Clinical significance of transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts / 中国辐射卫生

@#<b>Objective</b> To evaluate the clinical significance of transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts. <b>Methods</b> Patients who were diagnosed with clinically suspected or palpable adnexal masses and underwent gray-scale ultrasonography, transvaginal color Doppler ultrasonography, and ultrasound-guided fine-needle aspiration cytology (FNAC) during the period from 2018 to 2021 were enrolled in this study. The pulsatility index (<i>PI</i>) and resistance index (<i>RI</i>) were estimated, and an ovarian cyst with the lowest <i>PI</i> value of < 1.0 or the lowest <i>RI</i> value of < 0.4 was considered as malignant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of gray-scale ultrasound and transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts were estimated with FNAC as the gold standard. <b>Results</b> A total of 180 patients with ovarian cysts were recruited, and FNAC revealed that 81 of them had malignant lesions and 99 of them had benign lesions. The transvaginal color Doppler ultrasonograms showed that 75 patients (92.59%) with malignant lesions had blood-flow signals in their cysts and 42 patients (42.24%) with benign lesions had blood-flow signals in their cysts, with a significant difference in the proportion between the two groups (<i>χ</i>² = 49.29, <i>P</i> < 0.01). Among the 75 patients with blood-flow signals in malignant ovarian cysts, 75 had <i>PI</i> < 1.0 and 24 had <i>RI</i> < 0.4; among the 42 patients with blood-flow signals in benign ovarian cysts, 15 had <i>PI</i> < 1.0 and no one had <i>RI</i> < 0.4; there were significant differences in the proportions of <i>PI</i> < 1.0 and <i>RI</i> < 0.4 between the two groups (<i>χ</i>² = 62.68, <i>P</i> < 0.01; <i>χ</i>² = 16.91, <i>P</i> < 0.01). In addition, compared with the combination of gray-scale ultrasound and transvaginal color Doppler ultrasound, gray-scale ultrasound alone had significantly lower sensitivity (51.85% <i>vs</i> 81.48%; <i>χ</i>² = 16.00, <i>P</i> < 0.01), specificity (75.76% <i>vs</i> 93.94%; <i>χ</i>² = 12.73, <i>P</i> < 0.01), PPV (63.64% <i>vs</i> 91.67%; <i>χ</i>² = 15.90, <i>P</i> < 0.01), and NPV (65.79% <i>vs</i> 86.11%; <i>χ</i>² = 12.44, <i>P</i> < 0.01) for the differential diagnosis of benign and malignant ovarian cysts. <b>Conclusion</b> Gray-scale ultrasound is effective for diagnosing ovarian cysts; however, gray-scale ultrasound combined with transvaginal color Doppler ultrasound can improve the differential diagnosis of benign and malignant ovarian cysts.

The relationship between the lipid profiles and inflammation in patients with sepsis / 中华危重病急救医学

Objective:To explore the relationship between the changes in the lipid profiles and the intensity of inflammatory response and disease severity in patients with sepsis, in order to find a biomarker that can quickly evaluate the condition and prognosis of sepsis.Methods:A retrospective analysis was performed on 449 patients with sepsis admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from October 2019 to May 2021, and 355 patients without sepsis hospitalized in the same period served as the control. The general demographic data, blood lipid and other clinical indicators within 24 hours after admission were collected and compared between the two groups. Bivariate correlation study was used to analyze the relationship between blood lipid levels and inflammation indicators and severity of illness in patients with sepsis. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of each blood lipid component on the 28-day mortality of patients with sepsis. According to the results of ROC curve analysis, the blood lipids were divided into two groups with different levels, and the Kaplan-Meier survival curve was used to compare the cumulative survival rates of the two groups without end-point event (the 28-day mortality was the end-point event).Results:Compared with non-septic patients, the levels of plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were significantly lower in patients with sepsis [TC (mmol/L): 2.93±1.33 vs. 4.01±1.14, HDL-C (mmol/L): 0.78±0.47 vs. 1.16±0.40, LDL-C (mmol/L): 1.53±1.00 vs. 2.71±0.98, all P < 0.05]. In patients with sepsis, plasma cholesterol levels were correlated with the degree of inflammation and severity of the disease to varying degrees, but the HDL-C had the strongest correlation with interleukin-6 (IL-6; r = -0.551, P = 0.000), procalcitonin (PCT, r = -0.598, P = 0.000), sequential organ failure assessment (SOFA; r = -0.285, P = 0.000). The ROC curve analysis showed that among all blood lipid components, HDL-C had the highest predictive value for 28-day mortality of sepsis patients, and the area under the ROC curve (AUC) was 0.718, when the best cut-off value was 0.69 mmol/L, the sensitivity and specificity were 67.3% and 65.2% respectively, and the positive predictive value and negative predictive value were 60.6% and 71.5% respectively. According to Kaplan-Meier survival curve analysis, the mortality of sepsis patients with HDL-C ≤ 0.69 mmol/L was significantly higher than the patients with HDL-C > 0.69 mmol/L, and the difference was statistically significant ( P < 0.000 1). In addition, the 28-day mortality [59.73% (135/226) vs. 28.70% (64/223)], the incidence of multiple organ dysfunction [41.15% (93/226) vs. 31.84% (71/223)], the probability of requiring mechanical ventilation and vasoactive drugs [mechanical ventilation: 56.64% (128/226) vs. 46.18% (103/223); vasoactive drugs: 54.42% (123/226) vs. 38.57% (86/223)], the positive rate of microbial culture [45.58% (103/226) vs. 35.43% (79/223)], and the probability of drug-resistant bacteria [19.91% (45/226) vs. 10.31% (23/223)] in the low HDL-C group of sepsis patients were all higher than the high HDL-C group, the differences were statistically significant (all P < 0.05). Conclusions:Plasma cholesterol levels, especially the HDL-C levels, can well reflect the intensity of inflammation and the severity of the disease in patients with sepsis. And the HDL-C levels can be used as a good biomarker for predicting the short-term prognosis of sepsis.

Application of PCMC combined with PBL in teaching interns in department of emergency / 中华医学教育探索杂志

Objective:To explore the application effect of the problem-originated clinical medical curriculum (PCMC) and problem-based learning (PBL) on teaching interns in the department of emergency.Methods:A total of 71 interns received in the department of emergency from January 2018 to January 2020 were selected and divided into an observation group ( n=38) and a control group ( n=33) according to different teaching methods. Among them, the control group received traditional teaching, the observation group took PCMC combined with PBL teaching method. The comprehensive ability scores and teaching quality of the two groups of interns were observed, and their satisfaction with teaching and the patient's evaluation on them were recorded. SPSS was used for t test. Results:There was no significant difference in the theoretical test scores, case analysis ability, and operational skills scores between the two groups before the teaching. After teaching, they were all improved, and the improvement effect of the observation group was significantly better than that of the control group [(92.30±4.37) vs. (83.75±3.98); (90.24±5.31) vs. (85.35±4.57); (91.33±5.28) vs. (86.49±4.42), all P<0.05]; the scores of basic job mastery, work attitude, adaptability and doctor-patient communication of the two groups were all improved, and the observation group was higher than the control group ( P<0.05); the satisfaction of the interns and the evaluation results of patients in the observation group were better than those of the control group ( P<0.05). Conclusion:PCMC combined with PBL used in the teaching of interns in the department of emergency can not only stimulate the interns' interest in learning, increase their theoretical knowledge, improve their learning ability and practical ability, but also improve the quality of teaching and improve their clinical resilience.

A smart O2-generating nanocarrier optimizes drug transportation comprehensively for chemotherapy improving

@#Drug transportation is impeded by various barriers in the hypoxic solid tumor, resulting in compromised anticancer efficacy. Herein, a solid lipid monostearin (MS)-coated CaO2/MnO2 nanocarrier was designed to optimize doxorubicin (DOX) transportation comprehensively for chemotherapy enhancement. The MS shell of nanoparticles could be destroyed selectively by highly-expressed lipase within cancer cells, exposing water-sensitive cores to release DOX and produce O2. After the cancer cell death, the core-exposed nanoparticles could be further liberated and continue to react with water in the tumor extracellular matrix (ECM) and thoroughly release O2 and DOX, which exhibited cytotoxicity to neighboring cells. Small DOX molecules could readily diffuse through ECM, in which the collagen deposition was decreased by O2-mediated hypoxia-inducible factor-1 inhibition, leading to synergistically improved drug penetration. Concurrently, DOX-efflux-associated P-glycoprotein was also inhibited by O2, prolonging drug retention in cancer cells. Overall, the DOX transporting processes from nanoparticles to deep tumor cells including drug release, penetration, and retention were optimized comprehensively, which significantly boosted antitumor benefits.

miRNA-34a reverses cisplatin resistance of osteosarcoma through targeted inhibition of high mobility group box 1 / 肿瘤研究与临床

Objective:To investigate the related mechanism of miRNA-34a (miR-34a) reverses cisplatin resistance of osteosarcoma through targeted inhibition of high mobility group box 1 (HMGB1).Methods:The MG-63 cisplatin-resistant cell line (MG-63/DDP) was constructed by using dose escalation and intermittent action, and then the successfully constructed MG-63/DDP cells were treated with different concentrations of cisplatin (0, 1, 5, 10, 20, 30 μg/ml), and CCK-8 method was used to detect cell survival rate. The MG-63/DDP cells were transfected respectively and then randomly divided into two groups: the miR-34a overexpression vector group and the miR-34a empty expression vector (miR-34a-NC) group. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the relative expression level of miR-34a. Transfected cells were treated with different concentrations of cisplatin (0, 1, 5, 10, 20, 30 μg/ml), and CCK-8 method was used to detect cell survival rate, flow cytometry was used to detect cell apoptosis. The dual luciferase reporter gene experiment was used to verify whether miR-34a regulated the expression of HMGB1, and Western blotting method was used to detect the HMGB1 protein expression level of the transfected cells. MG-63/DDP cells were transfected respectively and then randomly divided into two groups: HMGB1 gene silencing vector (si-HMGB1) group and its negative control vector (si-NC) group. Western blotting method was used to detect HMGB1 protein expression level and CCK-8 method was used to detect cell survival rate.Results:The MG-63/DDP cell line was successfully constructed. The survival rate of MG-63/DDP cells was higher than that of MG-63 cells when cells were treated with different concentrations of cisplatin (all P < 0.01), and half inhibitory concentration ( IC50) value of MG-63/DDP cells and MG-63 cells on cisplatin was 25.80 μg/ml and 0.47 μg/ml, respectively. qRT-PCR results showed that the relative expression level of miR-34a in MG-63/DDP cells was lower than that in MG-63 cells (0.46±0.04 vs. 1.02±0.05, t = 15.14, P < 0.01); compared with miR-34a-NC group, the relative expression of miR-34a in MG-63/DDP cells was increased in miR-34a overexpression vector group (1.67±0.09 vs. 1.00±0.02, t = -12.58, P < 0.01). Cell survival rate of miR-34a overexpression vector group and miR-34a-NC group was decreased with the increase in the concentration of cisplatin; cell survival rate of miR-34a overexpression vector group was lower than that of miR-34a-NC group when cells were treated with different concentrations of 5- 30 μg/ml cisplatin (all P < 0.01). The apoptotic rate of MG-63/DDP cells in miR-34a-NC group and miR-34a overexpression vector group was (25.1±1.7)% and (42.3±2.3)%, respectively when cells were treated with 20 μg/ml cisplatin; and in miR-34a overexpression vector group, MG-63/DDP cells had a higher rate of apoptosis ( P < 0.01). The dual luciferase reporter gene experiment results showed that compared with miR-34a-NC group, miR-34a overexpression vector group could inhibit the luciferase activity of PGL3- wild-type-HMGB1, and the difference was statistically significant ( t = 6.37, P < 0.01), while miR-34a overexpression vector group had no significant inhibitory effect on the luciferase activity of PGL3- mutant-HMGB1 ( t = 0.35, P = 0.74). The relative expression level of HMGB1 protein in miR-34a overexpression vector group was lower than that in miR-34a-NC group (0.43±0.02 vs. 1.00±0.14, t = 6.98, P < 0.01). Compared with si-NC group, the relative expression level and IC50 value of HMGB1 protein in si-HMGB1 group were reduced (all P < 0.05). Conclusion:Overexpression of miR-34a can enhance the chemosensitivity of osteosarcoma cells MG-63/DDP to cisplatin, and its mechanism may be related to the inhibition of HMGB1 expression.

Research on the typical modes of medical alliances in China / 中华医院管理杂志

By means of analysis of related national policies on medical alliances, and investigation of their current development in China, the authors summarized the conceptual category of existing medical alliances. Typical cases were selected for comparative analysis in terms of urban medical groups, medical communities, specialized alliances and telemedicine collaboration networks. In view of such setbacks found as lack of health services, ambiguity of power and duties of stakeholders, and low penetration rate of composite medical insurance payment, as well as lack of effective incentives and poor online diagnosis and treatment mechanism, the authors recommended on development of medical alliances in respect of framework improvement and mechanism optimization among others.

Current status of prevention and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension patients in Ningxia region: a multicenter study / 中华消化外科杂志

Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.

The bone-hardness distributions of the human middle-upper thoracic vertebrae by micro-indentation / 中华骨科杂志

Objective:To measure and analyze the distribution characteristics of the micro-hardness of the middle-upper thoracic vertebrae (T 1-T 10) in the human body. Methods:T 1-T 10 vertebrae from three fresh cadavers were divided into vertebral body area and attachment area. 3 mm specimens were cut by a high-precision slow saw and 11 regions were selected and measured on each vertebrae by a Vickers microhardness tester (cortical bone: 1-9, cancellous bone: 10-11). The micro-hardness distribution of T 1-T 10 vertebrae was recorded and analyzed. Results:A total of 330 measurement areas from 30 vertebrae were measured, and 1 650 hardness values were collected. The average hardness values of the overall cortical bone of the middle-upper thoracic vertebrae of the 3 cadavers were 30.55±5.44 HV, 29.94±4.86 HV, and 29.55±4.36 HV, respectively. The difference among the groups was statistically significant ( F=4.680, P=0.009). The average hardness values of the overall cancellous bone were 27.93±5.61 HV, 28.21±4.96 HV, 27.98±3.94 HV, respectively. There was no significant difference among the groups ( F=0.091, P=0.913). There were statistically significant differences between the hardness values in the attachment area and vertebral body area of each cadaver ( t=7.467, 4.750, 6.621, P<0.001); the hardness of the cancellous bone in the attachment area of each cadaver was higher than that of the cancellous bone in the vertebral body ( t=1.785, 3.159, 3.103, P=0.077, 0.002, 0.003). The distribution of microhardness in 11 measurement areas of 3 cadavers were similar: the hardness of the cortical bone of pedicle, lamina and inferior endplate cortex (1, 2, 7) were higher; the hardness of the cortical bone of upper endplate and peripheral cortex (6, 8, 9) were lower. The distribution patterns of the microhardness in different vertebral segments of the 3 cadavers were similar: The hardness values gradually increased from T 1 to T 10. The vertebra with the largest hardness of the cortical bone was T 8; and the vertebra with the largest hardness of the cancellous bone were T 7, T 7 and T 6, respectively. Conclusion:The hardness of the upper endplate and peripheral cortex was low, which could disperse the load to protect the fragile cancellous bone. The hardness of the pedicle was the highest. The hardness of the cortical bone was higher than that of the cancellous bone, and the values of different segments gradually increased from top to bottom, which may be related to the physiological and anatomical morphology, and the gradual increase of the load of muscle force and body weight.

Ankylosing spondylitis coexistent with systemic lupus erythematosus: 8 cases reports and review of the literature / 中华风湿病学杂志

Objective:To summary the clinical features of 8 cases with ankylosing spondylitis (AS) complicated with systemic lupus erythematosus (SLE).Methods:This study was conducted retrospectively from January 2007 to November 2018. Eight patients with AS complicated with SLE who were admitted to Foshan Hospital of TCM were analyzed. Bath ankylosing spondylitis disease activity index (BASDAI) was compared using t-test. Results:Four patients were female. The mean age was (31±14) years, ranged from 16 to 59 years. The average disease duration of AS was (27±30) months(ranging from 4 to 144 months). The average disease of duration SLE was (69±51) months (ranging from 1 to 80 months). All patients was human lymphocyte antigen (HLA)-B27 positive. SLE-related organ involvement included kidney in 5 cases, leukocytopenia in 8 cases, arthralgia in 6 cases, nervous system in 1 case and skin rash in 3 cases. Renal biopsy were performed in 3 patients. And 2 cases were class Ⅲ+Ⅴ lupus nephritis, another one was class Ⅳ+Ⅴ lupus nephritis.Conclusion:AS may complicated with SLE. Some drugs may be able to active the potential SLE, which should be differentiated from drug-related lupus.

Value of serum cholinesterase in the prognosis of septic shock / 中华危重病急救医学

Objective:To investigate the relationship between serum cholinesterase (SChE) level and the prognosis of patients with septic shock (SS).Methods:A total of 594 patients with SS admitted to the First Affiliated Hospital of Zhengzhou University from June 2013 to June 2017 were enrolled. General data such as gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were recorded as well as routine blood test, procalcitonin (PCT), hepatic function, renal function, coagulation function and blood gas analysis parameters within 48 hours of SS diagnosis. The patients were followed by telephone from September to October in 2019, and the outcome was recorded. The primary outcome was all-cause death 28 days after discharge. The secondary outcomes were all-cause death in intensive care unit (ICU) and 2 years after discharge, and the length of ICU stay. The patients were divided into two groups according to prognosis of 28 days: the survival group and the death group. The clinical data of the two groups were compared. Multivariate Cox regression analysis was used to screen prognostic risk factors of 28 days in patients with SS. The receiver operating characteristic (ROC) curve was used to explore predictive value of liver function parameter SChE for 28-day prognosis of patients with SS. The patients were divided into two groups according to the levels of SChE: the low SChE group (SChE ≤ 4 000 U/L) and the normal SChE group (SChE > 4 000 U/L). Kaplan-Meier survival curves were used to compare the cumulative survival rates without endpoint event of patients with different SChE levels.Results:A total of 385 patients with SS were enrolled according to the inclusion and exclusion criteria, and a total of 356 patients were followed up successfully, with a follow-up rate of 92.5% (356/385). There were 142 survival patients and 214 death patients at 28 days, with a 28-day mortality rate of 60.1% (214/356). There were 116 survival patients and 240 death patients at 2 years, with a 2-year mortality rate of 67.4% (240/356). Compared with the 28-day survival group, the patients in the death group were older and had higher APACHEⅡ score, partial hepatic and renal function parameters, higher level of blood lactate (Lac) and lower levels of white blood cell count (WBC), platelet count (PLT) and SChE with statistically significant differences. Multivariate Cox regression analysis showed that the age [relative risk ( RR) = 1.444, 95% confidence interval (95% CI) was 1.090-1.914, P = 0.010], APACHEⅡ score ( RR = 2.249, 95% CI was 1.688-2.997, P = 0.000), SChE ( RR = 1.469, 95% CI was 1.057-2.043, P = 0.022), and Lac ( RR = 2.190, 95% CI was 1.636-2.931, P = 0.000) were independent risk factors for 28-day mortality of patients with SS. The ROC curve analysis showed that SChE had a weak prognostic value for 28-day prognosis of patients with SS [the area under ROC curve (AUC) was 0.574]. However, the combined predictive value of SChE, APACHEⅡ score and Lac was greater than APACHEⅡ score or Lac alone for prediction (AUC: 0.807 vs. 0.785, 0.697), with a sensitivity of 79.9% and a specificity of 68.5%. Compared with the normal SChE group ( n = 88), the 28-day mortality of patients in the low SChE group ( n = 268) was significantly increased [63.1% (169/268) vs. 51.1% (45/88), P < 0.05], but ICU mortality [59.7% (160/268) vs. 48.9% (43/88)], 2-year mortality [69.8% (187/268) vs. 60.2% (53/88)] or the length of ICU stay [days: 4 (2, 7) vs. 5 (2, 9)] between the two groups showed no statistical significance (all P > 0.05). Kaplan-Meier survival curve analysis showed that the cumulative survival rate without endpoint event of patients in the low SChE group was significantly lower than that in the normal SChE group (Log-Rank test: χ 2 = 5.852, P = 0.016). Conclusions:Increased risk of 28-day mortality in patients with SS whose SChE is below normal. The level of SChE is an independent risk factor for 28-day death in SS patients, and it is one of the indicators to evaluate the short-term prognosis of patients with SS.

Optimization of Anti-infective Program after Surgery for a Case of Infant Patient with Intussusception and Enterobrosis by Clinical Pharmacists / 中国药房

OBJECTIVE：To provide th e ideas a nd for individualized anti-infective treatment of infection after surgery for infants and young children with intussusception and enterobrosis ，and to provide reference for clinical pharmacists participating in the clinical treatment. METHODS ：Clinical pharmacists optimized the anti-infection program for an 11-month-old infant patient infected after surgery with intussusception and enterobrosis in Ordos Central Hospital ；they put forward medication suggestions in respects of the selection of initial anti-infection treatment program ，drug replacement ，the selection of anti-infection treatment program after blood culture showed Enterococcus coli and Enterococcus faecium ，and dosage adjustment. RESULTS ：According to the judgment of the common pathogens and the hospital or community infections in the infant patient with intussusception and enterobrosis，cefoperazone sulbactam 1.0 g，q12 h was adjusted to cefoperazone sulbactam 0.5 g，q8 h combined with Metronidazole chloride sodium injection 20 mL，q8 h；when the blood culture showed E. coli （ESBL-）and E. faecium ，it was recommended to add vancomycin 0.15 g，q12 h. After poor treatment ，it was recommended to adjust the vancomycin dose to 0.2 g，q8 h. All the above suggestions were adopted by doctors. And the child ’s body temperature dropped after treatment ，the blood culture turned negative and laboratory indicators returned to normal. The child was discharged smoothly. CONCLUSIONS ：Infants and young children are special groups. Therefore ，before using antibiotics ，clinical pharmacists should evaluate the age ，body weight ，liver and kidney functions of infants and young children. They should also help doctors select and adjust drugs ，frequency and dosage on the basis of pharmacokinetic characteristics and safety ，so as to avoid adverse drug reactions while ensure curative effect.

Platinum complexes of curcumin delivered by dual-responsive polymeric nanoparticles improve chemotherapeutic efficacy based on the enhanced anti-metastasis activity and reduce side effects

Platinum-based chemotherapy is used for non-small cell lung cancer (NSCLC). However, it has side effects and minimum efficacy against lung cancer metastasis. In this study, platinum-curcumin complexes were loaded into pH and redox dual-responsive nanoparticles (denoted as Pt-CUR@PSPPN) to facilitate intracellular release and synergistic anti-cancer effects. Pt-CUR@PSPPN was prepared by a nano-precipitation method and had a diameter of ∼100 nm. The nanoparticles showed increased anti-cancer effects both and . In addition, Pt-CUR@PSPPN blocked PI3K/AKT signal transduction pathway and inhibited MMP2 and VEGFR2, resulting in enhanced anti-metastatic activity. Furthermore, reduced side effects were also observed. In conclusion, Pt-CUR@PSPPN provided a novel and attractive therapeutic strategy for NSCLC.

Differences of the structure, succession and function of Clostridial communities between jiupei and pit mud during Luzhou-flavour baijiu fermentation / 生物工程学报

Clostridia inhabiting in jiupei and pit mud plays key roles in the formation of flavour during the fermentation process of Luzhou-flavour baijiu. However, the differences of Clostridial communities between jiupei and pit mud remains unclear. Here, the species assembly, succession, and metabolic capacity of Clostridial communities between jiupei and pit mud were analysed by high-throughput sequencing and pure culture approaches. The ratio of Clostridial biomass to bacterial biomass in the pit mud was relatively stable (71.5%-91.2%) throughout the fermentation process. However, it varied widely in jiupei (0.9%-36.5%). The dominant Clostridial bacteria in jiupei were Clostridium (19.9%), Sedimentibacter (8.8%), and Hydrogenispora (7.2%), while Hydrogenispora (57.2%), Sedimentibacter (5.4%), and Caproiciproducens (4.9%) dominated in the Clostridial communities in pit mud. The structures of Clostridial community in pit mud and jiupei were significantly different (P=0.001) throughout fermentation. Isolated Clostridial strains showed different metabolic capacities of volatile fatty acids in pure culture. Spatial and temporal heterogeneity of Clostridial communities existed in the baijiu fermentation pit, which was closely related to the main flavour components of Luzhou-flavour baijiu.

Analysis of Drug Therapy for a Case of Child with Human Herpesvirus 7 Infection in Central Nervous System by Clinical Pharmacist / 中国药房

OBJECTIVE：To investigate the r ole of clinical pharmacists on the therapy for human herpesvirus 7（HHV-7） infection in central nervous system. METHODS ：The clinical pharmacists participated in the treatment process of the hospitalized patient who was a 15-year-old patient with central nervous system infection. The doctor initially gave Levetiracetam tablets （500 mg，bid，po）to control epilepsy symptoms ，and Acyclovir for injection （500 mg，q8 h，ivgtt）for antiviral treatment. According to the large red wheal scattered rubella on the limbs and back of the patient ，clinical pharmacists recommended to give Dexamethasone sodium phosphate injection （10 mg，qd，iv）and Loratadine tablets （10 mg，qd，po）for anti-allergy treatment ；in view of involuntary shaking of limbs in the patient ，clinical pharmacists recommended to continue to give Dexamethasone sodium phosphate injection intravenously to control inflammation and Xingnaojing injection （20 mL，qd，ivgtt） to improve the convulsion. For HHV- 7 infection，based on consulting the relevant guidelines and existing treatment experience ，the clinical pharmacists recommended discontinuation of acyclovir ， dexamethasone combined with Human immunoglobulin （pH 0278）（17.5 g，qd，ivgtt）for impact therapy should be used and adverse drug reactions and therapeutic effects should be monitored at the same time. RESULTS ： The physiciansaccepted the suggestions of clinical pharmacists. The patient was improved and discharged from the hospital after 18 days of treatment. CONCLUSIONS ： During the treatment of ineffective case of clinic rare central nervous system infectious diseases with routine a ntiviral drugs ，clinical pharmacists assisted physicians to improve their treatment plan and ensure the effectiveness and safety of patient ’s medication.

Analysis of foodborne disease outbreaks in schools in Zhejiang Province during 2010-2019 / 中国学校卫生

Objective@#To understand the epidemiological characteristics of foodborne disease outbreaks in schools in Zhejiang province, and to provide evidence for effective prevention and control of foodborne disease outbreaks in schools.@*Methods@#A descriptive analysis was conducted on foodborne disease outbreaks in Zhejiang schools reported by the national foodborne disease outbreaks surveillance system from 2010 to 2019.@*Results@#During the past 10 years, a total of 86 foodborne disease outbreaks in schools were reported, with 1 755 illnesses, 240 hospitalizations, and no deaths. Pathogenic bacteria and their toxins were the main causes of foodborne disease outbreaks in schools, accounting for 83.0%(44/53) of all identified causes. The top four types of pathogenic bacteria were Staphylococcus aureus, Salmonella, diarrheagenic Escherichia coli, and Bacillus cereus. Meat products and mixed foods were the main foods that caused the outbreaks, each accounting for 16.3%(14/86) of total incidents. High school cafeterias were places with the highest incidence, accounting for 38.4%(33/86) of the total. School concession stands caused the largest number of hospitalizations, accounting for 37.1%(89/240) of the total. The peak month of foodborne disease outbreaks in schools was September, followed by June, May, and October. Crosscontamination and improper storage were the main causes of foodborne disease outbreaks in schools.@*Conclusion@#Bacterial foodborne disease is a major food safety issue in schools in Zhejiang Province. In summer and fall, school cafeterias and food stores should take effective measures to prevent bacterial foodborne disease outbreaks caused by cross-contamination and improper storage of high-risk foods such as meat products and cold-processed bakeries.

A research on mental health status of public health aid professionals from Chinese Center for Disease Control and Prevention in Africa / 公共卫生与预防医学

Objectives To investigate mental health status of public health aid professionals in Africa and its influencing factors. Methods From July of 2018 to July of 2019, all the third and forth batches of members from the Second Phase of the Fixed Biological Safety Laboratory Technical Cooperation Project in Chinese Centre for Disease Control and Prevention totaling 21 individuals were tested by Symptom Check List 90 (SCL-90), general information forms and influencing factors forms before departure, at three and six months in Sierra Leone, and at one month after return respectively. Results Some of public health aid professionals experienced a phased psychological abnormality response (SCL-90>160). The total score of SCL-90 rises after the team departs for the Sierra Leone, peaks at 3 months, and then falls to the baseline level, showing a low-high-low trend. The scores of hostile and paranoid factors show a low-high-low-high trend. At different time points, there was no statistical difference between the total scores of SCL-90(P>0.05) and the force factor score was statistically different (P<0.05). Conclusions The overall mental health status of the public health aid professionals is well. All departments should take appropriate measures to protect and pay attention to the mental health development of public health aid professionals.

Distribution of archaeal community in the mud pit during strong-flavor baijiu fermentation / 生物工程学报

Multi-species solid-state fermentation in a mud pit is one of the typical features of strong-flavor baijiu, in which archaea plays important roles, however, the archaeal community distribution and diversity during fermentation are still lack of research. The biomass, composition and succession of archaea communities in fermented grains and pit mud were analyzed by high throughput sequencing. The potential interaction between archaea and bacteria was analyzed by co-occurrence network. Results demonstrate that the average biomass of archaea in pit mud was about 200 times higher than that of fermented grains. There was no significant difference in archaeal community structure between fermented grains and pit mud (r=0.017, P=0.074), but succession patterns between them showed significant correlation (r=0.30, P=0.03). Methanobacterium was the most abundant archaea in fermented grains and pit mud, and other dominant groups included Methanosarcina, Methanocorpusculum, Methanoculleus, and Methanobrevibacter. The co-occurrence network analysis showed that Methanobacterium was positively correlated with most bacteria in fermented grains and pit mud, especially with Hydrogenispora and Caproiciproducens, the dominant bacteria in pit mud. Our results revealed the temporal and spatial distribution characteristics and potential functions of the archaeal community in the mud pit of strong-flavor baijiu.

Comparative analysis of the development of hospitals and primary healthcare institutions from 2009 to 2018 / 中华医院管理杂志

Objective:To comparatively analyze the development of hospitals and primary healthcare institutions during the healthcare reform since 2009.Methods:Based on statistical data from 2009 to 2018 and qualitative data, the development of primary healthcare institutions and hospitals was compared from 2009 to 2018 by computing the compound annual growth rate of health manpower, facilities, income, expenditure and service.Results:The growing speed of health professionals in hospitals(7.49%)was much faster than primary healthcare institutions(4.32%). The difference of healthcare professionals in hospitals and primary healthcare institutions grew larger and larger. The infrastructure in hospitals had developed much faster compared to that of primary healthcare institutions. The growing speed of fiscal subsidy in primary health care institutions was much faster. However the absolute number of fiscal subsidy for primary health care institutions was smaller than hospitals. The average growing speed of total income and medical income in hospitals was much faster. The average growing speed of health service in primary healthcare institutions was much slower, especially the inpatient service. The rates of hospital beds use in hospitals and primary health institutions were about 84% and 60% respectively.Conclusions:The quick expansion of hospitals was siphoning resources and curbing the development of primary healthcare institutions. Healthcare resources mismatch could hardly be overturned by measures taken in medical insurance. Rational health resources distribution was essential for hierarchical medical system to develop.

Micro-hardness distribution of proximal tibia in human skeleton / 中华骨科杂志

Objective@#To investigate the microhardness distribution of cancellous bone in the proximal tibia and its clinical significance.@*Methods@#Three fresh tibias were obtained and examined by X-ray and CT to exclude skeletal pathologies, such as osteoporosis, osteoarthritis. According to the Heim's square, the proximal tibias were cut off. Each of the proximal tibias was divided into three parts, the medial condyle, the intercondylar area and the lateral condyle. Each part was divided into three sections, proximal, middle and distal sections. Each of the proximal tibias was divided into 9 regions. Bone specimens with a thickness of 3 mm were taken from each region using a high precision low-speed saw and fixed on flat sheets. The microhardness of the bone tissue was measured using a Vickers microhardness tester after polish. Ten effective micro-indentation tests were conducted in each region. After measurement the diagonal length of the indentations, the microhardness values were calculated via software provided by the hardness tester. Analysis of variance and Tukey method were used to compare the microhardness values of different parts, sections and regions of cancellous bone. The microhardness distribution of the proximal tibia was analyzed.@*Results@#A total of 270 effective indentations were made in the specimens, and the microhardness values were obtained. The average microhardness of the three proximal tibias was 40.98±3.44, 34.92±4.64 and 39.49±3.86 HV, respectively. There was a significant difference among the groups (F=55.87, P=0.000). The microhardness distribution of bone tissue in the three proximal tibias was similar. In the comparison of different parts, the microhardness of medial condyle was greater than that of the lateral condyle, which was larger than that of the intercondylar area. The difference between the parts was statistically significant (F=18.42, 8.236, 10.877; P=0.000, 0.001, 0.000). In the comparison of different sections, the microhardness of the distal section was greater than that of the proximal section, which was larger than that of the middle section. The difference between the sections was statistically significant (F=8.720, 17.140, 6.142; P=0.000, 0.000, 0.003). The microhardness distribution was similar among different regions. The region with the highest microhardness is the medial condyle of the distal section with microhardness of 44.87±3.25 HV (range 39.2-49.7 HV). The lowest microhardness was in the intercondylar area of the middle section with hardness of 29.41±4.53 HV (range 24.8-36.2 HV).@*Conclusion@#The microhardness value of cancellous bone near the articular surface at the proximal tibia was smaller, which could disperse the load and protect the fragile of articular cartilage. Furthermore, the microhardness of the transition zone is larger. The microhardness value of the cancellous bone in medial tibia condyle is the greatest, which is related to load-bearing.

The outside measurement study of micro-hardness distribution of ulna / 中华骨科杂志

Objective To study the micro-hardness distribution of ulna and explore its correlation with surgical procedures of ulnar fractures,internal fixator,total elbow arthroplasty and the epidemiology of ulna fracture.Methods The ulna wasdivided into proximal metaphysis,diaphysis,and distal metaphysis.The proximal metaphysis was divided into the olecranon and the metaphysis olecranon of ulna.Thedistal epiphysis included the head of ulna.The shaft of the ulna was divided equally into nine segments.Each ulna was sawed by a band saw into twelve parts,which were prepared for the micro-indention testing.The micro-indention testing samples precision cuts were conductedwith a Buehler Isomet 11-1280-250 low speed diamond saw.Each micro-indention sample was cut 3mm thickness and fixed on glass sheet with epoxy resin.The samples surface was polished with progressive grades of sandpaper.Micro-indentation was pedormed on each bone sample sudace using a vicker micro-hardness tester,and the hardness value were measured as Hardness value (HV,HV=kgf/mm2).Twenty indentions were randomly selected on each sample,which were equally divided into four quadrants (anterior,medial,posterior and lateral).Hence,a total of 720 micro-indentations were pedormed on the three ulna.Before indention,each sample was controlled under the optical microscope where the bone surface was intact and not damaged.The micro-indentations were performed on each sample with a load of 50 g.The indentation time was set to 12 s.Hardness value (HV/0.05) was computed for each indentation.The lengths of the diagonals were measured under reflected light microscopy,and the Vickers hardness value was calculated.Indentations in which one diagonal was 10％ longer or more than the other were ignored.The indention was repeated.These preliminary data were used to determine the appropriate sample size of micro =indentation to be performed on each bone segment.SPSS 19.0 statistical software was used for statisticalanalysis.The one =way ANOVA analysis was used to compare the difference of bone micro-hardness values in different parts,and P ＜ 0.05 was statistically significant.Results The hardest part of the ulna is the lower ulnaand the value of micro-hardness was 47.77 HV.The least hard part was the head of ulna and the value of micro-hardness was 29.64 HV.The proximal metaphysis hardness value was 34.39 HV.The shaft hardness value was 43.47 HV.Thedistal metaphysis hardness value was 29.64 HV.The hardness was higher in diaphysis than metaphysis in the ulna with statistical significance.There was no statistically significant difference in the hardness of ulna anterior,medial,posterior and lateral quadrant.Conclusion It is demonstrated that the micro-hardnessof ulna shaft is significant higher than other two parts of ulna.The micro-hardness value difference was not significant among the anterior,medial,posterior and lateral quadrant.This study revealed the distribution rule of ulna micro-hardness and provided data support for the total elbow arthroplasty with human physiological characteristics through 3D printing.