Overexpression of lncRNA-MEG3 inhibits endometrial cell proliferation and invasion via miR-21-5p/DNMT3B/Twist

Abstract Recent studies have found that lncRNA-MEG3(MEG3) plays an important role in the development of EMs (Endometriosis), but the specific mechanism needs to be further explored. This study aimed to investigate the effect of MEG3 on the proliferation, invasion of EMs cells. The authors used RT-qPCR to detect the expression of MEG3 and miR-21-5p in EMs tissues and hESCs cells, MTT and Transwell to detect cell proliferation and invasion, western blotting assay to detect the expression of DNMT3B and Twist, MSP to detect the methylation of Twist. The present study's detection results showed that MEG3 was lowly expressed in EMs tissues and hESCs cells, and overexpression of MEG3 could down-regulate miR-21-5p and inhibit endometrial cell proliferation and invasion. In addition, overexpression of MEG3 upregulated the expression of DNMT3B and promoted the methylation of TWIST. In conclusion, the present findings suggest that MEG3 is downregulated in EMs tissues, and overexpression of MEG3 can promote the activity of DNA methyltransferase DNMT3B by downregulating miR-21-5p, thereby promoting the methylation of Twist, downregulating Twist level to inhibits hESCs cells proliferation and invasion.

Predictive effects of psychological stress in early and middle puberty on adolescent health risk behaviors / 中国学校卫生

Objective@#To explore whether psychological stress in early and mid puberty is predictive of adolescent healthrisk behaviors.@*Methods@#In April 2018, a total of 1 046 primary and secondary school students from grade 5 to 8 were recruited through purposive sampling. The basic information and psychological stress of the respondents were collected by questionnaire and physical examination. In addition, self reports of health risk behaviors were collected in October 2018. Logistic multiple regression analysis was used to analyze the relationship between psychological stress and health risk behaviors of adolescents.@*Results@#The reported health risk behaviors of the surveyed adolescents ranking from high to low were unreasonable physical activity (62.05%), food preferences (24.76%), fighting (21.03%), suicidal ideation (17.02%), ideation of running away from home (9.85%), low mood (8.80%), smoking (4.21%), drinking (3.73%), gambling (3.63%) and internet addiction (3.06%). Logistic multiple regression analysis showed that the high level of psychological stress was a risk factor for fighting ( OR =1.02, 95% CI =1.01-1.03), suicidal ideation ( OR =1.02, 95% CI =1.01-1.03), low mood ( OR =1.02, 95% CI =1.01-1.03), ideation of running away from home ( OR =1.02, 95% CI =1.01-1.03), unreasonable physical activity ( OR =1.01, 95% CI =1.00-1.02), smoking ( OR =1.02, 95% CI = 1.00-1.03), internet addiction ( OR =1.02, 95% CI =1.00-1.03), food preferences ( OR =1.01, 95% CI = 1.00-1.02) and gambling ( OR =1.02, 95% CI =1.01-1.04)( P <0.05).@*Conclusion@#Unreasonable physical activity and food preferences are most common health risk behaviors among adolescents. Psychological stress during early to middle puberty is predictive of adolescent health risk behaviors.

Associations between psychosocial stress in early and middle adolescence with emotional and behavioral problems one year later / 中国学校卫生

Objective@#This study explored the predictive effects of psychological stress in early and middle puberty on subsequent emotional and behavioral problems.@*Methods@#A cohort of 911 boys and girls from primary and secondary schools in Chongqing was studied. Psychological stress was measured in early and middle adolescence, and the levels of emotional and behavioral problems were determined in one year follow up. Logistic regression analysis was used to analyze the effects of psychological stress in early and middle adolescence on subsequent emotional and behavioral problems.@*Results@#The average psychological stress score in early and middle adolescence was (27.96±24.95), and the average scores of internalized and externalized behavioral problems and overall problems one year later were (8.21±8.46)(6.21±5.87) and (37.90±24.68) respectively. When grouped by gender, these scores, as well as the detection rate of anxiety and depression, withdrawal, physical discomfort, thinking problems, internalization problems and overall problems, were higher in girls than boys (t/Z=-6.38，-5.63，-6.06，-3.74，-6.80，-5.47， χ 2=15.88，12.01，3.92，6.64，24.67，15.88， P <0.05). Logistic regression showed that the psychological stress scale score was a risk factor for internalized and externalized behavioral problems and overall problems( P <0.05).@*Conclusion@#Psychological stress levels in early and middle puberty have a positive predictive effect on emotional and behavioral problems in the following year.

Associations between psychosocial stress in early and middle adolescence with emotional and behavioral problems one year later / 中国学校卫生

Objective@#This study explored the predictive effects of psychological stress in early and middle puberty on subsequent emotional and behavioral problems.@*Methods@#A cohort of 911 boys and girls from primary and secondary schools in Chongqing was studied. Psychological stress was measured in early and middle adolescence, and the levels of emotional and behavioral problems were determined in one year follow up. Logistic regression analysis was used to analyze the effects of psychological stress in early and middle adolescence on subsequent emotional and behavioral problems.@*Results@#The average psychological stress score in early and middle adolescence was (27.96±24.95), and the average scores of internalized and externalized behavioral problems and overall problems one year later were (8.21±8.46)(6.21±5.87) and (37.90±24.68) respectively. When grouped by gender, these scores, as well as the detection rate of anxiety and depression, withdrawal, physical discomfort, thinking problems, internalization problems and overall problems, were higher in girls than boys( t/Z =-6.38，-5.63，-6.06，-3.74，-6.80，-5.47， χ 2=15.88，12.01，3.92，6.64，24.67，15.88， P <0.05). Logistic regression showed that the psychological stress scale score was a risk factor for internalized and externalized behavioral problems and overall problems( P <0.05).@*Conclusion@#Psychological stress levels in early and middle puberty have a positive predictive effect on emotional and behavioral problems in the following year.

Depressive symptoms and associated factors among adolescents in different pubertal stages in a district of Chongqing / 中国学校卫生

Objective@#To explore the status of depressive symptoms among adolescents in different pubertal stages in a district of Chongqing.@*Methods@#A self designed questionnaire and Children s Depression Inventory were administered among 1 001 students in a district of Chongqing. Score and associated factors of depressive symptoms of adolescents through descriptive statistical analysis, Chi square test, analysis of variance and Logistic regression analysis.@*Results@#The detection rate of depressive symptoms among adolescents in a district of Chongqing was 17.3%, and the total score of depression scale was (12.02±6.72). There were statistically significant differences in the inefficiency subscale score of boys across stages of genital, pubic hair, armpit hair and beard, and whether the first spermatorrhea has occurred( t/F =7.08，5.46，5.18，4.21，5.84， P <0.05), while significant differences were found in the anhedonia and inefficiency subscales scores among girls across different stages of breast, pubic hair and armpit hair, and whether menarche has occurred( t/F =19.43，4.92，3.98，7.35， P <0.05). Multivariate Logistic regression analysis showed that the absence of first spermatorrhea and menarche were associated with lower prevalence of depressive symptoms in boys and girls ( OR=0.60, 95%CI=0.36-0.98; OR=0.46, 95%CI =0.22-1.00), while pubic hair development was associated with higher prevalence of depressive symptoms in girls ( OR=9.58, 95%CI =1.28- 71.71 ).@*Conclusion@#The detection rate of depressive symptoms among adolescents is relatively low. Boys who have had the first spermatorrhea, and girls with advanced pubic hair development or have had menarche are more likely to suffer from depressive symptoms.

The influence of parental company time before and after having second child on the emotional and behavioral problems of preschool firstborn children / 中国学校卫生

Objective@#To explore the influence of parental company before and after having second child on the emotional and behavioral problems of preschool firstborn children, and to provide a reference for emotional problems prevention of firstborn children.@*Methods@#Questionnaire survey was conducted among mothers of firstborn children who met the inclusion and exclusion criteria from two Grade A hospitals in Chongqing from March to December 2019. The average age of 845 firstborn children was (3.56±1.24) years old. The chi square test was used to compare the general characteristics and parent company of boys and girls. Rank sum test was used to compare the differences of emotional and behavioral problems of firstborn children with different parents company. Multiple linear regression models were used to compare the differences of internalizing, externalizing and total problems in firstborn children with different parents company.@*Results@#After having the second child, parents spent less time with their firstborn children, among which the decrease of the accompanying time of the mother and the total accompanying time of the parents were statistically significant( Z =3.76, 2.86, P <0.05). The scores of internalizing problem were higher when the mother s company time decreased ( B=1.18, 95%CI = 0.01 -2.36) and the parents total company time decreased( B=1.41, 95%CI =0.33-2.48). The scores of the externalizing problem ( B=1.25, 95%CI =0.10-2.39) and the total problem ( B=4.31, 95%CI =1.05-7.57) with the decrease of parents total company time were higher.@*Conclusion@#Parent company has an important influence on the emotional and behavioral problems of firstborn children. Firstborn children whose parents accompanying time decreases after having second children scored higher on emotional and behavioral problems.

Comparison of emotional and behavioral problems between preschool firstborn children across the transition to siblinghood and the only children / 中国学校卫生

Objective@#To compare the emotional and behavioral characteristics of preschool firstborn children across the transition to siblinghood with the only children in a district of Chongqing.@*Methods@#Data were derived from a cohort study on firstborn children transition to siblinghood. Totally 882 firstborn children (3.58±1.25) years old and 329 only children (3.98±1.02) years old were recruited from two hospitals and 19 kindergartens in a district of Chongqing, respectively. Their mothers filled out the parental version of Child Behavior Checklist (CBCL) and self designed questionnaire.@*Results@#The overall scores of emotional and behavioral problems of firstborn children and only children were (25.17±18.82) and (31.75±18.64). The results of rank sum test showed that the scores of the firstborn children in all dimensions, internalizing and externalizing behavior problems and overall emotional and behavioral problems were lower than those of the only children ( P <0.05). Chi square test results showed that the detection rates of internalizing, externalizing and overall emotional behavior problems in only children(12.77%, 13.07%, 14.59%) were higher than those in firstborn children(8.28%, 8.28%,8.16%) ( χ 2=5.62, 6.36, 11.09, P <0.05). Multiple linear regression showed that after adjusting for age, gender, family economic pressure, temperament type of children, family atmosphere and family type, the scores of internalizing problems, externalizing problems and overall problems of the only children were still higher than those of the firstborn children ( B =1.54, 2.32, 6.81, P <0.05).@*Conclusion@#The firstborn children across the transition to siblinghood show less emotional and behavioral problems than the only children, and the scores and detection rates of all types of emotional and behavioral problems of the firstborn children are lower than those of the only children.

A study on emotional behavioral problems and family relations of firstborn children from Chongqing during the role transition period / 中国学校卫生

Objective@#To explore the relationship between the emotional and behavioral problems and family relations of firstborn children from an urban area of Chongqing during the role transition period, to provide a scientific basis for creating a good family relationship and to reduce the occurrence of children s emotional behavior problems.@*Methods@#Totally 1 359 mothers of children in the role transition period were recruited from obstetric clinics at two Grade A hospitals in Chongqing, and mothers with informed consent using self designed questionnaire and parental version of the Child Behavior Checklist (CBCL). It was analyzed the association between family relationships and the emotional/behavioral problems of firstborn children of different ages. SPSS statistical software (version 20) was used for the descriptive statistical analysis, chi square test, and multiple linear regression analysis.@*Results@#The parental relationship (56.6%), mother child relationship (80.4%) and father child relationship (64.9%) of most firstborn children was good, and 61.7% of families enjoyed a harmonious atmosphere. For the age groups 1.5-5 years and 6-13 years, the respective CBCL total scores were (18.22±13.63) and (24.20±17.52), and the detection rates were 10.7% and 10.5%, respectively. The results of the multiple linear regression analysis showed that, for both age groups, firstborn children who had good parental relationships, good mother child relationships, good father child relationships, and a harmonious family atmosphere exhibited fewer internalizing, externalizing and overall emotional behavior problems ( P <0.05).@*Conclusion@#The total detection rate of emotional and behavioral problems among firstborn children in the role transition period, which is low. Good parental relationships, good parent child relationships, and a harmonious family atmosphere are protective factors against emotional and behavioral disorders in firstborn children during the role transition period.

Intra-host genetic evolution of HIV-1 pol gene and estimation of infection time for five infections / 预防医学

Objective@#To explore the intra-host genetic evolution of HIV-1 pol gene via follow-up for treatment-naïve HIV infections, and estimate the infection time with Bayesian coalescent theory, so as to support the evaluation of HIV epidemic. @*Methods@#Five cases were recruited and followed up. The pol gene fragments were amplified for the characteristics of transmitted drug resistance ( TDR ) by RT-PCR. Bayesian coalescent theory was utilized to construct maximum clade credibility ( MCC ) tree for genetic evolution and calculate the time to the most recent common ancestor ( tMRCA ). @*Results@#The five cases were all male, and aged from 27 to 50 years old.Five to nine sampling times were obtained from each case, and the pol gene sequences from each case formed a unique subcluster (posterior probability: 100% ), with different evolution characteristics, in the MCC tree. The three cases in primary HIV-1 infection were estimated to be infected one to five months before the first positive reaction of HIV screening, whereas the two HIV-1 diagnosed cases at first screening were extrapolated to get infected fourteen months and seven months before diagnosis, respectively. One case with acute HIV-1 infection carried TDR mutation ( M46I ) , expressing fast disease progress and quasispecies variation. @*Conclusions@#The general infection time can be estimated by analyzing the characteristics of intra-host genetic evolution of HIV-1 pol gene with Bayesian coalescent theory, and this method can help to estimate the HIV epidemic.

Mental health status of the pupils from Grade Four and Fivein Jiading District / 预防医学

Objective @#To investigate the mental health status of the pupils from Grade Four and Five in Jiading District of Shanghai, and to provide evidence for mental health intervention.@*Methods @# All the students from Grade Four and Five in Jiading District, Shanghai were selected as survey objects. The MHT was used to evaluate their mental health status, and the influencing factors of mental health problems were analyzed by multivariate logistic regression model.@*Results @#A total of 3 788 questionnaires were issued, of which 3 100 ones were valid and the effective rate was 81.84%. The detection rate of mental health problems was 17.06%. The detection rates of impulse tendency, terror tendency, physical symptoms, sensitivity tendency, self-blame tendency, loneliness tendency, anxiety towards people and learning anxiety were 11.77%, 15.55%, 12.97%, 16.19%, 10.10%, 4.81%, 13.16% and 14.00%, respectively. The results of multivariate logistic regression analysis showed that female students ( OR=1.617,95%CI: 1.325-1.974 ) , poor self-rated appearance ( OR=3.683, 95%CI: 2.428-5.586 ) ,only one or two friends ( OR=1.806, 95%CI: 1.342-2.428 ) , poor academic performance ( OR=1.626, 95%CI: 1.167-2.267 ) , primary school education or below of mother ( OR=1.539, 95%CI: 1.107-2.139 ) general or poor relationship with mother ( OR=1.785, 95%CI: 1.303-2.444 ) or father ( OR=1.745, 95%CI: 1.336-2.280 ) were risk factors for mental health problems. @*Conclusion @#The fourth-to fifth-grade primary school students in Jiading District of Shanghai have high detection rate of psychological problems. Gender, the number of friends, academic performance, education level of mother and the relation with parents are associated.

Screen time and associated factors among preschoolers in Wuxi during COVID-19 outbreak / 中国学校卫生

Objective@#To investigate the current status of screen time in preschoolers during the outbreak of Corona Virus Disease 2019 (COVID-19), and the influences of parent-child active play and school online education on screen time.@*Methods@#A total of 2 370 preschoolers were chosen through clustering sampling from 7 kindergartens in Wuxi urban areas. Questionnaire survey was administered to parents for child screen time, active play, online education as well as characteristics information.@*Results@#A total of 1 428(60.3%) preschoolers reported more than 1 hour screen time a day, and 1 915(80.8%) preschoolers reported more than 20 minutes consecutive screen time. Compared with the weekend before the COVID-19 outbreak, 1 551(65.4%) preschoolers reported an increase of 10 minutes in screen time perday, and 1 444(60.9%) reported an increase of 5 minutes for one sersion. Logistic regression analysis showed that after controlling for confounding factors, high frequency of parent-child active play, parents’ exercise habits, online education from kindergartens and children’s active participation in the online education were negatively associated with preschoolers’ excessive and increased screen time during this period(OR=0.39-0.79, P<0.05).@*Conclusion@#During the COVID-19 outbreak, preschoolers’ media use in Wuxi city is worrisome. Parent-child active play, parents’ exercise and online education from kindergartens may play a positive role in reducing preschoolers’ media use.

Efficacy of Small Dose HAG Regimen Combined with Decitabine in Treatment of Elderly Patients with Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To study the efficacy of small dose HAG combined with decitabine regimen in the treatment of elderly patients with acute myeloid leukemia (AML).@*METHODS@#134 elderly AML patients treated in our hospital from March 2015 to December 2018 were selected, and the patients were divided into CAG group and combined treatment group. The AML patients in CAG group was treated with CAG regimen, while the AML patients in combined treatment group was treated with small dose HAG regimen combined with decitabine. Efficacy was evaluated after treatment.@*RESULTS@#After treatment, the OR rate of the patients in combined treatment group was significantly higher than that in CAG group (χ=5.311, P=0.021). The nausea and vomiting rate, infection rate, myelosuppression rate, bleeding rate and intestinal discomfort rate showed no significant difference between the two groups (P＞0.05). The CD3, CD4 and CD8 levels of patients in combined treatment group were significantly lower than those in CAG group (P＜0.05). The result of followed-up for 2 years, showed that the overall survival rate of patients in combined treatment group was significantly higher than that in CAG group [(76.2±6.3)% vs (45.7±7.6)%] (χ=4.214, P＜0.05), while the disease free survival rate of patients in combined treatment group were (57.4±7.7)%, which was significantly higher than that in CAG group (30.3±7.9)% (χ=5.250, P＜0.05).@*CONCLUSION@#Small dose HAG regimen combined with decitabine for elderly patients with acute myeloid leukemia has a certain curative efficacy.

Comparation of Clinical Efficacy between Two Regimens of Preexcitation Chemotherapy for MDS-RAEB Patients / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safely of DAC and CAG/HAG preexcitation chemotherapy regimens for the treatment of patients with MDS-RAEB (refractory anemia with excess blasts, RAEB).@*METHODS@#The clinical data of 86 MDS-RAEB patients were analyzed retrospectively from February 2014 to February 2018. According to therapeutic regimem, the 86 patients were divided into 2 groups: group A (41 patients) with DAC preexcitation chemotherapy regimen, and group B (45 patients) with CAG/HAG preexcitation chemotherapy regimen; and the disease control effect, effective treatment course, median survival time and incidence of adverse reactions were compared between these 2 groups.@*RESULTS@#The CR rate and ORR rate were not significantly different between these 2 groups (P＞0.05). The mCR rate in group A was significantly higher than that in group B (P＜0.05). The numbers of cases obtained therapeutic efficacy at 2 rd and 3 rd conrse in group A significantly more than those in group B (P＜0.05), but the number of cases obtained efficacy at 1 st course in group B was significantly higher than that in group A (P＜0.05). The median OS time was not significanly different between 2 groups (P＞0.05). The duration of neutrophils deficiency in group A was significantly shorter than that in group B (P＜0.05). The transfusion volume of red blood cells and platelets in group A was significantly less than that of group B (P＜0.05). The incidence of neutropenia, anemia and thrombocytopenia of III-IV grade at different treatment courses of group A were significantly lower than that in group B (P＜0.05). The incidence of infection of III-IV grade in group A at 3rd treatment course was significantly lower than that in group B (P＜0.05).@*CONCLUSION@#Preexcitation chemotherapy regimens of DAC and CAG/HAG for the treatment of MDS-RAEB possess the same effects for disease control; application of DAC regimen can efficiently reduce the risk of adverse reaction, but CAG/HAG regimen can be helpful to accelerate the effective process of treatment.

Short-Term Therapeutic Efficacy, Survival Time and Side Effects in Treatment of Newly Diagnosed Multiple Myeloma Patients with Different Chemotherapeutic Regimens / 中国实验血液学杂志

OBJECTIVE@#To investigate the short-term therapeutic efficacy, survival time and side effects in newly diagnosed multiple myeloma patients treated with TCD regimen consisted of thalidomide, cyclophosphiamide and dexamethasone, and BCD reginen consisted of bortezomib, cyclophsphamide and dexamethasone.@*METHODS@#The clinical data of newly diagnosed MM patients admitted in our hospital from January 2011 to January 2018 were collected and analyzed retrospectively. According to chemotherapectic regimen, 106 patients were divided into 2 groups: 53 cases in one group were treated with TCD regimen (TCD group), and 53 cases in another group were treaded with BCD regimen (BCD group). The therapeutic efficacy, median PFS and OS time and incidence of side effects in 2 groups were compared, at the same time the relationship of the remission degree and the factors in different subgroups with the therapeutic efficacy was analyzed in 2 groups.@*RESULTS@#There was no significant difference in the ≥MR rate between 2 groups (P＞0.05). The ≥PR rate, ≥VGPR rate and CR rate of BCD group were significantly higher than TCD group (P＜0.05). The median PFS time of patients in BCD group were significantly longer than that in TCD group (P＜0.05). There was no significant difference in the median OS time of patients between 2 groups (P＜0.05). The median OS time of ≥MR patients in TCD group was significantly longer than that of ＜MR patients (P＜0.05). The median OS time of ≥PR patients in TCD group were significantly longer than that of ＜PR patients (P＜0.05). The median OS time of ≥VGPR patients in BCD group was significantly longer than that of ＜VGPR patients (P＜0.05). There was no significant difference in the median OS time of ≥PR and ＜PR patients in BCD group (P＞0.05). The ORR of ≥VGPR patients in BCD group was significantly higher than that in TCD group (P＜0.05). There was no significant difference in the incidence of infection, fatigue, gastrointestinal reactions and bone marrow suppression between 2 groups (P＜0.05). The incidence of numbness in distal extremities and herpes zoster in BCD group was significantly higher than that in TCD group (P＜0.05).@*CONCLUSION@#TCD and BCD in the treatment of patients with NDMM possess the same disease control effects; BCD regimen application can efficiently improve remission degree and prolong PFS time; but TCD regimen application have the advantages in reducing the side effects risk and improving treatment tolerance.

Effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction patients / 中国胸心血管外科临床杂志

@#Objective    To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods    This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results     The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min   (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion    The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.

The status quo of postoperative pain management in patients with pulmonary disease after discharge / 中国胸心血管外科临床杂志

@#Objective To investigate the current status of outpatient pain management in patients with pulmonary disease after surgery by WeChat and to provide a basis for postoperative pain management. Methods A total of 449 patients who underwent thoracic surgery in our hospital from December 2017 to May 2018 were enrolled, including 156 males and 293 females with an average age of 22-83 (55.54±11.17) years. Brief Pain Inventory was adopted for pain assessment in 24-48 hours after discharge and 24 hours after removal of from the wound. Results Totally 98.22% of the patients reported that they suffered from pain in 24-48 h after discharge, most pain position was still at drainage port (45.21%), the overall pain score was 2.75 (2.00, 3.25) points, and 82.85% of patients adopted physical methods to relieve pain. After removal of stitches at the drainage port, 79.29% of the patients suffered from pain, the pain site was mainly at the drainage port (47.88%), and the overall pain score was 1.75 (1.25, 2.25) points, and 73.94% of patients adopted physical methods to relieve pain. The score of the overall influence degree of pain on patients was 2.29 (1.86, 2.86) points and 1.86 (1.29, 2.43) points, while pain had the greatest influence on sleep and mood. The scores were 4.00 (3.00, 5.00) points, 3.00 (2.00, 4.00) points and 2.00 (1.00, 4.00) points, 3.00 (2.00, 4.00) points, respectively. Conclusion Under the concept of enhanced recovery after surgery, the overall pain level of patients with pulmonary disease after discharge is mild pain, but the application rate of drug analgesia in patients is low. The overall effect of pain on postoperative patients with lung cancer is low, but it has a great impact on sleep and mood. Medical staff should strengthen the pain education for patients in order to improve their pain self-management ability.

Anticoagulant effects of Rivaroxaban after surgical fixation of spinal fracture

In recent years, the concept of treatment after surgery in the department of orthopedics has changed from hemostasis to anticoagulant. This article analyses the safety and effectiveness of anticoagulants for prophylactic anticoagulants after spinal fractures. By analyzing the incidence of bleeding and VTE in 2 weeks after operation, there was no significant difference between the 2 groups [P>0.05], but the incidence of VTE in rivaroxaban group was significantly lower than that in control group. In conclusion, the rivaroxaban oral anticoagulants are stable, safe and easy to use. It significantly reduced the incidence of VTE after spinal fracture and nerve injury, and did not increase the risk of bleeding. It is an ideal type of prophylactic anticoagulant after the operation of spinal fracture, which is worthy of further clinical study

Utility and Safety of Tolvaptan in Cirrhotic Patients with Hyponatremia: a Prospective Cohort Study

Abstract: Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free wáter excretion, but its efficacy and safety in cirrhotic patients remain unclear. Material and methods. We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls. Improvement in serum sodium level was defined as an increase in serum sodium from < 125 to ≥ 125 mmol/L or from 125-134 to ≥ 135 mmol/L on day 7. Results. Twenty-three (47%) patients in the tolvaptan group and 17 (35%) in the control group had normal serum sodium on day 7 (p = 0.25). Serum sodium improved in 30 (61%) patients in the tolvaptan group and 17 (35%) patients in the control group (p = 0.011). Adverse events occurred in 46-47% of patients in both groups, and tolvaptan was not associated with worsened liver function. No patient with normal serum sodium on day 7 died within 30 days of treatment, whereas 16% of those with persistent hyponatremia died (p = 0.0019). Conclusion. In conclusion, short-term tolvaptan treatment is safe and can improve serum sodium level in cirrhotic patients with hyponatremia. Normalization of serum sodium level is associated with better survival.

A general evaluation indexing system for hospital administrators / 中华医院管理杂志

A general evaluation indexing system is constructed based on hospital specifics, in HR evaluation theory, on job orientation, HR competence, and by means of expert consultation and level of analysis. Four tier-1 indexes were earmarked as knowledge, basic competence, management capability, and research capability; 32 tier-2 indexes include education background, foreign language command, computer capability, legal knowledge, and professional knowledge, each having different weight. This indexing system enables hospitals to screen their management staff objectively, reliably and efficiently. Moreover, it serves as a reference not only for their recruitment, training, screening and promotion, but also for their personal development.

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Studies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures.</p><p><b>METHODS</b>Totally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up.</p><p><b>RESULTS</b>ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group.</p><p><b>CONCLUSION</b>ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.</p>