Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester / 中华妇产科杂志

Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ2 test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27+4 weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.

Epidemiological characteristics of syphilis in Yichang in 2011 - 2020 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of syphilis in Yichang City from 2011 to 2020, and provide a scientific basis for developing effective control measures. Methods The data of syphilis cases reported in Yichang City from 2011 to 2020 were collected and analyzed by descriptive epidemiological methods. Results A total of 8 107 cases of syphilis were reported in Yichang City from 2011 to 2020, with an average annual reported incidence rate of 19.76 per 100 000.The reported incidence of syphilis increased from 17.39/100 000 in 2011 to 24.49/100 000 in 2018 （APC=6.82%，95%CI：2.34%~11.49%， P＜0.05）, from 24.49/100 000 in 2018 Decline to 17.55/100 000 in 2020（P＞0.05）. Recessive syphilis is the main type, with 5 837 cases (72.00%), and the annual reported incidence rate is 14.23 per 100 000. The number of cases peaked in July, at 836 (10.31%), and 433 (5.34%) of the lowest in February . The top 3 counties with annual average reported incidence rates were Zigui County (28.51/100 000) , Xiling District (25.01/100 000), and Dangyang City (23.73/100 000). There were a statistically significant differences in reported incidence between counties (2 =933.92, P＜0.01). Gender ratio was 0.72. Cases mainly concentrated in people over 20 years old, 7901 cases (97.46%). The occupation distribution is mainly farmers, housework, unemployed, and retired people. Conclusion The incidence of syphilis in Yichang City has been on the rise in recent ten years, and there is still a long way to go to prevent and control syphilis. We suggested to continue to strengthen the prevention and control of syphilis and comprehensively prevent and control the spread of syphilis.

Recent advances in small molecule inhibitors of interleukin‑1 receptor-associated kinase / 药学学报

Interleukin-1 receptor associated kinase 4 (IRAK-4), acting as a serine threonine kinase, is considered as a key signal node for the transduction of IL-1R family and TLRs signal pathway. Studies have found that IRAK-4 has a hand in many signal pathways, involving the inflammatory response of human joints, intestines, liver and nervous system, as well as other autoimmune diseases. It is also one of the causes of drug resistance of some cancer cells. Therefore, IRAK-4 tends to be an effective therapeutic target for inflammatory diseases and cancer. The prospects for the development of drugs in this pathway is to develop novel IRAK-4 small molecule inhibitors and investigate their safety and effectiveness, enrich the clinical treatment of inflammatory and cancer diseases finally. This paper classified and summarized the latest research progress on small molecule inhibitors of IRAK-4 signaling pathway according to structures of the compounds, in order to provide assistances and references for the research and development of related drugs.

Effect of diosgenin on mTOR/FASN/HIF-1α/VEGFA expression in rats with non-alcoholic fatty liver disease / 中国中药杂志

The present study aimed to investigate the effect of diosgenin on mammalian target of rapamycin(mTOR), fatty acid synthase(FASN), hypoxia inducible factor-1α(HIF-1α), and vascular endothelial growth factor A(VEGFA) expression in liver tissues of rats with non-alcoholic fatty liver disease(NAFLD) and explore the mechanism of diosgenin on lipogenesis and inflammation in NAFLD. Forty male SD rats were divided into a normal group(n=8) fed on the normal diet and an experimental group(n=32) fed on the high-fat diet(HFD) for the induction of the NAFLD model. After modeling, the rats in the experimental group were randomly divided into an HFD group, a low-dose diosgenin group(150 mg·kg~(-1)·d~(-1)), a high-dose diosgenin group(300 mg·kg~(-1)·d~(-1)), and a simvastatin group(4 mg·kg~(-1)·d~(-1)), with eight rats in each group. The drugs were continuously given by gavage for eight weeks. The levels of triglyceride(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), alanine transaminase(ALT), and aspartate transaminase(AST) in the serum were detected by the biochemical method. The content of TG and TC in the liver was detected by the enzyme method. Enzyme-linked immunosorbent assay(ELISA) was used to measure interleukin 1β(IL-1β) and tumor necrosis factor α(TNF-α) in the serum. Lipid accumulation in the liver was detected by oil red O staining. Pathological changes of liver tissues were detected by hematoxylin-eosin(HE) staining. The mRNA and protein expression levels of mTOR, FASN, HIF-1α, and VEGFA in the liver of rats were detected by real-time fluorescence-based quantitative polymerase chain reaction(PCR) and Western blot, respectively. Compared with the normal group, the HFD group showed elevated body weight and levels of TG, TC, LDL-C, ALT, AST, IL-1β, and TNF-α(P<0.01), increased lipid accumulation in the liver(P<0.01), obvious liver steatosis, up-regulated mRNA expression levels of mTOR, FASN, HIF-1α, and VEGFA(P<0.01), and increased protein expression levels of p-mTOR, FASN, HIF-1α, and VEGFA(P<0.01). Compared with the HFD group, the groups with drug treatment showed lowered body weight and levels of TG, TC, LDL-C, ALT, AST, IL-1β, and TNF-α(P<0.05, P<0.01), reduced lipid accumulation in the liver(P<0.01), improved liver steatosis, decreased mRNA expression levels of mTOR, FASN, HIF-1α, and VEGFA(P<0.05, P<0.01), and declining protein expression levels of p-mTOR, FASN, HIF-1α, and VEGFA(P<0.01). The therapeutic effect of the high-dose diosgenin group was superior to that of the low-dose diosgenin group and the simvastatin group. Diosgenin may reduce liver lipid synthesis and inflammation and potentiate by down-regulating the mTOR, FASN, HIF-1α, and VEGFA expression, playing an active role in preventing and treating NAFLD.

Research progress in prevention and treatment of radiation-induced intestinal injury by traditional Chinese medicine active components / 中国中药杂志

Radiation-induced intestinal injury(RIII), a common complication of radiotherapy for pelvic malignancies, affects the quality of life and the radiotherapy efficacy for cancer. Currently, the main clinical approaches for the prevention and treatment of RIII include drug therapy, hyperbaric oxygen therapy, and surgical treatment. Among these methods, drug therapy is cost-effective. Traditional Chinese medicine(TCM) containing a variety of active components demonstrates mild side effects and good efficacy in preventing and treating RIII. Studies have proven that TCM active components, such as flavonoids, terpenoids, phenylpropanoids, and alkaloids, can protect the intestine against RIII by inhibiting oxidative stress, regulating the expression of inflammatory cytokines, modulating the mitochondrial apoptosis pathway, adjusting intestinal flora, and suppressing cell apoptosis. These mechanisms can help alleviate the symptoms of RIII. The paper aims to provide a theoretical reference for the discovery of new drugs for the prevention and treatment of RIII by reviewing the literature on TCM active components in the last 10 years.

Investigation of a suspected outbreak of carbapenem-resistant Klebsiella pneumonia infection / 上海预防医学

ObjectiveTo investigate a suspected outbreak of healthcare-associated infection （HAI） caused by carbapenem-resistant Klebsiella pneumonia （CRKP） in a secondary grade-A hospital， analyze the infection source and transmission route， and put forward corresponding preventive and control measures. MethodsEpidemiological investigation was conducted on 5 patients with CRKP infection in department of neurosurgery during December 23‒30， 2021. Specimens were collected with the environmental microbiology monitoring procedure. CRKP isolated from the environmental samples were analyzed by multilocus sequence typing （MLST） method. Comprehensive measures were taken to control the CRKP infection. ResultsThe 5 infected patients were located in 3 rooms， and all were diagnosed as HAI. The antimicrobial susceptibility testing results from the specimens of 3 CRKP infected patients were the same. Through environmental microbiology monitoring， CRKP strains were detected from the faucet handle and sink specimens in 3 rooms. The results of MLST analysis showed that the faucet handle and sink specimens in room 2 and 3 were ST11 type. The environmental specimen in room 1 was ST23 type. The suspected outbreak was effectively controlled after comprehensive interventions. ConclusionHAI suspected outbreak might be caused by the environmental contamination from the pathogens of CRKP-infected patients as well as the contaminated hands of medical staff and accompanying family members. Strengthening the publicity， education and management of medical staff and accompanying staff， early identification of infection outbreaks， and timely comprehensive control measures are the keys to controlling multidrug-resistant nosocomial infection outbreaks.

Survival analysis of patients with acute aortic dissection with different treatment modalities / 中国医师杂志

Objective:To investigate the survival status of patients with acute aortic dissection (AD) treated by different methods, and evaluate the factors affecting the survival of AD patients.Methods:According to the retrospective research method, the patients diagnosed with AD in the Affiliated Hospital of Jining Medical University from January 1, 2019 to December 31, 2020 were collected. The treatment data and follow-up of patients were counted, the survival of patients was analyzed by Kaplan-Meier survival curve, and the factors affecting the survival of patients were analyzed by Cox regression model.Results:A total of 251 patients were included in this study, including 169 patients in the surgical treatment group and 82 patients in the conservative treatment group. The in-hospital fatality rate in the surgical treatment group and the conservative treatment group were 8.88%(15/169) and 43.90%(36/82), respectively, and the difference were statistically significant ( P<0.05). The survival time of surgical treatment group and conservative treatment group was (328.08±8.17)d and (194.43±19.80)d, respectively, and the difference was statistically significant ( P<0.05). Surgery ( RR=5.424, 95% CI: 2.821-10.428, P<0.05), acute myocardial infarction ( RR=0.448, 95% CI: 0.221-0.906, P<0.05), and shock ( RR=0.266, 95% CI: 0.102-0.693, P<0.05) and stroke ( RR=0.277, 95% CI: 0.127-0.604, P<0.05) were the factors affecting 1-year survival in AD patients. Conclusions:Active surgical treatment is recommended for AD patients with surgical indication as soon as possible.

Clinical study of modified Huiyangyin Decoction combined with Kinesio taping for the patients with early and middle stage knee osteoarthritis / 国际中医中药杂志

Objective:To observe the clinical effect of modified Huiyangyin Decoction combined with Kinesio taping in the treatment of early and middle stage knee osteoarthritis.Methods:A total of 92 patients with early and middle stages of knee osteoarthritis, who admitted to our hospital from July 2021 to January 2022), were randomized into the western medicine group and the observation group by the random number table method, 46 in each group. The western medicine group received celecoxib capsules and sodium hyaluronate injection therapy, whicle the patients in the observation group received modified Huiyangyin Decoction combined with Kinesio taping on the basis of wetern medicine treatment. The treatment effect rates, angle of the knee joint initiative activity (AROM) changes and TCM syndrome (knee joint ache, swelling in the knee joint, rigid and claudication) changes, changes of pain intensity by visual analog scores (VAS), WOMAC scores, circumference of knee joint and Stand up time test, and adverse events were recorded and compared.Results:The total effective rate was 95.7% (44/46) in the observation group and 82.6% (38/46) in the control group, and the difference between the two groups was statistically significant ( χ2=4.04, P=0.045). After treatment, the flexion, internal rotation and external rotation of the observation group were significantly higher than those in the control group ( t=2.85, 2.29, 2.22, respectively, all Ps <0.05). The scores and total scores of knee pain, knee swelling, stiffness, claudication in the observation group were significantly lower than those in the control group ( t=20.53, 19.74, 17.40, 17.63, 27.13, respectively, all Ps<0.001). The VAS and WOMAC scores were significantly lower than those in the control group ( t=10.47, 10.55, respectively, all Ps<0.001). After treatment, the circumference of knee joint in the observation group [(33.69±1.11) cm vs. (34.55±1.37) cm; t=10.47, P<0.01] was significantly lower than that of the control group, and the time of standing up and walking was [(19.50±2.45) s vs. (28.12±2.22) s; t=10.55, P<0.01] were significantly shorter than those in the control group. During treatment, the incidence of adverse events in the observation group was 2.2% (1/46), and that in the control group was 4.3% (2/46). There was no significant difference between the two groups ( χ2=0.35, P=0.557). Conclusion:The modified Huiyangyin Decoction combined with Kinesio taping treatment has significant clinical effect, less adverse events for the patients with early and middle stage knee osteoarthritis.

The method of determination for butyronitrile and isobutyronitrile in the air of workplace by dissolved desorption-gas chromatography / 中华劳动卫生职业病杂志

Objective: To establish a method for the determination of butyronitrile and isobutyronitrile in the air of workplace by gas chromatography. Methods: In March 2020, butyronitrile and isobutyronitrile in the air of workplace was collected by silica gel, eluted with methanol, separated and determined by gas chromatogram with flame ionization detector, the characteristics of determination of nitrile and isobutyronitrile by gas chromatography were analyzed. Results: The limit of detection for butyronitrile and isobutyronitrile was 0.33 μg/ml. The linear range of butyronitrile determined by this method was 1.60-1600.00 μg/ml, y=2.295x-3.480, and the coefficient correlation was 0.99998, and the minimum detection concentration was 0.22 mg/m(3) (collected sample volume was 1.50 L) . The within-run precisions were 2.43%-4.12%, the between-run precisions were 1.72%-3.70%, and the desorption rates were 93.26%-98.41%. The linear range of isobutyronitrile determined by this method was 1.52-1520.00 μg/ml, y=2.208x-0.102, and the coefficient correlation was 0.99998, and the minimum detection concentration was 0.22 mg/m(3) (collected sample volume was 1.50 L) . The within-run precisions were 2.52%-3.22%, the between-run precisions were 1.20%-3.82%, and the desorption rates were 96.85%-102.50%. The sealed samples could be stored at least 10 days at room temperature without significant loss. Conclusion: The method has the advantages of good precision, high sensitivity and simple operation. It is suitable for the simultaneous determination of butyronitrile and isobutyronitrile in the air of workplace.

Study on the effect of functional movement on the recurrence of patients with ankylosing spondylitis after treat-to-target therapy / 中华风湿病学杂志

Objective:To investigate the effect of functional movement assessment on the recurrence of patients with ankylosing spondylitis (AS) after treat-to-target therapy.Methods:The clinical data of 61 patients with AS in Chengdu were collected including clinical symptoms and AS disease activity (ASDAS). After 24 weeks adalimumab treatment, motor function score of AS patients(ASDAS<1.3) was assessed by functional movement screen (FMS), then adalimumab was discontinued and the rest of the concurrent drugs were continued until the disease relapse or up to 1 year. The data of the two groups were compared using t-test analysis and Cox proportionate hazard model. Results:① The recurrence rate of patients with AS after treat-to-target therapy within 1 year follow-up was 57.4%; ② The recurrence group was younger [(27±7) vs (31±6), t=5.96, P=0.02], the ASADAS value was at the high end when adalimumab was withdrawal [(1.29±0.07) vs (0.87±0.16), t=177.31, P<0.01], and the FMS value was lower after treat-to-target [(12.9±2.7) vs (16.2±1.9), t=29.23, P<0.01], The time to reaching the treatment target was longer [(2.9±1.2) month vs (1.7±0.6) month, t=19.89, P<0.01] than the stable group; ③ The cut-off value of the FMS test of AS patients after treat-to-target therapy was 14.25 (sensitivity was 84.6%, specificity was 80%) . The time to treat-to-target was a risk factor for recurrence ( RR=2.285, P<0.05), and the FMS value after treat-to-target was a protective factor ( RR=0.625, P<0.05). Conclusion:After discontinuing the adalimumab, about half of the patients relapse. The time reaching the treatment target and the FMS value after treat-to-target therapy are the risk factors for disease recurrence.

Prevention from PICC-related venous thrombosis in the upper limbs of malignant tumor patients with moxibustion combined with plucking at Jiquan (HT 1): a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of moxibustion combined with plucking technique at Jiquan (HT 1) for preventing peripherally inserted central catheter (PICC)-related venous thrombosis in the upper limbs of malignant tumor patients.@*METHODS@#A total of 80 malignant tumor patients undergoing PICC were randomized into an observation group and a control group, 40 cases in each one. In the control group, the routine care for PICC was exerted. In the observation group, besides the routine care, moxibustion combined with plucking technique at Jiquan (HT 1) was added. Mild moxibustion was exerted along the venous distribution of PICC (avoiding the entry site) for 10 to 15 min, and then, the circling moxibustion was applied to Quchi (LI 11), Xuehai (SP 10) and Tianfu (LU 3), 3 to 5 min at each acupoint. Finally, plucking technique was given at Jiquan (HT 1) for 5 to 10 min. This combined therapy was intervened since the 2nd day of PICC placement, once daily, 5 times a week, for 3 weeks totally. The incidence of the PICC-related venous thrombosis in the upper limbs was compared between the two groups on day 42 of placement. On day 2, 7, 14, 21, 28, 35 and 42 of PICC placement, the peak systolic velocity (PSV) and the end-diastolic velocity (EDV) of the subclavicular vein on the placement side were observed separately in the two groups.@*RESULTS@#The incidence of the PICC-related venous thrombosis in the upper limbs in the observation group was lower than that in the control group (2.5% [1/40] vs 17.5% [7/40], P<0.05). From day 7 to 35 of PICC placement, PSV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement in the observation group (P<0.05). On day 28 and 42 of PICC placement, PSV of the subclavicular vein on the placement side was lower than that on the day 2 of PICC placement in the control group (P<0.05). In the observation group, EDV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement from day 7 to 28 of PICC placement (P<0.05). In the control group, EDV of the subclavicular vein on the placement side from day 28 to 42 of PICC placement was lower than that on the day 2 of PICC placement (P<0.05). From day 7 to 42 of PICC placement, PSV and EDV of the subclavicular vein on the placement side in the observation group were all higher than those in the control group (P<0.01, P<0.05).@*CONCLUSION@#The combined treatment of moxibustion with plucking technique at Jiquan (HT 1) can effectively prevent PICC-related venous thrombosis in the upper limbs and improve venous blood flow velocity in malignant tumor patients.

Study on the mechanism ，specific path and code of conduct of pharmaceutical enterprises ’participation in American active surveillance system and its enlightenment / 中国药房

OBJECTIVE To provide reference for developing pharmacovigilance and constructing an active surveillance system with extensive participation of pharmaceutical enterprises in China. METHODS Retrieving the literature and data from databases such as CNKI ，PubMed，and the official website of observational medical outcomes partnership （OMOP），the mechanism of pharmaceutical enterprises ’participation and its operation mode were investigated ，while specific path and code of conduct for pharmaceutical enterprises to participate in active surveillance system were analyzed. Finally ，the corresponding suggestions were put forward according to the actual situation of China. RESULTS & CONCLUSIONS Pharmaceutical enterprises in OMOP participated in project construction and operation through public private partnership （PPP）mechanism，and played the role of project funding ，project governance and project research. Pharmaceutical enterprises participating in OMOP need to carry out activities in accordance with the code of conduct of extensive cooperation ，transparency and openness and the protection of patient privacy. In the future practice of active surveillance system in China ，it is necessary to promote the relevant legislation of active monitoring system ，emphasize the responsibility of active surveillance of pharmaceutical enterprises ，establish a PPP mechanism of industry-university-research integration ，form a good governance ecology and strengthen the protection of patients ’privacy.

Design and research progress of nano-drug delivery system based on mitochondria targeting / 药学学报

Mitochondria is involved in many important physiological activities such as energy supply, signal transduction, cell differentiation, etc., and plays an significant role in the occurrence and development of diseases. Using mitochondria as a target is a new strategy for cancer treatment. The use of nanotechnology to construct a mitochondrial targeted nano-drug delivery system can improve the solubility of traditional drugs, prolong the half-life of drugs in the body, increase the bioavailability and concentration of drugs at the tumor site, and reduce the toxic and side effects of drugs. It is expected to solve the resistance in the process of tumor treatment. This review focuses on the field of cancer treatment. Firstly, it introduces the mechanism of mitochondrial targeted nano-drug delivery system for cancer treatment. Secondly, it outlines the design ideas, classification and application research of mitochondrial targeted nano-drug delivery systems in the past five years. Finally, it expands the analysis of other studies that target mitochondria, such as bionic vectors, and presents its advantages and disadvantages, which provide a basis for in-depth research on drug delivery systems in the future.

Analysis and Suggestions on Status Quo of Commissioned Production under Medical Device Marketing Authorization Holder System in China / 中国医疗器械杂志

OBJECTIVE@#Sort out and analyze the current status and existing problems of the pilot work of the medical device marketing authorization holder system to provide reference opinions for the full implementation of the medical device marketing authorization holder system.@*METHODS@#Use literature analysis, comparative analysis and field research to comprehensively analyze the status, advantages and risks of commissioned production under the medical device marketing authorization holder system.@*RESULTS@#The commissioned production under the medical device marketing authorization holder system brings dividends and also brings risks.@*CONCLUSIONS@#We should consider improving the medical device marketing authorization holder system from marketing authorization holder, the entrusted manufacturer, and the regulatory authority, and strengthen the quality supervision of the entrusted production of products.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

The application of three different risk stratification scores in patients with acute chest pain / 中华全科医师杂志

Objective:To assess the application of three risk stratification scoring systems in evaluation and management of patients with acute chest pain.Methods:Patients with chest pain who visited the emergency department of Affiliated Hospital of Jining Medical University from February 2021 to April 2021 were recruited. The risk stratification evaluation was performed with EMPACT, HEART-Pathway and EDACS-ADP scoring systems. The primary endpoint was the major adverse events (MAE) within 30 days.The application values of three scales in identifying high-risk chest pain were evaluated.Results:A total of 628 patients with acute chest pain were enrolled, and 92 of them(14.95%) had MAE within 30 days. The scores of three scales were all positively correlated with MAE occurrence, while the EMPACT score had the highest correlation( r=0.41, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of EMPACT score, HEART score and EDACS for predicting MAE within 30 days was 0.834(95% CI:0.790-0.878), 0.763(95% CI:0.710-0.817) and 0.635(95% CI:0.578-0.691), respectively. When the cut-off value was 9.5, the Yorden index of EMPACT score was the highest (0.561). Since all the scoring systems used integers, the EMPACT score of 10 was the threshold to distinguish low-risk chest pain from high-risk chest pain. The sensitivity of EMPACT, HEART-Pathway and EDACS-ADP scores in identifying high-risk chest pain patients was 0.707, 0.576 and 0.783, and the specificity of them was 0.854, 0.882 and 0.509, respectively. Conclusion:The EMPACT score has a good risk stratification ability, and it can be used for identifying patients with acute chest pain.

Application of a new V-shaped forearm flap in reconstruction of buccal cancer / 中华显微外科杂志

Objective:To design a new V-shaped forearm flap and to investigate the possibility of direct donor site closure and its value in the reconstruction of soft tissue defect after resection of buccal carcinoma.Methods:The new V-shaped forearm flap technique was applied in 10 patients with buccal carcinoma from October, 2018 to September, 2019. There were 6 males and 4 females aged from 35 to 63 years (48.3 years in average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing and the appearance forearm were recorded and evaluated three months after the surgery. Radial deviation angle, wrist flexion, ulnar deviation and dorsal extension were measured and calculated 3 months after the surgery. The wrist function was evaluated according to the Gartland-Werley scale. The recovery of wrist function was evaluated by comparing with the preoperative data.Results:Forearm donor sites were successfully closed without skin grafting in all 10 patients. Skin ischemia caused by excessive tension was observed at the incision edge in 3 patients, therefore leading to skin exfoliation and pigment loss without affecting wound healing. All patients were presented a cosmetic outcome during the follow-up period. No scar hyperplasia was observed. No significant difference was observed in perioperative wrist flexion angle, dorsal extension angle, radial deviation angle, ulnar deviation angle ( P>0.05)[data before surgery were (57.8±1.3) °, (58.4±0.7) °, (18.2±0.5) °, (28.5±1.1) ° respectively, and data 3 months after surgery were (53.2±2.1) °, (55.3±1.8) °, (16.4±0.4) °, (25.4±1.4) ° respectively]; Excellent and good rate of Gartland-Werley wrist score before and after surgery were both 100%. Conclusion:The new V-shaped free forearm flap can directly close small to medium forearm flap donor site. This method could avoid the trauma and complications of traditional free skin graft. The postoperative appearance on donor site is satisfactory and will not have adverse effects on wrist function. The new V-shaped free forearm flap is a novel method for repair of the defect of soft tissue defect after buccal cancer and it is worth to be applied in clinical practice.

Brief introduction of the application status, causes and countermeasures of laparoscopy repair of perforated peptic ulcer / 国际外科学杂志

Perforated peptic ulcer is a common acute abdominal disease and requires emergency surgical treatment. Laparoscopic repair PPU was started early but progressed slowly. Compared with the popularization of minimally invasive concept of laparoscopic cholecystectomy, laparoscopic repair is still under the situation of disputation, low overall application rate and extremely unbalanced development in different regions and organizations. With the embodiment of minimally invasive advantages of laparoscopy and the technology progress, as well as the updating of surgeons′ ideas and the emergence of higher quality RCT studies, the proportion of PPU in laparoscopic treatment is gradually increasing. In order to make full use of the minimally invasive value and differential diagnostic value of laparoscopy, the laparoscopy-first approach can be adopted as a routine for appropriate PPU patients. The key to case selection and the physicians experience and proficiency. Laparoscopy should be actively adopted but should not be easily expanded. If necessary, the patients should be converted to open operation. If not the advantages of laparoscopy will be drowned.

Intranasal temperature-sensitive hydrogels of cannabidiol inclusion complex for the treatment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric disease that seriously affects brain function. Currently, selective serotonin reuptake inhibitors (SSRIs) are used to treat PTSD clinically but have decreased efficiency and increased side effects. In this study, nasal cannabidiol inclusion complex temperature-sensitive hydrogels (CBD TSGs) were prepared and evaluated to treat PTSD. Mice model of PTSD was established with conditional fear box. CBD TSGs could significantly improve the spontaneous behavior, exploratory spirit and alleviate tension in open field box, relieve anxiety and tension in elevated plus maze, and reduce the freezing time. Hematoxylin and eosin and c-FOS immunohistochemistry slides showed that the main injured brain areas in PTSD were the prefrontal cortex, amygdala, and hippocampus CA1. CBD TSGs could reduce the level of tumor necrosis factor-

Finite element analysis of different intramedullary fixation methods for the treatment of senile pubic ramus fractures / 中国骨伤

OBJECTIVE@#To evaluate the biomechanical stability of elastic intramedullary nail in the treatment of pubic ramus fractures by finite element analysis, and to compare the stability of elastic intramedullary nail with cannulated screw intramedullary fixation.@*METHODS@#The CT data of the pelvis of a volunteer were selected, and the three-dimensional model of the pelvis was reconstructed by reverse engineering software and the fracture of the pubic ramus fractures was simulated by osteotomy. The hollow nail model, single elastic nail model and double elastic nailmodel were assembled with different implants respectively. The mesh division, material assignment loading and other steps were carried out in the ANSYS software, and then the calculation was submitted.@*RESULTS@#The overall displacement of the pelvis of the elastic nail model was smaller than that of the cannulated screw model, in which the double elastic nail model had the smallest overall displacement, but the cannulated screw model had the smallest plant displacement and the single elastic nail model had the largest plant displacement. Although the stress of cannulated screw was small, there was obvious stress concentration, the stress of elastic nail was large, but there was no obvious stress concentration, especially the stress distribution of double elastic nail was more uniform and the overall stress of pelvis was the smallest.@*CONCLUSION@#All the three fixation methods can effectively improve the stability of the anterior ring of the pelvis. Among them, there is no significant difference in the overall biomechanical propertiesof hollow nail fixation and double elastic nail fixation, which is better than that of single elastic nail fixation. Elastic nail fixation has the advantages of minimally invasive surgery and good biomechanical stability, so it can be used as a better surgical method for the treatment of pubic ramus fractures.