively analyzed. Of 202 patients, there were 102 males, and 100 females, aged (54±16) years old. Patients were divided into two groups by presence or absence of pancreatic infection: the pancreatic infection group ( n=20) and the non-pancreatic infection group ( n=182). Of the 76 patients with positive bile bacterial cultures, 60 patients with positive pancreatic fluid bacterial cultures were included in the positive pancreatic fluid culture group and 16 patients with negative pancreatic fluid cultures were included in the negative pancreatic fluid culture group. The clinical data including the type and distribution of bacteria cultured, complications, and co-infections of patients were compared. Factors associated with pancreatic infection were analyzed using logistic regression and the value of assessment of the associated factors was analyzed by plotting the receiver operating characteristic (ROC) curve. Results:Of 404 specimens (202 each of pancreatic fluid and bile) were sent for examination, 152 (37.6%) were positive. 174 strains were isolated from the 152 positive specimens, 96 (55.2%) gram-negative, 70 (40.2%) gram-positive and 8 (4.6%) fungal strains. Compared to the pancreatic fluid culture-negative group, patients in the pancreatic fluid culture positive group had a statistically significant ( P<0.05) increased risk of neutrophil to lymphocyte ratio, duration of fever, Balthazar CT score, complication rate, and development of pancreatic necrosis, pancreatic infection and systemic inflammatory response syndrome (SIRS). Compared to patients in the non-pancreatic infection group, patients in the pancreatic infection group had a statistically significant ( P<0.05) increase in duration of fever on admission, duration of fasting, and proportion of patients with combined SIRS, positive bile cultures, positive pancreatic fluid cultures, and diabetes mellitus. Logistic regression analysis showed that positive pancreatic fluid cultures ( OR=6.699, 95% CI: 1.159-38.725) and diabetes mellitus on admission ( OR=4.625, 95% CI: 1.304-16.394) were risk factors for late pancreatic infection ( P<0.05). The area under the ROC curve for the combination of both positive pancreatic fluid culture and diabetes mellitus in predicting late pancreatic infection in patients was 0.788, with a specificity of 59.30% and a sensitivity of 90.00%. Conclusions:Bacterial culture in pancreatic juice and bile of ABP patients showed mainly Gram-negative bacteria. Early culture of pancreatic juice and bile had positive significance in ABP evaluation, infection prediction and anti-infection treatment.

Investigation of fluoride content in drinking water of residents in Inner Mongolia Autonomous Region from 2017 to 2019 / 中华地方病学杂志

Objective:To learn about the distribution of fluoride content in drinking water of residents in Inner Mongolia Autonomous Region, so as to provide scientific basis for formulation of refined prevention and control measures for drinking-water-type endemic fluorosis.Methods:From January 2017 to December 2019, water fluoride surveys were carried out in all natural villages of 103 banners (counties) in 12 leagues (cities) of Inner Mongolia Autonomous Region, and drinking water samples of residents were collected according to different water supply methods (engineering water supply, physical and chemical water improvement, and decentralized water supply). The ion selective electrode method was used for water fluoride detection, and whether the water fluoride exceeded the standard was determined according to the "Standards for Drinking Water Quality" (GB 5749-2006).Results:The survey was carried out in 36 625 natural villages in 103 banners (counties) of 12 leagues (cities) in the region, among which 24 682 were engineering water supply villages, accounting for 67.39%; 2 610 were physical and chemical water improvement villages, accounting for 7.13%; and 9 333 were decentralized water supply villages, accounting for 25.48%. The median values of water fluoride in the engineering water supply villages, the physical and chemical water improvement villages and the decentralized water supply villages were 0.62, 0.23, and 0.52 mg/L, respectively, and the difference between different water supply methods was statistically significant ( H = 2 809.95, P < 0.001); the qualified rates of water fluoride were 96.47% (23 810/24 682), 99.73% (2 603/2 610) and 96.37% (8 994/9 333), respectively, and there was significant difference between different water supply methods (χ 2 = 132.74, P < 0.001). All the 12 leagues (cities) in the region had villages with water fluoride exceeding the standard, among which Chifeng City and Ordos City had more villages with water fluoride exceeding the standard (479, 282). Conclusions:All the 12 leagues (cities) in Inner Mongolia Autonomous Region have villages with water fluoride exceeding the standard. It is necessary to urge relevant departments to carry out planning and management of villages with water fluoride exceeding the standard.

Comparative analysis of blood components distribution in 24 domestic prefecture-level blood stations / 中国输血杂志

【Objective】 To understand the current situation of blood components distribution in domestic prefecture-level blood stations through analyzing the components distribution data of 24 prefecture-level blood stations in China. 【Methods】 The data of components distribution of 24 blood stations from 2017 to 2020 as well as the data of blood deployment of 24 blood stations from 2019 to 2020 were collected and analyzed. 【Results】 From 2017 to 2020, positive annual growth in red blood cells, plasma and cryoprecipitate was observed in 22, 19 and 15 out of the 24 blood stations, and the annual growth median rate of above three components was 5.24%, 3.80% and 3.25%, respectively. Among the 24 prefecture-level blood stations, 23 carried out the preparation of cryoprecipitate. 【Conclusion】 The distribution of red blood cells, cryoprecipitate and plasma in prefecture-level blood stations is increasing year by year. However, there is a overstock of plasma, and most blood stations need blood employment.

Prognostic value of coagulation function combined with acute physiology and chronic health evaluationⅡ and sequential organ failure assessment scores for patients with bloodstream infection / 中华危重病急救医学

Objective:To evaluate the prognostic value of platelet count (PLT), coagulation indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and sequential organ failure assessment (SOFA) in patients with bloodstream infection.Methods:A retrospective single center cohort study was conducted, patients with at least one positive blood culture bloodstream infection hospitalized in the intensive care unit (ICU) of Ningxia Medical University General Hospital from January 2016 to October 2020 were selected as the research objects, basic data and pathogen distribution, coagulation function, and prognosis at 28 days were collected, the APACHEⅡscore, SOFA score based on the results of laboratory examination within 24 hours of blood culture were calculated. Patients were divided into the survival group and the death group according to the 28-day prognosis, and the differences of the above indicators were compared. Multivariate Logistic regression analysis was used to screen out the risk factors for 28-day death of patients with bloodstream infection. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive efficacy of various risk factors for 28-day prognosis of patients with bloodstream infection.Results:A total of 215 patients with bloodstream infection were enrolled, of which 117 survived and 98 died within 28 days. The 256 strains of pathogenic bacteria were detected, including 161 (62.89%) Gram-negative bacteria (G -), 76 (29.69%) Gram-positive bacteria (G +), 17 fungi (6.64%), and 2 other strains (0.78%). The main pathogenic bacteria were Escherichia coli (53 strains, 20.70%), Enterococcus (37 strains, 14.45%), and Klebsiella pneumoniae (34 strains, 13.28%). Compared with the survival group, patients in the death group were older (years old: 60.98±16.08 vs. 55.64±16.35), had higher levels of body temperature, SOFA score, APACHEⅡ score, proportion of malignant tumor and pulmonary infection, blood lactic acid (Lac), and creatinine [Cr; body temperature (℃): 39.12±1.10 vs. 38.67±1.09, SOFA score: 13.05±4.40 vs. 7.85±3.74, APACHEⅡscore: 24.01±8.18 vs. 15.38±6.59, proportion of malignant tumor: 15.31% (15/98) vs. 12.82% (15/117), proportion of patients with pulmonary infection: 84.69% (83/98) vs. 72.65% (85/117), Lac (mmol/L): 7.13±6.04 vs. 4.31±2.98, Cr (μmol/L): 189.73±141.81 vs. 124.55±106.17, all P < 0.05]. The prothrombin time (PT), activated partial thrombin time (APTT), and thrombin time (TT) were significantly longer [PT (s): 19.51±15.16 vs. 14.94±2.86, APTT (s): 52.74±26.82 vs. 40.77±15.30, TT (s) : 21.59±18.46 vs. 17.38±2.59, all P < 0.05], PLT was significantly decreased [×10 9/L: 43.50 (18.75, 92.75) vs. 86.00 (36.00, 154.50), P < 0.05]. Logistic regression analysis showed that body temperature, age, SOFA score and APACHEⅡ score were independent risk factors [odds ratio ( OR) were 1.388, 1.023, 0.817 and 0.916, respectively, 95% confidence intervals (95% CI) were 1.001-1.926, 1.001-1.046, 0.730-0.913, 0.867-0.968, with respective P values of 0.046, 0.043, 0.000, 0.002]. ROC curve analysis showed that SOFA score, APACHEⅡ score, temperature, age had certain predictive values for the prognosis of patients with bloodstream infection, and area under ROC curve (AUC) was 0.815, 0.795, 0.625 and 0.594, respectively (all P < 0.05). The AUC predicted by the combination of the 4 variables was as high as 0.851, the specificity was 79.3%, and the sensitivity was 74.2%, suggesting that the combination variables could predict the death of patients with bloodstream infection with higher accuracy. Conclusions:PLT and coagulation indexes are helpful to evaluate the prognosis of patients with bloodstream infection in ICU. APACHEⅡscore and SOFA score are directly related to the prognosis of patients with bloodstream infection.

Efficacy Prediction Model for Neoadjuvant Chemotherapy on Breast Cancer Based on Differential Genes Expression / 肿瘤防治研究

Objective To screen out significant differential genes for predicting the effect of neoadjuvant chemotherapy (NAC) and select the most suitable breast cancer patients for NAC. Methods A total of 60 breast cancer patients' samples before and after NAC were collected for high-throughput RNA-Seq. We selected AHNAK, CIDEA, ADIPOQ and AKAP12 as the candidate genes that related to tumor chemotherapeutic resistance. We analyzed the correlation of AHNAK, CIDEA, ADIPOQ, AKAP12 expression levels with the effect of NAC by logistic regression analysis, constructed a prediction model and demonstrated the model by the nomogram. Results AHNAK, CIDEA, ADIPOQ and AKAP12 expression were up-regulated in the residual tumor tissues of non-pCR group after NAC(P < 0.05). Compared with pCR group, non-pCR group presented higher expression levels of AHNAK, CIDEA, ADIPOQ and AKAP12 (P < 0.05). The high expression levels of AHNAK, CIDEA, ADIPOQ and AKAP12 significantly reduced the pCR rate of NAC for breast cancer (P < 0.05). Our prediction model which AHNAK, CIDEA, ADIPOQ and AKAP12 were involved in showed a good fitting effect with H1 test (χ2=6.3967, P=0.4945) and the ROC curve (AUC 0.8249, 95%CI: 0.722-0.9271). Conclusion AHNAK, CIDEA, ADIPOQ and AKAP12 may be novel marker genes for NAC effect on breast cancer. The efficacy prediction model based on this result is expected to be a new method to select the optimal patients of breast cancer for neoadjuvant chemotherapy.

Analysis of correlation between fecal and alveolar lavage fluid flora of ventilator-associated pneumonia patients based on 16S rRNA sequencing technology / 中华危重病急救医学

Objective:To investigate the changes and correlation of intestinal and pulmonary microecological structures in patients with ventilator-associated pneumonia (VAP).Methods:A prospective observational study was conducted. Thirty-one patients with VAP admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from May 1st 2019 to May 1st 2020 were enrolled. Feces and alveolar lavage fluid samples from patients with the same day, feces and alveolar lavage specimen flora composition and the structure of biological information analysis by 16S rRNA sequencing technologies, the comprehensive sequencing results, and clinical data of patients were analyzed.Results:① The diversity (abundance and diversity) of flora in the alveolar lavage fluid of VAP patients was higher than that of fecal flora. Among them, Ace index, Chao index and Shannon index describing the abundance of flora showed statistically significant differences [Ace index: 305.89 (214.39, 458.66) vs. 204.51 (165.15, 247.61), Chao index: 259.83 (194.20, 459.31) vs. 187.67 (153.28, 234.01), Shannon index: 3.01 (2.39, 3.54) vs. 2.55 (1.86, 2.95), all P < 0.05], but there was no significant difference in Simpson index describing diversity [0.14 (0.08, 0.27) vs. 0.19 (0.10, 0.33), P > 0.05]. ② In the sequencing results of feces and alveolar lavage fluid of VAP patients, there were some intestinal related bacteria groups with high abundance, such as Escherichia-Shigella, Faecalibacterium, Bacteroides, and Lachnospira, etc. ③ In 31 VAP patients, suspicious pathogenic bacteria was found in 20 cases (6 cases of Streptococcus viridans, 5 cases of Escherichia coli, 3 cases of Klebsiella pneumoniae, 3 cases of Acinetobacter baumannii, 2 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa), and the same suspected pathogens also existed in the 17 patients' alveolar lavage and waste sequencing. ④ Fourteen VAP patients combined with sepsis, 14 patients without sepsis were selected for sample size matching. The results showed that, Jaccard similarity index to describe lung-correlation of intestinal flora in VAP with sepsis group was significantly elevated, and the difference was statistically significant (0.24±0.08 vs. 0.19±0.06, P < 0.01). Conclusions:There is a certain correlation between pulmonary and intestinal flora in VAP patients. In addition to the exclusion of pulmonary infection caused by environmental and upper respiratory micro-inhalation, the lower digestive tract may also be source of infection.

Analysis of monitoring data on drinking tea type of endemic fluorosis from 2009 to 2018 in Inner Mongolia Autonomous Region / 中华地方病学杂志

Objective:To understand the change trend of people's condition in tea drinking endemic fluorosis area of Inner Mongolia Autonomous Region, and to provide scientific basis for formulating prevention and control strategies.Methods:From 2009 to 2018, a cross-sectional survey was conducted in 30 villages of 6 banners (counties) of drinking tea type of endemic fluorosis of Inner Mongolia Autonomous Region. The tea drinking habits of residents were investigated. Ten families were selected from each monitoring village to collect brick tea samples, and the fluorine content in brick tea was detected for health risk assessment. In each monitoring village, one water sample was collected from each drinking water source. Fluoride ion selective electrode method was used to detect fluorine in tea and water. The prevalence of dental fluorosis in children aged 8-12 years old was examined and the X-ray examination and analysis were carried out for all the permanent residents aged 36-45 years and living in the local area for more than 5 years.Results:From 2009 to 2018, a total of 3 000 brick tea samples were collected. The geometric mean value of tea fluorine was 522.01 mg/kg, and the annual per capita consumption of brick tea by permanent residents was 2.52 kg. The average daily intake of fluorine in brick tea was 4.11 mg. According to the standard of "Total Fluoride Intake of Population" (WS/T 87-2016), there were 6 years of risk quotient > 1 in 10 years, while according to the World Health Organization (WHO) recommend standard, there were 5 years of risk quotient > 1. From 2012 to 2018, 210 water samples were detected, and the geometric mean value of fluorine in water was 0.90 mg/L, and the qualified rate was 84.76% (178/210). A total of 5 384 children aged 8-12 years old were examined and 1 562 dental fluorosis patients were detected. The total detection rate of dental fluorosis in children was 29.01% (1 562/5 384), and the dental fluorosis index was 0.62 (very mild). A total of 1 890 adults aged 36 to 45 years old were examined by X-ray. The detection rate of skeletal fluorosis was 18.10% (342/1 890). There were 77 patients with moderate and severe skeletal fluorosis.Conclusions:The brick tea fluorine content of residents in Inner Mongolia Autonomous Region is high, and there are health risks. The dental fluorosis of children aged 8-12 years old is very mild, and there are still moderate and severe skeletal fluorosis patients in adults. Therefore, it is necessary to strengthen the supervision of brick tea market and strengthen health education for residents.

Advances on intrauterine infection and pulmonary disease in premature infants / 国际儿科学杂志

Intrauterine infection is one of the most important cause of adverse outcomes in pulmonary diseases among preterm infants.The lung tissues of such infants are still immature, whose contact with pathogens when exposed to intrauterine inflammatory environment may trigger local or even systemic inflammatory response, causing different degrees of harm to fetal or neonatal lung tissue.Such damage could lead to bronchopulmonary dysplasia in preterm infants, neonatal pneumonia, neonatal respiratory distress syndrome, etc., affecting their quality of life.This review is about the research progress and the pathogenesis of intrauterine infection in pulmonary diseases of premature infants.

Current situation of water improvement and dental fluorosis in drinking-water-type endemic fluorosis areas of Inner Mongolia Autonomous Region in 2019 / 中华地方病学杂志

Objective:To understand the current situation of water improvement and the prevalence of dental fluorosis in children aged 8 to 12 in drinking-water-type endemic fluorosis (referred to as drinking-water-type fluorosis) areas in Inner Mongolia Autonomous Region (referred to as Inner Mongolia), and to evaluate the effectiveness of prevention and control measures, and provide a basis for timely adjustment of prevention and control strategies.Methods:In 2019, a cross-sectional survey was conducted to investigate the situation of water improvement and water fluoride content in all villages of 85 drinking-water-type fluorosis banners (counties) in Inner Mongolia, and all the children aged 8 to 12 were examined for dental fluorosis.Results:Among the 9 623 disease affected villages in the region, the water improvement projects were completed in 8 547 villages, and the water improvement rate was 88.82%. There were 7 145 water improvement villages whose water fluoride content met the national drinking water hygiene standard, which accounted for 83.60% (7 145/8 547) of the total villages with water improvement projects. A total of 118 857 children aged 8 to 12 were examined, and 9 123 cases of dental fluorosis were detected. The detection rate of dental fluorosis was 7.68%, which was lower than the upper limit of the dental fluorosis detection rate of fluorosis area standards (30%).Conclusions:The accomplishment rate of water improvement projects in drinking-water-type fluorosis areas of Inner Mongolia is high, and the condition of children's dental fluorosis has been effectively controlled. However, it is still necessary to strengthen the water quality monitoring, improve the qualified rate of water improvement projects, and effectively implement various comprehensive prevention and control measures.

Investigation of arsenic content in drinking water of residents in Inner Mongolia Autonomous Region from 2017 to 2019 / 中华地方病学杂志

Objective:To investigate the distribution of arsenic content in drinking water of residents in Inner Mongolia Autonomous Region, and to provide a scientific basis for formulation of detailed prevention and control measures for endemic arsenic poisoning.Methods:From 2017 to 2019, water arsenic survey was carried out in all natural villages in 103 banners (counties, districts) of 12 leagues (cities) in Inner Mongolia Autonomous Region, and drinking water samples were collected according to different water supply modes (engineering water supply, physical and chemical water purification, decentralized water supply). Among them, engineering water supply: one factory water sample was collected from each water modification project in dry season and wet season; and one terminal water sample was collected in historical arsenism area/high arsenic exposed villages covered by the project. Physical and chemical water purification: one water sample was collected from each household. Decentralized water supply: in historical arsenism area/high arsenic exposed villages, one water sample was collected from each household; in the villages with historical qualified water arsenic, one household was selected according to the five directions of east, south, west, north and middle, and one water sample was collected from each household. The content of arsenic in water was detected by atomic fluorescence spectrometry and a distribution map of water samples with excessive arsenic was drawn using ArcGIS 10.2 software.Results:A total of 90 455 water samples were collected, including 31 617 water samples for engineering water supply, 2 702 water samples for physical and chemical water purification, and 56 136 water samples for decentralized water supply. The medians of water arsenic content of engineering water supply, physical and chemical water purification, and decentralized water supply were 1.00, 1.00 and 0.50 μg/L, respectively, and the differences among different water supply modes were statistically significant (χ 2 = 1 147.831, P < 0.05). A total of 486 water samples with excessive arsenic were detected, the detection rate was 0.54% (486/90 455). The detection rates of water samples with excessive arsenic in engineering water supply and decentralized water supply were 1.48% (469/31 617) and 0.03% (17/56 136), the detection rate of water samples with excessive arsenic in engineering water supply was higher than that in decentralized water supply (χ 2 = 775.401, P < 0.05); there was no water samples with excessive arsenic in physical and chemical water purification. The top three areas with the detection rates of water samples with excessive arsenic were Bayannaoer [15.38% (343/2 230)], Hohhot [2.00% (86/4 293)], and Ordos [0.85% (50/5 848)]. ArcGIS 10.2 software showed that the water samples with excessive arsenic were mainly distributed in the western region in the shape of focal and block, and only existed sporadically in the eastern region. Conclusions:The detection rate of water samples with excessive arsenic in engineering water supply in Inner Mongolia Autonomous Region is high, the water samples with excessive arsenic are mainly distributed in the western region in the shape of focal and block, and sporadically in the eastern region. The management and supervision of engineering water supply should be strengthened, in areas where the water arsenic exceeds the standard, we should take physical and chemical water purification measures, such as change water sources, increase water purification equipment, and improve water purification technology to reduce arsenic hazards, so as to ensure that residents can drink qualified water.

Analysis of surveillance results of drinking-water-borne endemic fluorosis in Inner Mongolia Autonomous Region from 2009 to 2018 / 中华地方病学杂志

Objective:To master the operating situation of water-improvement, water fluoride content and the disease trends in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region.Methods:From 2009 to 2018, 30 diseased villages (Tun, hereinafter referred to as village) in 11 cities (districts, banners and counties) were selected as fixed monitoring sites in Inner Mongolia Autonomous Region for 10 consecutive years to investigate the operation status of the water-improvement project and water fluoride content; the prevalence of dental fluorosis in all children aged 8 to 12 in the monitoring sites were checked.Results:From 2009 to 2018, the water-improving rate of monitoring villages increased from 70.00% (21/30) in 2009 to 86.67% (26/30) in 2018, the ratio of beneficiary population raised from 82.94% (20 921/25 224) to 96.84% (18 513/19 118); the normal operation rate of water-improvement project increased from 85.71% (18/21) to 95.65% (22/23), and the water fluoride qualification rate of the water-improvement project increased from 61.90% (13/21) to 82.61% (19/23). The water fluoride content of the village with water-improvement project was 1.00 - 1.44 mg/L, and that of the village without water-improvement project was 2.15 - 2.69 mg/L. The water fluoride content of the village with water-improvement project was lower than that of the village without water-improvement project in each year ( P < 0.05). From 2009 to 2018, the total detection rate of dental fluorosis was 27.95% (2 610/9 339), the community fluorosis index was 0.56, and the epidemic intensity was marginal. There was significant difference in the detection rate of children's dental fluorosis between different years (χ 2 = 484.195, P < 0.05). There were statistically significant differences in the detection rate of dental fluorosis of villages with normal operation of water-improvement project and qualified water fluoride, villages with abnormal operation of water-improvement project or excessive water fluoride content, and villages without water-improvement (χ 2 = 210.73, 143.60, 22.67, P < 0.01). The results showed that the detection rate of children's dental fluorosis in the villages with normal operation of water-improvement project and qualified water fluoride content was lower than that in the villages with abnormal operation of water-improvement project or excessive water fluoride content and the villages without water- improvement ( P < 0.05). Conclusions:The improvement of water quality and the reduction of fluoride in Inner Mongolia Autonomous Region have achieved remarkable results, but there are still some water-improvement projects and villages with serious water fluoride exceeding the standard. The fluorosis has not been fully controlled, and it is still necessary to further strengthen the work of water-improvement, and the management and protection after water-improvement.

Comparison of IC and HB methods on energy consumption and its influencing factors in patients with multiple trauma / 中华急诊医学杂志

objective:To evaluate the difference 24h energy expenditure in patients with multiple trauma mechanical ventilation predicted by indirect calorimetry (IC) and HB formula. To explore the correlation between energy expenditure and Injury Severity Scoring (ISS) in patients with multiple trauma, and to predict the stress coefficient to improve the accuracy of HB prediction.Methods:A total of 152 patients with multiple trauma receiving mechanical ventilation were included in the ICU of the General Hospital of Ningxia Medical University during December 1st, 2016 to August 31st, 2018. As a research object, The IC method and the HB method were used to simultaneously measure the patient's 24h energy expenditure, and the difference between the two measurement methods was compared. The 24h energy consumption measured by the IC method was used as the "gold standard", and the 24h body weight energy expenditure per kilogram was calculated; Grouped according to the ISS score, compared 24h energy consumption with 24h body weight energy expenditure per kilogram. The Bland-Altman method was used to test the consistency of the two measurements. The two groups were compared using t test, the correlation was analyzed by pearson correlation, and the regression equation was linearly calculated by linear regression.Results:There was a significant bias between the IC method and the HB method in measuring the 24h energy expenditure of patients with multiple trauma, with an average bias of 394.0± 54.0Kcal/d. The 24h energy consumption and 24h body weight energy expenditure per kilogram in the severe injured group were significantly higher than those in the moderate injury group ( P<0.05). The stress coefficient was calculated, The stress coefficient of the HB method associated with the ISS using the one-way regression was Y=0.770+0.018×ISS. Conclusion:The HB method significantly underestimates the 24h energy expenditure of patients with multiple trauma . In order to improve the accuracy of the HB method to predict the 24h energy consumption of patients with multiple injuries, The HB method can be corrected using the stress coefficient associated with the ISS score, Y = (0.770 + 0.018 × ISS) × HB method.