Risk factor of the growth rate of cerebral infarction and its effects on the prognosis in elderly patients with acute ischemic stroke / 中华老年医学杂志

Objective:To investigate the risk factors of infarct growth rate of elderly acute ischemic stroke(AIS)patients with endovascular treatment(EVT)and its influence on prognosis.Methods:Elderly AIS patients who underwent EVT at Beijing hospital from June 2016 to October 2020 were retrospectively included.Infarct growth rate(ml/h)=infarct core volume(ml)/time from stroke onset to CTP examination(h).Based on the rate of infarct growth and the patient's clinical severity, ROC curve was established, and the cut-off value of the ROC curve was obtained.By the cut-off value of the rate of infarct growth, the patients were divided into cerebral infarct slow-growth group and rapid-growth group.Predictors of rapid growth in infarct were analyzed by univariate and multivariate analysis.The patients were divided into good prognosis group(mRS score 0-2)and poor prognosis group(mRS score 3-6)according to the mRS score at the day 90 and the predictors of poor prognosis were analyzed separately.Results:A total of 67 elderly AIS patients were included with age ranging from 65-96 years and an average of(78.8±7.6)years.(1)The cut-off value of the optimal infarct growth rate for patients with good and poor prognosis was 8.89 ml/h.The patients were divided into fast-growth group(26 patients)and slow-growth group(41 patients)according the cut-off value.(2)Multivariate logistic regression showed that only poor collateral circulation was an independent predictor for fast infarct growth( OR=0.162, 95% CI: 0.053-0.489).(3)Faster infarct growth rate( OR=1.173, 95% CI: 1.044-1.318)and high NIHSS score( OR=1.146, 95% CI: 1.018-1.291)were predictors of poor prognosis. Conclusions:Collateral circulation status is a major influencing factor for the infarct growth rate, and a faster infarct growth rate is a predictor of poor prognosis for elderly AIS patients after endovascular treatment.

The predictive value of the distance between the placenta and the internal os of the cervix in second trimester to placenta previa / 中国医师杂志

Objective:To explore the predictive value of the distance between the placenta and the internal os of the cervix (IOD) in second trimester to placenta previa.Methods:476 pregnant women with placenta previa diagnosed by systematic ultrasound in the Affiliated Hospital of North Sichuan Medical College from May 2016 to June 2020 were analyzed retrospectively. The ultrasonic parameters such as IOD, cervical length and placental main attachment position were measured, and the clinical characteristics and pregnancy outcome were recorded. Logistic regression analysis was used to analyze the influencing factors of placenta previa from mild pregnancy to late pregnancy. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of IOD value for placenta previa.Results:197 cases of placenta previa were diagnosed in this study. Multivariate regression analysis showed that the number of previous pregnancies, IOD and history of cesarean section were the related factors of placenta previa from mid pregnancy to late pregnancy ( P<0.05). The risk of placenta previa in pregnant women ≥3 pregnancies was 1.826 times that in pregnant women with less than 3 pregnancies. The risk of placenta previa when the lower edge of placenta covers and crosses the internal orifice of cervix (IOD<0 mm) was 11.494 times that of IOD=0 mm and 22.222 times that of IOD>0 mm<20 mm (low placenta). The risk of placenta previa in pregnant women with a history of cesarean section was 1.908 times that of pregnant women without a history of cesarean section. When the cutoff value of IDO was 20 mm, all pregnant women with placenta previa could be screened out in the group with cesarean section history and the area under the curve (AUC) was 0.840 (95% CI: 0.783-0.896, P<0.05); When the cutoff value of IOD was 13.5 mm, all pregnant women with placenta previa could be screened in the group without cesarean section history, and the AUC was 0.814 (95% CI: 0.759-0.869, P<0.05). Conclusions:The second trimester IOD has a good predictive value for placenta previa.

The application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital / 中华医学教育探索杂志

Objective:To explore the application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital.Methods:A total of 84 newly recruited nurses from Beijing Shijitan Hospital Affiliated to Capital Medical University from August 2017 to August 2018 were selected as the control group, and routine teaching was used. In addition, 116 new nurses from August 2019 to August 2020 were selected as the observation group, and on-demand teaching was adopted. The results of theory and practical operation, comprehensive ability and teaching satisfaction of the two groups were compared. The software SPSS 22.0 was used for t-test. Results:The nurses in the observation group had higher scores than the control group in theory [(96.38±2.14) vs. (91.56±3.75)] and practice [(95.49±2.23) vs. (90.91±4.02)]. The scores of nurses in the observation group were higher than those in the control group in accurate implementation of doctor's orders, emergency response ability, ability to observe illness, operation level, communication ability, professional image of nurses, cooperation satisfaction with doctors and harmony with nurses ( P<0.05). The nurses in the observation group scored higher than those in the control group in teaching content, teaching method, teaching attitude, and teaching effect satisfaction ( P<0.05). Conclusion:The application of on-demand teaching in the teaching of newly recruited nurses in the Class-A tertiary hospital can significantly improve their theoretical and practical skills, and improve their comprehensive ability and teaching satisfaction.

Autonomic nervous symptoms as the initial presentation in systemic light-chain amyloidosis with multiple myeloma: a case report / 中华神经科杂志

Immunoglobulin light chain amyloidosis (AL) is characterized by the extracellular tissue deposition of insoluble fibrils as a result of protein misfolding. These tissue deposits may be responsible for progressive failure in several organs. Among them, neuropathy may be presented as the first manifestation. The patient reported here presented initially with autonomic nervous system impairment, mainly characterized by severe refractory orthostatic hypotension, which became progressively invalidating, forcing the patient to bed. Moreover, since the systemic involvement of the disease, the patient also presented with diarrhea, peripheral polyneuropathy, and kidney dysfunction. Eventually, the massive myocardial depression and infiltration led to a fatal outcome due to ventricular fibrillation. Examination revealed M protein in serum and urine protein electrophoresis. Rectal mucosa and skin biopsy confirmed amyloidosis, and bone marrow biopsy showed cellular infiltration was over 35% with 23% immature plasma cells. The patient was confirmed as AL with multiple myeloma.

A multicenter, double-blind, randomized controlled clinical trial comparing ergometrine with oxytocin and oxytocin alone for prevention of postpartum hemorrhage at cesarean section / 中华妇产科杂志

Objective:To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS).Methods:This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration.Results:(1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant ( P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups ( P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion:The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

Preliminary clinical experience of the novel transcatheter aortic valve system Prizvalve® for the treatment of severe aortic stenosis / 中华心血管病杂志

Objective: To evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) with the novel Prizvalve® system in treating severe aortic stenosis. Methods: This is a single-center, prospective, single-arm, observational study. A total of 11 patients with severe aortic stenosis with high risk or inappropriate for conventional surgical aortic valve replacement (SAVR) were included, and TAVI was achieved with the Prizvalve® system between March 2021 and May 2021 in West China Hospital. Transthoracic echocardiography (TTE) was performed immediately after prosthesis implantation to evaluate mean transaortic gradient and maximal transaortic velocity. The device success rate was calculated, which was defined as (1) the device being delivered via the access, deployed, implanted and withdrawn, (2) mean transaortic gradient<20 mmHg (1 mmHg=0.133 kPa) or a maximal transaortic velocity<3 m/s post TAVI, and without severe aortic regurgitation or paravalvular leak post TAVI. TTE was performed at 30 days after the surgery, and all-cause mortality as well as the major cardiovascular adverse events (including acute myocardial infarction, disabling hemorrhagic or ischemic stroke) up to 30 days post TAVI were analyzed. Results: The age of 11 included patients were (78.1±6.3) years, with 8 males. A total of 10 patients were with NYHA functional class Ⅲ or Ⅳ. Devices were delivered via the access, deployed, implanted and withdrawn successfully in all patients. Post-implant mean transaortic gradient was (7.55±4.08) mmHg and maximal transaortic velocity was (1.78±0.44) m/s, and both decreased significantly as compared to baseline levels (both P<0.05). No severe aortic regurgitation or paravalvular leak was observed post TAVI. Device success was achieved in all the 11 patients. No patient died or experienced major cardiovascular adverse events up to 30 days post TAVI. Mean transaortic gradient was (9.45±5.07) mmHg and maximal transaortic velocity was (2.05±0.42) m/s at 30 days post TAVI, which were similar as the values measured immediately post TAVI (both P>0.05). Conclusions: TAVI with the Prizvalve® system is a feasible and relatively safe procedure for patients with severe aortic stenosis and at high risk or inappropriate for SAVR. Further clinical studies could be launched to obtain more clinical experience with Prizvalve® system.

Clinical characteristics of subjective cognitive decline in patients with Parkinson′s disease and its relationship with affective symptoms: a preliminary study / 中华神经科杂志

Objective:To investigate the characteristics and clinical related factors of Parkinson′s disease (PD) patients with subjective cognitive decline (SCD).Methods:Ninety-nine PD patients with normal cognitive function enrolled in Beijing Hospital from January to December 2018 were collected for the study. Patients with PD were divided into groups with ( n=57) and without ( n=42) SCD using the first question in Part 1 of the Unified Parkinson′s Disease Rating Scale (UPDRS). All patients were assessed by Montreal Cognitive Assessment (MoCA), modified Hoehn-Yahr grading, UPDRS, Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Parkinson′s Disease Sleep Scale, Ability of Daily Living Scale and 39-item Parkinson′s Disease Questionnaire (PDQ-39). Levodopa equivalent dose conversion was performed for patients taking anti-PD drugs. Patients′ self-reported years of formal education were collected. Results:The proportion of PD with SCD in this group was 57.58% (57/99). There were statistically significant differences in MoCA [28.00 (27.00, 29.00) vs 28.00 (27.00, 29.00) ,Z=-2.28, P=0.023], HAMD [6.00 (5.00, 8.50) vs 5.00 (2.00, 8.00), Z=-2.23, P=0.026], HAMA [7.00 (6.00, 11.00) vs 6.00 (3.00, 8.25) , Z=-2.70, P=0.007], PDQ-39-emotional health [2.00 (0, 5.00) vs 1.00 (0, 3.00), Z=-2.03, P=0.042] and PDQ-39-cognitive scores [4.00 (2.00, 5.00) vs 2.00 (0, 4.00), Z=-3.42, P=0.001] between PD with and without SCD groups. SCD was correlated with MoCA ( r=-0.23, P=0.022), HAMD ( r=0.23, P=0.025) and HAMA ( r=0.27, P=0.006) scores to varying degrees. When controlling for HAMD and HAMA scores, the correlation between SCD and MoCA scores ( r′=-0.18, P=0.084) was no longer existed. Conclusions:SCD is common in PD patients with normal cognitive function and is associated with poorer cognitive performance and more severe symptoms of depression and anxiety. In this group of patients, the relationship between SCD and affective symptoms may be greater than that of objective overall cognitive function, which is worthy of further studies.

A Propensity Score Matching Study of Autologous Hematopoietic Stem Cell Transplantation and New Drug Chemotherapy for Newly Diagnosed Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To compare the clinical efficacy, survival, and prognosis of autologous hematopoietic stem cell transplantation (ASCT) with new drug chemotherapy in the treatment of newly diagnosed multiple myeloma (NDMM) in the new drug era.@*METHODS@#The clinical data of 149 patients with NDMM treated with new drug induction regimen in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to December 2019 were retrospectively analyzed. Twenty-four patients who received ASCT were in ASCT group, and 125 patients who did not receive ASCT were in non-ASCT group. The median follow-up time was 43 (1-90) months. The propensity score matching (PSM) method was used to balance confounding factors, then depth of response, overall survival (OS), and progression-free survival (PFS) between the two groups were compared and subgroup analysis was performed.@*RESULTS@#After matching, the covariates were balanced between the two groups. Fifty-one patients (15 cases in ASCT group and 36 cases in non-ASCT group) were included. ASCT patients had a better complete response (CR) rate than non-ASCT patients receiving maintenance therapy (93.3% vs 42.3%, P=0.004), while there were no statistical differences in deep response rate and overall response rate (ORR) between the two groups (93.3% vs 65.4%, P=0.103; 93.3% vs 96.2%, P=1.000). Before matching, the 3 and 5-year PFS rate and median PFS (mPFS) in ASCT group and non-ASCT group were [89.6% vs 66.5%, P=0.024; 69.8% vs 42.7%; non-response (NR) vs 51.0 months], and the 3 and 5-year OS rate and median OS (mOS) were (100% vs 70.6%, P=0.002; 92.3% vs 49.6%; NR vs 54.0 months). After matching, the 3 and 5-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.6% vs 61.7%, P=0.182; 62.7% vs 45.7%; NR vs 51.0 months), the 3 and 5-year OS rate and mOS were (100% vs 65.6%, P=0.018; 88.9% vs 46.9%; NR vs 51.0 months). Subgroup analysis showed that patients with mSMART 3.0 high risk stratification, the 3-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.3% vs 41.5%, P=0.091; NR vs 34.0 months), and the 3-year OS rate and mOS were (100% vs 41.5%, P=0.034; NR vs 34.0 months). Patients with mSMART 3.0 standard risk stratification, the 3-year PFS rate and OS rate in ASCT group and non-ASCT group were (83.3% vs 76.8%, P=0.672; 100% vs 87.2%, P=0.155). The 3-year PFS and OS rate in MM patients who achieved deep response within 3 months after transplantation compared with non-ASCT patients who achieved deep response after receiving maintenance therapy were (83.1% vs 56.7%, P=0.323; 100% vs 60.5%, P=0.042), and the 3-year PFS and OS rate in patients who achieved overall response in both groups were (83.1% vs 62.5%, P=0.433; 100% vs 68.1%, P=0.082). After matching, Cox multivariate regression analysis showed that mSMART 3.0 risk stratification and ASCT were independent prognostic factors for OS.@*CONCLUSION@#In the new drug era, ASCT can increase CR rate and prolong OS of NDMM patients. ASCT patients who are mSMART 3.0 high risk stratification or achieved deep response within 3 months after transplantation have better OS than non-ASCT patients receiving new drug chemotherapy. ASCT and mSMART 3.0 risk stratification are independent prognostic factors for OS in NDMM patients.

Research progress of Notch signaling pathway in spinal cord injury / 中国骨伤

Spinal cord injury is a severe central nervous system disease, which will cause a series of complex pathophysiological changes and activate a variety of signaling pathways including Notch signaling. Studies have evidenced that activation of the Notch signaling pathway is not conducive to nerve repair and symptom improvement after spinal cord injury. Its mechanisms include inhibiting neuronal differentiation and axon regeneration, promoting reactive astrocyte proliferation, promoting M1 macrophage polarization and the release of proinflammatory factors, and inhibiting angiogenesis. Therefore, it has become a promising therapeutic strategy to inhibit Notch signal as a target in the treatment of spinal cord injury. In recent years, some researchers have used drugs, cell transplantation or genetic modification to regulate Notch signaling, which can promote the recovery of nerve function after spinal cord injury, thereby providing new treatment strategies for the treatment of spinal cord injury. This article will summarize the mechanism of Notch signaling pathway in spinal cord injury, and at the same time review the research progress in the treatment of spinal cord injury by modulating Notch signaling pathway in recent years, so as to provide new research ideas for further exploring new strategies for spinal cord injury.

Clinical Characterization of Patients with Ovarian Mass Combined with Dysplasia of Secondary Sexual Characteristics / 中国医学科学院学报

Objective To investigate the clinical characteristics of preadolescent and adolescent female patients with ovarian mass combined with dysplasia of secondary sexual characteristics. Methods This study retrospectively analyzed 18 cases of ovarian mass combined with dysplasia of secondary sexual characteristics aged 0-19 years admitted to Peking Union Medical College Hospital from January 2012 to November 2019.By analyzing the clinical manifestations,surgical methods,postoperative pathology,therapies and prognosis of the cases,we summarized the diagnosis and treatment ideas. Results Among the 18 cases,7(7/18,38.9%)developed secondary sex signs before puberty,including 5 cases showing precocity(including 2 cases of juvenile granulosa cell tumor,1 case of gonadoblastoma,1 case of ovarian follicular cyst,and 1 case of 46,XY simple gonadal dysplasia combined with dysgerminoma)and 2 cases presenting masculine manifestations(1 case of steroid cell tumor and 1 case of sclerosing stromal tumor).The rest 11(11/18,61.1%)cases showed abnormal development of secondary sexual characteristics during puberty,including 8 cases with masculine manifestations or abnormal menstruation after menarche(7 cases with sex cord stromal cell tumor and 1 case with cystic granulosa cell tumor),2 cases with primary amenorrhea(1 case with androgen insensitivity syndrome combined with testicular sertoli cell tumor and 1 case with endometriosis cyst combined with reproductive tract malformation),and 1 case diagnosed as 46,XX gonadal dysplasia with serous cystadenoma and no secondary sexual development during puberty. Conclusions Sex hormone levels should be actively tested in the case of prepubertal secondary sexual characteristics appearing early,pubertal secondary sexual characteristics being abnormal(underdevelopment),and/or menstrual abnormalities.Imaging examination should be performed to exclude ovarian organic lesions,and chromosome karyotype analysis should be performed if necessary.The diagnosis of ovarian mass in preadolescent and adolescent females with related symptoms should first be alerted to cord stromal cell tumor.It is recommended to rule out the possibility of combined reproductive tract malformation in the adolescent patients with primary amenorrhea.Chromosome examination should be conducted to rule out the possibility of gonadal dysplasia in the adolescent patients with primary amenorrhea and/or no development of secondary sexual characteristics.

BMP‑6 Attenuates Oxygen and Glucose Deprivation-Induced Apoptosis in Human Neural Stem Cells through Inhibiting p38 MAPK Signaling Pathway

Background and Objectives@#Neural stem cells (NSCs) remain in the mammalian brain throughout life and provide a novel therapeutic strategy for central nervous system (CNS) injury. Bone morphogenetic protein-6 (BMP-6) had shown a protective effect in different types of cells. However, the role of BMP-6 in NSCs is largely unclear. The present study was aimed to investigate whether BMP-6 could protect human NSCs (hNSCs) against the oxygen and glucose deprivation (OGD)-induced cell death. @*Methods@#and Results: Upon challenge with OGD treatment, cell viability was significantly decreased in a time-dependent manner, as indicated by the CCK-8 assay. BMP-6 could attenuate the OGD-induced cell injury in a dose-dependent manner and decrease the number of TUNEL-positive cells. Moreover, BMP-6 markedly weakened the OGD-induced alterations in the expression of procaspase-8/9/3 and reversed the expression of cleaved-caspase-3. Interestingly, noggin protein (the BMP-6 inhibitor) attenuated the neuroprotective effect of BMP-6 in cultured hNSCs. Furthermore, the p38 MAPK signaling pathway was activated by OGD treatment and BMP-6 markedly inhibited the phosphorylation of p38 in a concentration-dependent manner. Pretreatment with noggin abolished the effect of BMP-6 on p38 activation. SB239063, a selective p38 inhibitor, exerted similar effects with BMP-6 in protecting hNSCs against the OGD-induced apoptosis. These results indicated that blocking the phosphorylation of p38 might contribute to the neuroprotective effect of BMP-6 against the OGD-induced injury in hNSCs. @*Conclusions@#These findings suggested that BMP-6 might be a therapeutic target in the OGD-induced cell death, which provides a novel therapeutic strategy for enhancing host and graft NSCs survival in hypoxic-ischemic brain injury.

Evaluation of visual quality parameters changes in patients with meibornian gland dysfunction and aqueous deficient dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze ocular wavefront aberrations and scattering parameters changes in patients with meibornian gland dysfunction(MGD)and aqueous deficient dry eye(ADDE), and assess the visual quality of patients with two types of dry eye syndromes.METHODS:There were 25 patients with MGD, 25 patients with ADDE and 25 healthy controls treated in our hospital from January to October 2018 were included in this study. Ocular surface disease index questionnaire(OSDI)and tear film correlation examination were performed in three groups. The tear film correlation examination included tear break-up time(TBUT), Schirmer test( SⅠt )and cornea fluorescein staining(FL). The root mean square of total high order aberration(HO), comatic aberration(CA), trefoil aberration(TA)and spherical aberration(SA)were recorded with i-Trace visual function analyzer. The scattering values were recorded by the double-pass Optical Quality Analysis System(OQAS Ⅱ), including the modulation transfer function(MTF cutoff ), Strehl ratio(SR)and objective scattering index( OSI ). Three groups of subjects kept their eyes open for 20s, the mean value of OSI was recorded using OQAS Ⅱ tear film analysis program.RESULTS:The OSDI score in MGD group was significantly higher than that in ADDE group(38.2±5.6 <i>vs</i> 32.2±7.2, <i>P</i><0.01). The SⅠT score in ADDE group was significantly lower than that in MGD group(1.98±0.92 <i>vs</i> 12.52±6.80mm/5min, <i>P</i><0.001). The TBUT and FL staining score were lower in MGD group than those in ADDE group(TBUT: 3.27±1.91 <i>vs</i> 6.02±1.05s, FL:3.27±2.18 <i>vs</i> 6.23±2.19, all <i>P</i><0.001). There was no significant difference in HO, CA, TA and SA between MGD Group and ADDE group(HO: 0.385±0.081 <i>vs</i> 0.344±0.092, CA:0.210±0.062 <i>vs</i> 0.175±0.075, TA:0.107±0.056 <i>vs</i> 0.086±0.042, SA:0.322±0.078 <i>vs</i> 0.273±0.097, HO:<i>t</i>=1.67, <i>P</i>>0.05; CA: <i>t</i>=1.80, <i>P</i>>0.05; TA: <i>t</i>=1.50, <i>P</i>>0.05; SA: <i>t</i>=1.97, <i>P</i>>0.05). There was no statistically significant differences between MGD group and ADDE group with the value of MTF cutoff, SR and OSI(MTF cutoff: 33.28±8.28 <i>vs</i> 37.12±9.53, SR: 0.19±0.06 <i>vs</i> 0.22±0.08, OSI:1.30±0.32 <i>vs</i> 1.12±0.52, MTF cutoff: <i>t</i>=1.52, <i>P</i>>0.05; SR: <i>t</i>=1.50, <i>P</i>>0.05; OSI: <i>t</i>=1.47, <i>P</i> >0.05). In the condition of not blinking, the mean value of OSI in MGD group was significantly higher than that in ADDE group(2.386±0.118 <i>vs</i> 1.554±0.058, <i>P</i><0.001).CONCLUSION:In the treatment of symptoms of patients with dry eye, improving the visual quality of patients should also be considered. The visual quality in patients with MGD is more serious than those with ADDE. The OSI related parameters seem to be sensitive indicators indexes to evaluate the dynamic changes of tear film-related visual quality in dry eye patients.

Edible Bird's Nest Attenuates Menopause-Related Bone Degeneration in Rats via Increaing Bone Estrogen-Receptor Expression / 中国结合医学杂志

OBJECTIVE@#To investigate the mechanistic basis for the attenuation of bone degeneration by edible bird's nest (EBN) in ovariectomized rats.@*METHODS@#Forty-two female Sprage-Dawley rats were randomized into 7 groups (6 in each group). The ovariectomized (OVX) and OVX + 6%, 3%, and 1.5% EBN and OVX +estrogen groups were given standard rat chow alone, standard rat chow +6%, 3%, and 1.5% EBN, or standard rat chow +estrogen therapy (0.2mg/kg per day), respectively. The sham-operation group was surgically opened without removing the ovaries. The control group did not have any surgical intervention. After 12 weeks of intervention, blood samples were taken for serum estrogen, osteocalcin, and osteoprotegerin, as well as the measurement of magnesium, calcium abd zinc concentrations. While femurs were removed from the surrounding muscles to measure bone mass density using the X-ray edge detection technique, then collected for histology and estrogen receptor (ER) immunohistochemistry.@*RESULTS@#Ovariectomy altered serum estrogen levels resulting in increased food intake and weight gain, while estrogen and EBN supplementation attenuated these changes. Ovariectomy also reduced bone ER expression and density, and the production of osteopcalcin and osteorotegerin, which are important pro-osteoplastic hormones that promote bone mineraliztion and density. Conversely, estrogen and EBN increased serum estrogen levels leading to increased bone ER expression, pro-osteoplastic hormone production and bone density (all P<0.05).@*CONCLUSION@#EBN could be used as a safe alternative to hormone replacement therapys for managing menopausal complications like bone degeneration.

Family cohesion and adaptability among rural children with sexual abuse experience / 中国学校卫生

Objective@#To understand the prevalence of sexual abuse among rural children and its association with family cohesion and adaptability, and to explore factors that may affect household functions of the victims.@*Methods@#A total of 1 666 rural middle school students in Hanchuan and Yunxi, Hubei were recruited with stratified cluster sampling method, multivariate Logistic regression was used to analyze associated factors of the household functions of the victims.@*Results@#A total of 175 (10.50%) reported non-contact sexual abuse and 44 (2.64%) reported contact sexual abuse. Compared with control group, sexual abuse victims reported lower scores of family cohesion (F=8.97，P<0.01) and adaptability (F=4.09，P=0.02). Among the victims, maternal absence was a risk factor for poor family cohesion(OR=0.20，P<0.01), higher parental educational level and appropriate parenting methods(P<0.05) were protective factors for family cohesion and family adaptability.@*Conclusion@#Household functions of children sexual abuse victims in rural areas are generally poor, especially for victims with mothers absence, low parental education and improper parenting style. More attention should be paid to such children to minimize the impact of negative events such as sexual abuse.

Clinical features of corticobasal syndrome and associated chronic pain:analysis of 8 cases / 中华全科医师杂志

Objective:To investigate the clinical features and associated chronic pain in corticobasal syndrome (CBS).Methods:Clinical data of 8 patients diagnosed as probable CBS or possible CBS admitted to Beijing Hospital during January 2010 to June 2020 were retrospectively analyzed. The clinical information included sex, age, course of disease, chief complaint, neurological examination, blood biochemistry, tumor marker, infection and other laboratory tests; the neuropsychological evaluation included Mini-Mental State Examination (MMSE) scale and Hamilton Depression Scale (HAMD); the imaging studies included cranial magnetic resonance imaging (MRI) and/or 18F-Fluorodeoxyglucose positron emission tomography ( 18F-FDG PET). Results:The main clinical manifestations were asymmetrical movement disorders, including rigidity, tremor, myoclonus and abnormalities in posture and gait. Patients showed poor response to levodopa treatment. Among 8 patients, 7 had apraxia, 5 patients had alien hand, and 5 patients had various degrees of cognitive dysfunction. The cranial MRI demonstrated mild cerebral atrophy which was slightly more severe in the contralateral side of the initially affected limb in 7 of the 8 patients. The 18F-FDG PET scan revealed asymmetric decreased metabolism in the frontal, parietal, temporal, and occipital lobe, as well as in basal ganglia, which was more severe in the contralateral side of the initially affected limb in 5 of the 8 patients. Six of the 8 patients were associated with pain, including dystonic pain in 3 patients, neuropathic pain in 1 patient, musculoskeletal pain in 1 patient, and unexplained pain in 1 patient. Pain was the onset symptom in 1 patient and pain was relieved by taking levodopa in another patient. Conclusions:CBS is characterized by asymmetric dyskinesia and cognitive impairment, and often associated with apraxia, cortical sensory deficits, and alien limb. The MRI and PET are helpful for CBS diagnosis. Pain may be one of the common non-motor symptoms in CBS.

Analysis on the outcome of vaginal trial delivery in singleton full-term pregnancy with low-lying placenta / 中华妇产科杂志

Objective:To analyze the outcome of vaginal trial labor of pregnant women with low-lying placenta detected by translabial ultrasonography, and to explore the influencing factors of vaginal trial delivery and the risk factors of postpartum hemorrhage (PPH).Methods:A total of 80 pregnant women who were diagnosed by translabial ultrasonography with low-lying placenta and underwent vaginal trial delivery in Women′s Hospital, School of Medicine Zhejiang University were collected. Based on the distance of placenta lower edge to cervical internal os (IOD) 1 cm, and the general characteristics and pregnancy outcomes of pregnant women with IOD≤1 cm and 1-2 cm were compared and the related factors of PPH were analyzed by binary logistic regression analysis.Results:Among the 80 pregnant women with low-lying placenta, 41 cases with IOD≤1 cm and 39 cases with IOD 1-2 cm, respectively. The rate of cesarean section in the two groups were 15% (6/41) and 15% (6/39), respectively. The birth weight of newborns were (3 334±360) and (3 460±365) g, respectively. PPH rates were 24% (10/41) and 26% (10/39), respectively, and the differences were not statistically significant (all P>0.05). Among the 80 pregnant women with low-lying placenta, 60 cases did not have PPH, and 20 cases did. The rates of placenta manual removal were 2% (1/60) and 20% (4/20), respectively. The birth weight of newborns were (3 330±368) and (3 591±284) g, respectively. The differences were statistically significant (all P<0.05). Binary logistic regression analysis suggested that placenta manual removal was a risk factor for PPH in pregnant women with low-lying placenta ( OR=30.448, P=0.029). Conclusions:The results of vaginal trial labor in women with IOD≤1 cm and 1-2 cm are comparable, and vaginal trial labor could be attempted in those without contraindications of vaginal delivery. The main adverse complication of vaginal trial labor is PPH, and those with placenta manual removal need to make corresponding plans.

Clinical features and perinatal outcomes of 48 cases of pregnancy complicated with placental cystic lesions / 中华妇产科杂志

Objective:To investigate the clinical characteristics and perinatal outcomes of pregnancy with placental cystic lesions.Methods:A retrospective study was carried out on 48 pregnant women diagnosed as pregnancy complicated with placental cystic lesions from January 2000 to January 2020 at the Women′s Hospital, Zhejiang University School of Medicine. The clinical features, pathological diagnosis and perinatal outcome were analyzed.Results:The age of 48 cases was (30±5) years, and the diagnostic gestational week of ultrasound was (24±8) weeks. Twenty-five cases in which showed a cystic mass at the fetal surface were diagnosed as placental cyst. The live birth rate was 100% (25/25) and the premature birth rate was 20% (5/25). Twenty-three cases showed “honeycomb like” cystic echo. Cystic lesions of 10 cases were located in the uterine cavity connected with the margin of the normal placenta, and finally diagnosed as hydatidiform mole and coexisting fetus (HMCF). Six cases of HMCF terminated pregnancy, and the live birth rate was 4/10, the premature delivery rate was 2/4. Cystic lesions of 13 cases were located in the placenta substance, and finally diagnosed as 4 cases of placental mesenchymal dysplasia (PMD) and 9 cases of focal chorionic edema; the live birth rate was 6/13 and the premature delivery rate was 4/6. The median hCG was lower in focal chorionic edema group [80 kU/L (60-110 kU/L)] than in the groups of HMCF [240 kU/L (180-430 kU/L)] and PMD [360 kU/L (210-700 kU/L)], and the differences were statistically significant (all P<0.01). Conclusions:For pregnancy complicated with placental cystic lesions, prenatal ultrasound should be performed to evaluate the shape, location and blood flow of the lesions. Maternal serological examination and invasive prenatal diagnosis are helpful for prenatal diagnosis and treatment. Due to the difference of perinatal outcomes, maternal and fetal complications, individualized pregnancy management should be carried out.

Associations between sleep duration and negative emotions among junior college students / 中国学校卫生

Objective@#To explore the associations between sleep duration and negative emotions among junior college students,and to provide reference for mental health promotion among college students.@*Methods@#Cluster sampling method were used to select 2 524 freshmen from a college in Huainan, Anhui Province. Questionnaires were used to investigate general demographic characteristics, sleep timing, negative emotions and other information. The restricted cubic spline and multivariate Logistic regression were used to analyze the relationship between sleep duration and negative emotion among junior college students.@*Results@#The prevalence of depressive symptoms, anxiety symptoms, stress associated symptoms were 19.41%(490), 28.2%(713), 9.9%(250) respectively．The prevalence of negative emotions was higher among boys(24.3%,34.0%,19.1%) than girls(18.7%,27.4%,8.5%). The differences between groups were statistically significant( P <0.01). After adjusting for confounding factors, sleep duration and negative emotions showed a non linear dose response relationship. Compared with the reference group(8-<9 h), sleep duration <7 h was significantly associated with an increased risk of depressive symptoms and stress symptoms, and <8 h was associated with an increased risk of anxiety symptoms. The additional sleep time on weekends ≥5 h was associated with negative emotions compared with the reference group(<1 h)( P <0.01).@*Conclusion@#Short sleep duration and extra weekend sleep are associated with negative emotions. Reasonable sleep schedule among junior college students might be helpful for the prevention and control of negative emotions.

Advances in olfactory ensheathing cells for the treatment of spinal cord injury / 中国骨伤

Spinal cord injury is a highly disabled neurological disease, and there is still a lack of effective treatments. Studies have proved that olfactory ensheathing cells are one of the ideal seed cells for promoting nerve regeneration after spinal cord injury. Olfactory ensheathing cells can promote axonal germination and elongation through secretion, interaction with astrocytes, regulation of inflammatory reaction, migration characteristics, myelination, anti-oxidation, lipid regulation and other channels. Thus olfactory ensheathing cells play the role of neuroprotection and nerve repair. In recent years, some studies have used bioengineering, tissue engineering, reprogramming and other technologies to enhance the efficacy of olfactoryensheathing cells from different aspects, thereby providing new therapeutic strategies for optimizing the cell therapy of spinal cord injury. This article will summarize the mechanism of olfactory ensheathing cells in repairing spinal cord injury, and review the progress of optimizing strategy of olfactory ensheathing cells in treating spinal cord injury recently, so as to provide new research ideas for the further developing the repair potential of olfactory ensheathing cells and optimize the cell therapy effect of spinal cord injury.

Drug-resistant gene polymorphisms in Plasmodium falciparum isolated from Bioko Island, Equatorial Guinea in 2018 and 2019 / 中国血吸虫病防治杂志

Objective To investigate the genetic polymorphisms of Plasmodium falciparum multidrug resistance protein 1 (PfMDR1), chloroquine resistance transporter (PfCRT) and Kelch 13 (PfK13) genes in Bioko Island, Equatorial Guinea, so as to provide insights into the development of the malaria control strategy in local areas. Methods A total of 85 peripheral blood samples were collected from patients with Plasmodium falciparum infections in Bioko Island, Equatorial Guinea in 2018 and 2019, and genomic DNA was extracted. The PfMDR1, PfCRT and PfK13 genes were amplified using a nested PCR assay. The amplification products were sequenced, and the gene sequences were aligned. Results There were no mutations associated with artemisinin resistance in PfK13 gene in Bioko Island, Equatorial Guinea, while drug-resistant mutations were detected in PfMDR1 and PfCRT genes, and the proportions of PfMDR1_N86Y, PfMDR1_Y184F and PfCRT_K76T mutations were 35.29% (30/85), 72.94% (62/85) and 24.71% (21/85), respectively. Conclusion There are mutations in PfMDR1, PfCRT and PfK13 genes in P. falciparum isolates from Bioko Island, Equatorial Guinea.